Síndrome de atrapamiento del nervio cutáneo anterior: una causa de dolor abdominal crónico en niños frecuentemente pasada por alto / Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children

El síndrome de atrapamiento del nervio cutáneo anterior (ACNES) con frecuencia no se tiene presente enel diagnóstico diferencial del dolor abdominal crónico(DAC).Presentamos el caso de un varón de 11 años conDAC estudiado previamente en servicios de urgencia ydigestivo sin detectar patología orgánica, sugiriéndoseun origen psicosomático. En la exploración mostró doloren la pared abdominal localizado en el área de la ramaterminal del nervio intercostal T11, con signo de Carnettpositivo y respuesta favorable a la inyección con anestésico local en el punto gatillo. Los potenciales evocadossomatosensoriales revelaron neuropatía del nervio delmúsculo recto anterior derecho. Se diagnosticó de ACNES. Como tratamiento se administró en el punto gatillouna inyección subfascial ecoguiada de lidocaína y dexametasona. Tras cuatro meses, permanece asintomático.Para el tratamiento de ACNES en población pediátrica, recomendamos una estrategia terapéutica escalonadacomenzando con inyecciones en el punto gatillo y reservar la neurectomía anterior para cuando estas fracasan.(AU)

Anterior cutaneous nerve entrapment syndrome(ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP).An 11-year-old boy with CAP previously studied inemergency and digestive services without detectingorganic pathology, suggesting a psychosomatic origin.On examination, he showed pain in the abdominal walllocated to the area of the terminal branch of the T11intercostal nerve, with a positive Carnett’s sign and afavorable response to injection with local anestheticat the trigger point. Somatosensory evoked potentialsrevealed right anterior rectus nerve neuropathy. Hewas diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine anddexamethasone into the trigger point was administered. After four months, he remains asymptomatic.For the treatment of ACNES in pediatrics patients,a step-up strategy should be applied, starting with trigger point injections of lidocaine and dexamethasoneand reserving anterior neurectomy for those cases withlimited effect of these injections.(AU)

[Anterior cutaneous nerve entrapment syndrome: a frequently overlooked cause of chronic abdominal pain in children].

Anterior cutaneous nerve entrapment syndrome (ACNES) is often overlooked in the differential diagnosis of chronic abdominal pain (CAP). An 11-year-old boy with CAP previously studied in emergency and digestive services without detecting organic pa-thology, suggesting a psychosomatic origin. On examination, he showed pain in the abdominal wall located to the area of the terminal branch of the Th11 intercostal nerve, with a positive Carnett's sign and a favorable response to injection with local anesthetic at the trigger point. Somatosensory evoked potentials revealed right anterior rectus nerve neuropathy. He was diagnosed with ACNES. As treatment, an ultrasound-guided subfascial injection with lidocaine and dexame-thasone into the trigger point was administered. After four months, he remains asymptomatic. For the treatment of ACNES in pediatrics patients, a step-up strategy should be applied, starting with trigger point in-jections of lidocaine and dexamethasone and reserving anterior neurectomy for those cases with limited effect of these injections.

Prevalencia de sífilis en niños adoptados de Rusia / Prevalence of Syphilis in Children Adopted From Russia

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Sobrepeso y obesidad en adolescentes adoptados internacionalmente / Overweight and obesity in internationally adopted adolescents

