[Phylephebitis due to diverticulitis]. / Pileflebitis secundaria a diverticulitis.

A case of a 52 year-old-male, with past medical history of renoureteral crisis and recurrent episodes of abdominal pain, is presented. The patient presented to the Emergency Department with abdominal pain (similar to previous episodes), fever and abnormal liver function test (marked elevation of gammaglutamyltranspeptidase and alkaline phosphatase). An abdominal ultrasound was performed showing hepatomegaly, and enlarged spleen and an echogenic material that suggested a thrombosis. A CT scan confirmed the thrombosis of the inferior mesenteric vein extending up to the splenic vein and the portal vein. It also showed a large number of diverticulum. Surgery was performed in order to rule out an acute diverticulitis. A phylephlebitis, infective suppurative thrombosis of the portal vein and its branches (inferior mesenteric vein and splenic vein) was found due to an acute diverticulitis with neither perforation nor abscess. A ligature of the inferior mesenteric vein and a Hartmann procedure with resection of the diseased colon, and end colostomy and creation of a rectal stump, were performed. A favourable outcome was obtained with antibiotics and anticoagulation. Some aspects of the aetiology, symptoms, diagnosis and treatment of this unusual complication of diverticulitis are also presented.

Juxtaglomerular cell tumor of the kidney. Morphological, immunohistochemical and ultrastructural studies of a new case.

The authors describe a Juxtaglomerular Cell Tumor (JGCT) in a hypertensive young man whose symptomatology disappeared when the JGCT was removed. The clinical diagnosis was made before surgery by selective determination of plasma renin activity level in both renal veins and in the draining vein of the tumor. This neoplasm is benign and usually occurs in young patients. The morphological, immunocytochemical and ultrastructural features are described. Other renin-secreting tumors and the theories about histogenesis of JGCT are discussed.

Sarcomas of the kidney.

Sarcomas of the kidney are exceedingly uncommon. They represent between 1 and 3% of all malignant renal tumors. Several histological types have been reported. We have reviewed the renal tumors diagnosed in our department in the last 25 years and found 4 cases of sarcoma out of 390 malignant renal tumors (1.02%). They were a liposarcoma, a storiform-pleomorphic fibrous malignant histiocytoma, a rhabdomyosarcoma and a pleomorphic leiomyosarcoma. We report the clinical data and the outcome of the patients, together with the immunohistochemical and ultrastructural findings in these cases.

[Streptococcus pneumoniae and Haemophilus influenzae serotype B invasive disease. A 12-year retrospective study]. / Enfermedad invasiva por Streptococcus pneumoniae y Haemophilus influenzae serotipo b. Estudio retrospectivo de 12 años.

BACKGROUND: Streptococcus pneumoniae and Haemophilus influenzae serotype b (Hib) are two of the most common causes of invasive bacterial disease in children. The introduction of a successful Hib vaccine and the emergence of penicillin-resistant pneumococci have changed the epidemiology of these bacteria over the last few years. OBJECTIVES: To evaluate the incidence of S. pneumoniae and Hib invasive disease in children (0-15 years) admitted to our hospital during a 12-year period (January 1991-December 2002). METHODS: We retrospectively reviewed the medical records of 101 children with isolation of S. pneumoniae and Hib in blood, cerebrospinal fluid (CSF) or synovial fluid samples during the study period. RESULTS: SP was isolated in 81 samples (72 in blood and nine in CSF) from 73 children (72.6 % were aged < 2 years). The annual incidence per 100,000 children aged 0-2 years was 53.76 cases (95 % CI: 40.7-70.9). The most common clinical diagnosis was bacteremia (67 %). The percentage of penicillin-resistant strains was 44 %. Hib was isolated in 38 samples (26 in blood, 10 in CSF and two in synovial fluid) from 28 children (82.1 % were aged < 2 years). The most common clinical diagnosis was meningitis (35.7 %). The annual incidence per 100,000 children aged between 0-5 years dropped from 21.52 cases (95 % CI: 14.4-32) to 1.7 cases (95 % CI: 0.1-10.8) after systematic vaccination. The percentage of ampicillin-resistant strains was 63.1 %. CONCLUSIONS: The incidence of invasive pneumococcal disease and the increased antimicrobial resistance rates of pneumococcus are two major reasons to support the routine use of pneumococcal conjugate vaccination in children. Systematic Hib vaccination since October 1998 has dramatically reduced the incidence of this disease.

