Pos-infectious bronchiolitis obliterans in children.

Bronchiolitis obliterans (BO) is a rare disease in immunocompetent children that usually occurs after infection of the lower airways. While a diagnosis of BO was usually confirmed by lung biopsy, identification of prior lung lesion plus a typical clinical course and a suggestive chest X-ray and CT scan have replaced the need for more invasive procedures. The authors reviewed the clinical records of 10 BO patients, followed in the Outpatients Paediatric Pulmonology Unit from January 1997 to December 2002, to identify the most common aetiology, clinical and radiological profiles, treatment and course. All patients maintained cough and/or wheezing after the initial acute episode. 80% had failure to thrive at the time of the diagnosis, mean age 16 months. Viral pneumonia was the main initial event (5 adenovirus, 3 respiratory syncytial virus, 1 parainfluenza virus, 1 unknown). Lung biopsies were not performed as clinical and radiological presentations were typical of BO. The follow-up (mean 36 months) revealed clinical resolution in 3 children and persistent symptoms in 6. One patient had progressive respiratory failure and died. Prompt recognition of the diagnosis with supportive treatment that included oxygen therapy and an aggressive nutrition plan helped to improve the clinical state of the children.

Burkitt leukemia with numb chin syndrome and cavernous sinus involvement.

Cavernous sinus syndrome is a rare event. Non-Hodgkin lymphomas, are one possible cause. Neurological presentation of these lymphomas is also exceptional. We report the case of an 11-year-old boy that developed a right third cranial nerve palsy and numbness in the distribution of the right mental nerve, with normal CSF, and enlargement of cavernous sinus on the same side, who was diagnosed Burkitt leukemia.

Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case.

A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy's sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy's sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection.

Pneumotórax espontâneo em adolescentes observados num Serviço Pediátrico de Urgência / Spontaneous pneumothorax in adolescents observed in Pediatric Emergency Department / Pneumotórax espontaneo en adolescentes observados en un Servicio Pediátrico de Urgencia

OBJETIVO: Caracterizar o pneumotórax espontâneo (PE) em adolescentes observados num Serviço de Urgência (SU) Pediátrico.MÉTODOS: Estudo retrospectivo e descritivo dos adolescentes admitidos no SU por PE entre janeiro de 2009 e dezembro de 2011. Analisaram-se os dados demográficos, fatores de risco, classificação de PE, apresentação clínica, exames complementares, terapêutica e recorrência de PE.RESULTADOS: Foram admitidos oito adolescentes por PE, com predomínio do sexo masculino e idade compreendida entre os 13 e os 17 anos. A maioria apresentava PE primário, surgido em repouso. Os sintomas tiveram início, em média, um dia antes da admissão destacando-se a toracalgia, dispneia e tosse. A telerradiografia torácica póstero-anterior efetuada confirmou o diagnóstico em todos os casos, destacando-se o predomínio de PE de grande volume e à esquerda. Foi instituída oxigenoterapia a todos os casos. Um doente efetuou terapêutica conservadora isolada. Os restantes foram submetidos a drenagem transtorácica, com necessidade de sucção em dois casos. Necessitaram de intervenção cirúrgica três casos, um dos quais por air leak persistente e os demais por pneumotórax recidivante ipsilateral. Um terço dos doentes necessitou ser transferido, para observação por especialidade inexistente no hospital. Com um follow-up mediano de 13±7,4 meses, verificou-se recorrência do pneumotórax em 37,5% (todos ipsilaterais), em média 41 dias após o diagnóstico.CONCLUSÃO: Nesta amostra destaca-se a realização frequente de drenagem transtorácica, possivelmente decorrente do predomínio de PE de grande volume. Ressalva-se a importância de estudos acerca do PE, possibilitando a emergência de recomendações da terapêutica adequada às particularidades inerentes a esta faixa etária(AU)

OBJECTIVE: To characterize spontaneous pneumothorax (SP) in adolescents observed in Pediatric Emergency Department (ED).METHODS: Retrospective and descriptive study of adolescents admitted to ED due to SP between January 2009 and December 2011. Demographic data, risk factors, classification of PE, clinical presentation, laboratory tests, therapy and recurrence were analyzed.RESULTS: Eight adolescents were admitted for PE, with male predominance and ages between 13 and 17 years. The majority had primary PE. In those with secondary PE, 3 cases had asthma and 1 case had smoking habits. Symptoms began on average 1 day before admission. Chest pain, dyspnea and cough were the commonest. SP began mostly during rest. All had abnormal auscultatory findings. Respiratory distress was found in one case. Chest posteroanterior radiograph confirmed diagnosis, with predominance of high volume and left SP. Oxygenotherapy was applied in all cases. One patient performed conservative therapy alone. The remaining underwent transthoracic drainage and 2 cases required suction. 3 cases required surgery in other center, one by persistent air leak and the remaining by ipsilateral recurrent pneumothorax. One third of the patients needed to be transferred for observation by an unavailable specialty. With a median follow-up of 13 ± 7.4 months, recurrence of pneumothorax was verified in 37.5% (all ipsilateral) on average 41 days after diagnosis.CONCLUSION: In this sample transthoracic drainage was frequently performed, possibly due to prevalence of high volume SP. It is emphasized the importance of studies about SP in this age group, allowing emergence of recommendations about appropriate therapy(AU)

OBJETIVO: Caracterizar al pneumotórax espontaneo (PE) en adolescentes observados en un Servicio de Urgencia (SU) Pediátrico.MÉTODOS: Estudio retrospectivo y descriptivo de los adolescentes admitidos en el SU por PE entre enero de 2009 y diciembre de 2011. Se analizaron los datos demográficos, factores de riesgo, clasificación de PE, presentación clínica, exámenes complementarios, terapéutica y recurrencia de PE.RESULTADOS: Fueron admitidos ocho adolescentes por PE, con predominio del sexo masculino y edad comprendida entre los 13 y los 17 años. La mayoría presentaba PE primario, surgido en reposo. Los síntomas tuvieron inicio, en promedia, un día antes de la admisión destacándose la toracalgia, disnea y tos. La telerradiografía torácica posteroanterior efectuada confirmó el diagnóstico en todos los casos, destacándose el predominio de PE de gran volumen y a la izquierda. Fue instituida oxigenoterapia en todos los casos. Un enfermo efectuó terapéutica conservadora aislada. Los restantes fueron sometidos a drenaje transtorácico, con necesidad de succión en dos casos. Necesitaron de intervención quirúrgica tres casos, uno de los cuales por air leak persistente y los demás por pneumotórax recidivante ipsolateral. Un tercio de los enfermos necesitó ser transferido para observación por especialidad inexistente en el hospital. Con un follow-up mediano de 13±7,4 meses, se verificó recurrencia de pneumotórax en 37,5% (todos ipsolaterales), en promedio 41 días posteriores al diagnóstico.CONCLUSIÓN: En esta muestra se destaca la realización frecuente de drenaje transtorácico, posiblemente derivado del predominio de PE de gran volumen. Se resalta la importancia de estudios acerca del PE, posibilitando la emergencia de recomendaciones de terapéutica adecuada a las particularidades inherentes a esta franja etaria(AU)