Dolor musculoesquelético: una forma de inicio frecuente de leucemia linfoblástica aguda / Musculoskeletal pain: A common initial sign of acute lymphoblastic leukaemia

El dolor musculoesquelético es una consulta común en la infancia, y su etiología generalmente es banal. Sin embargo, hay que tener presente que los procesos neoplásicos pueden causar este tipo de síntoma. De hecho, 4 de las 9 leucemias diagnosticadas en nuestro hospital entre noviembre de 2008 y julio de 2009 se iniciaron con dolor musculoesquelético. Por este motivo, presentamos los casos de leucemia y revisamos los distintos parámetros a tener en cuenta para sospechar y realizar una detección precoz de estos procesos, ya que esto supone una mejoría importante del pronóstico (AU)

Musculoskeletal pain is a common complaint in paediatrics usually due to benign diseases. Nevertheless neoplasms, particularly acute leukaemia, must be considered in the differential diagnosis. During the last 9 months 4 of the 9 patients diagnosed with acute leukaemia at our hospital presented with a limp, arthralgias, lumbar or bony pain. We describe these cases and review the clinical and analytical parameters that help to differentiate benign pain from that associated with a malignant disease. The early detection of these processes may represent a significant improvement in their prognosis (AU)

Evolución a largo plazo de la nefritis lúpica de inicio en la edad pediátrica / Long-term outcome of paediatric lupus nephritis

Introducción: El riñón es uno de los órganos más frecuentemente afectados por el lupus eritematoso sistémico. Recientemente se ha indicado que el pronóstico renal en esta enfermedad ha mejorado con un diagnóstico y tratamiento específico más precoz e intenso. A menudo, los estudios en edad pediátrica carecen de un tiempo de seguimiento suficiente para conocer la evolución a largo plazo. Pacientes y métodos: Estudio descriptivo retrospectivo desde 1986 hasta 2009 basado en la revisión de historias clínicas de pacientes diagnosticados de nefritis lúpica en la sección de Nefrología Infantil de un hospital terciario. Se incluye a pacientes menores de 18 años de edad al diagnóstico y se excluye a pacientes con seguimiento menor de 3 meses o datos incompletos. Recogida y descripción evolutiva de variables clínicas, analíticas de función renal y actividad de la enfermedad así como anatomía patológica y tratamientos empleados. Análisis de variables de riesgo para existencia de afectación renal en el último control. Resultados: Recuperamos datos de 16 pacientes (3 varones y 13 mujeres) con una edad al inicio del lupus eritematoso sistémico de 10,6±2,9 años y al diagnóstico de nefritis lúpica de 12,6±3,5 años. Se obtuvo biopsia renal en 14 de ellos, en 11 de estos (78,6%) 3 meses o menos tras el diagnóstico. En 9 casos (64,3%) se encontró una clase IV de la OMS (3 casos clase III y 2 casos clase II). En el último control (10,7±6,7 años de evolución), 7/16 (43,8%) presentaban enfermedad renal crónica: 5 casos con proteinuria (uno en rango nefrótico), un caso en estadio 2 y un caso en hemodiálisis tras fracaso de injerto renal. Entre los seguidos más de 10 años, 4/9 (44,4%) tenían alteraciones: 3 pacientes presentaban proteinuria más el paciente en hemodiálisis. La mayoría (15/16) recibieron tratamiento con bolos de ciclofosfamida intravenosa en número variable tras el diagnóstico. Solamente se encontró asociación de la afectación renal con una mayor proteinuria a los 3 meses, al año y a los 3 años de evolución. Conclusiones: Consideramos la evolución de nuestros pacientes a largo plazo como muy satisfactoria. Aunque un 44,4% de aquellos con más de 10 años de seguimiento presentaba alguna alteración renal, solamente uno (11,1%) ha evolucionado a insuficiencia renal terminal. Estos pacientes presentaban una mayor proteinuria desde los primeros controles (AU)

Introduction: Kidney is frequently affected in patients with systemic lupus erythematosus (SLE). It has been recently suggested that the renal outcome in this disease has improved with an earlier diagnosis and intensive specific treatment. Quite often, articles with paediatric patients lack a prolonged follow-up which could help to predict long term outcome. Methods: This is a retrospective descriptive study based on the review of clinical records from patients with a diagnosis of lupus nephritis in a Paediatric Nephrology unit of a tertiary care centre, between 1987 and 2009. Patients were included with an age up to 18 at diagnosis. They were excluded if follow-up period was shorter than 3 months or if data lacked about it. It includes descriptive evolution of clinical parameters, kidney function, lupus activity as well as pathology and treatment. Several variables were tested for association with chronic kidney disease (CKD) in the last checkpoint. Results: Data were obtained from 16 patients, 3 men and 13 women. Age at the beginning of SLE was 10.6±2.9 years and 12.6±3.5 years at debut of lupus nephritis. Biopsy was obtained in 14 of them, in 11 cases (78.6 %), 3 or less months following diagnosis. In 9 cases (64.3 per cent), biopsy showed WHO class IV, 3 cases, class III and 2 cases, class II. In the last control (10.7±6.7 years of follow-up), 7/16 (43.8 %) had developed CKD: 5 cases with proteinuria (one in nephrotic range), one in stage 2 and one patient in haemodialysis after renal graft loss. Among those with a follow-up longer than 10 years, 4/9 (44.4 %) of them showed some sign of renal disease: 3/9 with proteinuria, and the one needing haemodialysis. Most of the patients (15/16) received treatment with intravenous cyclophosphamide boluses in a variable number after diagnosis. Only a more intense proteinuria at 3 months, 1 year and 3 years of evolution was related to CKD in the last visit. Conclusions: We consider the long term evolution of our patients to have been very satisfactory. Although 44.4 % of them developed renal anomalies after 10 or more years, only one (11.1%) reached an end-stage renal disease. These patients presented a higher grade of proteinuria from the first visits (AU)

[Long-term outcome of paediatric lupus nephritis]. / Evolución a largo plazo de la nefritis lúpica de inicio en la edad pediátrica.