Introducción: El objetivo de este trabajo es investigar la prevalencia de sobrepeso y obesidad (SP+O) en adolescentes adoptados internacionalmente (AAI) en Aragón, comparar los resultados con el estudio Health Behaviour in School-Aged Children-2014 en España (HBCS-2014 España), observar diferencias respecto a las áreas geográficas de origen, y realizar consideraciones etiológicas. Pacientes y métodos: Estudio transversal sobre 114 AAI (un 61,4% mujeres) de 11-17 años de edad (media ± desviación estándar: 12,8 ± 1,6). Para definir sobrepeso y obesidad se calculó el índice de masa corporal y se utilizaron los puntos de corte propuestos por la International Obesity Task Force. Para el estudio comparativo se utilizaron la prueba de la Z y el T-test, con un nivel de significación de p <0,05. Resultados: El 12,3% de los AAI presentaba SP+O (10,5 y 1,8%, respectivamente). La prevalencia fue significativamente superior en los procedentes de Latinoamérica (p = 0,0001) y significativamente inferior en los procedentes de Asia (p = 0,0173). No se observaron diferencias estadísticamente significativas con el HBCS-2014 España. Conclusiones: La prevalencia de SP+O en la población de AAI es inferior a la de los adolescentes españoles, a pesar de llevar conviviendo en nuestro entorno socioeconómico y cultural más de 8 años. Los AAI con SP+O proceden principalmente de Latinoamérica, donde la prevalencia de SP+O en los adolescentes autóctonos es elevada. Consideramos que en la etiología del SP+O de los AAI la predisposición genética puede ser un factor de primer orden

Introduction: The objective is to investigate the prevalence of overweight and obesity (OW+O) among internationally adopted adolescents (IAA) in Aragón, compare results with the study Health Behaviour in School-Aged Children-2014 in Spain (HBCS-2014 Spain Study), observe differences regarding the geographical areas of origin, and perform etiological considerations. Patients and methods: A cross-sectional study was performed among 114 IAA (61.4% female) aged 11-17 years (mean ± standard deviation: 12.8 ± 1.6). To define overweight and obesity, the BMI was calculated and the cut-off points proposed by the International Obesity Task Force were used. For the comparative study we used the Z-Test and the T-test, with a significance level of p < 0.05. Results: 12.3% of IAA showed OW+O (10.5 and 1.8%, respectively). The prevalence was significantly higher in those from Latin America (p = 0.0001), and significantly lower in those from Asia (p = 0.0173). No statistically significant differences were observed with the results of the HBCS-2014 Spain Study. Conclusions: The prevalence of OW+O in the IAA population is lower than that of Spanish adolescents, despite being lived in our socioeconomic and cultural environment for more than eight years. The IAA with OW+O comes mainly from Latin America, where the prevalence of OW+O among indigenous adolescents is high. We considerer that in the etiology of OW+O among the IAA, genetic predisposition may be a first order factor

Dificultades neuropsicológicas en niños adoptados de Rusia: consideraciones etiológicas / Neuropsychological difficulties in adopted children from Russia: aetiological considerations

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El retraso psicomotor de los niños adoptados en Rusia no está relacionado con el plomo / Psychomotor delay in children adopted in Russia is not associated with lead

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[Hepatitis B serological markers in children adopted from Russia and Ukraine]. / Marcadores serológicos de hepatitis B en niños adoptados de Rusia y Ucrania.

OBJECTIVE: To determine the prevalence of the hepatitis B virus (HBV) infection and to verify the immunization status against HBV of children adopted from Russia and Ukraine. PATIENTS AND METHODS: Cohort study of 102 children (58.8% boys) adopted from Russia (90) and Ukraine (12) between 2002 and 2007. All children had medical records that certified they had received 3 doses of HBV vaccine from the birth country. They were evaluated within 2 weeks of their arrival (mean age of 28.3 months; range, 12 to 88 months) according to a standard protocol that includes the hepatitis B serological markers, surface antigen (HBsAg), core antibody (HBcAb), and surface antibody (HBsAb). RESULTS: All children were negative for HBsAg and HBcAb (prevalence of active or previous HBV infection, 0%), and 78 (76.5%) showed a protective antibody response (HBsAb>or=10 mIU/ml) due to HBV vaccination. The results are contrasted with those observed by other researchers. CONCLUSIONS: We show that children adopted from Russia and Ukraine have a relatively high prevalence of protective immunity due to effective HBV vaccination. Therefore, we recommended determining the 3 serological markers for HBV (HBsAg, HBcAb, and HBsAb). Using this, we may detect an active infection or other infection risks, and we know the immunization status. Thus we can assess the need for retest, and provide criteria for individualized vaccinations, which could avoid generalized HBV vaccination in this specific population of internationally adopted children.

