ABSTRACT
@#Children with musculoskeletal symptoms are commonly seen by general practitioners (GPs). Those that present with atraumatic limp pose a particular diagnostic challenge. Although uncommon, Perthes disease (PD) is an important cause of atraumatic limp in children and may result in debilitating consequences if missed. We put forward a case of delayed diagnosis of PD in a child, thus highlighting the need for a greater index of suspicion among GPs in approaching any child with a limp.
ABSTRACT
La miositis aguda benigna de la infancia (MABI) es una entidad clínica autolimitada, infrecuente, que afecta a niños en edad preescolar y escolar. Dada su asociación a cuadros virales, se sugiere una relación con este tipo de agentes, entre los que predomina el virus influenza. OBJETIVO: Describir un brote de casos de MABI presentados en un servicio pediátrico. PACIENTES Y MÉTODO: Serie clínica retrospectiva de pacientes que consultaron por un cuadro clínico compatible con MABI en el período agosto-noviembre de 2012, en el Servicio de Urgencia pediátrico de un centro asistencial. RESULTADOS: Se presentan una serie de 9 niños, edades entre 4 y 12 años, con un pródromo de fiebre asociado a síntomas respiratorios, seguido de dolor agudo intenso de ambas pantorrillas y claudicación. En los exámenes de laboratorio destacaba un alza de creatincinasa, con un valor promedio de 4.066 UI/L. El estudio etiológico evidenció influenza B en 3 pacientes y Mycoplasma pneumoniae en uno. El manejo consistió en hidratación y antiinflamatorios no esteroidales, con favorable evolución clínica y de laboratorio. CONCLUSIONES: La MABI es una entidad benigna, autolimitada, de excelente pronóstico, con una presentación clínica que en la mayoría de los casos requiere manejo ambulatorio. Deben evitarse estudios invasivos y hospitalizaciones innecesarias.
Benign acute childhood myositis (BACM) is a rare clinical condition that mainly affects pre-school and school age-children. It is usually preceded by a viral illness, particularly influenza virus infection. OBJECTIVE: To describe a cluster of BACM cases that were seen in a paediatric unit. PATIENTS AND METHODS: A retrospective series of cases that presented with a clinical picture suggestive of BACM between August and November 2012 in the paediatric emergency department of a private clinic. RESULTS: Nine children, between 4 and 12 years, presented with a history of a recent febrile upper viral respiratory infection, followed by intense calf pain and claudication. They all recovered without complications. Laboratory results showed a marked increase in CK, with a mean of 4,066 IU/l. Three of the cases had influenza B infection and one Mycoplasma pneumonia infection. They were managed conservatively with hydration and non-steroidal anti-inflammatory drugs. CONCLUSIONS: BACM is a benign entity with a characteristic clinical presentation that can be managed most of the time in the ambulatory setting, avoiding invasive studies and unnecessary hospital admission.
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Respiratory Tract Infections/complications , Influenza, Human/complications , Myositis/etiology , Influenza B virus/isolation & purification , Pneumonia, Mycoplasma/complications , Acute Disease , Retrospective Studies , Myositis/diagnosis , Myositis/therapyABSTRACT
El absceso del psoas es una enfermedad infrecuente en niños. Puede tener una presentación clínica inespecífica, ser de inicio insidioso y relacionarse o no con fiebre. El tipo más frecuente en pediatría es primario; sin embargo, en ocasiones, puede ser de origen secundario y asociarse a infecciones graves, como la osteomielitis, por lo que se requiere un alto índice de sospecha para detectarlo y tratarlo oportunamente. Presentamos un caso atípico de absceso del psoas con infiltración del cuerpo vertebral de L2 en un paciente masculino de 14 años previamente sano, sin antecedente de traumatismo ni fiebre al momento del ingreso. Se realizaron una radiografía y una ecografía, pero el diagnóstico se confirmó a través de una resonancia nuclear magnética de columna lumbosacra. Conhemocultivos positivos para Staphylococcus aureus meticilino resistente, completó 2 semanas de tratamiento antibiótico endovenoso y 4 semanas por vía oral con negativización de cultivos y resolvió por completo la sintomatología inicial.
Psoas abscess is a common disease in children. It can have a nonspecific clinical presentation, insidious onset and sometimes fever. The most common type in children is the primary one; however, it can sometimes be of secondary origin and associated with severe infections such as osteomyelitis so a high index of suspicion is required to detect and treat it promptly. We present an unusual case of psoas abscess with infiltration of the vertebral body of L2 in a 14 year old male patient previously healthy with no history of trauma or fever on admission. X-ray and ultrasound were performed but the diagnosis was confirmed by magnetic resonance imaging of the lumbosacral spine. With positive blood cultures for methicillin-resistant Staphylococcus aureus he completed 2 weeks of intravenous antibiotic therapy and 4 weeks of oral antibiotic therapy with blood cultures negativization and resolution of symptoms.
Subject(s)
Humans , Male , Adolescent , Osteomyelitis/complications , Osteomyelitis/microbiology , Spinal Diseases/complications , Spinal Diseases/microbiology , Staphylococcal Infections/complications , Psoas Abscess/complications , Methicillin-Resistant Staphylococcus aureus , Lumbar VertebraeABSTRACT
Objective To set up an isolated limp perfusion (LIP) model of rabbit approximately asin the physiological state. Methods Measuring and calculating the average speed of blood circulation in rabbit's femoral artery with ultrasound, building up an isolated limp of perfusion system with a mini membrane oxygenator and a mini pump. Observing the values of blood analyses (pH, PO 2 and PCO 2) at prior , mid and post operation with differential exchanging speeds of oxygen, and probabilities of circulation failure with differential blood flow speeds, and the glucose change at several points of time and the difference between the groups with and without compensating glucose, and the dimensions of hind leg prior and post operation. Results Results of ultrasound showed that there was no difference in parameter between bilateral femoral arteries giving no effect on the results of differential groups. Total average flow speed was (12.0?1.8) ml/min. Blood analysis: the perfusion without oxygen exchange showed pH was lower than preperfusion and physiological low threshold. PO 2 was below the normal standard, PCO 2 was higher than prepefursion and physiological upper threshold. 100ml/min of oxygen exchange showed pH, PO 2 and PCO 2 were rearly normal post perfusion and 200ml/min group showed pH and PO 2 obviously higher than the normal physiological value. The gulcose was lower than the normal at 30min after perfusion, but could be recoveried under the compensation of glucose. There was significant difference between the groups processing with and without glucose. There was no circulation failure when the flow speed was in 10ml≤V