Timo cervical aberrante: masa cervical pediátrica inusual, revisión bibliográfica y reporte de caso / Aberrant cervical thymus: unusual type of pediatric cervical mass, bibliographic review and case report

Las masas cervicales representan un desafío habitual en pediatría, que en su mayoría son de etiología benigna. Una de las causas menos conocidas es el timo cervical aberrante, una entidad clínica resultante de anormalidades en el descenso del timo a lo largo de su ruta habitual (tracto timo-faríngeo). Este es un cuadro frecuentemente mal diagnosticado, del que se desconoce su incidencia real. Actualmente, su incidencia relativa parece ir en aumento en conjunto con la disponibilidad de la ecotomografía. En Chile no hay registro epidemiológico de este cuadro ni existen reportes de caso documentados. En este artículo se presenta una revisión bibliográfica sobre masa cervical pediátrica y un reporte de caso de un paciente chileno.

Cervical masses constitute a frequent challenge in pediatric care, mostly which are of benign nature. One of the lesser known causes is the aberrant cervical thymus, which results from embryological abnormalities during the thymus descent through its normal route (thymo-pharyngeal duct). This is a frequently misdiagnosed syndrome, for which its real incidence remains unknown. Nowadays, its relative incidence is on the rise along with ultrasound availability. There is no epidemiological record or documented case reports of this entity in Chile. In this article we present a bibliographic revision on cervical mass and a case report from a Chilean patient.

Síndrome metabólico en niñas púberes con hiperplasia suprarrenal congénita clásica / Metabolic syndrome among puberal girls with classic congenital adrenal hyperplasia

Background: Adult women with adrenal congenital hyperplasia (AH) have a higher risk for insulin resistance, dyslipidemia, hypertension, high body mass index (BMI) and increased body fat. All these factors are associated with cardiovascular risk and metabolic syndrome (MS). Aim: To evaluate the presence of MS in pubertal classic AH girls (CAH) and a control group (C). Material and Methods: We studied 15 pubertal AH patients (12.0 +/- 1.9 years) and 26 controls (11.7+/- 0.3 years) matched by age and tanner stage. Weight, height, BMI, waist/hip ratio, blood pressure and serum lipids were measured. An oral glucose tolerance test (OGTT) and insulin curve was performed in CAH girls whereas in controls basal insulin and glucose were determined. The homeostasis model assessment for insulin resistance (HOMAIR) was calculated. Cook, Ferranti and international diabetes federation (IDF) criteria were used to determine the presence of MS. Results: CAH and C girls had similar BMI (22.0 +/- 5.1 and 20.1 +/- 3.6 kg/m2 respectively; p = 0,11). CAH girls had higher basal blood glucose (80.8 +/- 7.7 and 60.6 +/- 10.6 mg/dl respectively, p < 0.01) and controls had higher triglyceride levels (147.0 +/- 69.3 and 79.7 +/-16.3 mg/dl respectively, p < 0.01) and lower HDL cholesterol levels (45.8 +/- 12.8 and 56.9 +/- 17.5 mg/dl respectively, p = 0.02). According to cook criteria 4 percent of CAH girls and 23 percent of controls has MS. These figures were 14 and 32 percent respectively according to Ferranti criteria and 0 and 5 percent respectively according to IDF criteria. Conclusions: CAH puberal patients do not have a higher prevalence of metabolic syndrome, compared with controls with similar Tanner stage and BMI.

Diabetes Mellitus tipo 1 (DM1) en niños menores de 5 años: Características al debut vs otros grupos etarios en Chile / Type I diabetes mellitus in Chilean children under 5 years-old: Onset characteristics in contrast with other age groups

