[Congenital dislocation of the knee: report of 2 cases]. / Luxación congénita de rodilla: a propósito de 2 casos.

Congenital dislocation of the knee is a rare disease. The diagnosis is made at birth by clinical findings, and confirmed radiologically. It has been associated with various etiologies from intrauterine fetal malpositions to genetic disorders. The prognosis depends on early treatment and whether there are other congenital anomalies. We report two new cases of congenital dislocation of the knee, observed in our hospital during the period of a month, diagnosed immediately after birth, and both with a good clinical outcome.

[Lumbar puncture and early neuroimaging in complex febrile seizures. Report of a case of shaken infant syndrome]. / Punción lumbar y neuroimagen precoz en las crisis febriles complejas. A proposito de un caso de síndrome de lactante sacudido.

INTRODUCTION: Febrile convulsions are one of the most frequent pathologies seen in paediatric emergencies. The diagnosis of febrile seizures is clinico evolutionary and is easily established once the acute process is overcome and a normal state is restored in the child. The differential diagnosis is established with the processes that associate fever and convulsions in children between the ages of 1 month and 6 years, many of which require specific treatment. Certain complementary examinations, essentially a blood test, lumbar puncture and neuroimaging, are needed to identify them. Shaken infant syndrome is a form of physical abuse which includes the presence of intracranial traumatic injury, retinal haemorrhage and, in general, the absence of other physical signs of traumatic injury in the child. CASE REPORT: An 8 month old infant who presented a convulsive seizure on the left side of the body which coincided with an axillary temperature of 38 C that remitted with intravenous diazepam 40 minutes after onset. An early cranial computerised tomography (CT) scan led to a diagnosis of shaken infant syndrome. DISCUSSION: This case constitutes an argument in favour of performing an early cranial CT scan in complex febrile convulsions and in prolonged or partial non provoked seizures. We highlight the risks involved in performing a lumbar puncture in the absence of suspected non complicated acute bacterial meningitis. The diagnostic usefulness of an early CT scan in diagnosing such an important problem as shaken infant syndrome must also be noted, due to the risk of repetition and its high morbidity and mortality rates.

[Inhaled nitric oxide in the treatment of persistent pulmonary hypertension in a newborn]. / Oxido nítrico inhalado en el tratamiento de la hipertensión pulmonar persistente del RN.

OBJECTIVE: Our aim was to assess from a clinical and analytical point of view the response to inhaled nitric oxide in patients with persistent pulmonary hypertension of the newborn (PPHN). PATIENTS AND METHODS: A retrospective study was analyzed in ten patients with PPHN who received inhaled nitric oxide. The ventilatory and gasometric data were reviewed before treatment, during the first hours and afterwards, in all patients, in the surviving group and in the most common associated disease group (intrauterine pneumonia). The parameters analyzed to assess the response to NO treatment were the oxygenation index (IO) and the PaO2 increase. Statistical analysis was performed by using a comparison of means. RESULTS: The mean oxygenation index before starting the treatment with inhaled NO was 39 +/- 7.3 in the total group and 38.4 +/- 8.8 in the surviving patients. At 2.9 +/- 1.1 hours after treatment a mild improvement was observed in the total group and it was more evident in the surviving group (32.4 +/- 15.2 and 26.4 +/- 7.8, respectively; p < 0.05). After treatment was discontinued, the IO was 24.7 +/- 21.9 (p < 0.05) and 12.8 +/- 7.5 (p < 0.001). The PaO2 increment in both groups was 51.2 +/- 55.5% and 66.8% +/- 28.1%. The patients with intrauterine pneumonia showed the highest PaO2 increase after treatment was discontinued (78.3% +/- 41.9%). CONCLUSIONS: Early treatment with inhaled NO in term newborns with PPHN produced a sustained improvement in oxygenation. This treatment might reduce the number of patients who need extracorporal membrane oxygenation.