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Preliminary cadaver, animal, and human studies were performed to determine the feasibility of axial anterior lumbosacral spine access using a percutaneous, presacral approach. Custom instruments were directed under fluoroscopic guidance along the midline of the anterior sacrum to the surface of the sacral promontory where an axial bore was created into the lower lumbar vertebral bodies and discs. Imaging and gross dissection were performed in cadavers and animals. The procedure was used for lumbosacral biopsy in human subjects guided by intraoperative imaging and clinical monitoring. All procedures were technically successful. This study demonstrates the feasibility of the axial access technique to the anterior lower lumbar spine.

Objective: This study outlined the epidemiological profiles of patients who were admitted to the Pediatric Intensive Care Center at Albert Einstein Israelite Hospital during 2009. Methods: Data were retrospectively collected for all patients admitted to the PICC during 2009. A total of 433 medical charts were reviewed, and these data were extracted using the DATAMARTS System and analyzed using the statistical software package STATA, version 11.0. Results: There were no statistically significant differences in regards to patient gender, and the predominant age group consisted of patients between the ages of 1 to 4 years. The average occupancy rate was 69.3% per year, and there was a greater number of admissions during April, August, and October. The average length of stay at the hospital ranged from 9.7 to 19.1 days. Respiratory diseases were the main cause for admission to the Pediatric Intensive Care Center, and the mortality rate of the patients admitted was 1.85%. Conclusions: Respiratory diseases were the most common ailment among patients admitted to the Pediatric Intensive Care Center, and the highest mortality rates were associated with neoplastic diseases.

The objective of this study was to review mortality from external causes (accidental injury) in children and adolescents in systematically selected journals. This was a systematic review of the literature on mortality from accidental injury in children and adolescents. We searched the PubMed, Latin-American and Caribbean Health Sciences and Excerpta Medica databases for articles published between July of 2001 and June of 2011. National data from official agencies, retrieved by manual searches, were also reviewed. We reviewed 15 journal articles, the 2011 edition of a National Safety Council publication and 2010 statistical data from the Brazilian National Ministry of Health Mortality Database. Most published data were related to high-income countries. Mortality from accidental injury was highest among children less than 1 year of age. Accidental threats to breathing (non-drowning threats) constituted the leading cause of death among this age group in the published articles. Across the pediatric age group in the surveyed studies, traffic accidents were the leading cause of death, followed by accidental drowning and submersion. Traffic accidents constitute the leading external cause of accidental death among children in the countries under study. However, infants were vulnerable to external causes, particularly to accidental non-drowning threats to breathing, and this age group had the highest mortality rates for external causes. Actions to reduce such events are suggested. Further studies investigating the occurrence of accidental deaths in low-income countries are needed to improve the understanding of these preventable events.

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ObjectiveTo evaluate anatomical and functional outcomes after silicone oil extraction in patients with retinal detachment and proliferative vitreoretinopathy in an eye care referral center in Joinville, SC, southern Brazil.MethodsRetrospective, noncomparative study of patients with retinal detachment and posterior proliferative vitreoretinopathy followed up after silicone oil removal. Prophylactic 360-degree peripheral laser photocoagulation was performed one to three months before silicone oil extraction. Patients with cataract underwent a combined clear corneal phacoemulsification with intraocular lens implantation in the same procedure. Anatomical outcomes were related to the duration of silicone oil tamponade and the surgical procedure performed. Functional outcomes were divided into three categories (stability, worsening, or improvement) according to visual acuity variation before the surgery and at the last follow-up visit.ResultsFifty-three patients were followed up for a mean period of 1,262 days.Fourteen eyes (26.4%) underwent cataract surgery combined with silicone oil extraction. Forty-eight eyes (90.5%) had attached retina at the last follow-up examination. Time of intraocular tamponade and association of phacoemulsification with silicone oil extraction were not considered as risk factors for retinal redetachment. Twenty-three cases (43.4%) showed visual acuity improvement, whereas 11 cases (20.8%) were stable and 19 cases (35.8%) showed visual acuity worsening. Five patients with attached retina had unexplained optic disc atrophy.ConclusionMost patients had good anatomical and visual outcomes after silicone oil extraction. Prophylactic 360-degree laser retinopexy may have led to favorable outcomes. Benefits of silicone oil extraction and the associated risks of complications due to a new surgical procedure must be carefully evaluated before surgical indication.

Objectives: This review aims to evaluate if the use of hypotonic saline solutions as maintenance intravenous fluid therapy in hospitalized children increases the risk of hyponatremia, if the administration of isotonic fluids is able to protect against acquired hyponatremia and if the isotonic solutions increase the risks of deleterious effects such as hypernatremia or fluid overload. Sources:We researched the relevant literature on the PubMed (Jan 01 1969 to Jul 13 2011), EMBASE (1989to 2011) and Cochrane Library (1989to 2011 databases. Furthermore, references of selected studies were included. Summary of the findings:Hospitalized children are potentially at risk of developing hyponatremia and the use of hypotonic saline solutions is the main risk factor for this disease. Isotonic saline solutions have shown a protective effect against hyponatremia, and, so far, there have been no significant deleterious effects such as fluid overload, hypernatremia or phlebitis. Conclusions:The evidence found indicates that the traditional recommendation of Holliday and Segar to use maintenance fluid therapy for sick and hospitalized children deserves to be reconsidered due to the adverse effects found to arise from it, apart from the better results obtained by using isotonic solutions.J Pediatr (Rio J). 2011;87(6):478-86: Isotonic solutions, hypotonic solutions, fluid therapy, hyponatremia, child, hospitalization. ResumoObjetivos: Avaliar se o uso de soluções salinas hipotônicas como fluidoterapia de manutenção em crianças hospitalizadas aumenta o risco de hiponatremia, se a administração de fluidos isotônicos é capaz de proteger contra a hiponatremia adquirida e se as soluções isotôni-cas aumentam os riscos de efeitos deletérios como hipernatremia ou sobrecarga hídrica. Síntese dos dados:Crianças hospitalizadas têm riscos potenciais para hiponatremia, e o uso de soluções salinas hipotônicas é o principal fator de risco para esse agravo. As soluções salinas isotônicas têm mostrado efeito protetor para hiponatremia e, até o momento, sem efeitos deletérios significativos, como sobrecarga hídrica, hipernatremia ou flebites. Conclusões:As evidências indicam que a tradicional recomendação de Holliday & Segar quanto à fluidoterapia de manutenção para crianças doentes e hospitalizadas merece ser reconsiderada em virtude das evidên-cias sobre os efeitos adversos dela advindos, assim como dos melhores resultados obtidos com o emprego das soluções isotônicas. J Pediatr (Rio J) IntroduçãoA hiponatremia é definida como a concentração do sódio sérico inferior a 136 mmol/L. Quando sintomático, esse distúrbio pode manifestar-se por disfunção do sistema nervoso central (SNC), caracterizado por: cefaleia, náuseas, vômitos, letargia, desorientação, depressão de reflexos tendinosos, convulsões, disfunção neurológica permanente, morte por

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