Neonatal spontaneous biliary perforation: Case report

AbstractObjectiveSpontaneous biliary perforation in neonates is rare. The etiology of this pathology is idiopathic and various management strategies ranging from non-operative treatment to complex operations, such as biliary-enteric reconstruction, are performed, with few reported outcomes.Case reportA 3-week-old female, born at term, presented fever, abdominal distension, and acholic stool. An ultrasound was performed, which revealed generalized ascites and a poorly-defined collection. An emergency laparotomy confirmed perforation in the distal common bile duct and a biliary-enteric-anastomosis was performed.DiscussionWide drainage has been reported as the best initial management strategy for spontaneous biliary perforation, although it depends on the patient's clinical status and intraoperative findings.ConclusionsSpontaneous infantile biliary perforation is rare. Main management is wide drainage with, most perforations being resolved in 2 weeks

Decreased pain in split-thickness skin graft donor sites with the use of a non-adherent polyurethane dressing

Donor sites of split-thickness skin grafts (STSGs) are painful and limit patient rehabilitation. We conducted this study to assess the efficacy of a non-adherent polyurethane dressing in reducing pain and its effect on the epithelialization rate of donor sites of STSGs. Methods: Fifteen patients requiring an STSG were included. In 10 patients the donor sites were randomly divided into two halves and covered with either a non-adherent polyurethane dressing or a standard non-adherent gauze. In five patients with bilateral donor sites, one side was covered with the non-adherent polyurethane dressing and the other with non-adherent gauze. The pain was assessed with a visual analog scale and epithelialization was also assessed, calculating non-epithelialized areas with image software by a blinded surgeon. Epithelialization of the wounds covered with the non-adherent polyurethane dressing was assessed at day 8 and 10 and those with non-adherent gauze at day 10. Results: Postoperative pain significantly decreased with the non-adherent polyurethane dressing during the length of the study (6.07 ± 1.46 vs. 1.72 ± 1.6) and at each time point (p < 0.001). Epithelialization was not affected with the polyurethane dressing, compared to the standard method

Infarto agudo del miocardio y trombolisis coronaria. Enero - diciembre del 2000. Acute myocardial infarction and coronary thrombolysis. January-December 2000

Se realizó un estudio retrospectivo y descriptivo en la Unidad de Cuidados Emergentes del Cuerpo de Guardia y la Unidad de Cuidados Intensivos del Hospital General Docente "Comandante Pinares", durante el periodo comprendido de enero del 2000 a diciembre del propio año, que incluyó a los casos con cuadro clínico caracterizado por dolor precordial opresivo, irradiado a miembro superior izquierdo, espalda, con sensación de muerte inminente, acompañado de elevación del "ST" del electrocardiograma, más de un milímetro en dos derivaciones consecutivas, lo cual fue sugestivo de IMA e indicación de estreptoquinasa recombinante. Precisamos el total de casos trombolizados y cuantos fueron excluidos; así como las causas de exclusión y se determino en que grupo de pacientes, atendiendo a la aplicación o no del fármaco existió mayor mortalidad. Se trombolizaron el 71,1 % de los pacientes. La principal causa de exclusión fue la llegada después de las 12 horas. Los pacientes no trombolizados tuvieron mayor mortalidad. DeCS: INFARTO DEL MIOCARDIO, EMBOLIA/mortalidad. ABSTRACTA retrospective study was carried out at the Emergency Room and at Intensive Care Unit of "Comandante Pinares" General Hospital during January - December 2000. In the current study the followed cases were included: oppressive precordial pain irradiating to left upper limb, back, immediate death sense associated with ST shift according to ECG, more than 1 mm in two consecutive leads suggesting AMI and the recombinants streptokinass. The total of thrombolysis was performed in 71,1 % of patients. The main exclusion cause was the arrival after 12 hours. A higher mortality was observed in patients without thrombolysis. DeCS: MYOCARDIAL INFARCTION, EMBOLISM/mortalit

