Neoadjuvant chemotherapy with or without radiotherapy versus upfront surgery for resectable pancreatic adenocarcinoma: a meta-analysis of randomized clinical trials.

BACKGROUND: The role of neoadjuvant chemotherapy (NC) in resectable pancreatic cancer (RPC) has yet to be defined. This review aims to analyze the benefit of NC in RPC compared with upfront surgery (US) in terms of overall survival (OS) and disease-free survival (DFS). PATIENTS AND METHODS: PubMed, CENTRAL (The Cochrane Library), and Embase were systematically reviewed until 3 November 2021. Abstract proceedings and virtual meeting presentations from the American Society of Clinical Oncology and the European Society of Medical Oncology conferences, reference articles of published clinical trials, and review articles were considered. Only randomized clinical trials (RCTs) comparing NC administration with or without radiotherapy previous with surgery (experimental arm) versus US followed by adjuvant chemotherapy with or without radiotherapy (control arm) for RPC were included. RESULTS: A total of 1135 studies were screened. Of these, 1117 studies were primarily excluded. Of the remaining 18 studies, 5 were excluded because of no adequate trial design for this work and 7 others had no available results. Finally, 6 trials with 469 patients with pancreatic cancer randomized to NC (n = 212) or US (n = 257) were selected. Compared with US, NC significantly improved OS [hazard ratio (HR) 0.75; 95% confidence interval (CI) 0.58-0.98; P = 0.033] and DFS (HR 0.73; 95% CI 0.59-0.89; P = 0.002). While the NC approach was not significantly associated with lower resection rate [relative risk (RR) 0.92; 95% CI 0.84-1.01; P = 0.069], the R0 resection rate was significantly higher for NC than for US (RR 1.31; 95% CI 1.13-1.52; P = 0.0004). CONCLUSION: This is the first meta-analysis of RCTs showing that NC improves OS for RPC compared with US followed by adjuvant therapy. Ongoing RCTs should confirm these findings with FOLFIRINOX to generalize the indication of NC.

Efficacy and safety of withholding antimicrobial treatment in children with cancer, fever and neutropenia, with a demonstrated viral respiratory infection: a randomized clinical trial.

OBJECTIVES: To determine efficacy and safety of withholding antimicrobials in children with cancer, fever and neutropenia (FN) with a demonstrated respiratory viral infection. METHODS: Prospective, multicentre, randomized study in children presenting with FN at five hospitals in Santiago, Chile, evaluated at admission for diagnosis of bacterial and viral pathogens including PCR-microarray for 17 respiratory viruses. Children positive for a respiratory virus, negative for a bacterial pathogen and with a favourable evolution after 48 h of antimicrobial therapy were randomized to either maintain or withhold antimicrobials. Primary endpoint was percentage of episodes with uneventful resolution. Secondary endpoints were days of fever/hospitalization, bacterial infection, sepsis, admission to paediatric intensive care unit (PICU) and death. RESULTS: A total of 319 of 951 children with FN episodes recruited between July 2012 and December 2015 had a respiratory virus as a unique identified microorganism, of which 176 were randomized, 92 to maintain antimicrobials and 84 to withdraw. Median duration of antimicrobial use was 7 days (range 7-9 days) versus 3 days (range 3-4 days), with similar frequency of uneventful resolution (89/92 (97%) and 80/84 (95%), respectively, not significant; OR 1.48; 95% CI 0.32-6.83, p 0.61), and similar number of days of fever (2 versus 1), days of hospitalization (6 versus 6) and bacterial infections throughout the episode (2%-1%), with one case of sepsis requiring admission to PICU in the group that maintained antimicrobials, without any deaths. CONCLUSIONS: The reduction of antimicrobials in children with FN and respiratory viral infections, based on clinical and microbiological/molecular diagnostic criteria, should favour the adoption of evidence-based management strategies in this population.

