Brain MRI without anesthesia in children less than 3 months old.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p = 0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6 min (range, 6-30 min). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Resonancia magnética cerebral sin anestesia en niños menores de 3 meses / Brain MRI without anesthesia in children less than 3 months old

Introducción: El uso de anestesia general en niños pequeños conlleva riesgos, a corto y largo plazo. El objetivo de este estudio fue evaluar la eficacia de la técnica de resonancia magnética (RM) cerebral sin anestesia mediante fijación con colchón en niños menores de 3 meses. Pacientes y métodos: Estudio prospectivo de casos y controles realizado en el año 2019. Los casos fueron pacientes menores de 3 meses con indicación de RM craneal, estables y sin soporte ventilatorio; las resonancias se realizaron usando la técnica de dar de comer y dormir y un colchón inmovilizador. Los controles fueron pacientes de la misma edad y sexo, inestables clínicamente, derivados para realizar RM craneal con anestesia general. Tres radiólogos pediátricos evaluaron el éxito de la RM (si respondía a la pregunta clínica), si era necesario repetirla y calificaron la presencia de artefactos de movimiento en una escala del 1 al 4. Resultados: 47 casos fueron incluidos en este estudio (28 niños, 19 niñas; media: 31 días de vida), de los cuales (89%) 42 RM fueron llevadas a cabo de manera exitosa. Los estudios realizados de manera ambulatoria se asociaron a mayor posibilidad de fallo de la técnica que los realizados a ingresados (valor de p 0,02). El 60% de las RM de los casos realizados tuvieron calidad óptima y el 30%, subóptima (artefacto de movimiento en una o dos secuencias). No se detectaron problemas de seguridad con esta técnica. La media de duración de los estudios fue de 16,6 minutos (rango 6-30 minutos). El 100% de las RM de los controles bajo anestesia general se llevaron a cabo con éxito, con una calidad óptima en el 89% y subóptima en el 11% restante. En el primer año de experiencia con esta técnica, de 47 RM realizadas, se evitó el uso de anestesia general a 42 recién nacidos. Conclusión: La técnica de dar de comer y dormir y fijación con colchón neumático para realizar RM sin anestesia puede realizarse de forma eficaz y segura en niños menores de 3 meses.(AU)

Introduction: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. Patients and methods: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. Results: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. Conclusion: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.(AU)

Brain MRI without anesthesia in children less than 3 months old. / Resonancia magnética cerebral sin anestesia en niños menores de 3 meses.

INTRODUCTION: The use of general anesthesia in infants involves both short-term and long-term risks. The aim of this study is to evaluate the efficacy of brain MRI without anesthesia in infants younger than 3-month-old immobilized with a pillow. PATIENTS AND METHODS: This prospective case-control study was done in 2019. Cases were stable patients less than 3 months old who did not require ventilatory support for whom brain MRI was indicated. Patients were fed so they would fall asleep and placed in the scanner with an immobilizing pillow. Controls were clinically unstable patients matched for age and sex referred for brain MRI under general anesthesia. Three pediatric radiologists evaluated the success of the MRI study (whether it answered the clinical question), recorded whether it was necessary to repeat the study, and rated the presence of motion artifacts on a scale ranging from 1 to 4. RESULTS: A total of 47 cases were included (28 boys and 19 girls; mean age, 31 days). Of these, 42 (89%) MRI studies were considered successful. The proportion of successful MRI studies was lower in outpatients than in inpatients (p=0.02). The quality of MRI in cases was considered optimal in 60% and suboptimal (motion artifacts in one or two sequences) in 30%. No safety issues related with the technique were detected. The mean duration of the studies was 16.6minutes (range, 6-30minutes). All of the MRI studies in controls were considered successful; quality was considered optimal in 89% and suboptimal in 11%. In the first year in which we used this technique, we avoided the use of general anesthesia in 47 MRI studies in 42 newborns. CONCLUSION: Brain MRI using the feed and sleep technique in infants younger than 3-month-old immobilized with a pillow can be done safely and efficaciously without general anesthesia.