Marcadores serológicos de hepatitis B en niños adoptados de Rusia y Ucrania / Hepatitis B serological markers in children adopted from Russia and Ukraine

Objetivo: Determinar la prevalencia de la infección por el virus de la hepatitis B (VHB) y verificar el estado de inmunización frente al VHB en niños adoptados de Rusia y Ucrania. Pacientes y métodos: Estudio de cohorte de 102 niños (58,8 % varones) adoptados de Rusia (90) y Ucrania (12) entre 2002 y 2007. Todos los niños contaban con documentación médica que certificaba haber recibido tres dosis de vacuna frente al VHB en su país de origen. Fueron evaluados en las dos primeras semanas tras su llegada (edad media: 28,3 meses; límites, 12-88 meses) de acuerdo con un protocolo estándar que incluye los marcadores serológicos del VHB, antígeno de superficie (HBsAg), anticuerpo núcleo (anti-HBc) y anticuerpo de superficie (anti-HBs). Resultados: Todos los niños fueron negativos para HBsAg y anti-HBc (prevalencia de infección activa o previa por el VHB, 0 %) y 78 (76,5 %) mostraron una respuesta de anticuerpos protectora (anti-HBs >= 10 mUI/ml) debida a la vacunación frente al VHB. Los resultados se contrastan con los observados por otros investigadores. Conclusiones: Se estima que los niños adoptados de Rusia y Ucrania presentan una prevalencia relativamente elevada de inmunidad protectora debida a vacunación efectiva frente al VHB. Por ello, se recomienda determinar los tres marcadores serológicos del VHB (HBsAg, anti-HBc y anti-HBs). De este modo podrá detectarse una infección activa u otras situaciones de riesgo de infección, y se conocerá el estado de inmunización. Asimismo, se valorará la necesidad de repetir los test y se pautarán las vacunaciones de forma individualizada, evitando una vacunación generalizada frente al VHB en esta población específica de niños adoptados internacionalmente (AU)

Objective: To determine the prevalence of the hepatitis B virus (HBV) infection and to verify the immunization status against HBV of children adopted from Russia and Ukraine. Patients and methods: Cohort study of 102 children (58.8 % boys) adopted from Russia (90) and Ukraine (12) between 2002 and 2007. All children had medical records that certified they had received 3 doses of HBV vaccine from the birth country. They were evaluated within 2 weeks of their arrival (mean age of 28.3 months; range, 12 to 88 months) according to a standard protocol that includes the hepatitis B serological markers, surface antigen (HBsAg), core antibody (HBcAb), and surface antibody (HBsAb). Results: All children were negative for HBsAg and HBcAb (prevalence of active or previous HBV infection, 0 %), and 78 (76.5 %) showed a protective antibody response (HBsAb >= 10 mIU/ml) due to HBV vaccination. The results are contrasted with those observed by other researchers. Conclusions: We show that children adopted from Russia and Ukraine have a relatively high prevalence of protective immunity due to effective HBV vaccination. Therefore, we recommended determining the 3 serological markers for HBV (HBsAg, HBcAb, and HBsAb). Using this, we may detect an active infection or other infection risks, and we know the immunization status. Thus we can assess the need for retest, and provide criteria for individualized vaccinations, which could avoid generalized HBV vaccination in this specific population of internationally adopted children (AU)

[Adoption in China of children with special needs: the "green passage"]. / Adopción en China de niños con necesidades especiales: el "pasaje verde".