Manejo multidisciplinario en retinoblastoma: experiencia en 37 ojos / Multidisciplinary management of retinoblastoma: Experience in 37 eyes

OBJETIVOS: Reportar los resultados del manejo multidisciplinario de pacientes con retinoblastoma, incluyendo supervivencia global, tasa de enucleación y éxito de la quimiorreducción sistémica. MÉTODOS: Estudio retrospectivo 27 pacientes (37 ojos) con diagnóstico de retinoblastoma, tratados por un equipo multidisciplinario en el Hospital San Juan de Dios. Se incluyeron información demográfica, características clínicas, supervivencia, tratamiento local y sistémico. Se realizó además un subanálisis de tratamiento con quimioterapia intraarterial (QIA). RESULTADOS: Catorce pacientes (52%) fueron de sexo masculino. La mediana de edad al ingreso fue de 8 meses (0,16-90). La mediana ± desviación estándar de seguimiento fue de 33 ± 21 meses. Diez casos (37%) se diagnosticaron después de los 15 meses de edad, con una mediana de 35 meses (24-90). En 17 (63%) pacientes fueron retinoblastomas unilaterales, mientras 10 (37%) tuvieron retinoblastoma bilateral. La leucocoria, aislada o asociada a otros signos, fue el motivo de consulta más frecuente (63%). La tasa global de enucleación fue del 57% (n = 21), siendo el tratamiento primario en 15 (55%) pacientes. La tasa de enucleación en retinoblastoma unilateral fue del 76,5% y en retinoblastoma bilateral del 60% de un ojo y el 10% de ambos. Diecisiete (63%) pacientes recibieron quimioterapia sistémica (media de ciclos: 5,3 ± 2,1). El éxito global de la quimiorreducción sistémica y la terapia focal fue del 68%. Tres pacientes fueron tratados con QIA como terapia de rescate, logrando controlar el tumor en 2 pacientes a 6 meses de seguimiento, siendo los primeros casos en Chile. La supervivencia fue del 100%. CONCLUSIÓN: El manejo multidisciplinario del retinoblastoma permite una supervivencia y una morbilidad comparable con la literatura internacional

OBJECTIVE: To report the results of the multidisciplinary management of patients with retinoblastoma, including survival, enucleation rate, and systemic chemoreduction success. METHODS: A retrospective study was conducted on 27 patients (37 eyes) diagnosed with retinoblastoma, and treated by a multidisciplinary team in San Juan de Dios Hospital. Demographic information, clinical characterization, survival, local and systemic treatments were included in the analysis. Patients treated with intra-arterial chemotherapy (IAC) were also reviewed. RESULTS: The study included14 male patients (52%). The median of age at presentation was 8 months (0.16-90). The median follow-up time was 33 ± 21 months. The diagnosis was made in 10 (37%) cases after 15 months old, with a median of 35 months (24-90). 17 (63%) patients had unilateral retinoblastoma, and 10 (37%) bilateral retinoblastoma. Leukocoria, isolated or associated with other signs, was the most frequent reason for referral (63%). Global enucleation rate was 57% (n = 21), being the primary treatment in 15 (55%) patients. Enucleation rate in unilateral retinoblastoma was 76.5%, and for bilateral retinoblastoma, it was 60% for one eye and 10% for both. Systemic chemotherapy was prescribed in 17 (63%) patients, with a mean number of cycles of 5.3 ± 2.1. The overall success of chemoreduction and focal therapy in order to avoid external radiotherapy and/or enucleation was 68%. Three patients were treated with IAC as a salvage therapy, controlling the tumor in 2 patients at 6 months of follow-up. These are the first cases reported in Chile. Survival rate was 100%. CONCLUSION: Multidisciplinary management of retinoblastoma led to a survival rate and morbidity comparable with international reports

[Multidisciplinary management of retinoblastoma: Experience in 37 eyes]. / Manejo multidisciplinario en retinoblastoma: experiencia en 37 ojos.

OBJECTIVE: To report the results of the multidisciplinary management of patients with retinoblastoma, including survival, enucleation rate, and systemic chemoreduction success. METHODS: A retrospective study was conducted on 27 patients (37 eyes) diagnosed with retinoblastoma, and treated by a multidisciplinary team in San Juan de Dios Hospital. Demographic information, clinical characterization, survival, local and systemic treatments were included in the analysis. Patients treated with intra-arterial chemotherapy (IAC) were also reviewed. RESULTS: The study included14 male patients (52%). The median of age at presentation was 8 months (0.16-90). The median follow-up time was 33 ± 21 months. The diagnosis was made in 10 (37%) cases after 15 months old, with a median of 35 months (24-90). 17 (63%) patients had unilateral retinoblastoma, and 10 (37%) bilateral retinoblastoma. Leukocoria, isolated or associated with other signs, was the most frequent reason for referral (63%). Global enucleation rate was 57% (n=21), being the primary treatment in 15 (55%) patients. Enucleation rate in unilateral retinoblastoma was 76.5%, and for bilateral retinoblastoma, it was 60% for one eye and 10% for both. Systemic chemotherapy was prescribed in 17 (63%) patients, with a mean number of cycles of 5.3 ± 2.1. The overall success of chemoreduction and focal therapy in order to avoid external radiotherapy and/or enucleation was 68%. Three patients were treated with IAC as a salvage therapy, controlling the tumor in 2 patients at 6 months of follow-up. These are the first cases reported in Chile. Survival rate was 100%. CONCLUSION: Multidisciplinary management of retinoblastoma led to a survival rate and morbidity comparable with international reports.

