Ileocolic intussusception: Ultrasound-guided hydrostatic reduction with sedation and analgesia.

INTRODUCTION: The first-choice treatment for ileocolic intussusception is imaging-guided reduction with water, air, or barium. The objectives of the current study were to evaluate the efficacy and safety of ultrasound-guided reduction of intussusception using water in patients under sedation and analgesia. We compare this approach with our previous experience in reduction using barium under fluoroscopic guidance without sedation and analgesia and investigate what factors predispose to surgical correction. MATERIAL AND METHODS: We retrospectively reviewed cases of children with ileocolic intussusception treated in a third-level pediatric hospital during a 52-month period: during the first 24 months, reduction was done using barium and fluoroscopy without sedoanalgesia, and during the following 28 months, reduction was done using water and ultrasound with sedoanalgesia. A pediatric radiologist and a pediatrician reviewed the clinical history, surgical records, and imaging studies. RESULTS: In the 52-month period, 59 children (41 boys and 18 girls; mean age, 16.0 months) were diagnosed with ileocolic intussusception at our hospital. A total of 33 reductions (28 patients and 5 recurrences) were done using barium under fluoroscopic guidance, achieving a 61% success rate. A total of 38 reductions (31 patients and 7 recurrences) were done using water under ultrasound guidance with patients sedated, achieving a success rate of 76%. No significant adverse effects were observed in patients undergoing ultrasound-guided hydrostatic reduction under sedation, and the success rate in this group was higher (p = 0.20). The factors that predisposed to surgical reduction were greater length of the intussusception (p = 0.03), location in areas other than the right colon (p = 0.002), and a greater length of time between symptom onset and imaging tests (p = 0.08). CONCLUSION: Ultrasound-guided hydrostatic reduction of ileocolic intussusception under sedoanalgesia is efficacious and safe.

Rasburicasa versus alopurinol como tratamiento de la hiperuricemia en el síndrome de lisis tumoral / Rasburicase versus allopurinol in the treatment of hyperuricaemia in tumour lysis syndrome

Introducción: La hiperuricemia secundaria al síndrome de lisis tumoral (SLT) es una complicación importante en neoplasias con rápida proliferación y destrucción celular. Introducción: El objetivo del estudio fue comparar la eficacia de la rasburicasa con la del alopurinol en la reducción de los niveles plasmáticos de ácido úrico, creatinina y fósforo en niños con SLT. Pacientes y método: Se realizó un estudio comparativo observacional no aleatorizado del tratamiento con alopurinol o rasburicasa en 32 niños con enfermedad oncohematológica ingresados en la unidad de cuidados intensivos pediátricos con SLT establecido o alto riesgo de desarrollarlo. Desde enero de 1991 hasta enero de 2003 16 pacientes recibieron alopurinol (10mg/kg/día cada 8h) y desde febrero de 2003 hasta junio de 2009 16 pacientes recibieron rasburicasa (0,2mg/kg/día, una dosis diaria). Se determinaron los niveles plasmáticos de ácido úrico, creatinina y fósforo previo al tratamiento y a las 4, 12, 24, 36, 48, 72 y 96h. Resultados: Los niveles basales de ácido úrico fueron similares en ambos grupos. A las 4h tras la primera dosis del fármaco los pacientes tratados con rasburicasa comparados con alopurinol tuvieron una mayor reducción (p<0,0001) de los niveles plasmáticos de ácido úrico, al igual que en las determinaciones posteriores. Los niveles de creatinina fueron más elevados en el grupo de alopurinol que en el de rasburicasa. Los niveles de fósforo fueron similares en ambos grupos. El 56% de los pacientes tratados con alopurinol requirió hemodiálisis, mientras que ningún paciente del grupo de rasburicasa la precisó. Conclusiones: Este estudio demuestra un control más rápido y niveles significativamente menores de ácido úrico tras tratamiento con rasburicasa comparado con alopurinol en el SLT así como niveles más bajos de creatinina y menor necesidad de hemodiálisis (AU)

Introduction: Hyperuricaemia accompanying tumour lysis syndrome (TLS) is a serious complication in neoplasias with rapid proliferation and cellular destruction. The aim of the study was to evaluate the effects of rasburicase versus allopurinol on plasma uric acid, creatinine and phosphorus levels in paediatric patients with TLS. Patients and method: A comparative study of treatment with rasburicase or allopurinol was performed in 32 paediatric patients with haematological-oncological malignancies and with established TLS or a high risk of developing it, admitted to the Paediatric Intensive Care Unit (PICU). Allopurinol (10mg/kg/day every 8h) was administered to 16 patients between January 1991 and January 2003, and 16 patients received rasburicase (0.2mg/kg/day, once daily), from February 2003 to June 2009. Plasma uric acid, creatinine and phosphorus levels were measured at baseline and 4, 12, 24, 36, 48, 72 and 96h after therapy in both study groups. Results: Baseline uric acid levels were similar in both groups. Four hours after the first dose, patients treated with rasburicase achieved a greater reduction (p<0.0001) of initial plasma uric acid levels compared to allopurinol, as in the other serial determinations. Creatinine levels were higher in the allopurinol group than in the rasburicase one. Plasma phosphorus levels were similar in both groups. Haemodialysis was required in 56% of patients in the allopurinol group, whereas none of rasburicase group needed this. Conclusion: This study demonstrated that there is more rapid control and lower plasma uric acid levels in patients at high risk for tumour lysis syndrome who received rasburicase compared to allopurinol, as well as lower levels of creatinine and a lower percentage of haemodialysis (AU)