Dilatación y fisuras anales: ¿abuso sexual? / Dilation and anal fissures: sexual abuse?

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[Scrotal hair in infants]. / Vello escrotal en lactantes.

The presence of pubic hair is exceptional in healthy infants of both sexes. In most of the cases described in the literature, the process was self-limited and no etiology was found. Nevertheless, in some patients, this finding has been associated with other manifestations of hyperandrogenism related to potentially serious diseases such as congenital adrenal hyperplasia or virilizing tumors. In the present article, we describe seven infants followed-up in the Pediatric Endocrine Clinic because of scrotal hair. In all patients, the process was self-limited and resolved spontaneously and no hormonal or developmental alterations were observed. Key words: Scrotal hair, infants, virilization.

Vello escrotal en lactantes / Scrotal hair in infants

La aparición de vello sexual es excepcional en los lactantes de ambos sexos. La mayoría de los casos descritos en la bibliografía constituyen procesos autolimitados, en los que su etiología no ha sido definida. Sin embargo, en algunos casos se ha asociado con otras manifestaciones de hiperandrogenismo relacionadas con procesos potencialmente graves como son la hiperplasia suprarrenal congénita y tumores productores de andrógenos. En el presente artículo se describe los casos de 7 lactantes varones que fueron vistos en la consulta de endocrinología pediátrica por vello escrotal. En todos ellos el proceso fue autolimitado, sin que se observaran alteraciones hormonales o en el desarrollo (AU)

The presence of pubic hair is exceptional in healthy infants of both sexes. In most of the cases described in the literature, the process was self-limited and no etiology was found. Nevertheless, in some patients, this finding has been associated with other manifestations of hyperandrogenism related to potentially serious diseases such as congenital adrenal hyperplasia or virilizing tumors. In the present article, we describe seven infants followed-up in the Pediatric Endocrine Clinic because of scrotal hair. In all patients, the process was self-limited and resolved spontaneously and no hormonal or developmental alterations were observed (AU)

Efectos del yogur enriquecido con isómeros del ácido linoleico conjugado, sobre resistencia a la insulina en adolescentes obesos / The effects of yogurt with isomer enriched conjugated linoleico acid on insulina resistance in obese adolescents

El incremento en la incidencia de obesidad es uno de los problemas sanitarios más relevantes en los países en desarrollo. La resistencia a la insulina juega un papel clave en las alteraciones metabólicas asociadas a la obesidad. Son pocas las intervenciones que permitan, de forma eficaz, reducir el peso corporal y las alteraciones metabólicas como consecuencia de la misma. Objetivos. Los objetivos del presente trabajo fueron determinar si la administración de una mezcla de isómeros de ácido linoleico conjugado (CLA) reduce el peso corporal y mejora la resistencia a la insulina en adolescentes obesos. Diseño experimental. Se llevó a cabo un estudio doble ciego, caso-control, donde se estudiaron 39 pacientes adolescentes obesos, a los cuales de forma aleatoria se les administro diariamente 200 g de yogur líquido suplementado con 3 g de CLA o placebo, durante 16 semanas. Se determinó el peso, talla índice de mas corporal (IMC), colesterol total en plasma y el HDL, insulina, glucosa, adiponectina, así como el índice de resistencia a la insulina (HOMA), antes del inicio de la ingesta, al finalizar, y tras un periodo sin la suplementación. Resultados. No se observaron diferencias significativas en el peso, talla, IMC, colesterol total y en HDL, y adiponectina, entre el grupo suplementado con CLA y el grupo placebo, ni al inicio del estudio, durante y tras el tratamiento. Tras 16 semanas de suplementación con CLA, los nivels de glucosa plasmática y el índice de resistencia a la insulina (HOMA) se redujeron comparado con el grupo placebo (p<0.05). Conclusión. En adolescentes obesos, la administración de CLA disminuye el índice de resistencia a la insulina, independientemente de los cambios en el peso y en el IMC (AU)

