[Necrotizing entercolitis and intestinal perforation in very low weight premature infants: which is the best surgical option?]. / Enterocolitis necrotizante y perforaciones intestinales en prematuros de muy bajo peso. Cuá1 es la mejor opción quirúrgica?

Necrotizing enterocolitis (NEC) and isolated intestinal perforation (IP) are common diseases in very low birth weight infants (VLBW) and require surgery in 20-40% of cases. We have performed a retrospective review of VLBW infants with NEC or IP who underwent a surgical procedure between 2000 and 2010, either initial laparotomy (group 1), peritoneal drain placement and subsequent laparotomy (group 2) or peritoneal drainage (group 3). Of 487 VLBW infants admitted to our hospital in the last ten years, 80 patients had NEC or IP, out of these, 31% (n=25) were treated surgically. The study population consisted of 14 girls and 11 boys with a mean gestational age of 26+3 weeks and mean birth weight of 801.4 g (range 460 to 1490 g). Pneumoperitoneum was seen in 48% of cases (n=12). Twelve patients underwent initial laparotomy, 10 patients were treated with peritoneal drainage and subsequent laparotomy and in 3 patients a peritoneal drainage was placed. Mean time between drainage and laparotomy was 69.6 hours. Sixty-eight percent of patients had NEC and thirty-two percent were IP. Survival rate was higher in the group who underwent initial laparotomy (p = 0.001) with an overall mortality of 32% (8 deaths). Optimal surgical procedure must be decided upon clinical condition of individual patients. We consider that initial laparotomy should be the treatment option in VLBW infants with intestinal perforation due to NEC or IP.

[Treatment of acute epiglottitis]. / Tratamiento de la epiglotitis aguda.

We analyze 13 children between 1 and 3 years old (mean: 24.6 +/- 6.5 months), who were diagnosed (by direct or radiological examination) of epiglottitis. Seven were male. All of them had fever and respiratory distress. Six blood cultures (46%) were positive for Hemophilus Influenzae, and in 5 cases were resistant to beta-lactamases. Diagnose was made by radiology (70%) or by direct examination (30%). Five patients were not intubated (38%), with a favorable outcome. One died after a cardiorespiratory arrest due to self-extubation. We describe in this study our experience in the conservative treatment of epiglotitis, although initial nasotracheal intubation is the safest method for the management of this entity.

[Renal function in meningococcal infection. Analysis of 116 cases]. / Función renal en la sepsis meningocócica. Estudio de 116 casos.

We study the renal function in meningococcal sepsis in other to get prognostic data in disease evolution. We include 116 patients of whom we take data of anamnesis; physical examination; blood, urine and cerebrospinal fluid biochemical and microbiologic studies and TISS and APS score. We analyze qualitative and quantitative data of renal function statistical and we compare with another prognostic data of disease. We find that renal failure in meningococcal sepsis gets worse the prognostic of the disease.

[Adenovirus infections in an emergency department]. / Infecciones por adenovirus en un servicio de urgencias.

We have reviewed 108 emergency ward reports of patients with adenoviral positive cultures in "Doce de Octubre" Hospital in Madrid. Our aim was to know the most frequent symptoms of the infection so that identification and treatment could be managed more efficiently in our department. Cellular cultures were negative for other viruses such as CMV, enterovirus and herpesvirus. No bacteria were found in the throat cultures. Of the children who were evaluated, 78% were younger than 3 years old. The most frequent symptom was high fever with an otherwise good state of health. During the physical examination, a reddened throat with an exudate was found in half of the patients. A white blood cell count of over 15,000 was found in 33% of the patients with a left shift in 20%. The clinical findings overlapped with throat bacterial infections in 66%, lower respiratory infections in 14%, and more unusual, gastroenteritis, hematuria, intestinal invagination or exanthemas. Only 15% were not given antibiotic therapy.

[Neonatal convulsions caused by incontinentia pigmenti with left opercular dysgenesia]. / Convulsiones neonatales por incontinencia pigmenti con disgenesia opercular izquierda.

AIMS: In this paper we review the main publications on incontinentia pigmenti (IP) and the current knowledge of the etiopathogenesis of the disease and of the convulsions in the neonatal period, by considering a clear case of neonatal IP, with skin, eye, brain and bone lesions. CASE REPORT: Our patient, a female, started with clonic seizures in the right half of the body at the age of three days. Method. IP, or Bloch Sulzberger syndrome, is a genetic multisystemic neuroectodermic disorder. It is a disease of low incidence (1% of all neuroectodermic disorders) which is transmitted by means of a pattern of dominant inheritance linked to X, and is lethal in males, except in rare cases of somatic mosaicism and Klinefelter. In the family forms the gene is located in the p11 (IP 1) and q28 (IP 2) regions of the X chromosome. It has recently been discovered that the cause lies in a mutation of a gene called NEMO (IKK gamma). Together with Bourneville s tuberous sclerosis it is the only neurocutaneous syndrome that can begin with neonatal convulsions. The convulsions start on the second or third day of life and are often limited to a single side of the body, although it can also appear as encephalitis. The origin of the convulsions has been linked with recurring encephalomyelitis, or with an alteration of the neuronal migration. CONCLUSIONS: The cause of the early convulsions in our patient, which we put down to a left perisylvian focal dysgenesia (unilateral opercular syndrome) observed in the computerised axial tomography (CAT scan), has not been reported up to the present associated with IP.

[Hemodynamic study in meningococcal septic shock]. / Estudio hemodinámico en el shock séptico meningocócico.

We analyzed 8 cases of meningococcal septic shock diagnosed in a three year period. The age varied from 20 months to 10 years (mean: 4.8 years). Two patients died. Every child was monitored with a Swan-Ganz catheter 5 F or 7F, placed on by puncture of internal jugular or subclavicular veins. Of this hemodynamic study, we can conclude that in septic shock, there is a myocardial depression, that persist for several days, and improves with dopamine and dobutamine. In addition to this, in sepsis exists a pulmonary hypertension that makes worse the prognosis.