[Status of pediatric hospital medicine in Spain: a report by the Spanish Pediatric Hospital Medicine Society (SEPHO)]. / Situación de la pediatría hospitalaria en España: informe de la Sociedad Española de Pediatría Hospitalaria (SEPHO).

Few reports are available on the status of pediatric hospital medicine in Spain. This has prompted the Spanish Society of Hospital Pediatrics (SEPHO) to conduct a study to determine the status of pediatric hospital care received. Data released by the Ministry of Health, the National Institute of Statistics have been used in the study, and an analysis was made of the results of a computerized survey designed and developed by SEPHO and available on the Internet for completion from November 2011 to December 2012 among Spanish hospitals. The results of this survey are part of the beginning of our journey as an association, and the current status of child and family welfare during hospitalization needs to be determined in order to consider and, where appropriate, make recommendations for improvement and standardization of care. The study, still unpublished, is to determine the state of pediatric hospital care as seen and analyzed from the perspective of the professionals directly involved in pediatric general hospital care. We included hospitals of different size and complexity of care. The aim of this report is to present the results of the survey and relate it to demographic and health care data from official sources.

Sociedad Española de Pediatría Hospitalaria / Spanish Society of Hospital Paediatrics

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Nódulos subcutáneos como forma de presentación de síndrome linfoproliferativo maligno / Subcutaneous nodules as a sign of malignant lymphoproliferative syndrome

En su mayoría, las lesiones cutáneas de los procesos malignos aparecen de forma concomitante o posterior al diagnóstico del tumor primario. Se presenta el caso de una niña con tumefacción en la cara externa del pie derecho desde los 5 meses de vida, durante un ingreso hospitalario a los 7 meses por bronquiolitis con pancitopenia, el mielograma mostró hipoplasia mieloide y megacariocítica, con ecografía abdominal y del pie normales. Tras la administración de corticoterapia por su cuadro respiratorio y soporte transfusional, al alta se objetivó desaparición de la lesión del pie. Dos meses más tarde presentó reaparición de la tumefacción junto con nódulos subcutáneos diseminados. Confirmada la infiltración maligna en la biopsia cutánea, la estadificación demostró infiltración blástica del 6% en mielograma y afectación ganglionar abdominal en ecografía y tomografía computarizada. El inmunofenotipo F confirmó el diagnóstico de linfoma linfoblástico pre-B muy inmaduro. Se administró quimioterapia según protocolo EURO-LB-02 para estadio IV. En remisión completa al finalizar la fase de inducción; la paciente presentó recaída leucémica refractaria a los 13 meses del diagnóstico. Comentario: Ante una lesión cutánea de evolución tórpida se debe realizar una toma de biopsia para descartar malignidad. El diagnóstico diferencial de las lesiones cutáneas malignas en los niños (especialmente en lactantes) incluye fundamentalmente infiltración secundaria a leucemia o linfoma, metástasis de neuroblastoma o rabdomiosarcoma y, con menor frecuencia, otros procesos primarios. En esta paciente con presentación cutánea aislada, el curso de su proceso linfoproliferativo maligno pudo modificarse mediante la corticoterapia recibida previa al diagnóstico definitivo (AU)

Skin involvement in children with malignant processes usually appears at the same time or after the diagnosis of the primary tumour. We present the case of a girl with cutaneous involvement prior to the diagnosis of a malignant lymphoproliferative process. A previously healthy 5-month old girl who presented with an inflammatory subcutaneous lesion on the right foot. During hospital admission due to bronchiolitis at 7 months with associated pancytopenia while the myelogram showed myeloid and megakaryocytic hypoplasia, the abdominal and foot ultrasound were normal. After completing corticoid therapy for her respiratory process and transfusional support, the foot lesion had disappeared at discharge. Two months later she had a local recurrence with associated scattered subcutaneous nodules. The skin biopsy confirmed malignant infiltration; the myelogram showed 6% blast infiltration, and both abdominal ultrasound and CT scan demonstrated lymph node involvement. Immunophenotype confirmed the diagnosis of Precursor B Cell Lymphoblastic Leukemia-Lymphoma. Although complete remission was achieved at the end of the induction chemotherapy according EuroLB-02 protocol for stage IV, the patient presented a refractory leukaemia relapse thirteen months after diagnosis. Commentary: Malignancy should be suspected in the presence of a skin lesion with torpid evolution and biopsy should be considered. Differential diagnosis of malignant skin lesions in children, especially in infants, must include mainly secondary involvement of leukaemia, lymphoma, metastases of neuroblastoma or rhabdomyosarcoma and less frequently other primary processes. In our patient with an isolated cutaneous presentation, the progression of her malignant lymphoproliferative process could be modified by the corticotherapy given before the definitive diagnosis (AU)

[Subcutaneous nodules as a sign of malignant lymphoproliferative syndrome]. / Nódulos subcutáneos como forma de presentación de síndrome linfoproliferativo maligno.

