[Amount of sleep and changes in its patterns in children less than two years old]. / Cuantificación del sueño y presencia de alteraciones en la duración del sueño en niños menores de 2 años.

OBJECTIVES: The aim is to study the sleep duration and the 24-hour sleep distribution pattern in children under 2 years-old from two different areas of Spain, as well as to determine the prevalence of abnormal sleep duration and the influence of age on this prevalence, and compare them with the already published data. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study on children from two health centers: one in Castilla y León and the other in Asturias. Their parents completed the Brief Infant Sleep Questionnaire (BISQ). Daytime and nighttime sleep duration was assessed, with percentiles being used to evaluate the results. Two groups were created: one according to the age (children under or above 6 months), and the other according to the area. RESULTS: A total of 125 children were studied (73 males). The nighttime sleep duration increased from 8.28±2.06 hours to 10.43±1.21 hours (P=.0001) and the daytime sleep decreased from 4.61±2.66 to 1.96±0.79 hours (P=.0001) for children under 6 months and above 6 months, respectively. The children from Castilla y León slept more during daytime than those from Asturias (3.91±2.67 vs 3.00±2.09 hours, P=.041). Nineteen children had a total sleep duration below the 2nd percentile. A sleep duration below normal percentiles was observed in children under 6 months (14/72 vs 5/53, P=.006). CONCLUSIONS: As children grow older, they substitute daytime sleep for nighttime sleep. Approximately 15% of the children under 2 years-old may have changes in sleep duration, and is more common in children under 6 months.

Tumores testiculares y paratesticulares en la infancia y adolescencia / Testicular and paratesticular tumors during childhood and adolescence

Introducción: Los tumores testiculares y paratesticulares constituyen el 1-2% de los tumores sólidos en la infancia. Se presenta una serie retrospectiva de 15 casos en menores de 18 años. Resultados: La edad media de los pacientes fue de 9,7 años, siendo prepuberales 6 (media 2,08 ± 1 año) y puberales 9 (media 15,1 ± 1,3 años). La forma de presentación clínica más frecuente fue una masa testicular indolora. Los niveles de alfa-fetoproteína estaban elevados en 5 pacientes (tumores de saco vitelino y carcinomas embrionarios).El estudio anatomopatológico demostró 11 tumores primarios testiculares y 4 paratesticulares (rabdomiosarcomas), siendo el 60% tumores germinales y el resto de células no germinales. El 60% de ellos fueron tumores malignos (2 tumores de saco vitelino, 2 carcinomas embrionarios, un seminoma y 4 rabdomiosarcomas). Entre los tumores benignos, el más frecuente fue el teratoma quístico maduro. La cirugía fue el tratamiento inicial en todos los casos (orquidectomía radical en 13 tumores y enucleación en 2 teratomas, con linfadenectomía retroperitoneal en 4 casos). En 11 de los pacientes el tumor se encontraba en estadio I y en 4 casos (2 carcinomas embrionarios y 2 rabdomiosarcomas), en estadio IV con metástasis pulmonares. Recibieron tratamiento adyuvante con quimioterapia asociada o no a radioterapia 7 de los pacientes (4 rabdomiosarcomas, 2 carcinomas embrionarios y un seminoma). Conclusiones: Los tumores testiculares y paratesticulares en niños prepuberales son un grupo con unas características epidemiológicas, histológicas, evolutivas y terapéuticas, bien diferenciadas respecto de las encontradas en pacientes pospuberales o adultos(AU)

Introduction: Testicular and paratesticular tumors represent 1-2% of the solid tumors in children. We present a retrospective series of 15 cases in patients less than 18 years of age. Results: The mean age of the patients was 9.7 yrs, 6 of them prepubertal (mean age: 2.08 ± 1 yrs) and 9 pubertal (mean age: 15.1 ± 1.3 yrs). The most common clinical form of presentation was a painless testicular mass. The alpha-fetoprotein levels were high in 5 patients (yolk-sac tumors and embryonal carcinomas).The pathological study showed 11 primary testicular tumors and 4 paratesticular tumors (rhabdomyosarcomas), with 60% being germinal tumors and the rest non-germinal. Around 60% were malignant tumors (2 from the yolk-sac tumors, 2 embryonal carcinomas, one seminoma and 4 rhabdomyosarcomas). Among the benign tumors, the most common was the mature cystic teratoma. Surgery was the initial treatment in all of the cases (radical orchiectomy in 13 tumors and enucleation in 2 teratomas, with retroperitoneal lymphadenectomy in 4 cases). In 11 patients the tumor was in stage I, while 4 cases (2 embryonal carcinomas and 2 rhabdomyosarcomas) were in stage IV with pulmonary metastasis. Chemotherapy whether or not combined with radiotherapy was applied in 7 patients (4 rhabdomyosarcomas, 2 embryonal carcinomas and one seminoma). Conclusions: Testicular and paratesticular tumors in prepubertal children show epidemiological, histological, therapeutical and evolutional characteristics well differentiated from postpubertal or adult subjects(AU)

[Testicular and paratesticular tumors during childhood and adolescence]. / Tumores testiculares y paratesticulares en la infancia y adolescencia.

INTRODUCTION: Testicular and paratesticular tumors represent 1-2% of the solid tumors in children. We present a retrospective series of 15 cases in patients less than 18 years of age. RESULTS: The mean age of the patients was 9.7 yrs, 6 of them prepubertal (mean age: 2.08 ± 1 yrs) and 9 pubertal (mean age: 15.1 ± 1.3 yrs). The most common clinical form of presentation was a painless testicular mass. The α-fetoprotein levels were high in 5 patients (yolk-sac tumors and embryonal carcinomas). The pathological study showed 11 primary testicular tumors and 4 paratesticular tumors (rhabdomyosarcomas), with 60% being germinal tumors and the rest non-germinal. Around 60% were malignant tumors (2 from the yolk-sac tumors, 2 embryonal carcinomas, one seminoma and 4 rhabdomyosarcomas). Among the benign tumors, the most common was the mature cystic teratoma. Surgery was the initial treatment in all of the cases (radical orchiectomy in 13 tumors and enucleation in 2 teratomas, with retroperitoneal lymphadenectomy in 4 cases). In 11 patients the tumor was in stage I, while 4 cases (2 embryonal carcinomas and 2 rhabdomyosarcomas) were in stage IV with pulmonary metastasis. Chemotherapy whether or not combined with radiotherapy was applied in 7 patients (4 rhabdomyosarcomas, 2 embryonal carcinomas and one seminoma). CONCLUSIONS: Testicular and paratesticular tumors in prepubertal children show epidemiological, histological, therapeutical and evolutional characteristics well differentiated from postpubertal or adult subjects.

Hemorragia intraventricular secundaria a aneurisma cerebral en gestante / Intraventricular haemorrhage secondary to cerebral aneuresym in pregnancy

Se presenta un caso de hemorragia intraventricular secundaria a rotura de aneurisma, de evolución aguda, en una tercigesta de 40 años a las 32 semanas de embarazo. Este cuadro, aunque infrecuente, es de una gravedad extrema tanto para la madre como para el feto. Se discute el manejo, tanto del cuadro materno como, sobre todo, de la actuación obstétrica ante este tipo de situaciones; sin olvidar un breve comentario acerca de la donación de órganos cuando la situación es irreversible (AU)