Absceso cerebral / Brain abscess

El absceso cerebral es una patología poco frecuente en la infancia, aunque grave, que puede presentar una alta morbimortalidad, a pesar de los avances diagnósticos y terapéuticos actuales. El germen causal depende de los factores predisponentes. La presentación clínica en niños es inespecífica, y requiere la sospecha precoz por parte del médico. La tomografía computarizada (TC) y/o la resonancia magnética (RM) son herramientas indispensables para realizar el diagnóstico de certeza. El tratamiento de la mayoría de los abscesos consiste en antibioterapia de amplio espectro y drenaje quirúrgico, aunque en la fase precoz de cerebritis puede responder sólo a tratamiento médico. Describimos una niña de 13 años diagnosticada de dos abscesos cerebrales originados a partir de una otitis media y que se encontraba en tratamiento antibiótico. Presentaba cefalea, vómitos y otalgia a su ingreso. El diagnóstico se hizo mediante TC. Se trató con antibioterapia de amplio espectro con buna penetración cerebral, con la que evolucionó a un aumento del tamaño del absceso y un empeoramiento clínico. Se realizó la aspiración estereotáxica de la lesión y la evolución fue favorable sin complicaciones postquirúrgicas (AU)

Brain abscess is uncommon but life- threatening infection in children with high mobility and mortality despite recent advances in diagnostic and therapeutic modalities. Predominant etiologic microorganisms vary depending on these predisposing factors. The clinical presentation in children can be nonspecific, and a high index of suspicion is required. Computed tomography (CT) and/or magnetic resonance imaging (MRI) are essential tools that enable the physician to diagnosis. Surgical drainage with antimicrobial therapy is the treatment of choice for most brain abscesses. In the early phase of cerebritis, infection can respond to long-term antibiotic therapy alone. We described a 13 years old girl with two brain abscesses originated form otitis media with antibiotic therapy. Diagnosis was given by CT. Initial treatment with broad spectrum antibiotics with good cerebral penetration was associated with an increase in the size of abscess and clinical worsening. Stereotactic aspiration of lesion and culture was performed and the patient showed improvement and there was any postoperative complication (AU)

[Acute meningococcal disease. Its prognostic assessment]. / Enfermedad meningocócica aguda. Valoración pronóstica.

We have studied 50 children affected with acute meningococcal disease (AMD). The ages of the children varied between 4 months and 12.58 years, with a mean age of 4.58 years. By using the shock state and DIC syndrome, both of which are indications of the severity of the illness, an evaluation of the discriminatory capacity was done with regard to significantly associate variables and 3 scores, Bjorvatn, Leclerc and PRISM, throughout 8 intervals within the first 48 hours of hospital treatment. We observed a very high survival rate (98%) associated with the early treatment for shock. Leukopenia and disseminated purpura were the best variables in order to discriminate shock and DIC, respectively. The greatest capacity for the diagnosis of the shock state and DIC syndrome were registered during the 0-6 hour period and the 0-12 hour period, respectively. The prognosis improved if the child remained alive 12 hours after the treatment had begun.

[Reye's syndrome in Spain, 1980-1984 (A cooperative study: Pediatric Intensive Care Section of the Asociación Española de Pediatría)]. / Síndrome de Reye en España, 1980-1984. (Estudio cooperativo. Sección de CIP de la AEP).

The incidence of the Reye syndrome in Spain has been retrospectively reviewed from 1980 to 1984. A survey of 57 cases has been available to study. It is pointed out the low frequency (0.12/10(5) 15 years); the low mean age (12 month) due to a higher prevalence in infants; the high mortality rate (49%), proportional to the great number of III and IV Lovejoy's stages; the low correlation with chicken-pox and salycilate-intake in the prodromic period and a better prognosis in patients when barbituric coma was established along with other measures.

[Election of a venous approach. The internal jugular vein]. / Elección de vía venosa. La vena yugular interna.

Due to the variety of venous routes and of techniques described, it may be difficult to choose most suitable one in every case. Authors found percutaneous internal jugular vein cannulation appropriate as alternative venous route for short-term routine use, and as a preferent one for long-term use or if central venous cannulation is necessary. They present their experience with this technique in 52 children from 7 days to 13 years old (3-36 kg). They achieved 44 cannulations (84,6%), with a greater success rate at right side (90,4%) than at left side (60%). As complications there were 4 carotid artery punctures (3,9% of the punctures) and one transient sinus bradycardia (0,9% of the punctures). They conclude that this technique is the one of choice for central venous cannulation.