[Why are pediatric empyemas on the increase in Spain?]. / Por qué hay más empiemas pediátricos en España?

There is a widespread perception among Spanish pediatricians that the incidence of empyema has significantly increased in the last few years, even though the objective information available is limited, and there is no specific active epidemiological surveillance system for this condition. In the present article, we review the situation of empyema in Spain, and discuss the main hypotheses put forward in the international literature to explain this increase, as well as the limitations of the sources available. Despite the scarcity of information, we draw the following conclusions: 1) the incidence of pediatric empyema is increasing in Spain, both generally and when caused by pneumococcus in particular; 2) the reason for this increase remains unknown, and to date no firm link has been established between this phenomenon and the heptavalent conjugate pneumococcal vaccine; and 3) this situation justifies the establishment of prospective systems for the surveillance and control of empyema and, once again, highlights the importance of developing active surveillance systems for pneumococcal disease.

[Human papillomavirus vaccines: a new challenge for pediatricians]. / Vacuna frente al virus del papiloma humano: un nuevo reto para el pediatra.

Human papillomavirus (HPV) infections are the most common sexually transmitted infections in the world. This infection is a necessary cause of cervical cancer, has been related to other forms of anogenital, airway and digestive cancers, and also causes anogenital warts. The recent advances in HPV prophylactic vaccines and their imminent commercial availability will post a new challenge to pediatricians: the indication and administration of these vaccines for the prevention of HPV infection, and consequently, of cervical cancer and other HPV-related diseases. The present article reviews the essentials of HPV infection, its relationship with cervical cancer, the advances in prophylactic HPV vaccines, and the role of the pediatrician in this context.

[Recommendations of the Vaccine Advisory Committee of the Spanish Association of Pediatrics: influenza vaccination campaign 2006-2007]. / Recomendaciones del Comité Asesor de Vacunas de la Asociación Española de Pediatría: vacunación antigripal campaña 2006-2007.

The recommendations of the Spanish Association of Pediatrics on influenza vaccination in the pediatric age group for the 2006-2007 season are presented. Influenza has special characteristics in children due to the high morbidity it carries. Moreover, children constitute the most frequent source of transmission. The risk factors supporting influenza vaccination in children and the need for immunization in persons living with high-risk children are discussed. The advisability of extending vaccination in health workers, and specifically to pediatricians and medical personnel in contact with sick children is stressed. The composition of the vaccine for the 2006-2007 seasons, the schedules and dosages in children depending on age, and the contraindications to vaccination are specified. Finally, the premises required to recommend universal vaccination in young children in Spain as a strategy to reduce morbidity due to this epidemic in children and adults are discussed.

[The role of the rotavirus vaccine in childhood vaccination schedules]. / El papel de la vacuna frente a rotavirus en los calendarios de vacunación infantil.

Rotavirus is the leading cause of diarrhea in infants. In developed countries, this infection leads to considerable morbidity with a high number of hospitalizations and medical interventions in the winter season, giving rise to substantial medical and social costs. In developing countries, rotavirus is a major cause of mortality in infants due to dehydration, with an estimated 600.000 deaths or more per year worldwide. A vaccine that is easy administrated, safe and with high efficacy would be the ideal means to reduce the burden of this disease and its high economic and social cost and to decrease the number of deaths in low-income countries. Recently, the results of two well-designed clinical trials with a large number of subjects have been reported. Both studies, which used different vaccines, reported high efficacy in the prevention of severe gastroenteritis and hospitalizations caused by rotavirus. When these vaccines become available in Europe, a reduction in hospitalizations, medical consultations, and days of work lost can be expected.

[Indications for tonsillectomy and adenoidectomy: consensus document by the Spanish Society of ORL and the Spanish Society of Pediatrics]. / Indicaciones de adenoidectomía y Amigdalectomia: Documento de Consenso entre la sociedad Española de Otorrinolaringología y patología Cervicofacial y la Asociación Española de pediatría.

Tonsillectomy and adenoidectomy are probably the commonest surgeries performed in the ENT field as well as the most controversial ones. There are very few consensus documents available for these two surgeries. In 1997 a document written by the two mentioned Societies was published, in order to update such document regarding tonsillectomy and adenoidectomy procedures we have met this year representatives from both scientific societies and a new document has been elaborated. We describe the diagnostic criteria of pharyngo-tonsillitis and adenoiditis as well as of obstructive sleep apnoea syndrome, with the aim of a better comprehension of these processes when a decision needs to be made regarding surgery. Indications and contraindications of tonsillectomy and adenoidectomy are here described.

[Brain abscess in children]. / Absceso cerebral infantil.

INTRODUCTION: Brain abscess is a rare infection in infants. Morbidity and mortality are high but have decreased due to advances in neuroimaging studies and the use of new antibiotics. We describe six cases of brain abscess diagnosed at the Gregorio Marañón Children's Hospital between January 1996 and September 2003. METHODS: We performed a retrospective chart review of patients with brain abscess. The variables analyzed were age, sex, clinical symptoms and signs, radiological studies, etiology, therapy, and clinical outcome. RESULTS: Age ranged from 8 to 15 years (mean age: 11 years). There were three girls and three boys. The most frequent symptoms were neurological with associated sinusitis in four patients, congenital cyanogenic cardiopathy in one patient and meningitis in one patient. Diagnosis was established through computed tomography (CT) of the brain in five patients and through magnetic resonance imaging (MRI) in one patient. In five patients the abscess was located in the frontal lobe. All patients received broad-spectrum antibiotics and five underwent surgical drainage. Two patients had neurological sequelae. CONCLUSIONS: Although rare, brain abscess should be considered in patients with neurological manifestations associated with otorhinolaryngological infections or congenital cyanotic cardiopathy. When suspected, a CT or MRI must be performed to rule out this diagnosis and, if confirmed, prompt therapy with broad-spectrum antibiotics should be started. Surgical drainage may be needed.

