Linfoma no Hodgkin: excelentes resultados a expensas de elevada toxicidad del tratamiento / Non-Hodgkin lymphoma: Excellent results at the expense of the high toxicity of the treatment

Introducción : Los linfomas son la tercera neoplasia maligna en los niños y, dentro de ellos, los linfomas no Hodgkin (LNH) representan tan solo el 7% del cáncer en menores de 15 años. La quimioterapia constituye actualmente el tratamiento de elección. El objetivo de este estudio es analizar la toxicidad secundaria al tratamiento en pacientes pediátricos diagnosticados de LNH. Material y métodos: Estudio retrospectivo de pacientes diagnosticados de LNH de células B maduras tratados según el protocolo LMB 2001, desde enero del 2007 hasta febrero del 2014. Se recogieron los datos referentes al diagnóstico, el tratamiento y las toxicidades que desarrollaron durante el mismo. Resultados: Se diagnosticaron 20 LNH de células B maduras: 16 linfomas Burkitt, 2 linfomas difusos de células grandes y 2 leucemias maduras. Un 65% de los pacientes se clasificó al diagnóstico en un estadio de alto grado (III-IV). Los procesos infecciosos graves, la mielosupresión severa, las alteraciones hepáticas y la mucositis fueron las toxicidades más frecuentes. La supervivencia global fue del 95% (19/20). Un paciente falleció por causas no relacionadas con su enfermedad. Conclusión: La mayoría de los pacientes diagnosticados de LNH de células B maduras experimentan toxicidades grado III y IV durante el tratamiento, a pesar de lo cual la supervivencia es excelente (AU)

Introduction: Lymphomas are the third malignancy in children, and within them non-Hodgkin lymphoma (NHL) accounts for just 7% of cancers in children under 15 years old. Chemotherapy is currently the treatment of choice. The objective of this study is to analyze the toxicity caused by the treatment in pediatric patients diagnosed with NHL. Material and methods: A retrospective study was conducted on patients diagnosed with mature B-cell NHL, treated according to the LMB protocol 2001, from January 2007 to February 2014. Data concerning the diagnosis, treatment and toxicities that developed in the patients during the same period were collected. Results: A total of 20 mature B-cell NHL cases were diagnosed: 16 Burkitt lymphomas, 2 diffuse large cell lymphomas and 2 mature leukemias. Almost two-thirds (65%) of patients were classified in a high grade stage (III-IV) at diagnosis. Serious infectious processes, severe myelosuppression, liver abnormalities, and mucositis were the most frequent toxicities. Overall survival was 95% (19/20). One patient died of causes unrelated to the illness. Conclusion: Despite the excellent survival rate, most patients diagnosed with NHL mature B cells experience grade III and IV toxicities during treatment (AU)

[Non-Hodgkin lymphoma: Excellent results at the expense of the high toxicity of the treatment]. / Linfoma no Hodgkin: excelentes resultados a expensas de elevada toxicidad del tratamiento.

INTRODUCTION: Lymphomas are the third malignancy in children, and within them non-Hodgkin lymphoma (NHL) accounts for just 7% of cancers in children under 15 years old. Chemotherapy is currently the treatment of choice. The objective of this study is to analyze the toxicity caused by the treatment in pediatric patients diagnosed with NHL. MATERIAL AND METHODS: A retrospective study was conducted on patients diagnosed with mature B-cell NHL, treated according to the LMB protocol 2001, from January 2007 to February 2014. Data concerning the diagnosis, treatment and toxicities that developed in the patients during the same period were collected. RESULTS: A total of 20 mature B-cell NHL cases were diagnosed: 16 Burkitt lymphomas, 2 diffuse large cell lymphomas and 2 mature leukemias. Almost two-thirds (65%) of patients were classified in a high grade stage (iii-iv) at diagnosis. Serious infectious processes, severe myelosuppression, liver abnormalities, and mucositis were the most frequent toxicities. Overall survival was 95% (19/20). One patient died of causes unrelated to the illness. CONCLUSION: Despite the excellent survival rate, most patients diagnosed with NHL mature B cells experience grade iii and iv toxicities during treatment.

