[Intestinal invagination: change in its incidence from 1987 to 2008]. / Invaginación intestinal: cambio en su incidencia desde 1987 a 2008.

Some series have shown a decrease in the incidence of intestinal invaginations in last years. Moreover, the recent introduction of new types of rotavirus vaccines increases the interest of invagination' s incidence. To this purpose, reliable local epidemiological data are needed. In order to ascertain the trend in the incidence of invaginations and their current value in our area we have performed a retrospective review of patients under 3 years of age with the diagnosis of intussusception and confiemes with barium enema or ultrasound examination during the past 21 years. Our results show a statistically significant decrease in the incidence rate, with an incidence rate of one year from the previous 0.82 (95% 0,78-0, 86) from an estimated incidence for 1987 of 17.74 cases per 10,000 girls and 30.04 cases per 10,000 boys, in 2008 an estimated incidence of 0.27 cases per 10,000 girls and 0.49 cases per 10,000 boys. We conclude that in our population during the dtudy period a significant decrease of invagination' sincidence has been seen, especially in patients younger than one year. The current incidence is 0.27 cases per 10,000 girls and 0.49 cases per 10,000 boys less than 3 years old.

[Utility of Pediatric Appendicitis Score and abdominal ultrasound in the diagnostic process of acute appendicitis]. / Utilidad del Pediatric Appendicitis Score y la ecografía abdominal en el proceso diagnóstico de apendicitis aguda.

INTRODUCTION: Pain in the right iliac fossa is a frequent reason for consultation and the diagnosis of appendicitis remains a challenge. The Pediatric Appendicitis Score (PAS) stratifies the risk of suffering appendicitis, and abdominal ultrasound provides information without irradiation. This study aims to correlate the score and the ultrasound with the screening of appendicitis and evaluate its efficiency. PATIENTS AND METHODS: Prospective study of cases and controls, analytical, observational and longitudinal. Patients <15 years of age, treated for suspected appendicitis in the emergency department of a II level center, were evaluated for 6 months. The data were analyzed univariate and bivariate, using nonparametric and parametric tests according to the distribution. RESULTS: 68 patients with pain in the right iliac fossa were included: 26 appendicitis (cases) (38.2%) and 42 (61.7%) other diagnoses (controls). The PAS in appendicitis was 7.5±1.8 and in other diagnoses 5.4±1.8 (p <0.01). At 70.5% with PAS ≥4 an ultrasound was performed (diagnosis of appendicitis 58.1%, discarded 25.6% and inconclusive 16.3%). Sensitivity and specificity were calculated by PAS groups only, and including ultrasound. The best result was for PAS ≥4 with ultrasound with a sensitivity of 96.2%, specificity 94.1%, PPV 96.1% and NPV 94.1%. CONCLUSIONS: PAS is a good screening tool for the diagnosis of appendicitis. Ultrasound presents a high efficiency for the diagnosis of appendicitis. This efficiency improves when performed in the group of patients with PAS ≥4.

INTRODUCCION: El dolor en fosa ilíaca derecha es un motivo frecuente de consulta y el diagnóstico de apendicitis sigue siendo un reto. El Pediatric Appendicitis Score (PAS) estratifica el riesgo de padecer apendicitis, y la ecografía abdominal aporta información sin irradiación. Este estudio pretende correlacionar su puntuación y la ecografía con el despistaje de apendicitis y valorar su rendimiento. MATERIAL Y METODOS: Estudio prospectivo de casos y controles, analítico, observacional y longitudinal. Se evaluó a los pacientes <15 años, atendidos por sospecha de apendicitis en urgencias de un centro de II nivel, durante 6 meses. Se analizaron los datos de forma univariante y bivariante, utilizando pruebas no paramétricas y paramétricas según la distribución. RESULTADOS: Se incluyeron 68 pacientes con dolor en fosa ilíaca derecha: 26 apendicitis (casos) (38,2%) y 42 (61,7%) otros diagnósticos (controles). El PAS en apendicitis fue de 7,5±1,8 y en otros diagnósticos de 5,4±1,8 (p <0,01). Al 70,5% con PAS ≥4 se les realizó una ecografía (diagnósticas de apendicitis 58,1%, descartaron 25,6% y no concluyentes 16,3%). Se calculó la sensibilidad y especificidad por grupos de PAS solamente, e incluyendo la ecografía. El mejor resultado fue para PAS ≥4 con realización de ecografía con una sensibilidad 96,2%, especificidad 94,1%, VPP 96,1% y VPN 94,1%. CONCLUSIONES: El PAS es una buena herramienta de cribado para el diagnóstico de apendicitis. La ecografía presenta un alto rendimiento para el diagnóstico de apendicitis. Este rendimiento mejora al realizarla en el grupo de pacientes con PAS ≥4.

[Bacteremia during the course of Salmonella gastroenteritis]. / Bacteriemia en el curso de gastroenteritis a Salmonella.

OBJECTIVE: Salmonella is the most frequent cause of bacterial acute gastroenteritis (AGE) in our setting. Usually its course is self-limited, but it sometimes can lead to bacteremia, principally in young infants and malnourished or immunosuppressed children. Bacteremia is less frequent in healthy people and in those over one year of age. This study was carried out to assess the incidence of bacteremia during Salmonella GE and to detect parameters that could lead to bacteremia. PATIENTS AND METHODS: A retrospective study of positive stool cultures in our hospital between 1991 and 1993 was performed. Data about the epidemiology, clinical features cultures and analytical procedures were drawn from clinical records. Data were analyzed using the Mann-Whitney test and Fisher's exact test. RESULTS: During this period of time, 860 cases of AGE were observed with 86 stool cultures positive for Salmonella (10%). Six of them also had positive blood cultures (7%). All 6 patients with bacteremia were healthy previously and five were over 12 months old. The outcome was good in all cases, without focalizations of the bacteremia. We could not detect any differences between patients with positive blood cultures and the patients without bacteremia. CONCLUSIONS: Bacteremia during Salmonella AGE is not infrequent and is not limited to young infants or patients with underlying diseases. None of the parameters analyzed were useful in predicting the possibility of bacteremia.