Síndrome del lóbulo medio y tuberculosis endobronquial. Aportación de la fibrobroncoscopia / Middle lobe syndrome and endobronchial tuberculosis. Contribution of fiberoptic bronchoscopy

El síndrome del lóbulo medio es una patología frecuente en el niño, sobre todo en relación con el asma y/o la hiperreactividad bronquial, aunque existen otras muchas causas, como los cuerpos extraños, la tuberculosis endobronquial, etc. Presentamos el caso de un niño de 5 años de edad, con atelectasia persistente en la base derecha con participación del lóbulo medio, que se diagnosticó de tuberculosis. La tomografía computarizada confirmó la lesión y, ante una prueba de la tuberculina positiva, se realizó una fibrobroncoscopia para descartar una tuberculosis endobronquial, que demostró la presencia de una lesión polipoidea en el bronquio intermediario a la entrada del lóbulo medio. Se describen las diversas formas de tuberculosis endobronquial, así como el tratamiento con corticoides sistémicos. Se aconseja la realización de una fibrobroncoscopia en los casos de tuberculosis pulmonar con alteraciones radiológicas persistentes (atelectasia, atrapamiento aéreo, etc.) y/o falta de mejoría clínica pese al tratamiento adecuado(AU)

Middle lobe syndrome is a common condition in children, mainly related to asthma and/or bronchial hyperresponsiveness, although there are many other causes, such as foreign bodies, endobronchial tuberculosis, etc. We report a 5-year-old child with persistent atelectasis involving the right middle lobe, and diagnosed with tuberculosis. Computed tomography confirmed the injury and after a positive tuberculin skin test, fiberoptic bronchoscopy is performed to rule out endobronchial tuberculosis showing a polypoid lesion in the bronchus intermedius at the entrance of the middle lobe. It describes the various forms of endobronchial tuberculosis, and treatment with systemic corticosteroids. Fiberoptic bronchoscopy is recommended in cases of pulmonary tuberculosis with persistent radiographic abnormalities (atelectasis, air trapping, etc.) and/or a lack of clinical improvement with an adequate treatment(AU)

Displasia broncopulmonar y prematuridad. Evolución respiratoria a corto y a largo plazo / Bronchopulmonary dysplasia and prematurity. Short-and long-term respiratory changes

La displasia broncopulmonar (DBP) es la enfermedad pulmonar crónica más frecuente en niños prematuros. Con la introducción de corticoides prenatales, la administración de agente tensioactivo y las nuevas estrategias de ventilación mecánica, se ha incrementado la supervivencia de neonatos cada vez más inmaduros, por lo que la incidencia de la DBP no sólo no ha descendido, sino que ha aumentado en este grupo de niños nacidos extremadamente pretérmino. Condiciona una gran morbilidad respiratoria en los 2–3 primeros años de vida, con numerosos ingresos hospitalarios y agudizaciones respiratorias provocados en su mayoría por infecciones víricas. Aunque hay una tendencia hacia la mejoría, en la edad escolar y la adolescencia persisten los síntomas respiratorios, así como alteraciones en la función pulmonar, y con cierta frecuencia estos niños presentan menor capacidad para el ejercicio. Aunque los síntomas de la DBP son muy parecidos a los del asma, ya que existe limitación al flujo aéreo e hiperrespuesta bronquial (HRB), el mecanismo fisiopatológico podría ser distinto en las 2 enfermedades. Por otra parte, la prematuridad aislada desempeña un papel importante en la enfermedad respiratoria crónica del niño y ya desde los primeros meses de vida se demuestran alteraciones en la función pulmonar de niños pretérmino sanos. Se ha observado que estos niños también tienen mayor morbilidad respiratoria que los nacidos a término no sólo en los primeros años de vida, sino en edades posteriores. En este artículo analizaremos distintos aspectos de la enfermedad respiratoria crónica asociada a la prematuridad, deteniéndonos en la sintomatología clínica, las alteraciones de la función pulmonar, la HRB y la capacidad de ejercicio. Haremos un recorrido desde la primera infancia hasta la adolescencia y la edad adulta joven. También veremos las similitudes y las diferencias entre la DBP y el asma (AU)

Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in premature children. With the inclusion of antenatal steroid therapy, surfactant use and novel mechanical ventilation strategies, survival of premature newborns has increased, whereupon the incidence of BPD has not only decreased but has also risen in extremely premature newborns. This has led to a high respiratory morbidity in the first 2–3 years of life, with numerous admissions to hospital and respiratory exacerbations mostly due to viral infections. Although there is a trend towards improvement, during school age and adolescence, respiratory symptoms may persist, due to changes in pulmonary function often showing a lower exercise capacity. Although BPD symptoms are similar to those of asthma, as there is limitation in airflow and bronchial hyperresponsiveness (BHR), pathophysiological mechanisms could be different in both diseases. On the other hand, isolated prematurity plays an important role in the child's respiratory pathology, proving that pulmonary function alterations in preterm children are present since the first months of life. A higher respiratory morbidity has also been observed in these children when compared to full-term newborns, not only during the first years of life but also subsequently. In this study, different aspects of chronic respiratory disease associated with prematurity will be analysed, drawing special attention to clinical symptoms, respiratory function changes, BHR and exercise capacity. All these aspects will be reviewed from early childhood until adolescence and young adult age. Similarities and differences between BPD and asthma will also be discussed (AU)

[Bronchopulmonary dysplasia and prematurity. Short-and long-term respiratory changes]. / Displasia broncopulmonar y prematuridad. Evolución respiratoria a corto y a largo plazo.

Bronchopulmonary dysplasia (BPD) is the most frequent chronic lung disease in premature children. With the inclusion of antenatal steroid therapy, surfactant use and novel mechanical ventilation strategies, survival of premature newborns has increased, whereupon the incidence of BPD has not only decreased but has also risen in extremely premature newborns. This has led to a high respiratory morbidity in the first 2-3 years of life, with numerous admissions to hospital and respiratory exacerbations mostly due to viral infections. Although there is a trend towards improvement, during school age and adolescence, respiratory symptoms may persist, due to changes in pulmonary function often showing a lower exercise capacity. Although BPD symptoms are similar to those of asthma, as there is limitation in airflow and bronchial hyperresponsiveness (BHR), pathophysiological mechanisms could be different in both diseases. On the other hand, isolated prematurity plays an important role in the child's respiratory pathology, proving that pulmonary function alterations in preterm children are present since the first months of life. A higher respiratory morbidity has also been observed in these children when compared to full-term newborns, not only during the first years of life but also subsequently. In this study, different aspects of chronic respiratory disease associated with prematurity will be analysed, drawing special attention to clinical symptoms, respiratory function changes, BHR and exercise capacity. All these aspects will be reviewed from early childhood until adolescence and young adult age. Similarities and differences between BPD and asthma will also be discussed.

Guía de diagnóstico y tratamiento del asma de control difícil en el niño / Diagnosis and treatment guidelines for difficult-to-control asthma in children

Los niños con asma de control difícil (ACD) requieren frecuentes consultas, reciben complejos regímenes de tratamiento y, a menudo, requieren ingresos en el hospital. Su frecuencia es escasa, y abarca no más del 5% de la población asmática. El ACD requiere un diagnóstico de certeza, por lo que se tendrán que descartar causas de falso ACD, y es necesario hacer un diagnóstico diferencial con factores de enfermedad sobreañadida, medioambientales, psicológicos, y analizar causas que determinen una baja adherencia al tratamiento. Ante un verdadero ACD, el estudio de la inflamación (óxido nítrico exhalado, esputo inducido, lavado broncoalveolar y biopsia bronquial), la función pulmonar y la clínica nos pueden permitir clasificar el ACD en diversos fenotipos que nos facilitarán la toma de decisiones terapéuticas (AU)

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier (AU)

[Diagnosis and treatment guidelines for difficult-to-control asthma in children]. / Guía de diagnóstico y tratamiento del asma de control difícil en el niño.