Introducción: En los últimos años, se ha visto un aumento en la incidencia de DM1 en niños. Objetivo: Determinar frecuencia y características clínicas y de laboratorio al debut de DM1 en niños chilenos menores de 5 años, comparado con los de mayor edad. Pacientes y Métodos: Se estudiaron los datos clínicos y de laboratorio de pacientes que debutaron entre 1998-2003 en cuatro centros de Santiago. Se clasificaron en 3 grupos etarios (G): 0-4 (GI), 5-9 (GII) y 10-14 años (GIII) y se compararon según los parámetros descritos. Resultados: Un 19,7 por ciento de los pacientes eran menores de 5 años; GI (n = 27), seguido de aquéllos pertenecientes a GII (43,8 por ciento; n = 60) y GIII (36,5 por ciento; n = 50). El periodo de síntomas previo al diagnóstico fue más corto en GI; 18,4 ± 23,7 vs 26,4 ± 27,4 y 40,1 ± 60 días (p < 0,0001) y su nivel de HbA1c fue más baja; 10,1 ± 1,7 vs 11,8 ± 3,4 por ciento en GII (p < 0,0001) y 12,4 ± 2,6 por ciento en GIII (p = 0,028), respectivamente. No hubo diferencias en la glicemia inicial entre los grupos. La acidosis metabólica fue mayor en GI; pH 7,14 ± 0,1 vs 7,19 ± 0,2 (GII) y 7,26 ± 0,1 (GIII) (p < 0,0001) y presentaron más infecciones concomitantes (33 por ciento, 20 y 28 por ciento respectivamente; p > 0,05). Conclusiones: Un porcentaje importante de las DM1 se inicia en niños < 5 años. Este grupo presenta un cuadro más grave, con mayor acidosis, menores niveles de HbA1c y periodo previo de síntomas, por lo que debe existir alerta para el diagnóstico en este grupo etario.

Background: During the last years, an increase in the incidence of DM1 in infants has been observed. Objective: to study the number of children younger than 5 years-old diagnosed with DM1 and compare clinical and laboratory features with older children at DM1 onset. Method: Study of the clinical and laboratory characteristics in subjects diagnosed with DM1 from 1998 to 2003 in Santiago. Patients were classified according to age in 3 groups: 0-4 (GI), 5-9 (GII) and 10-14 years-old (GIII). Results: 19,7 percent cases were younger than 5 years-old (GI n = 27), GII (43,8 percent n = 60) and GIII (36,5 percent n = 50). A shorter duration of symptoms was observed in GI (18,4 ± 23,7 vs 26,4 ± 27,4) (p < 0,0001) and HbA1c levels were lower in GII (10,1 ± 1,7 vs 11,8 ± 3,4 percent) (p < 0,0001) and in GIII (12,4 ± 2,6 percent) (p = 0,028). Glucose levels were similar among groups (p>0,05) and metabolic acidosis was more severe in GI (pH 7,14 ± 0,1 vs 7,19 ± 0,2 in GII and 7,26 ± 0,1 in GIII) (p < 0,0001). A concomitant infectious disease was observed in GI (33 percent), GII (20 percent) and GIII (28 percent) (p > 0,05). Conclusions: An important percentage of DM1 in children presents in subjects younger than 5 years-old. This group showed acute and severe clinical presentation with longer duration of symptoms, severe acidosis and lower HbA1c levels. It is necessary to evaluate carefully in order to suspect the diagnosis in this group.

Endocarditis por Abiotrophia defectiva en paciente adulto / Endocarditis caused by Abiotrophia defectiva in an adult patient

Abiotrophia defectiva, formerly designated as a member of nutritionally variant streptococci, is part of normal oral flora and may be a cause of culture-negative endocarditis. We report a case of infective endocarditis caused by A. defectiva in a 37-year-old man, allergic to penicillin. We also review the literature for antibiotic treatment alternatives and the microbiological diagnostic possibilities at present.

Abiotrophia defectiva es una cocácea grampositiva considerada anteriormente como parte del grupo de los estreptococos nutricionalmente variables. Es parte de la microbiota oral y puede ser causante de endocarditis bacteriana con cultivo negativo. Se reporta el caso de un paciente varón de 37 años de edad, alérgico a penicilina, con endocarditis infecciosa causada por A. defectiva y se realiza revisión de la literatura sobre las alternativas terapéuticas y el estado actual del diagnóstico microbiológico de este agente.