Fernando Montes-Tapia

Primary torsion of the vermiform appendix and undescended cecum treated by video-assisted transumbilical appendectomy.

Torsion of the vermiform appendix is a rare cause of appendicitis that is clinically indistinguishable from the classical presentation. In this paper, we present the first report in the literature of an appendicular torsion associated with an undescended cecum. A 3-year-old male patient with persistent pain in the right hypochondrium and peritoneal irritation underwent diagnostic laparoscopy, finding necrosis of the vermiform appendix caused by torsion of its base associated with an undescended cecum located in an indurated area of the subhepatic region. A video-assisted transumbilical appendectomy was performed.

Efficacy and safety of ultrasound-guided internal jugular vein catheterization in low birth weight newborn

BACKGROUND Central venous catheterization is not the first choice of vascular access in neonates. Success depends on the size of the vessel and the skill of the health professional performing the procedure. The internal jugular vein provides a predictable path for central venous cannulation, although it is more difficult to cannulate infants than adults and even more difficult in smaller newborns. METHODS We conducted a prospective study in 100 newborns, in which a 4 Fr ultrasound-guided central venous catheter was placed in the right internal jugular vein (RIJV). The study population was low birth weight (LBW) newborns <2500g, very low birth weight (VLBW) newborns <1500g and extremely low birth weight (ELBW) newborns <1000g. RESULTS There were 53% female patients, mean gestational age was 31weeks, mean weight 1352g and the CVC was placed at a mean of 12days of extrauterine life. Birth weight distribution was 39% LBW; 33% VLBW and 28% ELBW. A mean of two (1-8) attempts were necessary with a procedure duration of 16.8 (10-40) minutes. Success of RIJV catheterization was 94%. One attempt was necessary in 50% and up to 5 attempts in 95.7%. Success by weight was VLBW, 97.2%; ELBW, 92.9%; LBW, 91.7%. A venous hematoma occurred in 5% of cases. CONCLUSIONS Ultrasound-guided RIJV cannulation with real-time visualization to gain access to the central venous circulation in low birth weight newborns is effective and safe.

Sigmoid fixation associated with rectopexy using a laparoscopic approach could prevent relapse of rectal prolapse in pediatric patients with spinal dysraphia

UNLABELLED Recurrent rectal prolapse, resistant to medical treatment, is an indication for surgical treatment. Patients with spinal dysraphia frequently have already been treated by sclerotherapy or other surgical techniques, but unsuccessfully. METHODS We present 2 patients, who underwent laparoscopic rectopexy, with spinal dysraphia and complete rectal prolapse relapse after conservative treatment. In these patients, we performed, as an additional technique, fixation of the rectosigmoid to avoid recurrence by invagination or prolapse of the anterior wall. RESULTS Follow-up at 14 and 11 months, respectively, did not find any recurrence. CONCLUSION We suggest that laparoscopic rectopexy with sigmoid fixation should be considered as an alternative for the treatment for patients with spinal dysraphia and rectal prolapse to avoid recurrence.

Congenital lateral abdominal wall hernia

Congenital abdominal wall defects that are located outside of the anterior wall are extremely rare and difficult to classify because there are no well accepted guidelines. There are two regions outside of the anterior wall: the flank or lateral wall; and the lumbar region. We report the case of a patient with an oval 3 cm‐diameter hernia defect located above the anterior axillary line, which affects all layers of the muscular wall. An anorectal malformation consisting of a recto‐vestibular fistula was also identified, and chest X‐ray showed dextrocardia. The suggested treatment is repair of the defect before 1 year of age. Given that the anomalies described may accompany lateral abdominal wall hernia, it is important to diagnose and treat the associated defects.

Snake Bites in Pediatric Patients, a Current View

It has been estimated that worldwide about 5 million people (adults and children) are bitten by snakes every year (Kalantri et al., 2006), and 50,000 die according to data from the World Health Organization (Schaper, de Haro, Desel, Ebbecke, & Langer, 2004). However, it is well known that events related to snake bites are under-reported, especially in the authors country possibly because snakebites are not a very relevant cause of mortality. Nevertheless, they are a serious cause of morbidity, especially in children. Under-reporting of this important health issue can be blamed on the fact that the population is not well informed about snake classification causing them to not provide accurate information to healthcare personnel when a patient is taken for medical care after a snake attack. Children do not react to snake bites in the same way as adults. In children, this event is always more severe since they are exposed to a larger amount of venom per m2 of body surface (De la O Cavazos 2006). A small child is more vulnerable to a given volume of venom than a larger individual (Hodge III & Tecklenburg, 2006) Also, there will be different presentations including neurotoxicity, myotoxicity, renal failure, edema, bleeding due to activation of clotting proteins, and intravascular hemolysis, because different kinds of snakes have different types of venom that cause different symptomatology. (Jeng & Glader, 2004).