Increase in the incidence of obesity is one of the most relevant health care problems in the developing countries. Insulin resistance plays a key role in obesity associated metabolic disorders. There are few interventions that make it possible to effectively reduce body weight and metabolic disorders that occur as a consequence of it. Objectives: This present study aimed to determine if the administration of a mixture of conjugated linoleic acid (CLA) isomers reduces body weight and improves insulin resistance in obese adolescents. Experimental design. A double blind, case – controlled, study was conducted in which 39 obese adolescent patients were studied. Daily, they were randomly administered 200 g of liquid yogurt supplemented with 3 g of CLA, or placebo, for 16 weeds. Weight, height, body mass index (BMI), total cholesterol in plasma and in HDL, insulin, glucose, adiponectin and insulin resistance index (HOMA) were measured before the onset of intake, at completion, and after a period without supplementation. Results: No significant differences were observed in weight, height, BMI, total cholesterol and in HDL and adiponectin between the group supplemented with CLA and the placebo group at the onset of the study, during and after the treatment. After 16 weeks of supplementation with CLA, the plasma glucose levels and insulin resistance index (HOMA) were reduced compared with the placebo group (p<0.05). Conclusion. In obese adolescents, administration of CLA decreases the insulin resistance index, independently of weight changes and BMI changes (AU)

Síndrome de esplenomegalia tropical en el diagnóstico diferencial de esplenomegalia masiva / Tropical splenomegaly syndrome in the differential diagnosis of massive splenomegaly

Presentamos el caso de un niño de 11 años de edad, de origen guineano, enviado a nuestro hospital por presentar esplenomegalia masiva, anemia, eosinofilia y fiebre intermitente. El estudio etiológico inicial no fue concluyente. Finalmente, se estableció el diagnóstico de síndrome de esplenomegalia por hiperreactividad a la malaria, o síndrome de esplenomegalia tropical, para lo cual fueron esenciales la exclusión de otras causas y la respuesta al tratamiento antipalúdico; la biopsia hepática fue característica del cuadro

We report the case of an 11-year-old boy from Equatorial Guinea, referred to our hospital with massive splenomegaly, anemia, eosinophilia and intermittent fever. The preliminary etiological study was not conclusive. Finally, a diagnosis of splenomegaly syndrome due to hyperreactivity to malaria or “tropical splenomegaly syndrome” was established. The exclusion of other causes and the response to antimalarial treatment provided the key to the diagnosis, and liver biopsy revealed the pattern typically associated with this condition

[Tracheal agenesis associated with laryngeal malformations as an unusual cause of airway failure]. / Agenesia traqueal asociada a malformaciones laríngeas como causa inusual de fracaso de la vía aérea.

Tracheal agenesis is an uncommon congenital malformation with an extremely high mortality rate. This malformation manifests after delivery as severe respiratory distress, cyanosis, lack of crying and impossibility of endotracheal respiratory support. This anomaly is usually associated with cardiovascular, respiratory and gastrointestinal malformations. Only a high index of suspicion and early surgical management will prevent death. An early diagnosis may also help the parents and the medical team to take appropriate decisions. Currently, there is no effective therapy that guarantees long-term survival.

Agenesia traqueal asociada a malformaciones laríngeas como causa inusual de fracaso de la vía aérea / Tracheal agenesis associated with laryngeal malformations as an unusual cause of airway failure

La agenesia traqueal es una malformación congénita infrecuente con una tasa de mortalidad extremadamente alta. Se presenta tras el nacimiento como distrés respiratorio severo, cianosis, ausencia de llanto e imposibilidad de soporte respiratorio endotraqueal. En la mayoría de los casos, se asocia con malformaciones cardiovasculares, gastrointestinales y respiratorias. La sospecha diagnóstica y un manejo quirúrgico precoz son la única vía para prevenir el fatal desenlace. Además, el diagnóstico precoz puede ayudar a los padres y al equipo médico a tomar las decisiones apropiadas. Hoy en día, no existe terapia definitiva eficaz que garantice una supervivencia a largo plazo