Children suffering from difficult-to-control asthma (DCA) require frequent appointments with their physician, complex treatment regimes and often admissions to hospital. Less than 5% of the asthmatic population suffer this condition. DCA must be correctly characterised to rule out false causes of DCA and requires making a differential diagnosis from pathologies that mimic asthma, comorbidity, environmental and psychological factors, and analysing the factors to determine poor treatment compliance. In true DCA cases, inflammation studies (exhaled nitric oxide, induced sputum, broncho-alveolar lavage and bronchial biopsy), pulmonary function and other clinical aspects can classify DCA into different phenotypes which could make therapeutic decision-making easier.

Consensus Statement on the Management of Paediatric Asthma. Update 2007

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Causas de asma de control difícil (ACD). Factores que pueden agravar el asma / No disponible

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[Respiratory morbidity after hospital discharge in premature infants born at < or = 32 weeks gestation with bronchopulmonary dysplasia]. / Morbilidad respiratoria tras el alta hositalaria en prematuros (< or = 32 semanas) con displasia broncopulmonar.

BACKGROUND: Bronchopulmonary dysplasia (BPD) is the most frequent cause of respiratory morbidity in the first 2 years of life among preterm infants who survive the first 28 days. OBJECTIVES: To evaluate respiratory morbidity in the first 2 years of life in a group of preterm infants born at (32 weeks' gestation with BPD (oxygen requirement at 36 weeks' postconceptional age) by comparing it with that in preterm infants born at (32 weeks without BPD and with a control group of full term infants without neonatal morbidity. To determine whether respiratory morbidity in children with BPD decreases after the age of 2 years. PATIENTS AND METHOD: Group I: preterm children with BPD (n = 29). Group II: preterm children without BPD (n = 29). Group III: children with appropriate gestational age and weight (n = 32). A cross-sectional, descriptive study of the three groups was performed over a 2-year period. In 17 children in group 1, the study was prolonged to the age of 4 years. We analyzed wheezing on at least two occasions, use of inhaled bronchodilators, use of inhaled glucocorticosteroids for more than 6 months, and hospitalization for respiratory illness. The chi-square test and Fischer's exact test were performed. RESULTS: At least one episode of wheezing occurred in 25 children (86.2%) in group I compared with 12 children (41.4%) in group II and 6 (18.8%) in group III. Nineteen children (65.5%) in group I and none in the remaining two groups received treatment with inhaled glucocorticosteroids for more than 6 months (p < 0.001). Inhaled bronchodilators were used by 25 children (86.2%) in group I compared with 12 (41.4%) in group II and 6 (18.8%) in the control group (p < 0.001). Twelve children (41.3%) in group I were hospitalized for respiratory illness compared with 8 (27.6%) in group II. There were no admissions among the control group. None of the children with BPD who received prophylaxis with palivizumab contracted respiratory syncytial virus infection. Seventeen children with BPD were evaluated until the age of 4 years. Episodes of wheezing decreased from 88.2% in the first year to 41 % between the third and fourth years (p < 0.001). Treatment with inhaled glucocorticosteroids for more than 6 months was given to 88.2% in the first year, 41.2 % between the first and second year and to 0 % after the second year (p < 0.001). Hospital admissions for respiratory illness decreased from 52.9% in the first year to 17.6% in the second year. None of the children were hospitalized after the age of 2 years (p < 0.001). CONCLUSIONS: During the first 2 years of life, children with BPD showed a greater number of admissions and episodes of wheezing and a greater need for medical treatment. Respiratory morbidity improved with age, 40% showed recurrent wheezing episodes at the age of 4 years.

Morbilidad respiratoria tras el alta hospitalaria en prematuros (32 semanas) con displasia broncopulmonar / Respiratory morbidity after hospital discharge in premature infants born at<= 32 weeks´ gestation with bronchopulmonary dysplasia

