A. Concheiro Guisán

Parotiditis crónica recurrente juvenil

Abstract Objetivos La parotiditis cronica recurrente es una entidad infrecuente en pediatria y con un mecanismo etiopatogenico aun no aclarado. Metodos Se presenta una revision de 30 casos estudiados en el hospital de Sant Joan de Deu en los ultimos 4 anos. Se presenta el protocolo de actuacion seguido ante esta enfermedad y los datos epidemiologicos mas destacados, asi como las pruebas diagnosticas realizadas, los tratamientos seguidos y evolucion posterior. Resultados La edad media de presentacion en los pacientes fue de 6 anos de edad. Lo mas frecuente fue un numero de tres a cuatro episodios por ano. En la exploracion, la supuracion a traves del conducto de Stenon constituye un hallazgo infrecuente, y son el dolor y la fiebre los datos clinicos mas habituales. El curso medio de los episodios fue de una semana. Conclusiones Los datos epidemiologicos coinciden en gran parte con lo revisado en otras series. El diagnostico se establecio a partir de la sialografia con un buen curso posterior en la evolucion, lo cual podria relacionarse con un cierto efecto terapeutico de la prueba. La ecografia ha demostrado tambien su utilidad y podria plantearse como primera exploracion por su inocuidad.

Nephrotic syndrome associated with Celiac disease. A report of five cases.

Accessible online at: www.karger.com/journals/nef Dear Sir, The presence of circulating antigliadine antibodies is frequent in IgA nephropathy [1–5]. However, any sort of relationship between celiac disease and nephrotic syndrome has not been described in the medical literature until now. It is this association that we bring forth. Five patients (3 boys/2 girls) out of a total of 251 patients with nephrotic syndrome have been followed in our Department. All 5 presented both nephrotic syndrome and celiac disease and were diagnosed during the last 5 years. The mean age of onset was 4.5 years. Celiac disease was first diagnosed in 4 patients previous to the nephrotic syndrome. Celiac markers were looked for in the fifth patient after the first episode of nephrotic syndrome. One of the 5 patients presented both nephrotic syndrome and diabetes mellitus. The diagnosis of nephrotic syndrome was made according to clinical and analytical findings, whereas the diagnosis of celiac disease involved clinical and laboratory findings (chronic diarrhea, positive antibodies) and pathological confirmation after bowel biopsy. Kidney biopsies were done in 2 patients: 1 showed minimal change lesions while the other presented IgM infiltrates. Regarding clinical evolution, 1 of the patients resulted as corticosensitive and 3 of them were corticoid dependent, requiring cyclophosphamide and one of them levamisole. The fifth patient was lost during follow-up. After a review of the literature, no reference has been found of the association between celiac disease and nephrotic syndrome. Mignot et al. [6] looked for a relationship between HLA DQA1 and HLA DQB1 in three groups of patients with, respectively, nephrotic syndrome, diabetes mellitus and celiac disease. No genetic relationship was found. On the other hand, the prevalence of celiac disease in the general population is approximately 3 per thousand, whereas nephrotic syndrome in the pediatric population is around 2–7 per 100,000. In our series, the incidence of celiac disease in patients diagnosed with nephrotic syndrome amounts to 2%, without any explanation of the cause. With this note, we wish to underline the presence of celiac disease in nephrotic syndrome and recommend the inclusion of celiac disease screening in these children. ReferencesAccessible online at: www.karger.com/journals/nef Dear Sir, The presence of circulating antigliadine antibodies is frequent in IgA nephropathy [1–5]. However, any sort of relationship between celiac disease and nephrotic syndrome has not been described in the medical literature until now. It is this association that we bring forth. Five patients (3 boys/2 girls) out of a total of 251 patients with nephrotic syndrome have been followed in our Department. All 5 presented both nephrotic syndrome and celiac disease and were diagnosed during the last 5 years. The mean age of onset was 4.5 years. Celiac disease was first diagnosed in 4 patients previous to the nephrotic syndrome. Celiac markers were looked for in the fifth patient after the first episode of nephrotic syndrome. One of the 5 patients presented both nephrotic syndrome and diabetes mellitus. The diagnosis of nephrotic syndrome was made according to clinical and analytical findings, whereas the diagnosis of celiac disease involved clinical and laboratory findings (chronic diarrhea, positive antibodies) and pathological confirmation after bowel biopsy. Kidney biopsies were done in 2 patients: 1 showed minimal change lesions while the other presented IgM infiltrates. Regarding clinical evolution, 1 of the patients resulted as corticosensitive and 3 of them were corticoid dependent, requiring cyclophosphamide and one of them levamisole. The fifth patient was lost during follow-up. After a review of the literature, no reference has been found of the association between celiac disease and nephrotic syndrome. Mignot et al. [6] looked for a relationship between HLA DQA1 and HLA DQB1 in three groups of patients with, respectively, nephrotic syndrome, diabetes mellitus and celiac disease. No genetic relationship was found. On the other hand, the prevalence of celiac disease in the general population is approximately 3 per thousand, whereas nephrotic syndrome in the pediatric population is around 2–7 per 100,000. In our series, the incidence of celiac disease in patients diagnosed with nephrotic syndrome amounts to 2%, without any explanation of the cause. With this note, we wish to underline the presence of celiac disease in nephrotic syndrome and recommend the inclusion of celiac disease screening in these children. References