Tracheal agenesis is an uncommon congenital malformation with an extremely high mortality rate. This malformation manifests after delivery as severe respiratory distress, cyanosis, lack of crying and impossibility of endotracheal respiratory support. This anomaly is usually associated with cardiovascular, respiratory and gastrointestinal malformations. Only a high index of suspicion and early surgical management will prevent death. An early diagnosis may also help the parents and the medical team to take appropriate decisions. Currently, there is no effective therapy that guarantees long-term survival

[Group therapy for the treatment of obesity in children and adolescents]. / Terapia de grupo para el tratamiento de la obesidad infantil.

THERAPY: Although obesity is one of the leading health problems in developed countries, effective treatment is lacking. The aim of the present study was to determine whether group therapy is more efficient in inducing weigh loss than individual therapy in the pediatric age group. EXPERIMENTAL DESIGN: Fifty obese patients, 15 preadolescents and 33 adolescents (12 boys and 23 girls) were studied. In all patients, dietary intake was modified to reduce calorie intake. Initially all patients were followed-up individually every 3 months (individual therapy) until the beginning of group therapy when the patients were seen monthly in groups of 10-15 patients with their parents (preadolescents) or alone (adolescents). In the group sessions, talks were given about diet and exercise. In each session, the patient who had shown the greatest improvement in habits and weight loss received a prize. The patients were followed-up for 2 years, with individual therapy in the first year and group therapy in the second. Differences in body mass index (BMI) z-score before the beginning of therapy and during therapy were analyzed using Student's paired T test. RESULTS: With individual therapy, no changes in BMI z-score were observed throughout the study. In contrast, with group therapy, BMI z-score decreased in all the groups studied. During the 1-year follow-up with individual therapy, 60 % of the patients gained more than 5 kg. With group therapy, only 10 % of patients gained more than 5 kg. CONCLUSIONS: In obese children and adolescents, group therapy was more efficient than individual therapy in inducing weight loss.

Terapia de grupo para el tratamiento de la obesidad infantil / Group therapy for the treatment of obesity in children and adolescents

Objetivos. No existen formas eficaces de tratamiento de la obesidad a pesar de constituir uno de los principales problemas sanitarios de los países desarrollados. En el presente trabajo estudiamos si la terapia de grupo es más eficaz para perder peso que la terapia individual en la edad pediátrica. Métodos. Se seleccionó un grupo de 50 pacientes obesos; 15 niños preadolescentes y 35 adolescentes (12 niños y 23 niñas). En todos ellos, tras la revisión de la dieta se introdujeron modificaciones para disminuir la ingesta calórica. Los niños fueron seguidos trimestralmente (terapia individual) hasta que se inició la terapia de grupo, realizándose a partir de entonces visitas mensuales en grupos de 10-15 niños, junto con sus padres (los preadolescentes) o solos (adolescentes). En las sesiones se comentaron temas nutricionales y formas de incrementar la actividad física. Además se dio un premio al niño que conseguía mejorar sus hábitos y perdía peso. Los pacientes fueron controlados durante 2 años, el primero con terapia individual y el segundo con terapia de grupo. Utilizando el test de la T-pareada se comparó la diferencia entre la z-score del índice de masa corporal (IMC) al inicio del tratamiento y durante el mismo. Resultados. Con la terapia individual no se observaron cambios en la z-score del IMC a lo largo del tiempo de seguimiento, mientras que con la terapia de grupo se observó una disminución significativa en todos los grupos. Durante el año de seguimiento con terapia individual un 60 % de los niños ganaron más de 5 kg, comparado con el 10 % observado durante la terapia de grupo. Conclusiones. En niños y adolescentes obesos, la terapia de grupo resultó más eficaz para perder peso que la terapia individual