[Allergic sensitization profile in 0-5 year old children with wheezing and/or atopic dermatitis]. / Perfil de sensibilización alérgica en niños de 0 a 5 años con sibilancias o dermatitis atópica.

BACKGROUND: Although allergic diseases are frequent in childhood, few studies have characterised the IgE sensitization profile among young children with allergic-like symptoms. OBJECTIVE: To determine the prevalence and the type of allergic sensitization, as well as the demographic and environmental factors related to both characteristics, among 0-5 year old children presenting with wheezing and/or atopic dermatitis. METHODS: Collaborative cross-over study developed in the paediatric setting of 20 Spanish Primary Health Care Centres. An allergology evaluation including blood determination of specific IgE antibodies to common inhalant and food allergens was performed on 468 children who presented with wheezing and/or atopic dermatitis. RESULTS: Allergic sensitization was detected in 32.4% of the children with wheezing (95% confidence interval, 95%CI, 26.3-38.6%), in 54.8% of the children who had atopic dermatitis (95%CI, 42.1-67.6%) and in 39.2% of the children with both processes (95%CI, 32.0-46.4%). The risk of allergic sensitization was sex related (male versus female adjusted odds ratio, OR(A), 1.91, 95%CI, 1.24-2.95), and also related to the age (3-5 versus 0-2 year old OR(A) 1.96, 95%CI, 1.27-3.0), type of early feeding (maternal milk versus infant formula OR(A) 0.51, 95%CI, 0.31-0.84) and geoclimatic area (OR(A) Continental versus Atlantic 2.26, 95%CI, 1.30-3.93). Compared to the Atlantic area, the Continental area the sensitization was lower to mites (OR(A) 0.16, 95%CI, 0.07-0.36) and higher to grass (OR(A) 4.65, 95%CI 1.99-10.86), cow milk (OR(A) 5.17, 95%CI, 1.71-15.62) and egg (OR(A) 5.26, 95%CI, 2.04-13.62), whereas in the Mediterranean area the sensitization was lower to mites (OR(A) 0.29, 95%CI, 0.13-0.64) and higher to cow milk (OR(A) 3.81, 95%CI, 1.20-12.14) and egg (OR(A) 5.24, 95%CI, 1.94-14.20). CONCLUSION: A significant proportion of small children treated at the paediatric primary health care centres due to wheezing and/or atopic dermatitis had allergic sensitization. There appears to be a geoclimatic variation in the prevalence of sensitization to inhalant and food allergens among young children with allergic like symptoms who live in Spain.

Kikuchi's disease with multisystemic involvement and adverse reaction to drugs.

Kikuchi's disease (KD), or histiocytic necrotizing lymphadenitis, was initially described in Japan in 1972. In the following years, several series of cases involving patients of different ages, races, and geographic origins were reported, but pediatric reports have been rare. The etiology of KD is unknown, although a viral or autoimmune hypothesis has been suggested. The most frequent clinical manifestation consists of local or generalized adenopathy, although in some cases, it is associated with more general symptoms, multiorganic involvement, and diverse analytic changes (leukopenia, elevated erythrocyte sedimentation rate, and C-reactive protein, as well as an increase of transaminases and serum lactic dehydrogenase). Diagnosis is based on characteristic pathologic findings that permit differentiation of this disease from lymphoma, systemic lupus erythematosus, and infectious lymphadenopathies. We present here the case of a 14-year-old boy who presented with severe systemic manifestations and transient fulminant hepatic failure in response to treatment with antituberculosis drugs. Kikuchi's disease, lymphadenitis, liver failure, antituberculosis drugs.

[Sarcomatoid renal carcinoma]. / Carcinoma renal sarcomatoide.