Guía clínica: consenso para Chile en enfermedad de Fabry / Clinical guidelines: Chilean consensus in Fabry disease

Fabry's disease is an X-linked recessive inborn error of metabolism of glycosphingolipids, caused by the deficiency of the lisosomal enzyme alpha-galactosidase. It is a rare disease with an estimated incidence rate of approximately 1:80.000 to 1:117,000 births in the general population. Recently, the growing knowledge about this disease has permitted the development of enzyme replacement therapy, which has modified the prognosis and quality of life of these patients. In Chile, the real incidence is unknown, but the increase in the number of patients diagnosed during the last five years, mainly in the north of the country. This guide was prepared with the intention of establishing a consensus for the diagnosis, treatment and monitoring of the patients with Fabry disease based on the present available scientific evidence.

La enfermedad de Fabry es un error innato del catabolismo de los glucoesfingolipidos, de herencia recesiva ligada al cromosoma X, causado por la deficiencia de la enzima lisosomal alfa-galactosidasa A (alfa-gal A). Es un defecto poco frecuente, con una incidencia estimada de 1:80.000 a 1:117.000, entre la población general. Recientemente, el creciente conocimiento acerca de esta enfermedad, ha permitido el desarrollo de la terapia de reemplazo enzimático, la cual ha modificado el pronóstico y calidad de vida de los pacientes. En Chile, se desconoce la incidencia real, pero el aumento del número de pacientes diagnosticados durante los últimos cinco años, principalmente en la zona norte del país, ha generado un mayor interés por esta enfermedad. Esta guía fue elaborada con la intención de establecer un consenso para el diagnóstico, tratamiento y seguimiento de los pacientes con enfermedad de Fabry, basado en la evidencia científica, actualmente disponible.

[Cutaneous tuberculosis. Report of one case]. / Lupus vulgar: caso infrecuente de tuberculosis extrapulmonar.

BACKGROUND: Tuberculosis is uncommonly located in the skin, corresponding to 1 to 2% of extrapulmonary forms. We report a 61-year-old woman, referred due to a two months history of erythematous plaques covered with honey-colored crusts in the left preauricular region and below the chin. The lesions were previously treated as pyoderma with poor response. She was otherwise healthy, without any other symptom. Skin biopsy showed exudative tuberculoid granulomas with caseation necrosis. Koch culture was positive for Mycobacterium tuberculosis. Complementary studies ruled out other foci. Lupus vulgaris was diagnosed and antituberculous therapy started, achieving regression of cutaneous lesions.

Lupus vulgar: caso infrecuente de tuberculosis extrapulmonar / Cutaneous tuberculosis: Report of one case

Background: Tuberculosis is uncommonly located in the skin, corresponding to 1 to 2% of extrapulmonary forms. We report a 61-year-old woman, referred due to a two months history of erythematous plaques covered with honey-colored crusts in the left preauricular region and below the chin. The lesions were previously treated as pyoderma with poor response. She was otherwise healthy, without any other symptom. Skin biopsy showed exudative tuberculoid granulomas with caseation necrosis. Koch culture was positive for Mycobacterium tuberculosis. Complementary studies ruled out other foci. Lupus vulgaris was diagnosed and antituberculous therapy started, achieving regression of cutaneous lesions.

Definitive diagnosis of neuroendocrine tumors using fine-needle aspiration-puncture guided by endoscopic ultrasonography.

