Probable neuroborreliosis con parálisis de los nervios hipogloso y vago / Probable neuroborreliosis with paralysis of hypoglossal and vagus nerves

No disponible

Hemorragia suprarrenal neonatal. Consideraciones diagnósticas y de actitud clínica / Neonatal adrenal hemorrhage. Diagnostic considerations and clinical attitude

Se presenta una serie de 3 casos diagnosticados en nuestro Servicio de hemorragia suprarrenal unilateral. En dos de los casos el diagnóstico es en período neonatal y en el tercer caso se sospecha de forma retrospectiva, por encontrar en una radiografía abdominal calcificaciones suprarrenales. En los dos recién nacidos, la causa de ingreso es ictericia, acompañada en uno de ellos de masa abdominal. Los dos casos son varones sin antecedentes familiares de interés, procedentes de una primera gestación a término y sin incidencias. Parto prolongado en ambos, siendo instrumental en el primero. El período neonatal inmediato, somatometría y exploraciones complementarias al ingreso son normales. En ambos niños se realiza ecografía abdominal en la que se detecta masa suprarrenal con áreas anecoicas, compatible con hemorragia suprarrenal derecha. En ambos casos se mantiene una actitud expectante, con observación clínica estricta y centrada en la aparición de signos de insuficiencia suprarrenal (hipotensión, hipoglucemia, hipercaliemia, hiponatremia, acidosis, convulsiones, coma), hemorragia masiva o signos de indicación quirúrgica. La determinación de hormonas adrenales y el ionograma en suero y orina son normales. Los dos niños permanecen asintomáticos, no precisando otro tratamiento que fototerapia. Se realizan controles ecográficos seriados, que constituyen la base de la confirmación del diagnóstico y del diagnóstico diferencial con otras entidades como el neuroblastoma quístico, quiste cortical o absceso adrenal. Hemos querido añadir un tercer caso de diagnóstico retrospectivo probable. Es un varón de 8 años con calcificaciones suprarrenales derechas de hallazgo casual, sugerentes de antigua hemorragia suprarrenal, que presentó en período neonatal ingreso por ictericia sin sospecha de hemorragia suprarrenal. Los tres casos clínicos nos permiten revisar una entidad relativamente frecuente en el recién nacido, que cursa habitualmente de forma unilateral y asintomática, si bien en ocasiones puede producir un importante compromiso clínico con insuficiencia suprarrenal aguda, hemorragia masiva o muerte neonatal, obligando a un tratamiento precoz y enérgico (AU)

Three cases diagnosed at our Service of unilateral adrenal hemorrhage are presented. The diagnosis was at neonatal period in two cases and the third case should be suspected later by abdominal radiography revealed an adrenal calcifications. The first and second newborn was admitted to hospital by jaundice and the abdominal examination revealed a palpable mass in the first. Both cases are men. Families’ histories were no pertinent; they have been born at term after a normal pregnancy. The childbirth course was complicated by prolonged labor; it was Instrumental childbirth in the first. The neonatal period, anthropometric and laboratory studies were normal. In both children abdominal ultrasound revealed adrenal mass with anechoic areas, it is suggesting adrenal hemorrhage. In both cases was conservative man-agement, and clinical observation in the appearance of signs of adrenal insufficiency (hypotension, hypoglycemia, hyperkaliema, hyponatremia, acidose, convulsions, and comma), massive hemorrhage or signs of surgical indication. The hormonal determination, levels electrolytes blond and urine were normal. Both young they remain asymptomatic, treatment was phototherapy and serial ultrasounds. Follow up ultrasound is needed for diagnosis and differential diagnosis with neuroblastoma, cortical cyst or adrenal abscess. A third case the diagnosis was made later incidentally, suggestive adrenal calcifications of old adrenal hemorrhage. He was 8 years old boy. He was admitted to hospital by jaundice at newborn period. The three clinical cases allow to review an usually common disorder in the newborn period, that attends habitually an asyntomatic form; however sometimes it can produce an important clinical commitment with acute adrenal insufficiency, Massive adrenal hemorrhage or neonative death, forcing a precocious and energetic treatment (AU)

[Parapneumonic pleural effusion: an 11-year review]. / Derrame pleural paraneumónico: revisión de 11 años.

INTRODUCTION: In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. MATERIAL AND METHODS: We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. RESULTS: There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3%). The most effective diagnostic method was pleural-fluid culture (18/58, 31%). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16% underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7% showed full susceptibility to penicillin and 75% were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. CONCLUSION: The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance.

