A retrospective study of allergic diseases in children with food hypersensitivity

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Ingresos por varicela: estudio retrospectivo / Hospital admission due to varicella: a retrospective study

Objetivo: Describir las características de los pacientes ingresados por varicela en el Hospital «Príncipe de Asturias» y analizar las complicaciones que motivan su ingreso. Material y métodos: Estudio retrospectivo de los pacientes ingresados por varicela entre enero de 1996 y diciembre de 2002. Resultados: Se encontraron 61 pacientes ingresados por varicela. El 7,6% de los casos que consultaron en el Servicio de Urgencias fueron ingresados. La media de edad de estos pacientes fue de 3,1 ± 3,37 años. Fueron hospitalizados, fundamentalmente, para el tratamiento de complicaciones, terapia antiviral u observación. El tiempo medio de estancia fue de 5,32 días. Las complicaciones neurológicas y cutáneas fueron las más frecuentes (21,3%), seguidas de las respiratorias (16,9%). Otras complicaciones fueron: la escarlatina (8,2%), complicaciones hematológicas, vómitos, casos neonatales, amigdalitis y varicela hemorrágica. El 11,4% de los casos se produjeron por estreptococo betahemolítico del grupo A (5 pacientes con escarlatina, un caso de infección cutánea con hemocultivo positivo y otro caso en el que se aisló Streptococcus pyogenes de las lesiones cutáneas). Las complicaciones por varicela supusieron el 0,5% de los motivos de consulta en el Servicio de Urgencias, y un 7,6% de éstas precisó ingreso hospitalario. Conclusión: La introducción de la vacuna de la varicela en el calendario vacunal podría disminuir el número de ingresos debidos a complicaciones

Objective. To describe the features of the patients admitted to our hospital with varicella and analyze the complications that lead to hospital admission. Material and methods: We carried out a retrospective study of the children admitted with varicella between January 1996 and December 2002. Results: We identified 61 children who had been hospitalized for varicella during the study period. They represented 7.65% of the patients that were brought to the emergency room. The mean age was 3.1 ± 3.37 years. The children were admitted mainly for treatment of complications, for antiviral therapy or for observation. The mean length of the hospital stay was 5.32 days. The most prevalent reasons for admission were neurological and cutaneous complications (21.3%), followed by respiratory complications. Other complications were scarlet fever (8.2%), hematological disorders, vomiting, neonatal patient, tonsillitis and hemorrhagic varicella. Group A streptococcus was the cause in 11.4% of the cases (5 cases of scarlet fever, one case of skin infection with positive blood culture and another case in which beta hemolytic streptococcus was isolated from varicella skin lesions). Conclusion: Complications of varicella were the cause of 0.5% of emergency room visits; 7.65% of the patients with complications were admitted to the hospital. The introduction of a varicella vaccination program could decrease the number of hospital admissions produced by complications

Incapacidad para iniciar la deambulación tras el reposo prolongado en una adolescente / Inhability to begin ambulation after prolonged bed rest in a teenaged girl

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[Subacute sclerosing panencephalitis: a still existing disease]. / Panencefalitis esclerosante subaguda: una enfermedad que todavía existe.

Subacute sclerosing panencephalitis (SSPE) is a rare entity with an invariably fatal course that progressively affects the central nervous system. It is caused by persistent infection with the wild-type measles virus. While rare in industrial countries, it is not infrequent in developing countries, where there are still areas of endemic measles infection and immunization is not yet generalized. We describe an eight-year-old Spanish girl who presented rhythmic and symmetric myoclonus. She contracted measles at 13 months and required hospitalization. No cognitive deterioration was found. Neuroimaging and the initial electroencephalogram were normal. Oligoclonal bands and high titers of measles antibodies were found in serum and cerebrospinal fluid. She was treated with oral metisoprinol and intraventricular alpha-interferon (IFN-) and showed no further progression of her symptoms. The importance of including SSPE in the differential diagnosis of patients consulting for school failure, neurological deterioration or movement disorders is highlighted. Special attention should be paid to the immigrant population from countries where the incidence of SSPE is greater than in Spain.