BACKGROUND: The detection and diagnosis of neuroendocrine tumors (NETs) is challenging. Endoscopic ultrasonography (EUS) has a significant role in the detection of NETs suspected from clinical manifestations or imaging techniques, as well as in their precise localization and cytological confirmation using EUS-Fine-needle aspiration-puncture (FNA). OBJECTIVE: To assess the usefulness and precision of EUS-FNAP in the differential diagnosis and confirmation of NETs, in a retrospective review of our experience. PATIENTS AND METHODS: in a total of 55 patients with suspected NETs who underwent radial or sectorial EUS, 42 tumors were detected in 40 cases. EUS-FNA using a 22G needle was performed for 16 cases with suspected functional (hormonal disorders: 6 cases) and non-functional NETs (10 cases). Ki 67 or immunocytochemistry (ICC) testing was performed for all.There was confirmation in 9 cases (5 female and 4 male) with a mean age of 51 years (range: 41-81 years).All tumors were located in the pancreas except for one in the mediastinum and one in the rectum, with a mean size of 19 mm (range: 10-40 mm). RESULTS: There were no complications attributable to FNA. Sensitivity was 100% and both precision and PPV were 89%, as a false positive result suggested a diagnosis with NET during cytology that surgery finally revealed to be a pancreatic pseudopapillary solid tumor. CONCLUSIONS: EUS-FNA with a 22G needle for NETs has high sensitivity and PPV at cytological confirmation with few complications.

Comunicaciones científicas en los congresos de la Asociación Española de Nefrología Pediátrica(AENP), 1988-2007 / Scientific Presentations at the meetings of the Spanish Paediatric Nephrology Association (AENP), 1988-2007

Objetivos : Revisar las comunicaciones científicas presentadas en los congresos de la Asociación Española de Nefrología Pediátrica (AENP) . Material y métodos : En los programas científicos (1988-2007) de los congresos de la AENP se revisaron: número de presentaciones ,centros participantes y con el mayor número de comunicaciones , forma de presentación, estudios experimentales y temas elegidos. Resultados: En los últimos20 años, 91 centros presentaron 1.119 comunicaciones. El Hospital La Paz (Madrid) fue el que más comunicaciones presentó. Desde el año 1995 comenzaron a admitirse comunicaciones tipo póster y 369 de las 815 comunicaciones presentadas tuvieron ese formato. Dieciséis comunicaciones informaron de investigación animal. El tema más frecuente fue la enfermedad glomerular (203). Se presentaron 51 comunicaciones sobre diálisis. Trataron sobre trasplante renal 123 comunicaciones. Sólo una comunicación sobre genética fue presentada antes de 1998. Conclusiones : El formato póster es un método útil para las presentaciones científicas . El tema más habitual fue la enfermedad glomerular. En la última década han aparecido comunicaciones sobre genética, pero sobre experimentación animal son todavía excepcionales (AU)

Objectives and study: To find out that characteristics of the scientific presentations given at the AENP’s meetings in the past 20 years. Material and Methods: We reviewed in the scientific programs of the AENP’s meetings of the past 20years: number of presentations, number of participating institutions, institutions that provided the majority of the presentations, presentation format, number of studies involving experimental nephrology, topics most commonly presented. Results: There have been 1,119 presentations in the past 20 years, 45/year between 88-92 and 67/year between 03-07. Ninety-one institutions participated in the meetings, 17/year between 88-92 and 34/year between 03-07. Pediatric Nephrology unit from the H. La Paz (Madrid)contributed the most presentations. Poster presentations were accepted at the ANEP meetings after 1995. Since then,369 of the 815 presentations followed this format. Between88-07 only 16 presentations dealt with experimental nephrology. The most common topics of presentation waere glomerular disease (203) and urinary tract infection/VUR(132). Fifty-one presentations dealt with dialysis (almost2/3 peritoneal). Transplantation was the topic of 123presentations. Of the 21 presentations on molecular genetics only one happened before 1998. Conclusions: The poster is a useful alternative in scientific presentations which has allowed an increase in presentations, authors and institutions participating in the ANEP meetings. The main topic of presentation was glomerular disease. The frequency of presentations dealing with transplantation has increased in the last years. The past decade has seen more presentations on molecular genetics, but presentations dealing with experimental nephrology are still infrequent (AU)

[Scientific Presentations at the meetings of the Spanish Pediatric Nephrology Association (AENP), 1988-2007]. / Comunicaciones científicas en los congresos de la Asociación Española de Nefrología Pediátrica (AENP), 1988-2007.

