Infarto esplénico masivo en un paciente pediátrico sin factores predisponentes / Massive splenic infarct in a pediatric patient without predisposing factors

El infarto esplénico es una entidad rara en la edad pediátrica que, cuando se encuentra, se asocia a otros factores predisponentes, como enfermedades oncológicas, hematológicas o infecciosas. Su presentación es asintomática o sintomática con dolor abdominal, fiebre y esplenomegalia. No existe consenso sobre cuál es la mejor opción de tratamiento, y se decide, en la mayoría de los casos, un manejo conservador o quirúrgico de acuerdo con las características individuales del paciente. Se presenta el caso de un paciente escolar que acude por un cuadro de dolor abdominal agudo y fiebre con diagnóstico de infarto esplénico masivo sin etiología aparente que fue manejado de manera conservadora, con evolución favorable. Es importante considerar este padecimiento como causa de dolor abdominal asociado a esplenomegalia y destacar la relevancia de esta presentación de caso, ya que se presenta sin relación con enfermedades subyacentes.

Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases. It is whether asymptomatic or symptomatic with abdominal pain, fever and splenomegaly. There is no consensus on which is the best treatment option, in most cases deciding conservative or surgical management according to individual patient characteristics. We present the case of a patient with acute abdominal pain and fever with a diagnosis of massive splenic infarction without apparent aetiology that was managed conservatively with favourable evolution. It is important to consider this condition as a cause of abdominal pain associated with splenomegaly.

[Massive splenic infarct in a pediatric patient without predisposing factors]. / Infarto esplénico masivo en un paciente pediátrico sin factores predisponentes.

Splenic infarction is a rare entity in the paediatric age that, when found, is associated with other predisposing factors such as oncological, haematological or infectious diseases. It is whether asymptomatic or symptomatic with abdominal pain, fever and splenomegaly. There is no consensus on which is the best treatment option, in most cases deciding conservative or surgical management according to individual patient characteristics. We present the case of a patient with acute abdominal pain and fever with a diagnosis of massive splenic infarction without apparent aetiology that was managed conservatively with favourable evolution. It is important to consider this condition as a cause of abdominal pain associated with splenomegaly.

El infarto esplénico es una entidad rara en la edad pediátrica que, cuando se encuentra, se asocia a otros factores predisponentes, como enfermedades oncológicas, hematológicas o infecciosas. Su presentación es asintomática o sintomática con dolor abdominal, fiebre y esplenomegalia. No existe consenso sobre cuál es la mejor opción de tratamiento, y se decide, en la mayoría de los casos, un manejo conservador o quirúrgico de acuerdo con las características individuales del paciente. Se presenta el caso de un paciente escolar que acude por un cuadro de dolor abdominal agudo y fiebre con diagnóstico de infarto esplénico masivo sin etiología aparente que fue manejado de manera conservadora, con evolución favorable. Es importante considerar este padecimiento como causa de dolor abdominal asociado a esplenomegalia y destacar la relevancia de esta presentación de caso, ya que se presenta sin relación con enfermedades subyacentes.

Intracoronary infusion of CD133+ endothelial progenitor cells improves heart function and quality of life in patients with chronic post-infarct heart insufficiency.

AIM: To assess the safety and efficacy of the intracoronary infusion of CD133+ hematopoietic stem cells to improve ventricular function and quality of life in candidates for heart transplantation due to post-infarct chronic heart failure. METHODS: We selected seven candidates for heart transplantation (six males/one female, age range 44-65 years) in whom all treatment alternatives were exhausted (angioplasty/stent and bypass surgery). These subjects had a symptomatic New York Heart Association (NYHA) scale of at least II and ejection fractions (EFs) below 35%. After obtaining informed consent, CD133+ cells were obtained by stimulation with granulocyte-colony stimulating factor, apheresis, and separation with magnetic beads. Stem cells were implanted in the infarcted zone via intracoronary percutaneous angiography. Evaluations (NYHA scale classification, plasma concentration of pro-B-natriuretic-peptide and the risk of sudden death, echocardiography, cardiac magnetic resonance, and gated-SPECT with MIBI) were performed at baseline and at 3, 6, 12, and 24 months after cell infusion. RESULTS: Stem cell isolation was efficient and safe (around 10(7) cells/patient and >92% CD133+ viable cells). Two patients died during observation due to noncardiac conditions. In the five remaining subjects, the NYHA scale improved and no accounts of hospital admissions for heart failure were documented. Plasma concentrations of pro-B-natriuretic peptide and the risk of sudden death clearly decreased, while the EF increased significantly to 35% and 40% by echocardiography and cardiac MRI, respectively (P=.013 and .009, respectively) 24 months after treatment. No other major adverse events were noticed. CONCLUSIONS: The intracoronary inoculation of CD133+ stem cells was safe and effective to improve ventricular contraction and symptomatic class function in patients with refractory post-infarct heart failure.