Leptin, IL-6 and TNF-α levels in umbilical cord blood of healthy term newborns in relation to mode of delivery

In the development of the foetal immune system, cytokines play an important role in its function. Therefore, we sought to determine whether the mode of delivery affects the expression of leptin, IL-6 and TNF-α in umbilical cord blood in healthy term newborns. We collected 125 samples of umbilical cord blood to analyse leptin, IL-6 y TNF-α levels with multiplex immunoassay (MIA). The samples were classified according to mode of delivery: vaginal delivery (VD) and caesarean section (CS). Leptin and IL-6 had higher concentrations in umbilical cord blood in VD than in CS: 42.55 ng/ml (11.92–104.28) versus 35.20 ng/ml (3.26–9326.76), p  =  0.039; 9.32 pg/ml (1.13–2020.31) versus 3.81 pg/ml (0.52–834.69) p < 0.001, respectively. Also, a weak correlation between TNF-α and IL-6 was found (r = 0.238, p = 0.007). The most important finding in our study was the differential concentrations of leptin and IL-6 according to mode of delivery.

Adding Multiple Adipokines into the Model do not Improve Weight Gain Prediction by Leptin Levels in Newborns.

Objective: Most adipose tissue programming is realized in early life. Also, the postnatal three months, rather than the later phases of infancy, may be more relevant in the development of an adverse cardiometabolic risk profile. The adipokines phenotype, as a predictor of early-life weight gain, has been recently explored in cord blood. To determine whether in addition to leptin levels in cord samples, adiponectin, interleukin-6 (IL-6), monocyte chemoattractant protein-1 (MCP-1), resistin, plasminogen activator inhibitor-1 (PAI-1), and tumor necrosis factor alpha (TNF-α) levels improve weight gain prediction during the first three months of life. Methods: Adiponectin, IL-6, MCP-1, leptin, resistin, PAI-1, and TNF-α were measured by multiplex immunoassay in a subsample of 86 healthy term newborns. Results: Leptin levels significantly predicted weight gain at 3 months of follow-up (r2=0.09, p=0.006). In the multivariate analysis, including additional adipokines in the model, stepwise or all at once, did not increase the prediction of weight gain after the first three months of life. Conclusion: Adding adiponectin, IL-6, MCP-1, resistin, PAI-1, and TNF-α to the prediction model of weight gain in healthy newborns did not prove to be useful. It is probable that their relative contribution to weight gain is not important. Only leptin was relevant as a predictor of weight gain at the 3-month endpoint.

A new positive-pressure device for nasal foreign body removal.

Objectives Nasal foreign bodies (FBs) are common causes of pediatric emergency consultations. The different methods for removing nasal FBs have varying levels of efficacy. The aim of this study was to evaluate the safety and efficacy of a new device for nasal FB removal in children. Methods A nasal occlusion device that uses modulated positive pressure to remove FBs was evaluated in a series of 18 patients ranging in age from 1 to 8 years diagnosed with a nasal FB during a period of 7 months. Results The device successfully removed FBs in 17 (94.4%) of the 18 patients. In 12 of the cases (66.7%), the FB was removed during the first attempt. None of the patients had complications or sequelae at the time of removal or at the follow-up visit. Conclusions The nasal occlusion device used in this study was found to be a promising, safe, effective, and easy to use tool for FB removal in a pediatric emergency room setting.

Ultrasound- guided placement of double catheter in the right internal jugular vein: Two case reports

Central vascular access in critically ill paediatric patients is, many times, a challenge for physicians due to the number of lines needed for multiple infusions. We present ultrasound-guided placement of a double catheter in the right internal jugular vein in two patients that required multiple central lines for management.

Vascular assessment of the right internal jugular vein in low birth weight newborns.

Abstract Objective: To determine the dimensions and depth of the right internal jugular vein (RIJV) in low birth weight newborns by ultrasound and assess the differences in weight and determine the relationship of the vein with the carotid artery. Method: We performed a vascular assessment of the RIJV in 100 low birth weight newborns. The subjects were divided into three groups, low birth weight (LBW) newborns, <2500 g; very low birth weight (VLBW) newborns, <1500 g; and extremely low birth weight (ELBW) newborns <1000 g. Results: Of the newborns, 39% had LBW, 33% had VLBW, and 28% had ELBW. The medians were gestational age 31 weeks, weight 1300 g, anteroposterior diameter of the RIJV 2.2 mm, and the distance from the skin–RIJV 3.6 mm. In LBW newborns, the median anteroposterior diameter of RIJV was 2.7 mm; in LBW newborns 2.2; in ELBW newborns 1.9 (p < 0.001); the median distance from skin to RIJV for LBW newborns was 4.1 mm; for VLBW newborns, 3.6 and for ELBW newborns 2.9 (p < 0.01); differences that were statistically significant. Conclusions: In low birth weight newborns, the diameter and depth of the RIJV is directly proportional to the weight of the subjects studied.