Panencefalitis esclerosante subaguda:una enfermedad que todavía existe / Subacute sclerosing panencephalitis: a still existing disease

La panencefalitis esclerosante subaguda (PEES) es una enfermedad rara y de curso fatal, que afecta de forma progresiva al sistema nervioso central. Está causada por la infección persistente de una forma mutante del virus del sarampión. En países desarrollados la incidencia de PEES es muy baja; no ocurre lo mismo en países menos favorecidos, donde existen todavía zonas endémicas de sarampión y la vacunación no está al alcance de la mayoría de la población. Se presenta una niña española de 8 años con mioclonías rítmicas y simétricas. Como antecedentes tan sólo destacaba un ingreso hospitalario por sarampión a los 13 meses de edad. No presentaba deterioro cognitivo ni intelectual. Las técnicas de neuroimagen fueron normales, así como los electroencefalogramas iniciales. En la electroforesis en suero y líquido cefalorraquídeo (LCR) se detectaron bandas oligoclonales. Los niveles de anticuerpos antisarampión en suero y LCR eran muy elevados. Se inició tratamiento con metisoprinol oral e interferón alfa por vía intraventricular con lo que se ha detenido la progresión de la enfermedad. Se subraya la importancia que tiene incluir la PEES en el diagnóstico diferencial de pacientes que consultan por deterioro cognitivo, disminución del rendimiento escolar o trastornos del movimiento. Se debe prestar especial atención a la población inmigrante procedente de países donde la PEES presenta una mayor incidencia que en España (AU)

Parálisis facial bilateral como forma de presentación de síndrome de guillain-barré / Bilateral facial paralysis as the first manifestation of Guillain-Barré syndrome

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Infección pulmonar por "Mycobacterium" en huésped inmunocompetente / Pulmonary infection due to "Mycobacterium scrofulaceum" in an immunocompetent host

La existencia de micobacterias distintas a M. tuberculosis y M. leprae es conocida desde hace un centenar de años. Estudiadas más ampliamente desde los años cincuenta, su papel patógeno fue reconocido a partir de los años setenta. Entre las micobacterias atípicas se encuentra Mycobacterium scrofulaceum, que es el microorganismo causante de linfadenitis en niños, así como de infecciones en otras localizaciones en individuos inmunodeprimidos o con enfermedad pulmonar subyacente. Existen, no obstante, raros casos descritos en la bibliografía de afectación diferente a la ganglionar en individuos inmunocompetentes. Presentamos el caso de una niña de 11 años previamente sana, sin afectación del sistema inmune, con clínica pulmonar, prueba de la tuberculina positiva, afectación radiológica y aislamiento de Mycobacterium scrofulaceum. La resolución del cuadro clínico y radiológico se produjo con antituberculosos habituales, a pesar de que, in vitro, el microorganismo era resistente a todos ellos (AU)

[Urethrocystography in children. Practical considerations of irradiation doses]. / Uretrocistografía en niños. Consideraciones prácticas en relación con las dosis de irradiación.

OBJECTIVE: Rational use of voiding cystourethrography (VCUG) is imperative, as it is an invasive procedure exposing the child to ionizing radiation and other well documented risks. The objective of this study was to contribute to the achievement of a reduction in the irradiation dose in VCUG. PATIENTS AND METHODS: We reviewed the medical records of a consecutive sample of 125 children that underwent VCUG in our hospital between January 1995 and June 1996. RESULTS: Of the 125 VCUGs, 100 were normal, 13 showed vesicoureteric reflux grade II or higher, and 12 of them presented with other anomalies. The indication for VCUG was febrile UTI in 54 children, hydronephrosis detected prenatally in 12 and other causes in 60 children. It is important to note that children with vesicoureteric reflux presented as febrile UTI or fetal hydronephrosis. The age was significantly lower in the reflux group (p < 0.01). Eleven of the 13 children with vesicoureteric reflux were less than one year of age. Ultrasound anomalies and renal scarring in Tc99 DMSA were seen in a larger proportion in the reflux group. Preliminary X-rays showed anomalies in only 3 of 125 cases. CONCLUSIONS: 1) Vesicoureteric reflux is related to febrile UTI and fetal hydronephrosis. The other indications are questionable. 2) VCGU is not recommended following the first UTI in the evaluation of children 6 years of age or older who have a normal ultrasound and Tc99 DMSA. 3) VCUG could be substituted by a nuclear cystogram in girls who do not have a history of voiding dysfunction. 4) A preliminary X-ray is not justified.

Neonatal lupus erythematosus with multisystem organ involvement preceding cutaneous lesions.

Here we report a case of neonatal lupus erythematosus syndrome presenting with multisystem organ involvement, including anemia, thrombocytopenia, purpura, bloody diarrhea, enzymatic liver abnormalities, splenomegaly and pneumonitis. These findings preceded the cutaneous rash that was the clue for the diagnosis. The patient's mother had an undiagnosed subacute cutaneous lupus erythematosus. The various forms of onset of neonatal lupus erythematosus syndrome are emphasized.