UNLABELLED: OBJECTIVES AND STUDY: To find out that characteristics of the scientific presentations given at the AENP's meetings in the past 20 years. METHODS: We reviewed in the scientific programs of the AENP's meetings of the past 20 years: number of presentations, number of participating institutions, institutions that provided the majority of the presentations, presentation format, number of studies involving experimental nephrology, topics most commonly presented. RESULTS: There have been 1,119 presentations in the past 20 years, 45/year between 88-92 and 67/year between 03-07. Ninety-one institutions participated in the meetings, 17/year between 88-92 and 34/year between 03-07. Pediatric Nephrology unit from the H. La Paz (Madrid) contributed the most presentations. Poster presentations were accepted at the ANEP meetings after 1995. Since then, 369 of the 815 presentations followed this format. Between 88-07 only 16 presentations dealt with experimental nephrology. The most common topics of presentation were glomerular disease (203) and urinary tract infection/VUR (132). Fifty-one presentations dealt with dialysis (almost 2/3 peritoneal). Transplantation was the topic of 123 presentations. Of the 21 presentations on molecular genetics only one happened before 1998. CONCLUSIONS: The poster is a useful alternative in scientific presentations which has allowed an increase in presentations, authors and institutions participating in the ANEP meetings. The main topic of presentation was glomerular disease. The frequency of presentations dealing with transplantation has increased in the last years. The past decade has seen more presentations on molecular genetics, but presentations dealing with experimental nephrology are still infrequent.

Usefulness of endoscopic ultrasonography (EUS) for selecting carcinoid tumors as candidates to endoscopic resection.

INTRODUCTION: Carcinoid tumors (CTs) represent the most common type of neuroendocrine tumors (NETs). Digestive CTs in the gastroduodenal and colorectal tracts may be assessed using endoscopy and echoendoscopy or endoscopic ultrasonography (EUS) with the goal of attempting local resection with curative intent without having recourse to surgery. OBJECTIVE: Endpoints in this study included:--Assessing the usefulness of EUS for selecting CTs as candidates to endoscopic excision. --Assessing the effectiveness of local resection (complete carcinoid resection) and the safety (complications) of the technique involved. PATIENTS AND METHODS: OUr series included 18 patients (12 males and 6 females) with 23 tumors. Sixteen patients (10 males and 6 females) were selected, with age ranging from 40 to 81 years (mean: 57 years), biopsied, endoscopically treated digestive carcinoid tumors, and a previous negative extension study. Twenty-one 2-to-20-mm (mean size 8 mm) tumors were resected in 23 procedures. After endoscopy plus biopsy and echoendoscopy (EUS), excision was carried out with conventional polypectomy snare mucosectomy and submucosal injection with saline and/or adrenaline in most cases (15), and mucosectomy technique following lesion ligation with elastic bands for six cases. Two cases underwent transanal endoscopic surgery (TEM), one of them following non-curative polypectomy. A total of 23 local procedures were performed with the key goal of assessing efficacy (complete resection: CR) and safety (complications). RESULTS: There were no severe complications except for the last gastric mucosectomy for a 6-mm carcinoid, where a miniperforation occurred that was solved by using 3 clips (1/23: 4.3%).EUS sensitivity was 94%. Complete resection was 90.5% (19/21). CONCLUSIONS: The endoscopic mucosal resection of selected carcinoid tumors is a safe, effective technique. EUS is the technique of choice to select patients eligible for endoscopic resection (carcinoids smaller than 20 mm in superficial layers, with an unscathed muscularis propria and negative extension study).

[Renal and perinephric abscesses: a series of 44 cases]. / Abscesos renales y peri-renales: análisis de 44 casos.

Renal abscesses are infrequent event and may occasionally be fatal. In order to characterize its main clinical features, its diagnosis and evolution, a retrospective-descriptive study was done with cases identified between 1996 and 2006 in a teaching hospital. Forty-four cases were collected (mean age 49.9 years). Diabetes mellitus was present in 38.6%, urinary calculi in 36.4%, and previous urinary tract infection in 11.4% of the studied population. Enterobacteriaceae were the most frequent isolated microorganisms (44.4%), and 33.3% had a poli-microbial culture in abscess samples. S. aureus was rarely identified. Main therapeutic approaches were minimally invasive procedures (pigtails, percutaneous drainage or nephrostomy) in 50% followed by surgical interventions (nephrectomy or surgical debridement) in approximately 30%. Only 20.5% of patients were treated exclusively by antibiotics. Minimally invasive procedures were applied progressively after 2001 (p < 0.005). In this series case-fatality rate was 4.5%; 13.6% (n = 6) developed septic shock. Nephrectomy was performed in 9 cases (20.5%). Patients selected for nephrostomy had a lower risk for ICU admission (Odds Ratio 0.083 IC95 0.008-0.911). Renal abscesses are cause of morbidity but had a low case-fatality ratio; the therapeutic approach has changed in recent years favoring at present minimally invasive procedures.

