RESUMEN
BACKGROUND: Complications of intravenous lipid administration are relatively uncommon. However, inadvertent rapid infusion of intravenous fat emulsion (IVFE) is an inherent risk when fats are infused separately from the dextrose-amino acid solution. CASE REPORT: Extremely preterm infant, born at 25 weeks and 6 days of gestational age weighing 920 g, who inadvertently received a massive overdose of IVFE due to a device failure. He developed lethargy, apnea, metabolic acidosis and hemodynamic instability requiring mechanical ventilation and inotropic support. Despite discontinuation of IVFE and supportive care, clinical course and metabolic acidosis worsened, so a double-volume exchange transfusion was performed. The procedure was well tolerated, without complications. Serum triglyceride concentration as well as other laboratory data normalized immediately after the exchange transfusion. The patient was extubated to continuous positive airway pressure and inotropic support was discontinued 24 hours after the procedure. He was discharged home at 40 weeks of corrected age with normal magnetic resonance imaging and neurological examination. CONCLUSION: In cases of profound, symptomatic hypertriglyceridemia due to lipid overdose, double-volume exchange transfusion should be considered, even in extremely preterm infants.
Asunto(s)
Acidosis/terapia , Falla de Equipo , Recambio Total de Sangre , Emulsiones Grasas Intravenosas/administración & dosificación , Recien Nacido Extremadamente Prematuro , Nutrición Parenteral , Acidosis/etiología , Acidosis/fisiopatología , Presión de las Vías Aéreas Positiva Contínua , Grasas de la Dieta , Emulsiones Grasas Intravenosas/efectos adversos , Humanos , Enfermedad Iatrogénica , Fenómenos Fisiológicos Nutricionales del Lactante , Recién Nacido , Masculino , Nutrición Parenteral/efectos adversos , Nutrición Parenteral/instrumentación , Resultado del TratamientoRESUMEN
Introducción: La terapia de sustitución renal es necesaria hasta en el 10% de los niños que sufren cirugía cardiaca. La diálisis peritoneal (DP) es la modalidad preferida en el periodo neonatal. Objetivo: Evaluar la seguridad, la eficacia y los factores perioperatorios asociados a la necesidad de DP. Material y métodos: Revisión retrospectiva de neonatos sometidos a cirugía cardiaca con circulación extracorpórea (CEC) durante 2 años. Seleccionamos para su análisis y comparación un grupo de casos que precisaron de DP y otro aleatorizado de controles que no precisaron ninguna técnica de depuración extrarrenal. Resultados: Setenta y seis neonatos fueron sometidos a cirugía cardiaca con CEC y 24 precisaron DP. La necesidad de DP se asoció al bajo gasto en el postoperatorio inmediato y al mayor tiempo de ventilación mecánica. La indicación más frecuente fue la oligoanuria relativa. La técnica fue efectiva en el 66% de los pacientes. Solo en un caso registramos complicaciones. Conclusiones: La indicación más frecuente de DP tras la cirugía cardiaca mediante CEC en neonatos es la oligoanuria. La necesidad de depuración extrarrenal se asocia con el bajo gasto y conlleva mayor tiempo de ventilación mecánica. La DP es una técnica eficaz y con pocas complicaciones en estos pacientes (AU)
Introduction: Renal replacement therapy is required in up to 10% of children undergoing cardiac surgery. Peritoneal dialysis (PD) is the preferred treatment method in the neonatal period. Objective: To evaluate safety, efficacy and perioperative factors associated with the need forPD. Material and methods: Retrospective review of clinical charts over a two-year period of newborns undergoing cardiac surgery with cardiopulmonary bypass (CPB). The group of cases requiring PD were compared with a group of random controls that did not require any renal replacement therapy. Results: A total of 76 infants underwent cardiac surgery with CPB, of which 24 required PD. The need for PD was associated with low cardiac output in the immediate postoperative period and longer mechanical ventilation. The most frequent indication was fluid overload. The technique was effective in 66% of patients. Complications were only recorded in one patient. Conclusions: The most common indication for PD after cardiac surgery with CPB in neonates is fluid overload. The need for renal replacement therapy is associated with low cardiac output and a longer duration of mechanical ventilation. PD is an effective technique with few complications in these patients (AU)
Asunto(s)
Humanos , Masculino , Femenino , Recién Nacido , Diálisis Peritoneal , Procedimientos Quirúrgicos Cardíacos/métodos , Cardiopatías Congénitas/cirugía , Circulación Extracorporea , Estudios Retrospectivos , Complicaciones Posoperatorias/epidemiología , Estudios de Casos y ControlesRESUMEN
INTRODUCTION: Renal replacement therapy is required in up to 10% of children undergoing cardiac surgery. Peritoneal dialysis (PD) is the preferred treatment method in the neonatal period. OBJECTIVE: To evaluate safety, efficacy and perioperative factors associated with the need for PD. MATERIAL AND METHODS: Retrospective review of clinical charts over a two-year period of newborns undergoing cardiac surgery with cardiopulmonary bypass (CPB). The group of cases requiring PD were compared with a group of random controls that did not require any renal replacement therapy. RESULTS: A total of 76 infants underwent cardiac surgery with CPB, of which 24 required PD. The need for PD was associated with low cardiac output in the immediate postoperative period and longer mechanical ventilation. The most frequent indication was fluid overload. The technique was effective in 66% of patients. Complications were only recorded in one patient. CONCLUSIONS: The most common indication for PD after cardiac surgery with CPB in neonates is fluid overload. The need for renal replacement therapy is associated with low cardiac output and a longer duration of mechanical ventilation. PD is an effective technique with few complications in these patients.
Asunto(s)
Puente Cardiopulmonar , Diálisis Peritoneal , Procedimientos Quirúrgicos Cardíacos , Estudios de Casos y Controles , Femenino , Humanos , Recién Nacido , Masculino , Diálisis Peritoneal/estadística & datos numéricos , Estudios RetrospectivosRESUMEN
Breast tumors in adolescents are very rare and mostly benign. Fibroadenomas are the most frequent, but within the extensive differential diagnosis, the phyllodes tumor must be mentioned, which accounts for about 1% of breast tumors and the diagnosis of which is very rare in patients younger than 20 years. There are no specific symptoms or radiological images to distinguish phyllodes tumor from fibroadenoma; therefore, histological examination is mandatory for diagnosis. Histology also allows the classification of phyllodes tumor into benign, borderline, or malignant types for appropriate surgical treatment: freemargin excision in benign tumors and mastectomy in the other two types. Fortunately, the majority of these tumors are benign, and treatment maximizes breast conservation with free infiltration margins surgery, given that this fact is the most important factor to prevent local recurrence. In this article, we describe a rare case of borderline cystosarcoma phyllodes in a 12-year-old girl (AU)