[Registry of mild craniocerebral trauma: multicentre study from the Spanish Association of Pediatric emergencies]. / Registro de traumatismos craneoencefálicos leves: estudio multicéntrico de la Sociedad Española de Urgencias Pediátricas.

OBJECTIVE: To determine management practices of minor head trauma in children evaluated at Spanish Hospital Emergency Departments and to determine patient variables associated with intracranial injury. METHODS: Multicenter and prospective study during 18 months in 9 hospitals in Spain. Patients up to the age of 18 years with minor head trauma (Glasgow Coma Scale score higher than or equal to 13 on admission), treated in Emergency Departments and with a maximum onset of 72h since the traumatism, were included in the study. RESULTS: A total of 1070 patients were studied with a median age of 2.4 years (p25-75 0.9-6.4 years); 61.2% were male. The median time between head trauma and medical consultation was 1 hour (p25-75 0.6-2.5h). Skull X-rays were performed on 64.5% of the children and a head CT scan on 9%; 91.4% of X-ray and 84.4% of CT were normal. The prevalence of intracranial injury was 1.4% (95% CI: 0.8-2.3). Twenty-five point three percent of the patients were admitted; 4 (3.7%) required neurosurgical intervention during admission. None of the patients died. Multiple logistic regression analysis identified loss of consciousness (OR 4.2, 95% CI: 1.1-17; P=0.045), neurological deterioration (OR 8.8, 95% CI: 2.1-37.6; P=0.003) and cephalhaematoma (OR 14.6, 95% CI: 4.9-44; P <0.001) as independent predictors of intracranial injury. CONCLUSIONS: The combination of clinical parameters allows selection of patients with minor head trauma who need complementary explorations. In consequence, the routine use of skull X-ray in their initial evaluation is unnecessary.

[Short course treatment for visceral leishmaniasis with liposomal amphotericin B in immunocompetent patients]. / Tratamiento de corta duración de la leishmaniasis visceral con anfotericina B liposómica en pacientes inmunocompetentes.

INTRODUCTION: Visceral leishmaniasis is endemic in southern Europe. Traditional treatment consists of pentavalent antimonial compounds. However, treatment failures, the treatment's long duration, and toxicity have led to the introduction of new therapies, such as liposomal amphotericin B (LAB). In this study we evaluate the safety and efficacy of LAB at a maximum dose of 4 mg/kg/day on days 1, 2, 3, 4, 5, and 10. PATIENTS AND METHODS: A prospective, observational, open study was conducted in 13 Spanish centers. The diagnosis of visceral leishmaniasis was based on visualization of Leishmanias sp. in bone marrow aspirate or culture or positive serology together with compatible clinical symptoms. RESULTS: Thirty-two immunocompetent children aged from 7 months to 7 years were treated. All the children had rapid clinical response and bone marrow aspirate performed on day 21 was normal in the 24 patients (100 %) who underwent this procedure. In the remaining eight children efficacy was assessed by clinical response. Two relapses were observed. Cure was achieved in 18 patients (90.0 %) and in 87.5 % of the patients with microbiological confirmation of the disease. No adverse events were detected. CONCLUSIONS: A total dosage of 24 mg/kg of liposomal amphotericin B administered in 6 doses within 10 days is safe and effective for the treatment of visceral leishmaniasis and reduces the length of hospital stay.

[Technetium-99m-dimercaptosuccinic acid (DMSA) scintigraphy in the first febrile urinary tract infection in children]. / Gammagrafía con tecnecio-99m-ácido dimercaptosuccínico en el estudio de la primera infección urinaria febril del niño.

OBJECTIVE: The objective of this study was to evaluate the findings of 99mTc-DMSA renal scintigraphy in children with their first acute febrile urinary tract infection in relation with several clinical-biological parameters and other imaging studies and a long-term follow up. MATERIAL AND METHODS: 103 children between 1 month and 10 years old with their first acute febrile urinary tract infection were studied by means of clinical and laboratory assessment, renal ultrasonography and 99mTc DMSA renal scintigraphy in the acute illness period. Patients were divided into two groups, those under 2 years old (n = 63) and those over 2 years old (n = 40). RESULTS: Cortical scintigraphy showed renal changes in 56 patients (54,5%). Children over 2 years of age had a higher incidence of renal lesions than younger children (39,7% vs. 77,5%). Ultrasonography measuring renal volume showed a simple concordance with scintigraphy in 64% of the patients. Reflux was demonstrated in 23 patients (22,3%) without differences between patients with normal or abnormal cortical scintigraphy. After having studied the factors that were associated independently to the pathological results in the scintigraphy through a logistical multivariant regression, it was observed that the child's age, the elevation of the PCR and the alterations of the renal volume were significant according to statistics and also associated to a larger amount of pathological DMSA scintigraphy. CONCLUSIONS: DMSA scintigraphy associated with other diagnostic methods can improve the sensitivity and specificity to establish renal damage stage. During the follow-up the acute lesions disappeared or improved in all cases and the chronic lesions have not been modificated.

[Familial hypomagnesemia with hypercalciuria and nephrocalcinosis]. / Hipomagnesemia familiar con hipercalciuria y nefrocalcinosis.

Familiar hypomagnesemia with hypercalciuria and nephrocalcinosis is a rare syndrome belonging to the group of heterogeneous tubular diseases whose common characteristic is renal magnesium wasting. We present a 9 year old boy with polyuria, polydipsia and enuresis. Radiologic and ultrasonographic examinations showed nephrocalcinosis. Hypomagnesemia, normokaliemia, hypermagnesiuria, hypercalciuria, incomplete distal tubular acidosis, hypocitraturia and mild renal failure were found. Treatment with magnesium salts, hydrochlorothiazide, potassium citrate and sodium bicarbonate did not restore magnesium or calcium levels to normal. Renal function and nephrocalcinosis remain stable after 3 year's treatment. In conclusion, we report a new case of this rare syndrome caused by a congenital defect in magnesium reabsorption and discuss the evolution of the illness during 3 years' treatment.

[Acute lobar nephronia. Report of 3 new cases]. / Nefronía lobar aguda. Aportación de tres nuevos casos.

We present three patients, aged 4, 6 and 8 years old, with a diagnosis of urinary tract infection. In all patients, initial ultrasonographic studies revealed a single area of acute lobar nephronia (ALN). The patients underwent renal scintigraphy with dimercaptosuccinic acid-99mTc (DMSA Tc 99m), which showed multiple foci with below normal uptake in both kidneys of two patients, consistent with bilateral multifocal bacterial nephritis. Although this entity has been reported together with ALN in adults, very few pediatric cases have been reported. We emphasize the diagnostic value of ultrasonography and renal scintigraphy.