Prolactinoma: un diagnóstico que debe tenerse en cuenta en niños con neoplasias hipofisarias / No disponible

En la infancia y la adolescencia, los adenomas hipofisarios son raros, y la mitad de ellos sonprolactinomas. Se presenta un niño de 13 años con una lesión quística selar y supraselar tratadacon cirugía, tras la cual el examen histológico e inmunohistoquímico diagnosticó un prolactinoma.Los macroprolactinomas quísticos antes de la pubertad son muy raros, pero se han descritodesde la edad de 9 años. El diagnóstico diferencial con el craneofaringioma quístico es muy importante,puesto que el tratamiento de primera elección del prolactinoma son los agonistas dopaminérgicos,mientras que en el craneofaringioma se prefiere la cirugía transcraneal(AU)

Pituitary adenomas are rare in childhood and adolescence and half of them are prolactinomas.In this report, we present a 13-year-old boy with a sellar and suprasellar cystic lesion treatedwith surgery; afterwards, histopathological and immunohistochemical examinations revealeda prolactinoma. Cystic macroprolactinomas are extremely rare in prepuberty, neverthelessthey have been reported from the age of 9 years. The differential diagnosis with cystic craniopharyngiomais important, as treatment with dopamine-agonists may be the first choice in prolatinomas,whereas a transcranial surgery is required for a suprasellar craniopharyngioma(AU)

[Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis]. / Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática.

OBJECTIVES: To analyze the international consensus statement on diagnostic criteria for idiopathic pulmonary fibrosis. METHODS: All patients diagnosed of any interstitial lung disease by means of open lung biopsy since 1980 were included. The patients' clinical records were examined to determine whether they fulfilled the diagnostic criteria, and their biopsies were reviewed to find those with the usual interstitial pneumonia pattern. We calculated sensitivity, specificity, positive and negative predictive values and likelihood ratios for the diagnostic criteria in the consensus statement. Afterwards, we performed the analyses again using only one of the two conditions for fulfilling the function criterion. RESULTS: Of 39 patients enrolled in the study, 17 had idiopathic pulmonary fibrosis. Specificity and positive predictive value were both 100%, but sensitivity was 41.2% and negative predictive value was 68.7%. The likelihood ratio for a negative result was 0.59. In the second analysis, sensitivity was 64.7% and negative predictive value was 78.5%, while specificity and positive predictive value remained unchanged. The likelihood ratio for a negative result was 0.35. CONCLUSIONS: The criteria are sufficiently specific to allow us to diagnose confidently when the criteria are fulfilled. However, a slight change in the function criterion should be considered in order to increase diagnostic yield.

Evaluación de los criterios diagnósticos clínicos de fibrosis pulmonar idiopática / Evaluation of clinical diagnostic guidelines for idiopathic pulmonary fibrosis

OBJETIVOS: Estudiar los criterios diagnósticos de la fibrosis pulmonar idiopática según el último Consenso Internacional. PACIENTES Y MÉTODO: Se incluyó a todos los pacientes diagnosticados de cualquier enfermedad intersticial por medio de biopsia pulmonar abierta desde 1980. Se revisaron sus historias clínicas para averiguar si cumplían los criterios diagnósticos, así como sus biopsias pulmonares en busca del patrón de neumonía intersticial usual. Se calcularon la sensibilidad, la especificidad, los valores predictivos positivo y negativo y los cocientes de probabilidad. Posteriormente, se realizó el mismo análisis requiriendo sólo una de las dos condiciones funcionales para cumplir el criterio funcional. RESULTADOS: Se incluyó a 39 pacientes, 17 de los cuales presentaban una fibrosis pulmonar idiopática. La especificidad y el valor predictivo positivo fue del 100 per cent, mientras que la sensibilidad y el valor predictivo negativo fueron del 41,2 y del 68,7 per cent, respectivamente. El cociente de probabilidad para un resultado negativo fue de 0,59. En el segundo análisis, la sensibilidad y el valor predictivo negativo fueron del 64,7 y del 78,5 per cent, respectivamente, con idéntica especificidad y valor predictivo positivo. El cociente de probabilidad para un resultado negativo fue de 0,35. CONCLUSIONES: Los criterios diagnósticos son lo suficientemente específicos como para estar seguros del diagnóstico cuando se cumplen. Debería considerarse un pequeño cambio en el criterio funcional para aumentar la rentabilidad del diagnóstico (AU)