Aftas orales recurrentes como manifestación clínica en un caso de neutropenia cíclica con mutación en el gen ELA 2 / Mouth ulcers as a clinical sign in a case cyclic neutropenia with an ELA 2 gene mutation

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Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal / Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal Intubation

OBJETIVOS: Evaluar la utilidad de la ecografía frente a la capnografía y la radiografía en la intubación traqueal (IT) en niños y neonatos. MATERIAL Y MÉTODOS: Se incluyó a pacientes hemodinámicamente estables intubados en la UCIP y UCIN. Se verificó la posición del tubo endotraqueal (TET) tras cada intubación mediante ecografía traqueal y capnografía. Posteriormente, se comprobó la profundidad del TET por ecografía mediante la visualización de la punta del mismo y el deslizamiento pleural y, posteriormente, con radiografía de tórax. Se cronometraron los tiempos de realización de las técnicas. RESULTADOS: Se incluyó a 31 intubaciones en 26 pacientes (15 en UCIP y 16 en UCIN). No hubo diferencias significativas entre la ecografía y la capnografía ni entre la ecografía y la radiografía en la detección de la IT ni en la comprobación de la profundidad del TET. La sensibilidad y la especificidad de la ecografía comparada con la capnografía y la radiografía fueron del 92 y el 100%, y del 100 y el 75%, respectivamente. La ecografía fue significativamente más lenta que la capnografía (12 [4-16] vs. 6 [3-12] s; p < 0,001) y más rápida que la radiografía (0,22 [0,17-0,40] vs. 20 [17-25] min; p < 0,001). CONCLUSIONES: La ecografía parece tan efectiva como la capnografía, aunque más lenta en la comprobación de la IT. Podría ser de utilidad en situaciones donde la capnografía no sea fiable. La ecografía es tan efectiva y más rápida que la radiografía en la evaluación de la profundidad del TET, por lo que podría disminuir la utilización rutinaria de la radiografía

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation

Colecistitis aguda alitiásica en paciente sin enfermedad subyacente / Acute acalculous cholecystitis in a patient without underlying pathology

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[Usefulness of bedside ultrasound compared to capnography and X-ray for tracheal intubation]. / Utilidad de la ecografía comparada con la capnografía y la radiografía en la intubación traqueal.

OBJECTIVES: The aim of this study was to assess the usefulness of bedside ultrasound compared to capnography and X-ray for endotracheal intubation in children and newborns. MATERIALS AND METHODS: Hemodynamically stable children intubated in pedriatric and neonatal intensive care unit were included. Endotracheal tube insertion was checked after every intubation attempt by tracheal ultrasound and capnography simultaneously. The endotracheal tube insertion depth was then checked by assesment of lung sliding by thoracic ultrasound. Thereafter, Chest X-ray was performed and interpreted as usual. Time to perform each technique was recorded. RESULTS: The study included 31 intubations in 26 patients (15 in PICU and 16 in NICU). There were no statistically significant differences between tracheal ultrasound and capnography or between thoracic ultrasound and x-ray in identifying the correct endotracheal intubation and assessment of endotracheal tube insertion depth, respectively. Sensibility and specificity of ultrasound compared to capnography was 92% and 100%, and 100% and 75% compared to X-ray. Ultrasound was significantly slower compared to capnography [12 (4-16) vs 6 (3-12) seconds; P<.001] and significantly quicker compared to X-ray [0.22 (0.17-0.40) vs. 20 (17-25) minutes, P<.001]. CONCLUSIONS: Ultrasound appears to be as effective as capnography, although slower, for identifying endotracheal intubation. Ultrasound may be useful in clinical situations, such as cardiopulmonary resuscitation where capnography is less reliable. Ultrasound is as effective and quicker than X-ray for assessment of endotracheal tube insertion depth, and it may contribute to decrease the routine use of X-ray after tracheal intubation.