UNLABELLED: Skin involvement in children with malignant processes usually appears at the same time or after the diagnosis of the primary tumour. We present the case of a girl with cutaneous involvement prior to the diagnosis of a malignant lymphoproliferative process. A previously healthy 5-month old girl who presented with an inflammatory subcutaneous lesion on the right foot. During hospital admission due to bronchiolitis at 7 months with associated pancytopenia while the myelogram showed myeloid and megakaryocytic hypoplasia, the abdominal and foot ultrasound were normal. After completing corticoid therapy for her respiratory process and transfusional support, the foot lesion had disappeared at discharge. Two months later she had a local recurrence with associated scattered subcutaneous nodules. The skin biopsy confirmed malignant infiltration; the myelogram showed 6% blast infiltration, and both abdominal ultrasound and CT scan demonstrated lymph node involvement. Immunophenotype confirmed the diagnosis of Precursor B Cell Lymphoblastic Leukemia-Lymphoma. Although complete remission was achieved at the end of the induction chemotherapy according Euro-LB-02 protocol for stage IV, the patient presented a refractory leukaemia relapse thirteen months after diagnosis. COMMENTARY: Malignancy should be suspected in the presence of a skin lesion with torpid evolution and biopsy should be considered. Differential diagnosis of malignant skin lesions in children, especially in infants, must include mainly secondary involvement of leukaemia, lymphoma, metastases of neuroblastoma or rhabdomyosarcoma and less frequently other primary processes. In our patient with an isolated cutaneous presentation, the progression of her malignant lymphoproliferative process could be modified by the corticotherapy given before the definitive diagnosis.

Sepsis neonatal recurrente por estreptococo del grupo B, con un primer episodio de celulitis-adenitis / recurrent neonatal sepsis due to group B streptococci involving a first episode of cellulitis-adenitis

Se presenta el caso de un neonato de 28 días con un primer episodio séptico causado por estreptococo del grupo B, con manifestaciones asociadas de celulitis-adenitis mandibular. Tras un periodo de 50 días asintomático, el paciente padece un segundo episodio de sepis por estreptococo del grupo B. Dada la evolución recurrente, después del tratamiento antibiótico estándar, se decide efectuar quimioprofilaxis con rifampicina oral

The authors present the case of a 28-day-old infant with a first septic episode caused by group B streptococci associated with mandibular cellulitis-adenitis. After an asymptomatic period lasting 50 days, the patient presented a second episode of group B streptococcal sepsis. In view of the recurrent course, following standard antibiotic therapy, it was decided to give him chemotherapy with oral rifampicin

Incarcerated groin hernias in adults: presentation and outcome.

Despite universal acceptance of the value of elective hernia repair, many patients present with incarceration or strangulation, which are associated with significant morbidity and mortality. We reviewed 147 patients who underwent emergency surgery for incarcerated groin hernias during a 10-year period in order to analyze the presentation and outcome in our practice. Median age of the patients was 70 years. There were 77 men and 70 women. Femoral hernias were seen in 77 patients and inguinal hernias in 70. Coexisting diseases were found in 82 cases (55.8%). Bowel resection was required in 19 patients (12.9%). The overall and major morbidity rates were 41.5% and 9.6%, respectively. The mortality rate was 3.4%. Longer duration of symptoms, late hospitalization, concomitant diseases, and high ASA class were found to be significant factors linked with unfavorable outcomes. Because of high morbidity and mortality associated with incarceration, elective repair of groin hernias should be done whenever possible.