INTRODUCTION: Kidney is frequently affected in patients with systemic lupus erythematosus (SLE). It has been recently suggested that the renal outcome in this disease has improved with an earlier diagnosis and intensive specific treatment. Quite often, articles with paediatric patients lack a prolonged follow-up which could help to predict long term outcome. METHODS: This is a retrospective descriptive study based on the review of clinical records from patients with a diagnosis of lupus nephritis in a Paediatric Nephrology unit of a tertiary care centre, between 1987 and 2009. Patients were included with an age up to 18 at diagnosis. They were excluded if follow-up period was shorter than 3 months or if data lacked about it. It includes descriptive evolution of clinical parameters, kidney function, lupus activity as well as pathology and treatment. Several variables were tested for association with chronic kidney disease (CKD) in the last checkpoint. RESULTS: Data were obtained from 16 patients, 3 men and 13 women. Age at the beginning of SLE was 10.6 + or - 2.9 years and 12.6 + or - 3.5 years at debut of lupus nephritis. Biopsy was obtained in 14 of them, in 11 cases (78.6 %), 3 or less months following diagnosis. In 9 cases (64.3 per cent), biopsy showed WHO class IV, 3 cases, class III and 2 cases, class II. In the last control (10.7 + or - 6.7 years of follow-up), 7/16 (43.8 %) had developed CKD: 5 cases with proteinuria (one in nephrotic range), one in stage 2 and one patient in haemodialysis after renal graft loss. Among those with a follow-up longer than 10 years, 4/9 (44.4 %) of them showed some sign of renal disease: 3/9 with proteinuria, and the one needing haemodialysis. Most of the patients (15/16) received treatment with intravenous cyclophosphamide boluses in a variable number after diagnosis. Only a more intense proteinuria at 3 months, 1 year and 3 years of evolution was related to CKD in the last visit. CONCLUSIONS: We consider the long term evolution of our patients to have been very satisfactory. Although 44.4 % of them developed renal anomalies after 10 or more years, only one (11.1%) reached an end-stage renal disease. These patients presented a higher grade of proteinuria from the first visits.

[Musculoskeletal pain: a common initial sign of acute lymphoblastic leukaemia]. / Dolor musculoesquelético: una forma de inicio frecuente de leucemia linfoblástica aguda.

Musculoskeletal pain is a common complaint in paediatrics usually due to benign diseases. Nevertheless neoplasms, particularly acute leukaemia, must be considered in the differential diagnosis. During the last 9 months 4 of the 9 patients diagnosed with acute leukaemia at our hospital presented with a limp, arthralgias, lumbar or bony pain. We describe these cases and review the clinical and analytical parameters that help to differentiate benign pain from that associated with a malignant disease. The early detection of these processes may represent a significant improvement in their prognosis.

Lesiones equimóticas en miembro superior / Ecchymotic injuries in u pper extremity

El maltrato infantil es un problema que en muchos casos no llega a ser identificado. El papel del pediatra en la detección de una posible situación de abuso a través de la anamnesis, la exploración física, las pruebas complementarias y los datos sociales es fundamental. El maltrato físico debe formar parte del diagnóstico diferencial de cualquier lesión hallada en un niño. Las contusiones y los hematomas constituyen las manifestaciones más comunes, y existen hallazgos en la exploración que pueden orientar sobre su origen. Toda sospecha de maltrato debe comunicarse a las autoridades competentes. Se presenta un caso de maltrato físico detectado en el servicio de urgencias de un hospital terciario a partir de datos incongruentes en la anamnesis y lesiones sospechosas en la exploración(AU)

Child abuse is an important health problem which is often misdiagnosed. Paediatricians play a vital role in the detection of child maltreatment where, interviewing of parents and child, physical examination, diagnostic testing and investigation of any possible social risk factors is crucial when there is a suspicion. Maltreatment should be considered as part of the differential diagnosis when we face injuries in children. Haematomas and bruises are the most common clinical manifestation of physical abuse, and there are certain patterns which may be suggestive or even diagnostic of its probable origin. Suspected cases of child abuse should be always reported to the appropriate public agency. We present the case of a 12 year old boy, victim of physical abuse, diagnosed in the emergency department of a tertiary hospital based on a suspicion after vague explanation, inconsistent with the injury’s characteristics(AU)

El tortícolis como manifestación inicial de un tumor de fosa posterior: el caso de una niña con astrocitoma pilocítico / Torticolis as an initial sign of posterior fossa tumor: case of child with pilocytic astrocytoma

No disponible

No disponible

Brote intrafamiliar de gastroenteritis por Shigella flexneri en Madrid / Intrafamilial outbreak of Shigella flexneri gastroenteritis in Madrid

No disponible