Estudio comparativo de dos equipos para el test de H2 en aire espirado / Evaluation of breath H2 measured by means of two different analyzers

El test de hidrógeno (H2) en aire espirado es ampliamente utilizado en el estudio de malabsorción de hidratos de carbono, sobrecrecimiento bacteriano intestinal (SBI) y tiempo de tránsito orocecal (TTOC). Objetivo: Comparar los resultados obtenidos por dos equiposde detección de H2, uno de ellos de introducción reciente en nuestro medio. Material y Métodos: 50 pacientes, edad promedio 38,5 +/- 5,2 años (rango 7-77 años), 40 mujeres, se les realizó el test de H2 en aire espirado en paralelo con ambos equipos bajo métodos estandarizados. En 25 de ellos se investigó la presencia de malabsorción de lactosa, y en los otros 25, la presencia de SBI con lactulosa. Se evaluaron los valores de H2 obtenidos con ambos equipos. Resultados: Las lecturas de H2 con ambos equipos no mostraron diferencias significativas tanto para lactosa (p > 0,1), como para lactulosa (p > 0,5). Tampoco hubo diferencias en el TTOC de los pacientes (90 +/- 33,75 min v/s 90.8 +/- 32,42 min) (p > 1). Se obtuvo un índice de concordancia Kappa de 0,92 entre ambos equipos con el test con lactosa y con lactulosa. Conclusión: El equipo portátil es altamente confiable, entregando resultados con una excelente concordancia con respectoal equipo de referencia.

The hydrogen (H2) breath test (BT) is widely used to investigate carbohydrates malabsorption, small intestinal bacterial overgrowth (SIBO) and orocaecal transit time (OTT). Aim: To compare the results of two hydrogen breath devices, one of them, of recent introduction in our country. Methods: Fifty patients were included, mean age 38.5 +/- 5.2years (range 7-77 yrs), 40 women, H2 BT was performed in parallel with both analyzers under standardized methods. Lactose malabsorption was investigated in 25 patients with lactose, and the presence of SIBO in the resting 25 patients, with lactulose, hydrogen values obtained with both devices were evaluated. Results: No differences were observed between the H2 concentrations for lactose BT (p > 0.1) as well as lactulose BT (p > 0.5)and also between the OTT measured by the two devices (90 +/- 33.75 min. v/s 90.8 +/- 32.42 min) (p > 1). We detected a Kappa concordance index of 0.92 for both equipments. Conclusion: The portable device is highly reliable to detect the presence of breath hydrogen, giving results with an excellent concordance to the reference device.

Eritema nudoso inducido por querion de Celso / Celso’s kerion induced erythema nodosum

No disponible

Epidemiología de la neumonía adquirida en la comunidad en pacientes pediátricos hospitalizados / Epidemiology of community acquired pneumonia in hospitalized pediatric patients

Objetivos: Identificar las posibles etiologías infecciosas bacterianas en los niños ingresados con neumonía adquirida en la comunidad en el Complejo Asistencial de León a lo largo de un año y conocer sus características epidemiológicas, clínicas y tratamientos pautados. Materiales y métodos: Se diseña un estudio observacional, descriptivo y transversal. Se incluyen niños, con edades entre 1 mes y 14 años, hospitalizados con diagnóstico de neumonía adquirida en la comunidad o bronconeumonía durante el período comprendido entre el 1 de junio del2005 y el 31 de mayo de 2006 en el Complejo Asistencial de León. Se recogieron datos demográficos, ambientales, clínicos, radiológicos, analíticos y de tratamiento. Resultados: Forman parte de la muestra 78 pacientes. La edad media fue de 45,8 ± 31,3 meses. La mayoría de los episodios se produjeron en los meses de otoño e invierno(37,2 y 29,5%, respectivamente). 18 pacientes presentaron una neumonía bacteriana típica (23%), y 5 pacientes una neumonía atípica (6,4%), quedando un 70,5% sin catalogar su etiología. Comparando los 2 primeros grupos no se vio ningún dato que mostrara de manera significativa diferencias entre ambos. Sin embargo el primer grupo mostró un porcentaje mayor de neumonías necrotizantes que precisaron drenaje pleural. Conclusión: La neumonía adquirida en la comunidad o la bronconeumonía en niños presenta una elevada morbilidad. El diagnóstico etiológico es una tarea difícil. El neumococo tiene un papel muy importante en este tipo de infección (AU)

