[Modifications of the glucose curves and gastric voiding of children with Dumping syndrome after laparoscopic Nissen surgery]. / Modificaciones de las curvas de glucemia y vaciamiento gástrico de los niños con síndrome de dumping tras cirugía de nissen laparoscópico.

INTRODUCTION: There has been an important evolution of surgical treatment in recent years due to the progressive generalization of laparoscopic surgery. All of the available techniques can be done laparoscopically with similar results to those of open surgery. In 1978, Villet et al. described the Dumping syndrome (DS) as a frequent complication of Nissen fundoplication. DS is a group of signs and symptoms that appear shortly after surgery, including abdominal pain, paleness, sweating, diarrhea, nausea, even weight loss. These symptoms can be differentiated into early dumping that occurs between 30 to 60 minutes after eating and late dumping that occurs 92-240 minutes after the postprandial period. MATERIAL AND METHODS: A total of 8 patients (3 boys and 5 girls) have been studied. Their ages ranged from 3 to 12 years (mean 9 years), and they were diagnosed of dumping syndrome after performing the laparoscopic Nissen-Rossetti. All underwent a gastric voiding study by scintigraphy after administration of a volume of milk adjusted to their weight labeled with 99Tc-DTPA and oral glucose overload test with 1.75 g/kg of glucose, determining the baseline glycemia and every 30 minutes post-intake, at 0, 30 and 90 minutes. Insulin was also measured to obtain the glucose/insulin ratio. This study was conducted for all patient diagnosed of dumping syndrome before and after laparoscopic Nissen-Rossetti surgery. RESULTS: The following results were obtained: Glucose Curve: 1. Maximum glycemia. PreNissen. The mean of the maximum glycemia values before surgery was 133.9+/-32.11 mg/dl. Post-Nissen. Mean maximum glycemias after surgery was 208.5 +/- 45.07 mg/dl with a range of 147-276 mg/dl. These differences of maximum glycemia were clearly significant with a p <0.002. Minimum glycemia. The mean value of the minimum glycemias after the surgery, compared with the previous value, did not show significant differences: 62.6+/- 11.51 mg/dl versus 71.8 +/- 28.04 mg/dl. Glucose/insulin ratio. The hyperinsulinism values after the intervention studied by means of the glucose/insulin ratio were abnormal in 70.5% (defined as ratio under 3). The mean value was also characteristic of hyperinsulinism (2.3 +/- 1.62). The mean value of the coefficient prior to the surgery was 4.6 with a deviation of 3.04, the differences not being statistically significant with a p= 0.097. Measurement of gastric voiding: The T1/2 (decay) value in post-Nissen patients was significantly lower than in pre-Nissen patients. The postsurgical mean and standard deviation was 29.74 +/- 7.92 min, while in the presurgical group, the mean and standard deviation was 73.75 +/- 28.34 min with p< 0.011; statistically significant. CONCLUSIONS: From the values obtained, we can state that a significant increase in maximum glycemia has been found in all children after surgery who were diagnosed of dumping syndrome and a significant decrease in the mean time of gastric voiding and therefore an increase in the acceleration of gastric voiding after the performance of the Nissen regarding the previous values. The dumping syndrome is a frequent side effect that we must keep in mind in patients who have been previously operated for anti-reflex surgery, the symptoms being greater in most of the transitory cases. Furthermore, it is important to keep in mind because it has an easy treatment that reverts the symptoms in a short time

[Ischemic stroke secondary to post varicella angiopathy in a 3 year old male]. / Accidente cerebrovascular isquémico secundario a angiopatía posvaricela en varón de 3 años.

INTRODUCTION: Ischemic cerebrovascular disease is an infrequent problem in the paediatric age, but one which we now understand better thanks to modern neuroimaging techniques. We know little about its aetiopathogenesis, which is very varied, and it has been reported as being associated with viral infections such as chicken pox. CASE REPORT: A male, aged 3 years, who presented sudden hemiparesis, facial paralysis and dysarthria, without any other accompanying neurological symptoms. The patient had suffered a bout of chicken pox 6 weeks earlier. Of the abnormal complementary explorations, the most notable were varicella positive serological tests and MRI and MR angiography that pointed to ischemic involvement of the cortex. The patient progressed very well and the clinical features had completely reverted at five weeks. CONCLUSION: Post varicella angiopathy is one of the acquired risk factors for an ischemic stroke, and has been claimed to account for up to a third of all strokes in infants. Neuroimaging techniques allow the topographic determination of the ischemic repercussions. Patients usually progress well and in most cases the clinical features completely revert within a short time. We conclude that chicken pox should be included in the vaccination schedule as soon as possible in order to prevent complications that, as in the case we have reported, can be very serious.

[Lactose-free formula versus adapted formula in acute infantile diarrhea]. / Fórmula sin lactosa versus fórmula adaptada en la diarrea aguda del lactante.

We have studied a population of 60 children with acute diarrhea. In order to evaluate the benefit of lactose suppression from the diet on the clinical course of the disease, these children were randomly assigned to either the control group or the experimental group. No differences were found in respects to the duration of the illness (lactose containing formula 4.8 +/- 2 days vs lactose free formula 4.4 +/- 3.1 days). Similarly, body weight change did not change significantly (12.5 +/- 235.8 gr vs 55.9 +/- 238.0 gr, t-test non-significant). Children fed with the lactose free diet voided less frequently than did children in the control group (12.8 +/- 10.5 vs 19.8 +/- 9.5 times; p < 0.01). This difference disappeared when only invasive diarrheas were considered (26.6 +/- 12 vs 21.5 +/- 9.5 voidings; t-test nonsignificant). Finally, only 2 of the 32 cases fed with lactose containing formula showed clinical intolerance to lactose. Therefore, we conclude that in patients with mild-to-moderate acute diarrhea, the resumption of feeding should be undertaken with the same formula that they were previously fed, restricting the use of lactose free formulas to selected cases and to those children in whom a standard milk made symptoms reappear.