Congenital cutaneous candidiasis: report of four cases and review of the literature.

Congenital cutaneous candidiasis (CCC) is a rare disease acquired by an ascending route, liable to affect the offspring of pregnant women suffering from vulvovaginitis. The cutaneous lesions are present at birth or within the first hours of life. Some infants may present with respiratory distress or clinical signs of sepsis during the first 2 days of life. We report four new cases of CCC, three of which presented transient respiratory distress and clinical signs of sepsis with hepatosplenomegaly. The evolution was favourable in all three cases with topical and oral therapy. We emphasize the self-limited character of this disease, although preterm infants may be at risk of systemic spread. Only one infant presented paronychia as a late complication.

[Partial trisomy 18q]. / Trisomía parcial 18q.

Authors present a new case with partial trisomy for long arms of chromosome 18(q12-qter) resulting from a balanced translocation t(4;18) on her mother. Comparing clinical features of our patient with that of other reported cases with the same trisomic segment, we can deduce that most important characteristics on this syndrome are: psychomotor and grow retardation, congenital heart disease, dolicocephaly, low set and malformed ears, micrognathia, short neck with redundant skin and a longer survival than in total trisomy 18.

Caudal deficiency and asplenia anomalies in sibs.

The caudal deficiency and asplenia anomalies have been described separately in children. Two sibs with these two entities are described. Only another similar case, with caudal deficiency and polysplenia anomalies was found in the literature. It is possible that this association could be a new syndromic entity. An autosomal recessive mode of inheritance is suggested.

[Treatment of patent ductus arteriosus in preterm infants]. / Tratamiento del "ductus" arterioso persistente en recién nacidos pretérmino.

A retrospective study is made on the results of the treatment of 38 preterm infants with symptomatic PDA; they represented an incidence of 4% of all the admissions to our Unit from June 1978 to March 1980. 30 of the 38 infants (79%) had PDA associated with RDS. Conservative medical treatment failed in 42% of the patients, requiring the administration of indomethacin for pharmacologic closure of their PDA. The different responses to the drug in each of the established groups are commented, being the group with a birth weight less than 1,500 g who presented the highest percentage of re-openings (62.5%) and of therapeutic failures (50%). An early closure of the PDA can contribute to decrease the morbidity and mortality of these infants, specially those with lower birth weight.

[Lumbosacral agenesis. Presentation of one case. Literature review and embriological considerations (author's transl)]. / Agenesia lumbosacra. Presentación de un caso. Revisión de la literatura y consideraciones embriológicas.

A case of a complete lumbosacral agenesis is presented, whose etiological factors are unknown. Clinically, motor deficit corresponded to the agenesis level, but the sensibility and the autonomous nervous system functions, which were conserved, partially, in lower levels than the normal ones in the agenesis. The case report is completed with electromiography, mielography, rectal biopsy, urography, cistography, opaque enema and inborn infection study. There are three facts: a partially conserved sensibility in the lower extremities, normal bladder function and above all, the presence of nervous parasympatics normal fibers in rectum wall, in contrast with the serious motor alteration just in the same medullar levels. Explanation of these facts suggest origin of an embryological source. It is assumed that the noxa must have acted between the third and the fourth weeks of pregnancy at a caudal cordomesoblast level, supposing that it did not affect neural crest.

[Evaluation of mechanical ventilation in meconial aspiration syndrome]. / Valoración de la asistencia respiratoria en el síndrome de aspiración meconial.

Twenty seven newborn with serious meconial aspiration syndrome are studied. Two groups are stablish weather they require or not mechanical ventilation during evolution. When comparing various perinatal and clinical data, only the Silverman test showed statistically significant differences; pH and gases in blood during the first hours of life did not showed differences. Pneumothorax incidency in both groups was 33%. Twelve newborn required mechanical ventilation. The starting age was 24 hours of life range 3-54 hours. Most frequent indication was hipoxemia and apnea. Use of intermitent positive pressure improved PaCO2 with a light increase in PaO2 though it also increased alveolo-arterial oxygen gradient. Hipoxemia was the most relevant data in evolution of these patients. In seven cases continuous distending pressure was applied, with a light increase in PaO2 only in three patients. No patient suffered pneumothorax during mechanical ventilation. In patients with mechanical ventilation mortality was 25%. The possibility of an addition in certain cases of pulmonary hypertension with right-to-left shunting ductal and atrial is reported.