Objectives: Identify the possible bacterial infectious etiologies in hospitalized children with community acquired pneumonia in the Complejo Asistencial of Leon during one year and know their epidemiological and clinical characteristics and treatments prescribed. Materials and methods: An observational, descriptive and cross-sectional study was designed. Children whose ages ranges from 1 month to 14 years who were hospitalized with the diagnosis of community acquired pneumonia or bronchopneumonia during the period ranging from June 1, 2005to May 31, 2006 in the Complejo Asistencial of León was designed. Demographic, environmental, clinical, radiological, laboratory analysis and treatment data were collected. Results: A total of 78 patients made up the sample. Mean age was 45.8 ± 31.3 months. Most of the episodes occurred in the months of fall and winder (37.2% and 29.5%, respectively).A total of 18 patients had typical bacterial pneumonia(23%), and 5 patients atypical pneumonia (6.4%), and there is 70.5% in whom the etiology has not been classified. Comparing the first 2 groups, no data that significantly showed any differences between both were found. However, he first group showed a greater percentage of necrotizing pneumonia that required pleural drainage. Conclusion: Community acquired pneumonia or bronchopneumonia in children has an elevated morbidity. The etiological diagnosis is a difficult task. Pneumoccocus plays a very important role in this type of infection (AU)

Características perinatales del recién nacido hijo de madre inmigrante en el Complejo Asistencial de León / Perinatal characteristics of the newborn child of an immigrant mother in the Health Care Complex of León

Antecedentes y objetivos: Conocer las características perinatales de los recién nacidos hijos de madre inmigrante en el Complejo Asistencial de León. Métodos: Se recogen datos de los neonatos nacidos en nuestro Hospital, hijos de madre inmigrante, durante un periodo de cuatro meses. La muestra consta de un total de521 recién nacidos, de los cuales 60 son hijos de madre inmigrante(11,5%). Los datos analizados son: sexo, nacionalidad, edad materna, paridad, control, edad e incidencias de la gestación, tiempo de amniorrexis, tipo de parto, riesgo infeccioso, características antropométricas, incidencias y duración del ingreso. Resultados: En nuestra muestra de recién nacidos hijos de madre inmigrante predomina sexo femenino (34/60 vs222/461), mayor número de partos prematuros de ≤ 36 semanas(6/60 vs 15/461, p:0,011, OR: 3,38, IC-95%: 2,39-4,37),menor edad de las madres inmigrantes (25,9±5,1 vs 31,6±5,3,p<0,001) y menor número de primíparas entre las mismas(31/60 vs 273/461). Predomina en inmigrantes el embarazo no controlado (6/60 vs 1/461, p<0,000), mayor tiempo de amniorrexis (8,0±9,8 vs 5,4±7,2, p:0,055) y de riesgo de infección vertical (37/60 vs 164/461, p:0,000, OR: 2,83, IC-95%: 2,27-3,39). Las inmigrantes presentan menos hipotiroidismo y diabetes gestacional y más infecciones de orina y amenazas de aborto, siendo los resultados no significativos. En inmigrantes son más frecuentes los partos eutócicos(38/60 vs 262/461). Los recién nacidos hijos de madre inmigrante tienen características antropométricas similares a los hijos de madre española y padecen las mismas incidencias durante su ingreso en la Unidad de Neonatología. Conclusiones:- El 11,5% de nuestros recién nacidos son hijos de inmigrantes.- Las madres extranjeras son más jóvenes y con una gestación menos controlada que las nacionales.- Tienen mayor número de partos prematuros y mayor riesgo de infección por transmisión vertical (AU)

Background and Objectives: To determine the perinatal characteristics of the newborn son of immigrant mothers in the Complejo Asistencial de Leon. Methods: We collected data from infants born in our hospital, children of immigrants, over a period of four months. The sample consists of a total of 521 infants, 60 of whom are children of immigrant mothers (11.5%). The data analyzed are: Sex, nationality, maternal age, parity, control, age and incidences of gestation, amniorrhexis time, type ofdelivery, risk of infection, anthropometric characteristics, incidence and duration of admission. Results: In our sample of immigrants dominates female(34/60 vs 222/461, p: 0.27), a greater number of miscarriages of ≤ 36 weeks (6/60 vs. 15/461, p: 0011, OR: 3.38,-95% CI:2.39-4.37), younger mothers immigrants (25.9 ± 5.1 vs 31.6± 5.3, p <0001) and fewer primiparous (31/60 vs 273/461).No controlled pregnancy predominates in inmigrants (6/60vs 1/461, p <0.000), longer time of amniorrhexis (8.0 ± 9.8vs. 5.4 ± 7.2, p : 0.055) and risk of vertical infection (37/60vs 164/461, p:0.000, OR: 2.83, IC-95%: 2.27-3.39). The immigrants have less hypothyroidism and gestational diabetes, and more urinary infections and threats of abortion, with no significant results. In immigrants are more frequent eutocicdeliveries (38/60 vs 262/461). The newborn children of immigrant mothers have anthropometric characteristics similar to the children of Spanish mother and suffer the same incidents during his admission to the neonatal unit. Conclusions:- 11.5% of our newborn is son of immigrant mother.- The foreign mothers are younger, with more children and a less controlled gestation than national ones.- There is a greater number of premature births and a higher risk of infection by vertical transmission (AU)