Abscesos hepáticos piógenos. Importancia de la existencia de gas / Pyogenic liver abscesses. The importance of the presence of gas

Introducción. Nuestro objetivo fue analizar el comportamiento clínico de los pacientes con abscesos hepáticos piógenos formadores de gas y, además, determinar si existía alguna diferencia en relación con los enfermos con abscesos sin producción de gas. Pacientes y métodos. Mediante un estudio multicéntrico se han revisado, retrospectivamente, las historias clínicas de 126 pacientes diagnosticados de abscesos hepáticos piógenos, durante un período de 13 años. Los enfermos fueron divididos en dos grupos: 25 con visualización radiológica de gas en el absceso (grupo 1) y 101 sin formación de gas (grupo 2). Los aspectos estudiados y comparados entre ambos grupos fueron: características clínicas, biológicas y bacteriológicas, morfología y topografía lesional, tratamiento y evolución clínica. Resultados. La presentación clínica de los pacientes del grupo 1 se caracterizó por la mayor frecuencia de pérdida de peso (60 frente al 37,6 por ciento; p = 0,03), shock (16 frente al 4 por ciento; p = 0,04) y derrame pleural (48 frente al 26 por ciento; p = 0,03). También en dicho grupo hubo mayor tasa de complicaciones relacionadas con el absceso (36 frente al 18 por ciento; p = 0,04). En el resto de datos clínicos, microbiológicos y terapéuticos no hubo diferencias significativas entre los dos grupos. Conclusiones. La aparición de gas en los abscesos genera escasas peculiaridades en la presentación clínica, pero su presencia implica peor evolución clínica, sobre todo en lo concerniente a la morbilidad relacionada con el absceso (AU)

Single and multiple pyogenic liver abscesses: etiology, clinical course, and outcome.

BACKGROUND: Pyogenic liver abscesses are uncommon but they still carry a high mortality rate when encountered. This study was undertaken to evaluate the differences in the clinical behaviour of patients with single and multiple abscesses. METHODS: From January 1985 to December 1997, 133 patients with this disease were treated in the surgical departments of five hospitals, 97 had a single abscess and 36 had multiple abscesses. Clinical features, methods of treatment, and outcome were assessed and compared in both types of abscesses. RESULTS: A biliary origin from ascending cholangitis was most frequently found in multiple abscesses (p = 0.007). Mean age and duration of symptoms were higher in multiple lesions (p = 0.03 and p = 0.001). High levels of alkaline phosphatase were more frequently seen in multiple abscesses than in solitary ones (p = 0.02). They were both most frequently located on the right side. Antibiotic therapy alone was most frequently used in multiple abscesses (p = 0.01). Mortality rate was also higher in this type of patients (p = 0.01). The abscess-related morbidity rate was higher in multiple lesions as well but the statistical difference was not significant. CONCLUSIONS: These results suggest that multiple liver abscesses comprise a disease of biliary origin, higher age, longer symptomatic periods, and also higher mortality rate than in single abscess.

Clinical course, treatment, and multivariate analysis of risk factors for pyogenic liver abscess.

BACKGROUND: Pyogenic liver abscess is a threatening condition. The purpose of this study was to audit the clinical behavior and to analyze the risk factors. METHODS: One hundred and thirty-three patients treated in five hospitals during the years 1985 to 1997 were studied. By univariate and multivariate analysis we tried to identify any risk factor associated with complicated clinical course and complicated-related clinical course, and with hospital mortality. RESULTS: Sixty-three patients (47%) were subjected to a percutaneous drainage, 45 (34%) were treated by open surgical drainage, and the remaining 25 cases (19%) received antibiotic therapy alone. Prognostic variables for a complicated clinical course were the presence of shock, low hemoglobin level, elevated prothrombin time, and polymicrobial infection. Shock, distress, low hemoglobin level, increased creatinine, and positive blood culture were significant predictors of a complicated-related clinical course. Concerning mortality, a biliary origin, shock, multiple abscesses, low hemoglobin level, and high concentration of blood urea nitrogen were independent predictors. CONCLUSIONS: Treatment of pyogenic liver abscesses should be tailored to each patient, however, the majority of them can be successfully treated with antibiotics and percutaneous methods. Those with signs of organ failure or septicemia should preferably be managed in the intensive care unit.

[Pertussis. Study of an epidemic]. / Tosferina. Estudio de una epidemia.

Forty-six children seen during 1989 with the clinical diagnosis of Pertussis are reviewed in this study. In 64.5% of the cases the Bordet-Gengou medium nasopharyngeal culture was positive for B. pertussis. Two age groups showed more susceptibility to B. pertussis, children under one year of age (70%) and of more than five years of age (20%). The disease was of more severity among infants younger than two months of age (apnea, choking spells, etc.). Most infants needed to be admitted to the hospital. All patients received therapy with erythromycin, salbutamol (80%) and general supportive medical care. No deaths or other medical sequelae were observed.