Náuseas, vómitos, diarrea, estreñimiento e hiporexia en la alimentación del niño con cáncer / Nausea, vomiting, diarrhea, constipation and decreased appetite in feeding the child with cancer

Entre las manifestaciones digestivas que se presentan en el tratamiento del niño con cáncer, bien sea por la quimioterapia, la radioterapia, los medicamentos subyacentes a estas terapias o a la misma enfermedad per sé, se encuentran las náuseas, los vómitos, la diarrea, el estreñimiento y la disminución del apetito. Todos ellos, junto con la pérdida de la actividad física y los cambios en los hábitos alimentarios, pueden conllevar a malnutrición. Es necesario así entonces realizar algunas sugerencias preventivas nutricionales y de puericultura, para evitar la morbilidad secundaria a ello.

Among the digestive symptoms that occur in the treatment of children with cancer, either gy chemotherapy, radiotherapy, drug therapy or underlying these the same disease per se, include nausea, vomiting, diarrea, constipation and the decline and loss of appetite. They, along with the loss of physycal activit and changes in eating habits, can lead to malnutrition. Need and then make some suggestions preventive nutrition and childcare, to avoid the morbidity secondary to it.

Aspectos clínicos y demora para el diagnóstico en niños con tumores del sistema nervioso central en el Instituto Nacional de Cancerología de Colombia / Clinical aspects and delay in diagnosis of children with central nervous system tumors at the National Cancer Institute of Colombia

Objetivo: Determinar las características clínicas y el intervalo de tiempo transcurrido entre la presentación y el diagnóstico de los tumores del sistema nerviosso central en niños atendidos en el Instituto Nacional de Cancerología. Métodos: Se estudió una cohorte de 64 pacientes entre enero de 2008 y agosto de 2010. El análisis se realizó mediante la estadística descriptiva. Se realizaron análisis exploratorios utilizando prueba de X ². Los resultados se considerarán estadísticamente significativos si P <0,05. Resultados: El sexo masculino fueron 36 pacientes (56,3%). La mediana de edad fue 8 años con rango de 0 a 17 años. El 12,5 % procedían de una zona rural. La cefalea, el vómito, las convulsiones, las alteraciones de la marcha y el estrabismo fueron las manifestaciones clínicas más frecuentes. El 60,9 % de los pacientes fueron evaluados en su primera consulta por un médico general, el 12,5 % por un pediatra, y 6,3 % por un oftalmólogo. La mediana de consultas previas a la sospecha diagnóstica fue de dos. En el 72 % de los pacientes el médico no sospechó la presencia de un tumor cerebral y en su defecto el diagnóstico inicial fue migraña en 18,8 %. La localización más frecuente fue hemisferios cerebrales 37,5 %. La mediana del tiempo entre los síntomas y el diagnóstico fue 41 días con promedio 122 días (DE ± 181). Conclusiones: Existe demora en la realización del diagnóstico de tumores del SNC y baja sospecha diagnóstica debido a un origen multifactorial, por síntomas inespecíficos, dificultad de los pacientes en sus primeros años para comunicarlos, y de los padres y los médicos para detectarlos.

Objective: To determine the clinical presentation and the time interval between the clinical presentation and diagnosis of central nervous system tumors in children treated at the National Cancer Institute (NCI). Methods: We studied a retrospective and prospective cohort of 64 patients between January 1, 2008 and August 31, 2010. The analysis was performed using descriptive statistics. Exploratory analysis was performed using X² test. Results were considered statistically significant with value P<0,05. Results: Of the 64 patients included for analysis 36 (56,3%) were male. The median age was 8 years with a range of 0 to 17,12.5% were from a rural area of the country. Headache, vomiting, seizures, gait abnormalities and strabismus were the most frequent clinical manifestations. 60,9% of patients were assessed at their first visit by a general medical, 12,5% by a pediatrician, and 6.3% by an ophthalmologist. The average consultation prior to the suspicion diagnosis was of three. In 72% of patients the doctor who treated the child for the first time do not suspect the presence of a brain tumor and the initial diagnosis was migraine in 18.8%. The most frequent location was in cerebral hemispheres 37,5%. The median interval between symptoms and diagnosis was 41 days and an average of 122 days (SD ± 181). Conclusions: The delay in making the diagnosis of brain tumor and low diagnostic suspicion due to a multifactorial origin by nonspecific symptoms, shortness of patients in their early years to express symptoms, and parents and medical staff to detect.