Injerto columelar extendido angulado. Método para prevenir la rotación cefálica y lateral de los injertos de cartílago en la punta nasal Angulated extended collumelar graft. A method to prevent the cephalic and lateral rotation of the cartilage graft in the nasal tip

El paciente mestizo generalmente posee una nariz pequeña, de base ancha, con fosas nasales redondas y dorso convexo. Los cartílagos alares son débiles, delgados y cortos, proporcionando un soporte estructural deficiente y pobre definición de la punta nasal. Los injertos de cartílago de la punta nasal se usan frecuentemente para corregir esta condición; sin embargo un problema común es la rotación cefálica, caudal y lateral de estos cartílagos. Empleamos un injerto columelar extendido angulado (ICEA) para proporcionar elongación y soporte columelar; la extensión angulada nos brinda a su vez un mejor control y predicción de la posición de los injertos de la punta nasal al prevenir su desplazamiento cefálico y lateral. El protocolo quirúrgico empleado incluyó historia clínica completa, desarrollo de un plan quirúrgico mediante análisis de la deformidad y fotografías pre y postoperatorias para el control de los pacientes a medio y largo plazo. Tratamos 95 pacientes usando este procedimiento; 75 con rinoplastia abierta y 20 con técnica cerrada. El rango del periodo de seguimiento fue de 6 meses a 4 años. Los resultados obtenidos fueron satisfactorios, mostrando mejor control y predicción de la forma de la punta nasal. En conclusión, creemos que el injerto columelar extendido angulado proporciona un mejor control de la proyección y angularidad de los injertos colocados en la punta nasal.The mestizo patient usually has a small nose, with wide base, round nostrils and convex dorsum. The alar cartilages are weak, thin and short, providing a deficient structural support and poor definition of the nasal tip. Cartilage graft in the nasal tip are very often used to correct this condition, but a commun problem of this procedure is the cephalic or lateral rotation of these grafts. We used an angulated extended collumalar graft to give collumelar support and elongation. The angulated extension of the graft provides a better control and prediction of the position of the grafts of the nasal tip preventing the lateral and cephalic displacement. The surgical protocol included a medical history, development of a surgical plan by analysis of the deformity and the use of pre/and postoperative photographs taken at both intermediate and long time, and long/term follow-up visits for evaluation of the results. Ninety-five patients underwent surgery using this procedure: 75 whit an open technique and 20 with a closed technique. Follow/up ranged from 6 months to 4 years. The results obtained were satisfactory, showing better control and prediction of the shape of the nasal tip. As a conclusion, in our experiencie, the angulated extended collumelar graft provides better control of the proyection and angularity of cartilage grafts pleced in the nasal tip

Association of the polymorphism 12109g>A from the gene as a risk factor for preterm birth

Introduction: Preterm birth is the most important cause of neonatal mortality and morbidity. It is a multifactorial disease with different etiologies, including genetic factors. Genetic variability is represented by single nucleotide polymorphisms (SNPs) in genes of proteins involved in the contractile activity. We determine the association between SNP 12109G> A in REN associated with preterm birth and premature rupture of membrane. Materials and methods: A study of cases ( N =112, 22–36 weeks of gestation; mean: 31, 95% confidence interval 30.7–32.2) and controls ( N =66; 38–40 weeks of gestation from the last menstrual period; mean: 39.8, 95% confidence interval 38.9–39.4) was performed. Genomic DNA was isolated in all patients from peripheral blood. The SNP 12109G> A ( Mbo I) in REN was typified by PCR-restriction fragment length polymorphism. Results: A significant difference in the case group for the SNP 12109G>A was observed. The A allele was increased in women with preterm birth (81% cases vs . 15% control, p A has odds ratio 6.62 (95% confidence interval 3.14–14.15), which means a high risk of preterm birth/premature rupture of membrane in presence of allele A, both in homozygotes and in heterozygotes. Conclusion: Allelic frequency of A of SNP 12109G>A was higher in women with preterm birth than in women with normal vaginal delivery and could be considered a risk factor