Test de elevación pasiva de las piernas y respuesta a líquidos en un niño politraumatizado / Passive leg raising test and fluid responsiveness in a child with multiple injuries

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Uso de la ecografía en la comprobación de la intubación traquealurgente en Pediatría: experiencia preliminar / Use of ultrasonograph in the verification of urgent tracheal intubation in pediatrics: preliminary experience

Introducción y objetivos. El método estándar para la confirmación de la intubación traqueal es la laringoscopia directa; siendo el método secundario más recomendado la capnografía. Por otro lado, existe un interés creciente en el uso de la ecografía como técnica alternativa y complementaria, con la ventaja añadida de permitir comprobar los movimientos respiratorios, sin embargo, su uso es aún limitado. Exponemos nuestra experiencia preliminar con el uso de la ecografía para este fin, describiendo e ilustrando la técnica en una pequeña serie de pacientes. Material y métodos. Se comprobó la intubación correcta en los planos longitudinal y transversal así como la ausencia de intubación bronquial selectiva mediante ecografía. Posteriormente un segundo investigador revisó y analizó las imágenes obtenidas para evaluar la concordancia entre ambos. Casos clínicos. Fueron incluidas 7 intubaciones en 5 pacientes, sin producirse en ningún caso intubación esofágica. La mediana del tiempo de comprobación fue 63,5 (28- 97,5) segundos. La posición del tubo fue considerada como correcta ecográficamente en 6 de los casos, según el signo del lung sliding y la motilidad diafragmática; sin embargo, por radiografía convencional sólo se consideró correcta en 5. En 27 de las 28 imágenes registradas hubo concordancia entre ambos investigadores. Comentarios. La ecografía parece ser un método alternativo útil y rápido para la confirmación de la intubación traqueal. En comparación con los métodos convencionales se trata de una técnica no invasiva, que permite descartar la intubación selectiva del bronquio derecho de forma rápida y podría contribuir a evitar la realización de radiografías (AU)

Introduction and objectives. Direct laringoscopy is the standard method to confirm proper endotracheal tube placement; capnography represents the second most recommended method. Nowadays, ultrasound is gaining interest as an alternative and complementary technique, which also allows the comprobation of respiratory movements. Unfortunately this use is still limited. This study aimed to show our experience with the use of ultrasound for this purpose, describing and illustrating the technique in a small series of patients. Material and methods. Proper intubation in longitudinal and transverse plane, as well as the absence of selective bronchial intubation was verified by ultrasound. Subsequently the obtained images were reviewed and analyzed by a second researcher to evaluate the correlation between them. Clinical cases. Seven intubations in five patients were included, none of them were esophagical. The average time to verify was 63.5 (28-97.5) seconds. Correct tube position was considered by ultrasound lung sliding and diaphragmatic motility in 6 cases, in contrast with 5 cases by conventional radiography. In 27 of 28 recorded images there was an agreement between both researchers. Comments. Ultrasound appears to be a useful and fast alternative technique to confirm tracheal intubation. Compared with conventional methods it is a noninvasive technique that allows to dismiss selective right bronchial intubation in a fast way and can contribute to avoid excessive use of radiography (AU)

Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular / Systematic assessment of the paediatrician’s performance during simulated supraventricular tachycardia