Derrame pleural paraneumónico: revisión de 11 años / Parapneumonic pleural effusion: An 11-year review

Introducción En los últimos años parece existir un aumento en la incidencia del derrame pleural asociado a neumonía adquirida en la comunidad. Los objetivos de nuestro estudio fueron describir la etiología y las características clínicas de los derrames paraneumónicos y determinar su incidencia a lo largo de 11 años. Material y métodos Estudio retrospectivo de las historias clínicas de los pacientes menores de 15 años con derrame pleural paraneumónico en el período comprendido entre 1993 y 2003. Se calcularon incidencias anuales por cada 100.000 niños menores de 15 años del Área 5 de la Comunidad de Madrid y por cada 100 ingresos en la Unidad de Enfermedades Infecciosas del hospital y se evaluó su tendencia a aparecer a lo largo del período de estudio mediante el test de asociación lineal. Resultados Se diagnosticaron 130 derrames pleurales paraneumónicos. La edad media fue de 4,7 años. El 41 % recibieron tratamiento antibiótico previo al diagnóstico. Se descubrió la etiología en 42 pacientes (32,3 %). El mejor método diagnostico fue el cultivo de líquido pleural (18 aislamientos de 58 muestras, 31 %). Las bacterias más frecuentes fueron Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) y Mycobacterium tuberculosis (2). El 32 % requirieron drenaje pleural y el 16 %, toracoscopia. De los 12 antibiogramas de S. pneumoniae disponibles, 91,7 % fueron sensibles a penicilina y 75 % a eritromicina. La incidencia anual de derrame pleural paraneumónico por cada 100.000 niños aumentó de 18,1 en 1993 a 42,9 en 2003 (p < 0,005) y de 0,76 en 1993 a 3,3 en 2003 (p < 0,005) por cada 100 niños hospitalizados en nuestra unidad. Conclusión Existe un aumento estadísticamente significativo en la incidencia de derrame pleural paraneumónico entre 1993 y 2003. S. pneumoniae es el microorganismo causal más frecuente con un bajo porcentaje de resistencia a penicilina

Introduction In the last few years, the incidence of parapneumonic effusions in children with community-acquired pneumonia seems to have increased. The aim of this study was to determine the clinical features and incidence of parapneumonic effusions throughout an 11-year period. Material and methods We retrospectively reviewed the medical records of patients aged < 15 years old with parapneumonic effusions from 1993 to 2003. Annual incidence rates were calculated per 100,000 children < 15 years old from Health Area 5 of Madrid and per 100 children hospitalized in the Infectious Diseases Department of our hospital. The linear association test was used to compare the incidence rates over the previous 11 years. Results There were 130 patients with parapneumonic pleural effusions. The mean age was 4.7 years. Forty-one percent received antibiotics before diagnosis. The causative organisms were identified in 42 patients (32.3 %). The most effective diagnostic method was pleural-fluid culture (18/58, 31 %). The most common organisms were Streptococcus pneumoniae (18), Mycoplasma pneumoniae (8), Staphylococcus aureus (4), Streptococcus pyogenes (3), Haemophilus influenzae (3) and Mycobacterium tuberculosis (2). Thirty-two percent of the patients required pleural drainage and 16 % underwent video-assisted thoracoscopic surgery. Of 12 S. pneumoniae antibiograms available, 91.7 % showed full susceptibility to penicillin and 75 % were susceptible to erythromycin. The annual incidence of parapneumonic effusions rose from 18.1 in 1993 to 42.9 in 2003 (p < 0.001) per 100,000 children and from 0.76 in 1993 to 3.3 in 2003 (p < 0.001) per 100 children hospitalized in our unit. Conclusion The incidence of parapneumonic effusions in children with community-acquired pneumonia showed a statistically significant increase between 1993 and 2003. The most common causal organism was S. pneumoniae, with a low rate of penicillin resistance

[Morbidity at 2 years in infants with a birth weight of < 1,500 g]. / Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g.

OBJECTIVES: To determine morbidity at 2 years' corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. PATIENTS AND METHODS: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87%) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. RESULTS: Among the patients initially included in the study, 87% completed the follow-up; 17.1% had one or more major sequela. We found one case (0.4%) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9% had a development quotient below 85 and 18% had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of 2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. CONCLUSIONS: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years' corrected age.

Morbilidad a los dos años de edad en niños con un peso al nacimiento menor de 1.500 g / Morbidity at 2 years in infants with a birth weight of < 1.500 g

Objetivos: Conocer la morbilidad a los 2 años de edad corregida de una cohorte de recién nacidos con un peso inferior a1.500 g durante los años 1999-2000 en un hospital terciario de la Comunidad de Madrid. Pacientes y métodos: Estudio observacional de seguimiento longitudinal de una cohorte de 213 pacientes con peso inferior a 1.500 g al nacimiento. De éstos, 188 (87 %) finalizaron el seguimiento completo a los 2 años. Se estudiaron de forma prospectiva las diferentes morbilidades neurosensoriales, prestando especial atención a las morbilidades mayores: oftalmológicas, auditivas, motoras y bajo cociente de desarrollo (CD). Resultados: Completaron el seguimiento el 87 % de los pacientes incluidos inicialmente en el estudio; el 17,1 % presentaron una o más secuelas mayores. Encontramos un caso (0,4%) de sordera neurosensorial bilateral y un caso de ceguera bilateral; el 5,8 % (11/188) de los niños presentaron alguna forma de parálisis cerebral y un 14,9 % tuvieron un CD < 85 a los 2 años de edad. El 18 % no había alcanzado el percentil 3 (P3) de peso a los 2 años de seguimiento. Hallamos, como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad y la aparición de lesiones de sustancia blanca (incluyendo la hiperecogenicidad periventricular persistente y ventriculomegalia de bordes irregulares) como alteraciones ecográficas. Conclusiones: Menos de una quinta parte de los recién nacidos de muy bajo peso (RNMBP) presentan alguna secuela grave a los 2 años de seguimiento. Encontramos como factores de mal pronóstico neurológico la microcefalia a los 2 años de edad corregida y la presencia de alteración de la sustancia blanca en los hallazgos ecográficos. Nos preocupan los datos de crecimiento y desarrollo, puesto que el 18 % de los pacientes no han alcanzado el P3 de peso a los 2 años de edad corregida (AU)

