Asunto(s)
Síndrome de Inmunodeficiencia Adquirida/transmisión , Infecciones por Citomegalovirus/transmisión , Infecciones Oportunistas/transmisión , Síndrome de Inmunodeficiencia Adquirida/complicaciones , Adulto , Infecciones por Citomegalovirus/complicaciones , Femenino , Humanos , Recién Nacido , Intercambio Materno-Fetal , Infecciones Oportunistas/complicaciones , EmbarazoRESUMEN
Two cases of postoperative intussusception (POI) are reported. Both children, 13 and 6 months old, had long and difficult surgery for abdominal neuroblastoma after four courses of chemotherapy. Obstruction of the small intestine occurred on the fifth postoperative day, after feeding had been started again, in the first child, and on the third day in the second one. Surgery revealed a loose ileo-ileal invagination of 10 and 15 cm respectively, which was easily reduced. The postoperative course was uneventful in both cases. Although POI is a classical complication of abdominal surgery, it is often forgotten. In the cases described, the first surgical procedure combined most causative factors for POI: young age, preoperative chemotherapy, prolonged general anaesthesia, extensive retroperitoneal dissection close to components of the neurovegetative system. The use of opioids for postoperative analgesia may be an additional risk factor, as they alter intestinal motility. Epidural analgesia with local anaesthetics should be preferred in such cases.
Asunto(s)
Enfermedades del Íleon/etiología , Intususcepción/etiología , Complicaciones Posoperatorias , Neoplasias Abdominales/cirugía , Femenino , Motilidad Gastrointestinal/efectos de los fármacos , Humanos , Enfermedades del Íleon/diagnóstico por imagen , Lactante , Intususcepción/diagnóstico por imagen , Masculino , Narcóticos/farmacología , Narcóticos/uso terapéutico , Neuroblastoma/cirugía , Dolor Postoperatorio/tratamiento farmacológico , UltrasonografíaAsunto(s)
Anestesia General/instrumentación , Máscaras Laríngeas , Imagen por Resonancia Magnética , Niño , Preescolar , Humanos , LactanteRESUMEN
The authors report the results of a prospective survey concerning the children examined in the pediatric emergency ward of the Lenval's hospital in Nice. The study was conducted over a period of 124 days, one month of each season, and included 3,611 children. There was a majority of boys (60.8%) and children older than 7 years (56.8%). The representation of foreign children was 11.2%. Most of the consultations were decided by the parents (86%); 6.2% were sent by a general practitioner and 1.1% by a pediatrician; 6.5% were conveyed through a professional public health service transport. Traumatology was the main surgical etiology and supplied the large majority of benign cases and 23% of the emergencies. Upper respiratory and bronchopulmonary tract infections and gastroenteritis represented 70% of medical etiologies. A complementary investigation, essentially a radiological examination, was carried out in 53.6% of cases. A wound suture was performed in 13% and a plaster immobilization in 9.2% of cases. The hospitalisation's rate was 22%. Emergencies represented 1.8% of cases. A surgical intervention with general anesthesia was performed in 4.4% of cases within 12 hours following the admission. A recent law (ministerial circular: 14.05, 1991) defines the organisation and working principles of the public emergency departments in France as requiring an uninterrupted activity, a continuous medical presence and an area for very short hospitalization. This should improve the quality of the pediatric emergency wards, providing that the financial means will be available.