Objetivo: El presente estudio persigue dos objetivos: a) analizar mediante una lista estructurada de tareas la calidad del manejo clínico en un escenario simulado de la taquicardia supraventricular (TSV) aguda y b) identificar posibles errores y áreas de mejora sobre las que incidir en el entrenamiento. Material y métodos: Se han revisado y valorado de forma sistemática los escenarios simulados de TSV realizados en los cursos de simulación avanzada pediátrica llevados a cabo entre junio2008 y abril 2010. Se programaron en el sistema SimBaby(R) tres escenarios de dificultad creciente: TSV estable (TSV-E), TSV inicialmente estable que progresa a inestable (TSV-EI) y TSV inestable (TSV-I). La evaluación del escenario se basó en una lista de 18 tareas derivadas de las recomendaciones del ILCOR. Resultados: Se analizaron 45 escenarios (15 escenarios de TSV-E, 25 de TSV e-I y 5 de TSVI),en los que participaron 167 pediatras. Se completaron correctamente 328 de 551 (59,5%) tareas posibles. El porcentaje medio (desviación estándar) de tareas correctas por escenario varió en función del caso: 63,4 (16,7) en la TSV-E, 47,8 (20,3) en la TSV-EI y 38,6 (31) en la TSV-I (p = 0,028). No se observaron diferencias significativas entre los pediatras de atención primaria y los de atención hospitalaria. La mayoría de los participantes diagnosticaron correctamente la TSV; sin embargo, se cometieron errores importantes como no identificar la inestabilidad hemodinámica en 20 de 43 (48%) escenarios, dosis incorrectas de adenosina en 18 de 39 (48%) escenarios, la administración inadecuada de adenosina en 23 de 39 (59%) escenarios y no reconocer la indicación de cardioversión inmediata en 15 de 31 (48%) escenarios. Conclusiones: Los pediatras saben identificar una TSV pero precisan mejorar su capacitación para tratarla de forma adecuada. El análisis sistemático de la actuación de los profesionales ante un caso simulado permite detectar tanto sus puntos fuertes como las áreas en las que es preciso reforzar la enseñanza (AU)

Introduction: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training maybe needed. Material and methods: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby(R) simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. Results: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p = 0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls wereobserved, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardio version in 15 out of 31 (48%).Conclusions: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed(AU)

[Systematic assessment of the paediatrician's performance during simulated supraventricular tachycardia]. / Evaluación sistemática de la actuación de los pediatras ante un caso simulado de taquicardia supraventricular.

INTRODUCTION: The aims of this study are to: a) assess the quality in clinical management during a simulated scenario of acute supraventricular tachycardia (SVT) by means of a structured task-based checklist and to b) detect pitfalls and grey areas where reinforcement in training may be needed. MATERIAL AND METHODS: We systematically reviewed SVT simulated scenarios during simulation courses between June 2008 and April 2010. Three scenarios were programmed using SimBaby® simulation system, and included stable SVT (S-SVT), stable progressing to unstable SVT (SU-SVT) and unstable SVT (U-SVT). Scenarios were evaluated by means of an 18-task checklist based on ILCOR international recommendations. RESULTS: A total of 45 scenarios were assessed with the participation of 167 paediatricians, including 15 S-SVT, 25 SU-SVT and 5 U-SVT scenarios. Out of a total of 551 possible tasks, 328 (59.5%) were completed correctly. The mean percentage of correct tasks per scenario was 63.4 (16.7) for S-SVT, 47.8 (20.3) for SU-ST and 38.6 (31) for U-SVT (p=0.028). There were no significant differences between primary care paediatricians and hospital paediatricians. Most of the participants correctly identified non-sinus rhythm as SVT. However, important pitfalls were observed, including failure to identify haemodynamic instability in 20 out of 43 (48%) cases, an incorrect dose of adenosine in 18 out of 39 (48%), incorrect adenosine administration in 23 out of 39 (59%), and non-recognition of indication to emergent cardioversion in 15 out of 31 (48%). CONCLUSIONS: Paediatricians are able to diagnose SVT correctly, but need to improve their skills in treatment. Systematic analysis of clinical performance in a simulated scenario allows the identification of strengths, as well as weak points, where reinforcement is needed.

Epilepsia versus síncope convulsivo: la cama basculante como herramienta diagnóstica / Epilepsy versus convulsive syncope: tilt table test as a diagnostic tool

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