Therapy. Although obesity is one of the leading health problems in developed countries, effective treatment is lacking. The aim of the present study was to determine whether group therapy is more efficient in inducing weigh loss than individual therapy in the pediatric age group. Experimental design. Fifty obese patients, 15 preadolescents and 33 adolescents (12 boys and 23 girls) were studied. In all patients, dietary intake was modified to reduce calorie intake. Initially all patients were followed-up individually every 3 months (individual therapy) until the beginning of group therapy when the patients were seen monthly in groups of 10-15 patients with their parents (preadolescents) or alone (adolescents). In the group sessions, talks were given about diet and exercise. In each session, the patient who had shown the greatest improvement in habits and weight loss received a prize. The patients were followed-up for 2 years, with individual therapy in the first year and group therapy in the second. Differences in body mass index (BMI) z-score before the beginning of therapy and during therapy were analyzed using Student's paired T test. Results. With individual therapy, no changes in BMI z-score were observed throughout the study. In contrast, with group therapy, BMI z-score decreased in all the groups studied. During the 1-year follow-up with individual therapy, 60 % of the patients gained more than 5 kg. With group therapy, only 10 % of patients gained more than 5 kg. Conclusions. In obese children and adolescents, group therapy was more efficient than individual therapy in inducing weight loss

Comentario al artículo 'Tratamiento con infusión subcutánea continua de insulina en pacientes pediátricos con diabetes mellitus tipo 1' / Comment on the article 'Continuous subcutaneous insulin infusion in pediatric patients with type 1diabetes mellitus'

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[The cannabinoid system and its importance in the perinatal period]. / El sistema cannabinoide y su importancia en el período perinatal.

The cannabinoid system has been recently described, including the endogenous ligands, mainly arachidonic acid derivatives, and their specific receptors. Endocannabinoids are involved in the modulation of synaptic transmission, through which they exert their psychoactive, motor and antinociceptive effects, among others; they also exert extraneural effects, mainly immunomodulation and vasodilation. Recent data suggest that the cannabinoid system might play an important role in human ontogeny and could participate in the implantation and early development of the embryo, in fetal brain development, and in the beginning of breast feeding after birth. In addition, the vasodilatory effect of cannabinoids, together with inhibition of the release of excitotoxic amino acids and cytokines, as well as modulation of oxidative stress and the toxic production of nitric oxide, justify the growing evidence pointing to a possible neuroprotective effect of cannabinoids in perinatal asphyxia.

El sistema cannabinoide y su importancia en el período perinatal / The cannabinoid system and its importance in the perinatal period

El cannabinoide es un sistema de reciente descubrimiento, constituido por unos ligandos endógenos, que mayoritariamente derivan del ácido araquidónico, y sus receptores específicos. Los endocannabinoides participan en la regulación de la transmisión sináptica, mediante la cual ejercen sus efectos psicoactivos, motores y anticonceptivos, entre otros; asimismo desarrollan efectos extraneurales, especialmente inmunomodulación y vasodilatación. Los descubrimientos recientes apuntan a un papel relevante de este sistema en la ontogenia del ser humano, postulándose una participación destacada en la implantación y desarrollo inicial del embrión, en el desarrollo cerebral fetal, y en el inicio de la lactancia tras el nacimiento. Asimismo, sus efectos vasodilatadores e inhibidores de la liberación de aminoácidos excitotóxicos y de citocinas, así como moduladores del estrés oxidativo y de la producción tóxica de óxido nítrico, justifican la creciente evidencia de un posible papel neuroprotector de los cannabinoides en la asfixia perinatal

The cannabinoid system has been recently described, including the endogenous ligands, mainly arachidonic acid derivatives, and their specific receptors. Endocannabinoids are involved in the modulation of synaptic transmission, through which they exert their psychoactive, motor and antinociceptive effects, among others; they also exert extraneural effects, mainly immunomodulation and vasodilation. Recent data suggest that the cannabinoid system might play an important role in human ontogeny and could participate in the implantation and early development of the embryo, in fetal brain development, and in the beginning of breast feeding after birth. In addition, the vasodilatory effect of cannabinoids, together with inhibition of the release of excitotoxic amino acids and cytokines, as well as modulation of oxidative stress and the toxic production of nitric oxide, justify the growing evidence pointing to a possible neuroprotective effect of cannabinoids in perinatal asphyxia