OBJECTIVE: To analyze the pathological and clinical features of a variant of renal carcinoma: sarcomatoid renal carcinoma. METHODS: Of 316 patients diagnosed as having a renal tumor from 1975 to 1995, 11 (3.5%) with a pathological diagnosis of sarcomatoid renal carcinoma were analyzed. The clinical history, biological data and diagnostic imaging findings of these patients were reviewed. All patients had undergone surgical exploration. RESULTS: All the tumors showed a double cellular population, with a fusiform component. Histological analysis showed a high grade and stage tumor. Ten patients died from the disease, the mean survival rate was 9 months (range 2-48) following diagnosis. CONCLUSIONS: Sarcomatoid carcinoma of the kidney is uncommon and can be occasionally difficult to distinguish from sarcoma. It has a worse prognosis than other variants of renal carcinoma.

[Renal metastasis from breast carcinoma: a new case and review of the literature]. / Metástasis renal de un carcinoma de mama: un nuevo caso y revisión de la literatura.

OBJECTIVES: Breast carcinoma is the most common malignant tumor in the female. A vast majority of the cases present metastasis at the time of diagnosis. A case of breast carcinoma metastatic to the kidney is described to emphasize that in the presence of a renal mass, a secondary or metastatic tumor should be suspected. The literature is briefly reviewed. METHODS: We report on the diagnosis and treatment of an expanding left renal mass in a female patient with a previous history of multiorgan tumors (ovarian, breast and small bowel) or different histological types that had been diagnosed and treated at different periods. RESULTS: Following radical nephrectomy, analysis of the surgical specimen disclosed a metastatic tumor from breast carcinoma. No subsequent treatment was required and the patient is well 6 months postoperatively. CONCLUSIONS: Metastasis from a primary tumor must be suspected in patients with a previous history of tumor presenting with a renal mass. Renal metastasis presents in the advanced stages of tumor dissemination. Treatment depends on patient general condition and the stage of the primary and metastatic tumors.

[Cavernous hemangioma of the scrotum]. / Hemangioma cavernoso de escroto.

OBJECTIVE: To describe a case of scrotal cavernous hemangioma. METHODS: A 4-year old boy with a painful left scrotal mass is described. The epidemiology, natural history, diagnosis, differential diagnosis, treatment and prognosis of this tumor are reviewed. RESULTS: Analysis of the surgical specimen disclosed a scrotal cavernous hemangioma. CONCLUSIONS: A scrotal mass diagnosed at an uncommon age or atypical site warrants considering hemangioma as a possible etiology.

Tonsillar metastases: report on two cases and review of literature.

Metastases to the tonsils are extremely infrequent. Less than 70 cases have been reported in literature since 1858. The commonest sources of tonsillar metastases are malignant melanomas and carcinomas of the breast and the lungs. We report about two new cases of tonsillar metastases, one of which developed from a malignant melanoma, the other one from a hepatocellular carcinoma. We have not found any reports on tonsillar metastases stemming from hepatocellular carcinomas in literature and, moreover, in our case, this was the clinical presentation of the primary tumor.

[Management of parapneumonic pleural effusions]. / Tratamiento de los derrames pleurales paraneumónicos.

Pleural effusion in children is most often due to bacterial pneumonia. Between 0.6 and 2% of pneumonias are complicated by empyema and approximately 40% of children hospitalized with pneumonia have a pleural effusion. In recent years Streptococcus pneumoniae is the most prevalent organism. Treatment is based on the early and judicious use of antibiotics, imaging techniques, thoracocentesis, pleural drainage, fibrinolytics, thoracoscopy and thoracotomy. Indications for early pleural drainage are gross pus, positive Gram stain in pleural fluid, pleural glucose less than 50mg/dL, pleural fluid pH of less than 7 and sonographic evidence of loculations. Local fibrinolytics may decrease the need for surgical treatment, with a success rate between 38 and 100%, according to the effusion stage. Thoracoscopic debridement is useful in the fibrinopurulent stage with loculations, with favorable results in 30-100% of patients, also depending on the effusion stage.

[Retroperitoneal ganglioneuroma. Report of a case]. / Ganglioneuroma retroperitoneal. A propósito de un caso.