Antecedentes: La displasia broncopulmonar es la causa más frecuente de morbilidad respiratoria en los primeros 2 años en el niño pretérmino que sobrevive a los 28 días de vida. Objetivos: Valorar la morbilidad respiratoria durante los primeros 2 años de vida en un grupo de niños pretérmino (>=32 semanas) con displasia broncopulmonar (necesidad de oxígeno a las 36 semanas de edad posconcepcional), comparándola con la de niños pretérmino (<=32 semanas) sin displasia broncopulmonar y con un grupo control de nacidos a término sin enfermedad neonatal. Comprobar si la morbilidad respiratoria en los niños con displasia broncopulmonar disminuye a partir de los 2 años de edad. Pacientes y método: Grupo I: niños pretérmino con displasia broncopulmonar (n=29). Grupo II: niños pretérmino sin displasia broncopulmonar (n=29). Grupo III: niños de peso y edad gestacional adecuados (n=32). En los 3 grupos se realizó estudio longitudinal descriptivo durante 2 años, y en 17 niños del grupo I se realizó el mismo estudio hasta la edad de 4 años. Se analizaron las siguientes variables: sibilancias en al menos dos ocasiones, empleo de broncodilatadores inhalados, utilización de glucocorticoides inhalados durante más de 6 meses, ingresos hospitalarios por problemas respiratorios mediante test de chi cuadrado (X2) y test de Fischer. Resultados: Tuvieron algún episodio de sibilancias 25 niños del grupo I (86,2 por ciento) frente a 12 (41,4 por ciento) del grupo II y 6 (18,8 por ciento) del grupo III. Fueron tratados con glucocorticoides inhalados durante más de 6 meses, 19 niños del primer grupo (65,5 por ciento) y ninguno de los otros 2 grupos (p < 0,001). Utilizaron broncodilatadores inhalados 25 niños del grupo I (86,2 por ciento) frente a 12 (41,4 por ciento) del grupo II y 6 (18,8 por ciento) del grupo control (p < 0,001). Fueron hospitalizados por problemas respiratorios 12 niños del grupo I (41,3 por ciento) frente a 8 (27,6 por ciento) del grupo II, sin que ingresara ninguno del grupo control. De los niños con displasia broncopulmonar que recibieron profilaxis con palivizumab ninguno tuvo infección demostrada por virus respiratorio sincitial (VRS).Se evaluaron hasta los 4 años de edad 17 niños con displasia broncopulmonar. Los episodios de sibilancias disminuyeron del 88,2 por ciento en el primer año al 41 por ciento entre el tercer y cuarto años (p < 0,001). Recibieron tratamiento con glucocorticoides inhalados durante más de 6 meses el 88,2 por ciento en el primer año, el 41,2 por ciento entre el primer y segundo años y ninguno a partir del segundo año (p < 0,001).Los ingresos hospitalarios por problemas respiratorios descendieron del 52,9 por ciento en el primer año al 17,6 por ciento en el segundo, y ningún niño necesitó ingreso a partir de los 2 años (p < 0,001). Conclusiones: Durante los primeros 2 años, los niños con displasia broncopulmonar tienen mayor número de ingresos, más episodios de sibilancias y más necesidad de tratamiento médico; mejoran con la edad, aunque a los 4 años el 40 por ciento tienen episodios repetidos de sibilancias (AU)

Seguimiento posterior al alta de la unidad neonatal / No disponible

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Sucralfate in the treatment of reflux esophagitis in children. Preliminary results.

In order to evaluate the use of sucralfate in the treatment of children with reflux esophagitis, we studied 66 children aged from 4 months to 12 years (mean 5.9 years, SD 3.5) diagnosed to have gastroesophageal reflux by means of esophageal isotopic examination and radiology. An endoscopic examination was carried out in all cases. None of the patients suffered from kidney disease or had taken antacids, cimetidine, sucralfate or antirheumatic drugs in the two weeks prior to the study. Patients were divided into three groups matched according to age, grade of esophagitis, sex, nutritional state and semiology and treated with sucralfate in tablets, cimetidine, or sucralfate in suspension; no dietetic or postural measures were used. On days 14, 28, 42 and 56, clinical control was carried out and endoscopy was done on day 28, this being repeated on day 56 if the course was not satisfactory. From the statistical analysis of the results we deduce that there are no differences between the three groups. Therefore sucralfate appears to be a useful drug for the treatment of children with esophagitis due to GER.

[Pulmonary arteriovenous fistula treated using percutaneous transcatheter embolization]. / Fístulas arteriovenosas pulmonares tratadas mediante embolización percutánea transcatéter.

Authors report results of treatment of two patients with congenital pulmonary arteriovenous fistulae by means of percutaneous transcatheter embolization utilizing metallic coils. They found a total regression of clinical signs after a follow-up of 36 and 30 months respectively.