Hipoglucemia debida a insuficiencia suprarrenal secundaria a déficit de CRH / Hypoglycemia due to adrenal insufficiency secondary to corticotropin-releasing hormone deficiency

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Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades / The clinical semiology of attention déficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages

Introduction. Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. Aim. To analyse the different clinical features and the response to psychostimulant therapy, according to the age. Subjects and methods.We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners’ Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. Results. ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. Conclusions. The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6 (AU)

Introducción. El trastorno por déficit de atención con hiperactividad (TDAH) es la causa más importante de fracaso escolar, y suele asociarse además a trastornos de conducta, emocionales y de sociabilidad. Objetivo. Analizar las distintas manifestaciones clínicas y la respuesta al tratamiento con psicoestimulantes, en función de la edad. Sujetos y métodos. Se revisan 152 niños remitidos a Neuropediatría por sospecha de TDAH en 6 años. El diagnóstico y la comorbilidad se investiga mediante anamnesis, exploración y observación, entrevista a padres (criterios DSM-IV), cuestionario de Conners para padres y profesores, y pruebas neuropsicológicas. Para mejor tratamiento de los datos, realizamos cuatro grupos según la edad al diagnóstico e inicio del tratamiento: G1: 3-5; G2: 6-8; G3: 9-11 y G4: 12-15 años. Resultados. De los 152 niños, se diagnosticó TDAH en 102; el 53% fueron de tipo combinado, el 26% inatencional, y el 20% hiperactivo/impulsivo. El mal rendimiento escolar aumenta con la edad, y un 75% es en el G4. Lo mismo sucede con los trastornos de conducta: a los 6 años ya encontramos un 23% de trastorno negativista desafiante, y a partir de los 9 años más de un 60% presentan trastornos de conducta. Mejoran con psicoestimulantes un 70% hasta los 12 años, y, después, el índice de abandono del control clínico médico y del tratamiento es de más de un 40%. Conclusiones. Cuanto mayores y más tarde se atienden los TDAH, más problemas tienen. La prevención hace conveniente empezar el tratamiento incluso antes de iniciar la educación primaria (5 años), en un intento de evitar las repercusiones pedagógicas y conductuales observadas ya a los 6 años en estos niños (AU)

[The clinical semiology of attention deficit hyperactivity disorder according to age, and the effectiveness of treatments at different ages]. / Semiología clínica del trastorno por déficit de atención con hiperactividad en función de la edad y eficacia de los tratamientos en las distintas edades

INTRODUCTION: Attention deficit hyperactivity disorder (ADHD) is the most important cause of poor academic performance and is also usually associated with behavioural, emotional and sociability disorders. AIM: To analyse the different clinical features and the response to psychostimulant therapy, according to the age. SUBJECTS AND METHODS: We reviewed the cases of 152 children referred to Neuropaediatrics owing to suspected ADHD over a 6-year period. Diagnosis and comorbidity were investigated by the looking at their case history, by examination and observation, as well as by interviewing the parents (DSM-IV criteria), and by applying Conners' Rating Scale for parents and teachers, in addition to neuropsychological tests. In order to improve data processing, we established four groups according to the patient's age at diagnosis and when treatment was started: G1: 3-5; G2: 6-8; G3: 9-11; and G4: 12-15 years. RESULTS: ADHD was diagnosed in 102 of the 152 children; 53% had the combined type, 26% were of the inattentional type, and 20% were hyperactive/impulsive. Poor school performance increased with age and reached 75% in G4. The same occurred with conduct disorders: at 6 years of age, 23% were found to have oppositional defiant disorder, and from the age of 9 onwards over 60% of them had conduct disorders. Up until 12 years of age they showed some improvement with psychostimulants and later the rate of dropouts from medical clinical controls and from treatment was over 40%. CONCLUSIONS: The older patients are and the later ADHD is attended, the more problems they have. If successful preventive measures are to be implemented, it would be advisable to begin treatment even before children start primary education (5 years old), so as to try and avoid the pedagogical and behavioural repercussions observed in these children at the age of 6.