[Orbital and periorbital cellulitis in childhood. A review of 116 cases]. / Celulitis orbitarias y periorbitarias en la infancia. Revisión de 116 casos.

Orbital and periorbital cellulitis, which can result from a spectrum of disorders that are commonly encountered in pediatric practice, usually develops as a complication of paranasal sinus infection, and also can result from dental infection, trauma to the eyelids or external ocular infection. The clinical features, microbiological data and treatment of 97 children with periorbital cellulitis and 19 children with orbital cellulitis, admitted to our hospital from January 1983 through December 1993, are reported here. Twenty-three percent of the children (27 cases) had positive cultures, 7 cases with orbital cellulitis developed neurological or ophthalmological complications. Antibiotic therapy alone was effective in 97 patients, but a significant proportion required paranasal sinus or orbital surgery (16%).

[Clinical evolution of rheumatic carditis treated with aspirin]. / Evolución clínica de las carditis reumáticas tratadas con aspirina.

We have analyzed the clinical, laboratory, electrocardiographic and echocardiographic findings of six patients with rheumatic carditis whose antiinflammatory treatment was aspirin. We include one case who was initially treated with steroids. She relapsed when the steroid treatment was discontinued and she was then treated with aspirin. There were 2 males and four females. The age range was 9 to 14 years. This was the first rheumatic attack for all the patients. They were also treated with penicillin G during ten days. The prophylaxis was accomplished with benzatine penicillin 1.200.000 IU at 28 days intervals. The aspirin was given at doses ranging from 60 to 100 mg/Kg/day for eight to twelve weeks. All the patients had auscultatory findings consistent with mitral insufficiency accompanied in two cases with findings of aortic regurgitation. In three cases, there was a transient mild diastolic murmur during the first five days. In one case the rheumatic carditis was complicated with acute renal failure due to acute rheumatic nephritis that required peritoneal dialysis. The follow-up period ranged from nine to twenty six months. There have been no relapses. All the patients remain asymptomatic and leading a normal life. At the last visit three patients had mild mitral insufficiency and in three patients the clinical findings, electrocardiogram and echocardiogram were normal. If we accept that most of the cases of rheumatic carditis are mild or moderate, is our believe that the aspirin is the antiinflammatory treatment of choice at the present time.

[Coinfection with chlamydia and mycoplasma. Incidence in our environment]. / Coinfección por Chlamydia y Mycoplasma. Incidencia en nuestro medio.

OBJECTIVES: To investigate the presence Mycoplasma pneumoniae and Chlamydia pneumoniae and to determine their importance as the cause of community-acquired pneumonia in childhood. MATERIAL AND METHODS: We performed a retrospective descriptive study of all the patients aged less than 15 years old diagnosed with community-acquired pneumonia due to M. pneumoniae in the pediatric emergency department of our hospital between May 1998 and May 2000. Patients in whom C. pneumoniae was also identified as a cause of pneumonia were investigated. RESULTS: Of 242 cases of community-acquired pneumonia, 82 were due to M. pneumoniae (34.7 %) and 32 were due to C. pneumoniae (13.22 %) Of these, eight cases were coinfections with C. pneumoniae and M. pneumoniae. Most infections occurred in boys (5/8). The mean age at diagnosis was 7.7 years. No seasonal predominance was found. CONCLUSIONS: Both C. pneumoniae and M. pneumoniae play a substantial role in community-acquired pneumonia in children aged more than 5 years old. Although coinfection with both species usually worsens the course of the disease, outcome in all the patients studied was satisfactory.

Neumonía por mycoplasma: cuatro años de estudio / Mycoplasma pneumonia: four years study

Mycoplasma pneumoniae constituye una de las causas, cada vez mas frecuente, de neumonias en la infancia. Objetivos: estudiar 105 casos de neumonias por Mycoplasma pneumoniae habidos en nuestro hospital en los ultimos cuatro anos. Material y metodos: durante dicho tiempo se diagnosticaron en el Servicio de Urgencias de nuestro hospital, un total de 452 neumonias ambulatorias, 132 de ellas causadas por Mycoplasma pneumonlae, lo que significa un porcentaje de casi 30 por ciento; todas fueron seguidas mediante un protocolo de neumonias, recogiendose datos epidemiológicos, clínicos, analíticos y microbiológicos, analizándose sus resultados según un programa estadístico. Resultados: edad media de presentación de 6.38 anos, 38.6 por ciento menores de cinco arlos. No encontramos ningun predominio de sexos en su distribución, aunque si una mayor distribución de los casos entre los meses de enero y julio con 83 por ciento de los casos. Epidemiológicamente encontramos la aparición de casos familiares similares en 37 por ciento de los casos, por 52 por ciento de casos en donde no se encontraron casos similares en el entorno, se hallaron factores de riesgo en 36 por ciento de los casos (enfermedades del tracto respiratorio inferior). La clinica consistió fundamentalmente en fiebre superior a 38§C, tos seca y buen estado general, acompanandose de sintomatologia catarral en los pacientes mas pequenos. A la exploración ffsica encontramos estertores a la auscultación pulmonar en 75 pacientes y una auscultación normal en 23 casos, cinco pacientes cursaron con derrame pleural de leve a moderado. La afectación faringo-amigdalar estaba presente en 74 casos y 14 pacientes cursaron con afectación dermatológica, sólo cuatro de los pacientes precisaron ingreso hospitalario. El tratamiento consistió en batalactamicos y macrólidos, evolucionando a su total curación al mes de iniciado el estudio 93 por ciento de los casos