OBJECTIVE: To report an additional case of retroperitoneal ganglioneuroma. METHODS/RESULTS: A case of retroperitoneal ganglioneuroma that had been incidentally discovered in a 27-year-old male during abdominal US evaluation is described. The diagnosis was based on the histopathological findings after US-guided biopsy. The clinical features and the findings of the complementary tests, which included radiological assessment, intravenous urography, CT and cavography are presented, as well as the pathology findings. Treatment was by complete surgical excision of the tumor. CONCLUSION: Treatment of ganglioneuroma is by surgery, since the diagnosis is generally based on the histopathological analysis of the surgical specimen. For those cases with a preoperative diagnosis, some authors advocate surgery for patients with clinical evidence of neuroblastoma or another pathology arising from this disease. Although infrequent, ganglioneuroma coexisting with neuroblastoma can occur. For this reason, complete excision of the tumor is preferred.

Pileflebitis secundaria a diverticulitis / Phylephebitis dur to diverticulitis

Presentamos el caso de un varón de 52 años, con antecedentes de cólicos renoureterales que había consultado por un episodio de similares características, acompañado de fiebre y elevaciones de la GGT y de la fosfatasa alcalina. Una ecografía abdominal mostró hepatoesplenomegalia y un material ecogénico en el eje esplenoportal, sugerente de trombosis. La TAC abdominal demostró trombosis de la vena mesentérica inferior, continuándose por la vena esplénica hasta el origen proximal de la vena porta. También se observaron numerosos divertículos. Se sospechó que el paciente presentaba una diverticulitis aguda complicada con trombosis vascular, por lo que se decidió la realización de cirugía, que confirmó la existencia de diverticulitis sin perforación ni abscesos, flebitis con pileflebitis de la arteria mesentérica inferior hasta su unión con la vena esplénica, con salida de pus al seccionar la vena. Se realizó ligadura de la vena mesentérica inferior e intervención de Hartman con ligadura del muñón rectal y colostomía. Además se indicó tratamiento antibiótico de amplio espectro y anticogulación, siendo la evolución favorable. Posteriormente comentamos algunos aspectos etiológicos, clínicos, diagnósticos y terapéuticos de esta infrecuente complicación de la diverticulitis

A case of a 52 year-old-male, with past medical history of renoureteral crisis and recurrent episodes of abdominal pain, is presented. The patient presented to the Emergency Department with abdominal pain (similar to previous episodes), fever and abnormal liver function test (marked elevation of gammaglutamyltranspeptidase and alkaline phosphatase). An abdominal ultrasound was performed showing hepatomegaly, and enlarged spleen and an echogenic material that suggested a thrombosis. A CT scan confirmed the thrombosis of the inferior mesenteric vein extending up to the splenic vein and the portal vein. It also showed a large number of diverticulum. Surgery was performed in order to rule out an acute diverticulitis. A phylephlebitis, infective suppurative thrombosis of the portal vein and its branches (inferior mesenteric vein and splenic vein) was found due to an acute diverticulitis with neither perforation nor abscess. A ligature of the inferior mesenteric vein and a Hartmann procedure with resection of the diseased colon, and end colostomy and creation of a rectal stump, were performed. A favourable outcome was obtained with antibiotics and anticoagulation. Some aspects of the aetiology, symptoms, diagnosis and treatment of this unusual complication of diverticulitis are also presented

Perfil de sensibilización alérgica en niños de 0 a 5 años con sibilancias o dermatitis atópica / Allergic sensitization profile in 0–5 year old children with wheezing and/or atopic dermatitis