Isquemia coronaria secundaria a anomalías congénitas de las arterias coronarias

Coronary artery anomalies constitute 2.2 % of congenital malformations of the heart. The most common abnormality is anomalous origin of the left coronary artery from the pulmonary trunk, also known as Bland-White-Garland syndrome. Clinical manifestations are due to myocardial ischemia caused by the creation of an arteriovenous shunt. The childhood type of this anomaly presents high mortality from heart failure. The adult type develops myocardial infarction, arrhythmias, sudden cardiac death or signs of congestive heart failure. Surgical repair is essential. Various surgical approaches are available and the treatment of choice is direct left coronary artery reimplantation in the aorta. An alternative technique is to create an aortopulmonary tunnel (Takeuchi technique). Marked improvement is usually observed after surgical repair. We report two cases of myocardial ischemia due to coronary anomalies.

Retención aguda de orina

CASO CLÍNICO Niño de 18 meses sin antecedentes personales de interés, que acude a la consulta por episodios repetidos de retención urinaria. Como antecedentes familiares presenta madre con episodios de retención urinaria asociada a cistitis de repetición. En los últimos tres meses había consultado en el Servicio de Urgencias en dos ocasiones por episodios de retención aguda de orina, consistentes en ausencia de diuresis en las 12 h. En ambos casos se precisó sondaje vesical para su resolución, y se obtuvieron aproximadamente 300 mililitros de orina, que se remitieron para cultivo y análisis. En la exploración física destacaba globo vesical palpable; el resto era normal. En ambas ocasiones el urinálisis (incluido índice proteína/creatinina y calcio/creatinina) y el urinocultivo fueron negativos. Se realizó hemograma y bioquímica sanguínea, que fueron normales. La ecografía renal y vesical muestra distensión vesical, sin hidronefrosis, litiasis, ni otros hallazgos patológicos. Ante la recurrencia del proceso se solicita cistografía miccional que demuestra la existencia a la altura de la uretra posterior de una lesión ocupante de espacio, exofítica, polipoidea que se inicia en el verum montanum, se extiende distalmente y obstruye de manera parcial la uretra (figs. 1 y 2).

Recomendaciones para la asistencia respiratoria en el recién nacido (iii). Surfactante y óxido nítrico

The recommendations included in this document will be part a series of updated reviews of the literature on respiratory support in the newborn infant. These recommendations are structured into twelve modules, and in this work module 7 is presented. Each module is the result of a consensus process including all members of the Surfactant and Respiratory Group of the Spanish Society of Neonatology. They represent a summary of the published papers on each specific topic, and of the clinical experience of each one of the members of the group.

Aplicación de criterios de atención preferente (triage) en un servicio de urgencias

Objetivo La creciente demanda asistencial de los servicios de urgencia obliga a establecer unos sistemas de seleccion que detecten la urgencia preferente Material y metodos Se han establecido una serie de criterios de seleccion del paciente. Entre octubre de 1998 y abril de 1999 se han seleccionado 20 dias de maxima demanda asistencial (media de pacientes visitados, 225 pacientes/dia). Se seleccionan los pacientes con criterios de atencion preferente. Se estudian las siguientes variables: edad, sexo, criterio de seleccion, tiempo de espera, tiempo de visita y diagnostico final. Resultados Se obtuvieron 513 informes que cumplen criterios de atencion preferente (11 % de los pacientes visitados). Los pacientes presentaban una mediana de edad de 3,4 anos. El motivo de consulta mas frecuente es la dificultad respiratoria (36,4 % casos), seguido por la derivacion por otro facultativo (29 %), la fiebre acompanada de exantema (11,7 %) y la edad menor de 1 mes (5,8 %). Los motivos de derivacion por otro facultativo mas frecuentes han sido el dolor abdominal agudo y la fiebre (ambos, 31 %). Los tiempos de espera y visita de los pacientes seleccionados presentan una mediana de 29 y 55 min, respectivamente. Conclusion Definir unos criterios de seleccion parece eficaz y equiparable a la realizacion de un triage clinico, lo cual permite optimizar los recursos humanos.