Objectives: To determine morbidity at 2 years’ corrected age in a cohort of neonates with a birth weight of less than 1,500 g born in 1999-2000 in a tertiary hospital in the Autonomous Community of Madrid. Patients and methods: An observational longitudinal follow-up study was performed in a cohort of 213 infants with a birth weight of < 1,500 g. Of these, 188 (87 %) completed the 2-year follow-up. Various types of neurosensorial disability were studied, paying special attention to the main impairments: vision, hearing and motor impairment, and low development quotient. Results: Among the patients initially included in the study, 87%completed the follow-up; 17.1 % had one or more major sequela. We found one case (0.4 %) of bilateral neurosensorial deafness and one case of bilateral blindness. At the age of 2 years, 5.8 % (11/188) had cerebral palsy, 14.9%had a development quotient below 85 and 18 % had not reached the 3rd percentile for weight. Factors of poor neurological prognosis were subnormal head size at the age of2 years and white matter disease (including persistent intraparenchymal periventricular echodensity and ventriculomegaly or irregular shape) as ultrasound findings. Conclusions: Less than a fifth of the very low birth weight infants presented severe sequelae at 2 years of follow-up. Factors of poor neurological prognosis were subnormal head size at 2 years and the presence of white matter disease on ultrasonography. The findings on growth and development were worrying, since 18 % of the patients had not reached the 3rd percentile for weight at 2 years’ corrected age (AU)

Aumento de la incidencia de neumonía de posible origen bacteriano en el último trienio / Increased frequency of pneumonia of possible bacterial etiology during the last three years

Objetivo: Estudiar a los pacientes ingresados por neumonía en el último trienio, considerando sólo la neumonía definida previamente como típica o bacteriana. Métodos: Se estudiaron retrospectivamente todas las neumonías típicas adquiridas en la comunidad ingresadas durante los años 1998, 1999 y 2000. Se consideró como neumonía típica o de origen bacteriano aquella que cumplía 3 de 5 criterios: Fiebre >39 °C y de presentación brusca, dolor de costado o equivalentes (dolor abdominal o meningismo); auscultación de condensación, radiología de consolidación; leucocitosis >-12.000 mm3 con neutrofilia >-6.000 mm. Resultados: Se diagnosticaron un total de 271 neumonías, 75 en 1998, 85 en 1999 y 111 en 2000. La incidencia por 100.000 niños al año <5 años de nuestra Area Sanitaria era de 87,9, 98,6 y 126,3, respectivamente, y el porcentaje de ingresos por neumonía típica en relación con el número total de ingresos al año en la Unidad era de 5,8, 6,8 y 8 por ciento, respectivamente. Se realizó hemocultivo en 155 pacientes, que era positivo en 8 casos (5 por ciento): Streptococcus pneumoniae (n= 6), Haemophilus in fluenzae (n= 1) y Streptococcus pyogenes (n= 1): En la radiología, el 93,4 por ciento de los pacientes tenía una consolidación y el 6,6 por ciento presentaba un infiltrado. Se diagnóstico un derrame pleural en el 10 por ciento de los casos. Conclusiones: Existe un aumento de la frecuencia de niños ingresados en nuestro hospital por neumonía de características bacterianas en el último trienio. Consideramos que este aumento es debido, fundamentalmente, a neumonías causadas por neumococo (AU)

Encefalitis por virus de la gripe serotipo A / Encephalitis due to influenza A virus

No disponible

[Vascular sutures using polyglycolic acid in growing arteries. Experimental study]. / Suturas vasculares con ácido poliglicólico en arterias en crecimiento. Estudio experimental.

Vascular anastomoses, carried out in a growing vessel, have certain peculiarities, since with the development of the artery a stenosis may remain in the suture zone which can compromise its success. We believe that the suture material should be absorbable. We carried out an experimental study in which we performed 18 anastomoses of the femoral artery in dogs using 5/0 polyglycolic acid sutures and vascular microsurgery technique. In no case, on reoperating, did we find the existence of stenosis, granuloma, false aneurysm, or disruption. Polyglycolic acid begins to be reabsorbed after one month of evolution, and after two months the reabsorption is almost total. Biological tolerance is optimal.