Antecedentes Aunque las enfermedades alérgicas son frecuentes en la infancia, pocos estudios han caracterizado el perfil de sensibilización inmunoglobulina (Ig) E en niños pequeños con síntomas de posible origen alérgico. Objetivo Establecer la prevalencia y el tipo de sensibilización alérgica, y los factores demográficos y ambientales relacionados con ambas características, en niños de 0 a 5 años de edad con sibilancias o dermatitis atópica. Población y métodos Estudio transversal colaborativo en el que participaron 20 centros de atención primaria de diversas áreas geográficas de España. En conjunto, 468 niños con sibilancias o dermatitis atópica realizaron una evaluación alergológica que incluyó la determinación en sangre de anticuerpos IgE específicos frente a neumoalérgenos y trofoalérgenos prevalentes. Resultados Se detectó sensibilización alérgica en el 32,4% de los niños con sibilancias (intervalo de confianza [IC] del 95%: 26,3–38,6%), el 54,8% de los niños con dermatitis atópica (IC del 95%: 42,1–67,6%) y el 39,2% de los que tuvieron ambos procesos (IC del 95%: 32,0–46,4%). El riesgo de sensibilización se vio influido por el sexo (odds ratio ajustado [ORA] masculino versus femenino: 1,91; IC del 95%: 1,24–2,95), la edad (ORA 3–5 versus 0–2 años: 1,96; IC del 95%: 1,27–3,0), el tipo de lactancia (ORA materna versus artificial: 0,51; IC del 95%: 0,31–0,84) y el área geoclimática (ORA continental versus atlántica: 2,26; IC del 95%: 1,30–3,93). Con respecto al área atlántica, la sensibilización en el área continental fue menor a ácaros (ORA: 0,16; IC del 95%: 0,07–0,36) y mayor a gramíneas (ORA: 4,65; IC del 95%: 1,99–10,86), leche de vaca (ORA: 5,17; IC del 95%: 1,71–15,62) y huevo (ORA: 5,26; IC del 95%: 2,04–13,62), mientras que en el área mediterránea fue menor a ácaros (ORA: 0,29; IC del 95%: 0,13–0,64) y mayor a leche de vaca (ORA: 3,81; IC del 95%: 1,20–12,14) y huevo (ORA: 5,24; IC del 95%: 1,94–14,20). Conclusiones Una proporción relevante de los niños pequeños asistidos en atención primaria por sibilancias o dermatitis atópica presentan sensibilización alérgica. En España parecen existir variaciones según el área geoclimática en la prevalencia de sensibilización a inhalantes y alimentos en lactantes y niños preescolares con síntomas de posible origen alérgico (AU)

Background Although allergic diseases are frequent in childhood, few studies have characterised the IgE sensitization profile among young children with allergic-like symptoms. Objective To determine the prevalence and the type of allergic sensitization, as well as the demographic and environmental factors related to both characteristics, among 0–5 year old children presenting with wheezing and/or atopic dermatitis. Methods Collaborative cross-over study developed in the paediatric setting of 20 Spanish Primary Health Care Centres. An allergology evaluation including blood determination of specific IgE antibodies to common inhalant and food allergens was performed on 468 children who presented with wheezing and/or atopic dermatitis. Results Allergic sensitization was detected in 32.4% of the children with wheezing (95% confidence interval, 95%CI, 26.3–38.6%), in 54.8% of the children who had atopic dermatitis (95%CI, 42.1–67.6%) and in 39.2% of the children with both processes (95%CI, 32.0–46.4%). The risk of allergic sensitization was sex related (male versus female adjusted odds ratio, ORA, 1.91, 95%CI, 1.24–2.95), and also related to the age (3–5 versus 0–2 year old ORA 1.96, 95%CI, 1.27–3.0), type of early feeding (maternal milk versus infant formula ORA 0.51, 95%CI, 0.31–0.84) and geoclimatic area (ORA Continental versus Atlantic 2.26, 95%CI, 1.30–3.93). Compared to the Atlantic area, the Continental area the sensitization was lower to mites (ORA 0.16, 95%CI, 0.07–0.36) and higher to grass (ORA 4.65, 95%CI 1.99–10.86), cow milk (ORA 5.17, 95%CI, 1.71–15.62) and egg (ORA 5.26, 95%CI, 2.04–13.62), whereas in the Mediterranean area the sensitization was lower to mites (ORA 0.29, 95%CI, 0.13–0.64) and higher to cow milk (ORA 3.81, 95%CI, 1.20–12.14) and egg (ORA 5.24, 95%CI, 1.94–14.20). Conclusion A significant proportion of small children treated at the paediatric primary health care centres due to wheezing and/or atopic dermatitis had allergic sensitization. There appears to be a geoclimatic variation in the prevalence of sensitization to inhalant and food allergens among young children with allergic like symptoms who live in Spain (AU)

Lactante con hiperreactividad bronquial postbronquiolitis: visión desde la pediatría general / No disponible

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Hepatitis tóxica secundaria a hierbas chinas / Toxic hepatitis induced by Chinese herbs

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