[Coronary angiography with multislice computed tomography]. / Angiografía coronaria mediante tomografía computarizada multicorte.

Echocardiography allows visualization of the origin of the coronary arteries and their proximal trajectory but evaluation of the middle and distal portions of these vessels is limited. Invasive coronary angiography is currently the procedure of choice to evaluate coronary anatomy. New imaging techniques have recently been developed that allow coronary structures to be visualized. One of these techniques is multislice or multidetector computed tomography (MSCT) which provides a static image of the final distribution of contrast in the vascular tree. We report a patient in whom a differential diagnosis between myopericarditis and myocardial ischemia was being considered. MSCT coronary angiography allowed the coronary tree to be visualized and anomalies in this location to be ruled out. The main limitations of MSCT coronary angiography in children are elevated cardiac frequency, making high quality images difficult to obtain, and irradiation. Although the use of MSCT coronary angiography to evaluate coronary arteries in the pediatric population currently presents considerable limitations, this procedure can be useful in selected children with suspected congenital anomalies, aneurysms or coronary fistulas who are not considered suitable candidates for conventional invasive coronary angiography.

Angiografía coronaria mediante tomografía computarizada multicorte / Coronary angiography with multislice computed tomography

La ecocardiografía es una técnica que permite visualizar el origen de las arterias coronarias y su trayecto proximal, pero la valoración de los trayectos medios y distales de dichos vasos es limitada. La angiografía coronaria invasiva es actualmente el procedimiento de elección para la evaluación de la anatomía coronaria. Recientemente han surgido nuevas técnicas de imagen que permiten la visualización de la anatomía cardíaca entre las que destaca la tomografía computarizada multicorte o multidetector (TCM) que ofrece una imagen estática de la distribución final del contraste en el árbol vascular. A propósito de un paciente en el que se planteó el diagnóstico diferencial entre miopericarditis e isquemia miocárdica se presenta una angiografía coronaria mediante TCM que permitió el estudio del árbol coronario y descartar anomalías en esa localización. Las principales limitaciones de la angiografía mediante TCM en niños son la frecuencia cardíaca elevada que dificulta la obtención de imágenes de calidad en niños pequeños y la irradiación. Aunque la aplicación de la TCM en la población infantil para valorar las arterias coronarias tiene, por el momento, importantes limitaciones, puede resultar útil en niños seleccionados con sospecha de anomalías congénitas, aneurismas o fístulas coronarias y que no se consideren candidatos para la práctica de una angiografía coronaria invasiva convencional

Echocardiography allows visualization of the origin of the coronary arteries and their proximal trajectory but evaluation of the middle and distal portions of these vessels is limited. Invasive coronary angiography is currently the procedure of choice to evaluate coronary anatomy. New imaging techniques have recently been developed that allow coronary structures to be visualized. One of these techniques is multislice or multidetector computed tomography (MSCT) which provides a static image of the final distribution of contrast in the vascular tree. We report a patient in whom a differential diagnosis between myopericarditis and myocardial ischemia was being considered. MSCT coronary angiography allowed the coronary tree to be visualized and anomalies in this location to be ruled out. The main limitations of MSCT coronary angiography in children are elevated cardiac frequency, making high quality images difficult to obtain, and irradiation. Although the use of MSCT coronary angiography to evaluate coronary arteries in the pediatric population currently presents considerable limitations, this procedure can be useful in selected children with suspected congenital anomalies, aneurysms or coronary fistulas who are not considered suitable candidates for conventional invasive coronary angiography