Enfermedad inflamatoria intestinal y enfermedad celíaca: una asociación infrecuente / Inflammatory bowel disease and celiac disease: an uncommon association

The prevalence of inflammatory bowel disease (IBD) and celiac disease (CD) have increased during the last decades; however the occurrence of both conditions together is uncommon. In spite of this fact, the literature has suggested an association between IBD and CD because an aberrant innate immune reaction is a contributory risk factor in both diseases. The combined presentation of IBD and CD in five patients is presented and we analyzed the clinical and laboratory characteristics of this condition. The occurrence of both diseases should be kept in mind at the time of diagnosis and at relapse, or when the remission is difficult to maintain.

La prevalencia de las enfermedades inflamatorias intestinales (EII) y de la enfermedad celiaca (EC) ha aumentado durante las ultimas décadas; sin embargo la asociación de ambas condiciones es infrecuente. A pesar de ello, la literatura ha sugerido una asociación entre ambas entidades, ya que una respuesta inmune innata aberrante es un factor de riesgo de ambas enfermedades. Presentamos cinco pacientes con la presentación combinada de EII y EC y se analizan las características clínicas y de laboratorio de esta condición. La presencia de ambos cuadros debe ser tenida en mente al momento del diagnostico, recaída de la enfermedad sin causa clara o si existe alguna dificultad en mantener la etapa de remisión de la enfermedad.

[Interventionist endoscopic ultrasonography. A retrospective analysis of 60 procedures]. / Ultrasonografía endoscópica intervencionista. Análisis retrospectivo de 60 procedimientos.

INTRODUCTION AND OBJECTIVE: interventionist endoscopic ultrasonography is increasingly used because of its growing indications. We present here our retrospective and initial experience (60 procedures) with endoscopic ultrasonography (EUS) both for diagnosis (EUS-FNA) and therapy (EUS-guided tumorectomy and mucosectomy). PATIENTS AND METHOD: in a group with 27 cases including 10 submucosal tumors (SMTs), 2 adenopathies, and 15 potential pancreatic tumors (8 pancreatic cancers), a sectorial EUS-FNA at 7.5 MHz was performed for diagnosis prior to therapy (mainly surgical). A pancreatic pseudocyst was drained. In 21 cases with 27 SMTs (10 patients with 13 carcinoids) a tumorectomy was carried out using the standard loop or assisted polypectomy technique with submucosal injection, and in a few cases (two) using elastic band ligation following a radial EUS at 7.5, 12, or 20 MHz. In 6 cases of superficial gastroesophageal cancer or gastric dysplasia an endoscopic mucosal resection (classic EMR) was performed after EUS or MPs at 7.5 and 20 MHz. Fifty-five patients with 60 lesions, 29 femaes and 26 males with a mean age of 60 years (30-88 years) were retrospectively analyzed. RESULTS: diagnostic precision (P), sensitivity (S), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) for EUS-FNA was 85, 83, 100, 100, and 43%, respectively, when comparing results with specimen histology. P was higher for adenopathies (100%) and pancreatic tumors (87%) than for SMTs (80%). No complications arose, except for one episode of upper gastrointestinal bleeding (UGIB) (3.7%) that was endoscopically and satisfactorily treated in a gastric SMT. In the group with 21 patients (10 carcinoids with 13 tumors) 27 SMTs were endoscopically treated by tumorectomy with no perforation and only 2 UGIBs (7.4%), one of them self-limited, recorded. Endoscopic resection was complete in 92% of cases. No complications occurred with classic EMR, and all patients are still alive with no evidence of relapse, either local or metastatic. In this group the rate of complete resections was 100%. CONCLUSIONS: EUS-FNA is a safe technique with high diagnostic accuracy. EUS-guided tumorectomy and mucosectomy are also safe and effective techniques in the endoscopic management of these tumors.