Treatment of gastroesophageal reflux disease

OBJETIVO: Rever a literatura sobre tratamento da doença do refluxo gastroesofágico (DRGE) com ênfase nos aspectos farmacológicos. Identificar particularidades do tratamento farmacológico nas manifestações esofágicas e extra-esofágicas da doença. FONTES DE DADOS: Busca eletrônica na base de dados PubMed/MEDLINE e Cochrane Collaboration. Procurou-se identificar estudos controlados e randomizados publicados a partir de 2000, bem como revisões que representassem consensos e diretrizes publicados nos últimos 10 anos. SíNTESE DOS DADOS: Nenhuma das drogas atualmente usadas no tratamento da DRGE altera comprovadamente o mecanismo principal da doença, ou seja, os relaxamentos transitórios do esfíncter esofágico inferior. O tratamento farmacológico da DRGE com sintomas ou com lesões esofágicas é baseado na inibição da secreção ácida, em particular pelos inibidores da bomba de prótons (IBP). Nas situações em que a hiper-reatividade das vias aéreas inferiores coexiste com sintomas esofágicos da DRGE, a inibição da secreção ácida deve trazer benefícios na condução da doença respiratória se houver uma relação causal; contudo, essa situação não é comum. Quando não coexistem sintomas esofágicos, a pHmetria esofágica de 24 h deve ser realizada previamente ao tratamento farmacológico da DRGE. A melhora dos sintomas respiratórios pode ser tardia em relação aos sintomas esofágicos. A DRGE freqüentemente recorre, e o tratamento farmacológico deve ser repetido ou mantido indefinidamente, conforme a apresentação clínica da doença. CONCLUSÃO: As condutas propostas para o tratamento farmacológico da DRGE na criança são oriundas principalmente de estudos de séries de casos ou de estudos em adultos. Existem poucos estudos controlados e randomizados em crianças. A realização de um número maior desses estudos poderá reafirmar ou introduzir novos aspectos nas condutas propostas.

OBJECTIVE: To review the literature on the treatment of gastroesophageal reflux disease (GERD) with emphasis on pharmacological aspects. To identify particularities of pharmacological treatment of esophageal and extraesophageal manifestations of the disease. SOURCES: Electronic search of the PubMed/MEDLINE and Cochrane Collaboration databases. Controlled and randomized studies published since 2000 and reviews representing consensus positions and directives published within the last 10 years were identified. SUMMARY OF THE FINDINGS: The drugs currently available for the treatment of GERD do not act in the primary mechanism of the disease, i.e., transitory relaxation of the lower esophageal sphincter. Pharmacological treatment of GERD with symptoms or with esophageal injury is based on the suppression of acid secretion, particularly with proton pump inhibitors. When the hyperreactivity of the lower airways coexists with esophageal GERD symptoms, suppression of acid secretions should be of benefit in managing the respiratory disease in the presence of a causal relationship; however, this is not usual. When esophageal symptoms are not present, esophageal 24-hour pH study should be carried out prior to starting pharmacological treatment for GERD. Improvement of respiratory symptoms may be delayed with relation to esophageal symptoms. It is common for GERD to recur and pharmacological treatment should be repeated or continued indefinitely, depending on clinical presentation of the disease. CONCLUSIONS: The strategies that have been proposed for the pharmacological treatment of GERD in children are primarily based on studies of case series or on studies with adults. There have been very few controlled and randomized studies in children. Undertaking a greater number of these studies might reinforce existing aspects or establish new aspects of management.

Lactante vomitador / Vomiting in children

El vómito en el lactante es un síntoma de gran importancia por su frecuencia, significado clínico y repercusión secundaria en el metabolismo hidroeléctrico que se manifiesta como un fenómeno único, transitorio o puede acompañarse de un cortejo sintomático, donde éste constituye la clave del proceso. Los datos de la anamnesis y la exploración clínica permiten orientar el diagnóstico en la mayoría de los casos

Necrotizing enterocolitis in neonates and infants: a retrospective study of 13 cases

Necrotizing enterocolitis has become a major concern to neonatologists and the paediatric surgeons, which has been estimated to occur in 1-2% of all admission to Newborn Intensive Care Units. Our retrospective study has been done on case of NEC during the period from April 1992 to April 1994 in Newborn Intensive Care Unit of King Khalid General Hospital, Hafr Al Batin, Saudi. Thirteen cases were treated initially nasogastric suction, intravenous fluids and parentral atibiotics, 4 cases cured completely and 3 cases died from septicaemia and DIC. The remaining 6 cases developed surgical complication, 4 cases were explored out of which 3 cases got cured and one died. In the last 2 cases, of < 1000 Gms. birth weight, precutaneous peritoneal drainage under local anaesthesia was done, one got cured without residual problems and the other died. Clinical examination, radiological and laboratory investigations were done in all cases, however 4 cases were diagnosed histopathologically