[Neonatal septicemia: incidence and risk factors]. / Sepsis neonatal: incidencia y factores de riesgo.

The cases of 131 newborns with positive blood cultures have been reviewed. These children were born in our hospital between 1985 and 1990. We found that the incidence of sepsis was 4.3/1000 newborns. Early neonatal sepsis was the most frequent, representing 58% of the cases. Late sepsis in hospitalized infants represented 1.34% of the cases. Streptococcus B was the microorganism most frequently isolated (26.7%), followed by S. epidermidis (19.8%), E. coli (13.7%) and S. aureus (10.68%). In over 50% of the cases of early sepsis, maternal-fetal risk factors were present. Mortality was 7.6%, with half of these cases due to Streptococcus B.

[Childhood kala-azar: the cases of a decade]. / Kala-azar infantil: casuística de una década.

The aim of our work was to review the epidemiological, clinical and laboratory features of the cases of Kala-azar in our hospital during a decade in order to outline data that might be useful in helping to make an earlier diagnosis and subsequently, earlier treatment. We report eighteen cases of visceral Leishmaniasis treated in our hospital between January 1981 and December 1990. The ages of the patients varied between five months and seven years. In our experience, medullar aspirate was the most effective diagnostic method. However, it this test is negative, specific serological tests should be included in the assessment of any pediatric inpatient with fever and splenomegaly. In our opinion, it is very important to keep this disease in mind, especially in non-endemic areas.

[Fatal nanism: 3 different entities]. / Enanismos letales: tres entidades diferentes.

Three cases of congenital dwarfism are presented. All of them are lethal and represent the three better known nonviable nosologic entities: Achondrogenesis I, Achondrogesis II and Thanatophoric dwarfism. According to clinical features and radiologic data it is possible to approach the diagnosis accurately. We comment genetic, clinic, radiologic and histologic aspects of these processes. It is important to establish a differential diagnosis as these entities have different genetic basis, what influences genetic counsel.

[Reference levels for phenylalanine and tyrosine in discs impregnated with blood during analysis by HPLC]. / Niveles de referencia de fenilalanina y tirosina en discos impregnados en sangre mediante HPLC.

Aromatic amino acids tyrosine and phenylalanine have been measured on paper with dried blood samples, using high performance liquid chromatography (HPLC) in reverse phase. The aim of this procedure is to discriminate unclear cases of general screening for aminoacidopathies avoiding unnecessary retest. Plasma normal values of tyrosine and phenylalanine have been obtained in full term babies (0.82 +/- 0.39 mg/dl and 0.53 +/- 0.23 mg/dl) preschool boy (0.78 +/- 0.21 mg/dl and 0.63 +/- 0.20 mg/dl), school boys (0.89 +/- 0.16 and 0.76 +/- 0.22 mg/dl) and normal adults (1.48 +/- 0.19 and 1.41 +/- 0.12 mg/dl). In order to assess if fasting levels can be altered by breast feeding or formula feeding, a sample was obtained after various feeds and postprandially. Results show no differences before or after feeding. A group of malnourished infants showed greater plasma values of tyrosine and phenylalanine (p less than 0.002) conversely a group children suffering for diabetes showed no differences when comparing with matched age controls. In conclusion, measurement of tyrosine and phenylalanine on dried blood in filter paper is accurate enough, to avoid unnecessary recall in unclear cases of screening, and those levels do not alter significantly with normal milk intake.

[Mail handling: a possible cause of error in the non-selective screening for congenital hypothyroidism]. / Envío por correo: una posible causa de error en el "screening" no selectivo del hipotiroidismo congénito.

Remittance by mail of blood samples and subsequent time of permanency in mail boxes are not supposed to be best thermic conditions for dried blood samples in paper used for neonatal screening. With the idea of checking if temperatures variations can altered or not the content of TSH and T4, some samples of known concentrations of TSH and T4 has been heated to different temperatures between less than -40 degrees C and 100 degrees C during weekly periods. At such temperatures between less than -40 degrees C and 25 degrees C significant hormones losses are not observed. Nevertheless under higher temperatures the percentages of losses increases. Specifically between 37 degrees C and 60 degrees C an hormonal loss of approximately 36% is observed. T4 had also suffered losses of concentration in relation with temperature. These variations make indispensable the change of the way of managing samples that could had suffered modifications with temperatures, and that have been sent by mail. Therefore, considering that about a 40% loss can exist, limit of 40 mu UI/ml should be modified about 25 mu UI/ml.

[Mineral metabolism of calcium, magnesium and phosphorus in the normal newborn infant]. / Metabolismo mineral de calcio, magnesio y fósforo en el recién nacido normal.

The mineral metabolism of calcium, magnesium and phosphorus in 20 newborns and infants was studied. All children were born from term deliveries and none presented clinic, biochemistry signs or radiological evidences of bone mineral metabolism disturbances. In this way, metabolic blance technics were applied. Net absorption of calcium, magnesium and phosphorus were: 54,9 +/- 18,8; 8,7 +/- 4,8 and 64,6 +/- 14,2 mg/kg/day respectively. The retentions of the three elements were: 54,4 +/- 20,6; 7,4 +/- 4,5 and 43,2 +/- 13,6 mg/kg/day. A significative lineal correlation between plasmatic levels of 250Hd and 24,25 (OH)2D with calcium retention was found. The correlation of intestinal calcium apsorption was positive and significative only with 250HD levels. It wasn't found signification between the vitamin D metabolites with the magnesium and phosphorus balance. In other way, it was found a relation between the dietary intake of this two elements with absorption and retention of both of them.