Falso hematoma epidural ecográfico en un neonato / False epidural haematoma in a neonatal ultrasound

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[Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak]. / Complicaciones postquirrgicas de la malformación de Chiari tipo I: duroplastia y fístula de líquido cefalorraquídeo.

UNLABELLED: The surgical treatment of Chiari I malformation is to carry out a suboccipital decompression. It is described that postoperative complications may occur, especially if the dura is open and closed using a graft (duraplasty). Among them, one of the most important events due to its difficult handling is cerebrospinal fluid leak through the suture line. OBJECTIVE: To conduct a postoperative review to analyze the outcome of the patients and the occurrence of complications depending on the dural plasty used. MATERIAL AND METHODS: A retrospective study was carried out between 1997 and 2008, both inclusive, where we assessed 36 patients. All of them were studied with preoperative and postoperative craniospinal magnetic resonance, and by a thorough clinical examination performed before and after the surgery. The surgical procedure consisted of suboccipital decompression and resection of the posterior arch of C1 or C1 and C2 (depending on the extent of the caudal displacement of the tonsils), followed by duraplasty using either an autologous graft (pericranium) or a synthetic graft (Gore-tex). RESULTS: After a mean follow-up of 2 years, the clinical results were: excellent (55%), if there was a great clinical improvement; good (29%), if there was slight improvement; and bad (16%), if there was no improvement or there was worsening. In the 30 patients given a duraplasty (18 with an artificial graft, 12 with an autologous pericranium graft), 6 cases of cerebrospinal fluid leak appeared, although no significant association between the type of dural plasty and the presence of leak was observed. CONCLUSIONS: The best results were obtained for headaches, cervical pain and dizziness. Despite the fact that there were more cases of cerebrospinal fluid leak in patients receiving an artificial graft compared to patients with pericranium graft, there was no significant difference.

Complicaciones postquirúrgicas de la malformación de Chiari tipo I: duroplastia yfístula de líquido cefalorraquídeo / Postoperative complications in Chiari I malformation: duroplasty and cerebrospinal fluid leak

El tratamiento quirúrgico de la malformación deChiari tipo I consiste en realizar una descompresiónósea suboccipital. Está descrito que pueden producirsecomplicaciones derivadas de la cirugía, sobre todo sise realiza apertura dural y posterior cierre con injerto(duroplastia). Una de las más importantes por su difícilmanejo, es la fístula de líquido cefalorraquídeo en lazona quirúrgica.Objetivo. Llevar a cabo una revisión postquirúrgica,donde analizaremos la evolución de los pacientes y lacorrelación de las complicaciones respecto al tipo deplastia dural usada.Material y métodos. Se ha realizado un estudio retrospectivode los pacientes intervenidos en nuestro centroentre el año 1997 y 2008, ambos inclusive, recogiendoun total de 36 pacientes. A todos ellos se les realizó unestudio pre y postoperatorio con resonancia magnéticacraneoespinal, así como un examen neurológico antes ydespués de la intervención. La intervención quirúrgicaconsistió en una descompresión ósea suboccipital, juntocon la extirpación del arco posterior de C1 o C2 (dependiendodel descenso amigdalar), y duroplastia coninjerto autólogo (pericráneo) o con injerto heterólogo(Gore-tex).Resultados. Tras un seguimiento medio de 2 añosobtuvimos los siguientes resultados clínicos: excelente(55%), si hubo gran mejoría clínica; bueno (29%), sihubo leve mejoría; y malo (16%), si no hubo mejoría ohubo empeoramiento. En los 30 pacientes a los que seles realizó duroplastia (18 plastia artificial, 12 plastiaautóloga de pericráneo occipital), (..) (AU)

The surgical treatment of Chiari I malformation is tocarry out a suboccipital decompression. It is describedthat postoperative complications may occur, especiallyif the dura is open and closed using a graft (duraplasty).Among them, one of the most important events due toits difficult handling is cerebrospinal fluid leak throughthe suture line.Objective. To conduct a postoperative review toanalyze the outcome of the patients and the occurrenceof complications depending on the dural plasty used.Material and methods. A retrospective study wascarried out between 1997 and 2008, both inclusive,where we assessed 36 patients. All of them were studiedwith preoperative and postoperative craneoespinalmagnetic resonance, and by a thorough clinical examinationperformed before and after the surgery. Thesurgical procedure consisted of suboccipital decompressionand resection of the posterior arch of C1 or C1 andC2 (depending on the extent of the caudal displacementof the tonsils), followed by duraplasty using either anautologous graft (pericranium) or a synthetic graft(Gore-tex).Results. After a mean follow-up of 2 years, the clinicalresults were: excellent (55%), if there was a great (..) (AU)

Endobronchial atypical mycobacteria in an immunocompetent child.

Endobronchial granulomas in children are mainly caused by mycobacterial infections. In addition to Mycobacterium tuberculosis, other organisms such as nontuberculous mycobacteria (NTM) have emerged. These organisms cause a broad spectrum of pulmonary diseases. An isolated endobronchial NTM infection in a child is reported. After bronchoscopic removal, a decision not to add drug treatment was made, with satisfactory results. Treatment options are not well established in children and remain a source of controversy. Different options are discussed.

Neumonía afebril del lactante / Afebrile pneumonia syndrome of the unweaned baby

La infección por Chlamydia trachomatis es una de las enfermedades de transmisión sexual más frecuentes. El neonato puede infectarse en el canal del parto, y puede desarrollar una neumonía o una conjuntivitis posteriormente. La neumonía suele presentarse entre el primer y el tercer mes de vida, y cursa con accesos de tos y congestión nasal. Dada su similitud clínica con la bronquiolitis, debemos tenerla en cuenta en el diagnóstico diferencial, especialmente en los primeros 3 meses de vida. El diagnóstico puede hacerse tanto por cultivo de C. trachomatis como por la detección de antígeno en muestras de aspirado nasofaríngeo o mediante la determinación de anticuerpos en sangre. El tratamiento de elección para su erradicación es la eritromicina oral durante 14 días (AU)

The Chlamydia trachomatis infection is one of the most frequent diseases of sexual transmission. The newborn can be infected through the birth canal, and develop a pneumonia or a conjunctivitis later. Pneumonia can appear between the first and third month of life, and is manifested with coughing fit and nasal congestion. Given its clinical similarity with the bronchiolitis, it should be considered in its differential diagnosis, especially during the first three months of age. The diagnosis can be performed either by culture of C. trachomatis or by the detection of antigens in nasopharyngeal aspirate samples or determination of antibodies in blood. A 14-day course of oral erythromycin is the best treatment option for its eradication (AU)