Requests of international adoption in China can be processed by the ordinary way and by the so-called way "green passage" (GP). All the children for adoption by the GP have special needs because to suffer from congenital malformations, chronic diseases or development disabilities that will need medical or surgical treatment and a specialized monitoring in the adoptive country. The medical literature warns that the preadoptive medical records from China do not offer absolute guarantee of veracity. This problem has been observed in adoptions by the ordinary way of children diagnosed like healthy, but also it can happen in children for adoption by the GP. The clinical cases of three children with special needs recently assigned to Spanish families are presented. We think that in all the assignations of children with special needs from China, the Adoption Organizations must offer to the families the complete medical records, the certified results of the laboratory tests and the pictures so that, of exclusive and absolutely confidential manner, they consult with specialized doctors in order to obtain the highest information of the health problems and to value the medical prognosis before taking a decision on the acceptance of the adoption.

Adopción en China de niños con necesidades especiales: el 'pasaje verde' / Adoption in China of children with special needs: the 'green passage'

En China se pueden tramitar solicitudes de adopción internacional por la vía ordinaria y por la vía denominada "pasaje verde" (PV). Todos los niños adoptables por el PV tienen necesidades especiales por padecer malformaciones congénitas, enfermedades crónicas o discapacidades del desarrollo que precisarán de tratamiento médico o quirúrgico y de un seguimiento especializado en el país adoptivo. La literatura médica advierte de que los informes médicos preadoptivos procedentes de China no ofrecen garantía absoluta de veracidad. Este problema se ha observado en adopciones por la vía ordinaria de niños diagnosticados como sanos, pero también puede ocurrir en niños adoptables por el PV. Se presentan los casos clínicos de tres niños con necesidades especiales asignados recientemente a familias españolas. Consideramos que en todas las asignaciones de niños con necesidades especiales de China, las organizaciones de adopción deben ofrecer a las familias el expediente médico completo, los resultados certificados de las pruebas de laboratorio y las fotografías para que, de forma exclusiva y absolutamente confidencial, consulten con médicos especializados para obtener la máxima información de los problemas de salud y valorar el pronóstico médico antes de tomar una decisión sobre la aceptación de la adopción

Requests of international adoption in China can be processed by the ordinary way and by the so-called way "green passage" (GP). All the children for adoption by the GP have special needs because to suffer from congenital malformations, chronic diseases or development disabilities that will need medical or surgical treatment and a specialized monitoring in the adoptive country. The medical literature warns that the preadoptive medical records from China do not offer absolute guarantee of veracity. This problem has been observed in adoptions by the ordinary way of children diagnosed like healthy, but also it can happen in children for adoption by the GP. The clinical cases of three children with special needs recently assigned to Spanish families are presented. We think that in all the assignations of children with special needs from China, the Adoption Organizations must offer to the families the complete medical records, the certified results of the laboratory tests and the pictures so that, of exclusive and absolutely confidential manner, they consult with specialized doctors in order to obtain the highest information of the health problems and to value the medical prognosis before taking a decision on the acceptance of the adoption

Estado de salud de niños adoptados en China / No disponible

Objetivos: mejorar el conocimiento sobre el estado de salud de los niños adoptados en China. Pacientes y métodos: estudio retrospectivo transversal de 60 niñas chinas adoptadas evaluadas de forma protocolizada a su llegada (edad media de 15,5 meses) en el Centro de Pediatría y Adopción Internacional de Zaragoza entre los años 2001 y 2005. Los datos obtenidos se compararon con los divulgados en el grupo de 192 niños chinos adoptados (98% de mujeres) evaluados a su llegada (edad media de 15,7 meses) en la International Adoption Clinic de Boston (EE. UU.) entre los años 1991 y 1998. Resultados: el grupo de niñas chinas adoptadas en nuestro país presentó unos porcentajes inferiores de retraso de crecimiento, retraso psicomotor (p = 0,0309), infección tuberculosa latente (p = 0,0472), parasitosis intestinal, infección por el virus de la hepatitis B, niveles séricos de plomo elevados (p = 0,0466), anemia y diagnósticos médicos importantes no sospechados antes de la adopción respecto del grupo clínico de niños chinos adoptados evaluado en los EE. UU. durante la década de los noventa. Conclusiones: los resultados sugieren que la calidad en micronutrientes de la alimentación, los cuidados médicos, los controles higiénicos y sanitarios y la estimulación psicoafectiva que han recibido estos niños durante su institucionalización han mejorado de forma notoria en el último quinquenio. Sin embargo, las familias adoptivas y los pediatras que atienden a estos niños a su llegada deben estar advertidos de que el relato de una exploración clínica normal y unos resultados de laboratorio negativos en los informes médicos preadoptivos elaborados en China no garantizan la ausencia de enfermedades infecciosas u otros problemas significativos de salud (AU)

Objectives: to improve the knowledge on the health status of the children adoptedfrom China. Patients and methods: cross-sectional retrospective study of 60 adopted Chinese girls who were routinely evaluated after their arrival (mean age of 15.5 months) in the Pediatrics and International Adoption Center of Zaragoza (Spain) between 2001 and 2005. The collected data were compared with the disclosed ones in the clinic group of 192 adopted Chinese children (98% girls) routinely evaluated after their arrival (mean age of 15.7 months) in the International Adoption Clinic of Boston (U.S.A.) between 1991 and 1998. Results: respect to the clinic group of adopted Chinese children evaluated in U.S.A. during the 90s, the clinic group of adopted Chinese girls in our country displayed lower rates of growth delay, developmental delay (p = 0.0309), latent tuberculosis infection (p = 0.0472), intestinal parasitism, hepatitis B infection, elevated lead levels (p = 0.0466), anemia and unsuspected important medical diagnoses before the adoption. Conclusions: the results suggest that the quality in micronutrients of the feeding, the medical care, the hygienic and health controls and the psicoaffective stimulation that these children have received during their institutionalization has notoriously improved in the last quinquennium. Nevertheless, the adoptive families and the pediatricians that take care of these children after their arrival, must be aware that the story of a normal clinical exploration and negative results of laboratory tests in the preadoptive medical records performed in China, do not guarantee the absence of infectious diseases or other significant problems of health (AU)

Estudio auxológico de niñas adoptadas en China / Auxologic study of girls adopted in China

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"Consenso en adopción internacional. Guía para pediatras y otros profesionales sanitarios". Resumen estructurado / No disponible

Se presenta un resumen estructurado del documento “Consenso en adopción internacional.Guía para pediatras y otros profesionales sanitarios” publicado en noviembre de 2005. Elresumen presentado trata de ser una muestra representativa del conjunto del documentooriginal y reflejar con fidelidad su contenido y propósitos.La adopción internacional ha aumentado en nuestro entorno de forma extraordinaria.En el período de tiempo de 1997 a 2004 han llegado a nuestro país 24.042 niños procedentesde 49 países. Los niños adoptados en el extranjero tienen mayor riesgo de presentar problemasde salud. El viaje y la estancia en el extranjero implican riesgos adicionales. Se describenel contenido de la consulta preadoptiva y las recomendaciones para llevar a cabo una evaluacióncompleta tras la llegada del niño desde su lugar de origen a su nueva familia. También sedestaca la necesidad de hacer un seguimiento longitudinal a largo plazo

We present a structured summary of the document “Consensus on international adoption.Guidelines for paediatricians and other health professionals” published on November2005. The summary presented tries to be a representative sample of the whole original documentand to reflect its contents and proposals with fidelity. International adoption hasincreased in an extraordinary way in our country. Between 1997 and 2004, 24042 childrenfrom 49 countries have arrived. Children adopted abroad have an increased risk of presentingwith health problems. The journey and stay abroad implies additional risks. We describethe contents of the preadoptive medical visit and recommendations for making acomplete evaluation after the arrival of the child from his/her country of origin to the newfamily. We also stress the need of undertaking a long follow up