Tratamiento del pseudoquiste pancreático / Treatment of pancreatic pseudocyst

El pseudoquiste pancreático corresponde a una complicación alejada de la pancreatitis aguda. En nuestro medio son más frecuentes las de etiología biliar. El pseudoquiste se manifiesta en el 10% de estos pacientes. Presentamos el caso de un paciente con un pseudoquiste pancreático resuelto según abordaje endoscópico. Mediante este caso clínico destacamos el abordaje endoscópico de esta patología como un método seguro para el tratamiento de tal complicación.

Pancreatic psudocyst is a late complication of acute pancreatitis. In our environment, cholelithiasis is the most common cause of pancreatitis, and pancreatic pseudocyst occurs in 10% of these patients. We report the case of a patient with a pancreatic psudocyst treated with endoscopic drainage. We highlight that the endoscopic approach is a safe method to treat this complication.

Síndrome de Turcot / Turcotꞌs syndrome

RESUMEN Se presenta a una paciente de 27 años de edad, con varios ingresos en el Hospital Provincial Clínico Quirúrgico Docente “José Ramón López Tabrane”, de Matanzas. Por presentar clínica compatible con pólipos de colon, corroborados por videocolonoscopia, diagnosticados en marzo de 2015. Posteriormente reingresa a los 14 meses por convulsiones, al inicio generalizado y luego limitado al hemicuerpo derecho, cefalea universal y vómitos. Falleció a los 23 días de su ingreso, en los antecedentes patológicos familiares destaca madre fallecida a los 52 años por cáncer de colon y hermana a los 21 años por neoplasia maligna colorectal (AU).

ABSTRACT The case of a female patient, aged 27 years is presented. She was in-patient in the Teaching Clinical Surgical Provincial Hospital “José Ramón López Tabrane”, of Matanzas for several times presenting clinical characteristics compatible polyps in the colon, corroborated by video colonoscopy, and diagnosed in March 2015. She was readmitted 14 months later because of convulsions, generalized firstly and lately limited to the right side of the body, universal headache and vomits. She died 23 days after the admittance. The family history shows that her mother died when she was 52, due to colon cancer and her sister died at twenty one due to colorectal malignant neoplasia (AU).

Bilateral spontaneous chylothorax after severe vomiting in children / Quilotórax bilateral espontâneo após vômitos excessivos em criança

Abstract Objective: To report the case of a child with bilateral chylothorax due to infrequent etiology: thoracic duct injury after severe vomiting. Case description: Girl, 7 years old, with chronic facial swelling started after hyperemesis. During examination, she also presented with bilateral pleural effusion, with chylous fluid obtained during thoracentesis. After extensive clinical, laboratory, and radiological investigation of the chylothorax etiology, it was found to be secondary to thoracic duct injury by the increased intrathoracic pressure caused by the initial manifestation of vomiting, supported by lymphoscintigraphy findings. Comments: Except for the neonatal period, chylothorax is an infrequent finding of pleural effusion in children. There are various causes, including trauma, malignancy, infection, and inflammatory diseases; however, the etiology described in this study is poorly reported in the literature.

Resumo Objetivo: Relatar o caso de uma criança com quilotórax bilateral devido a etiologia pouco frequente: lesão do ducto torácico após quadro de vômitos excessivos. Descrição do caso: Menina, sete anos, apresentava edema facial crônico iniciado após quadro de hiperemese. À avaliação, também apresentava derrame pleural bilateral, com líquido quiloso obtido na toracocentese. Após extensa investigação clínica, laboratorial e radiológica da etiologia do quilotórax, foi definido ser secundário a lesão do ducto torácico por aumento da pressão intratorácica pela manifestação inicial de vômitos, corroborado por achados de linfocintilografia. Comentários: À exceção do período neonatal, o quilotórax é achado infrequente de efusão pleural em crianças. As causas são diversas, incluindo trauma, neoplasia, infecção e doenças inflamatórias; contudo, etiologia como a aqui descrita é pouco relatada na literatura.

Vómitos en pediatriía: presentación de caso clínico y abordaje diagnóstico / Vomiting in pediatrics: Clinical case presentation and Diagnostic Approach

El vómito es uno de los síntomas que se presen- ta con mayor frecuencia en los centros de aten- ción pediátrica. Sus causas son múltiples y abar- can cualquier sistema de nuestro organismo. La estenosis del píloro es una condición común en la infancia con una incidencia de 2 a 5 casos por cada mil nacidos vivos. Esta suele presen- tarse entre la 3era semana y 3 meses de vida, siendo excepcional su debut en edad más tardía. Se presenta el caso de femenina de 2 años de edad, con cuadro de vómitos de larga evolu- ción como signo principal, con distintos trata- mientos pero sin mejoría y mediante un estu- dio contrastado de vía digestiva superior y con rmado mediante endoscopia se llegó al diagnóstico de una obstrucción de hipertró ca congénita de píloro. Después de una breve revisión de la siopato- logía del vómito presentamos un abordaje diagnóstico que pueda ser de utilidad para identi car la causa y ofrecer un tratamiento oportuno en los pacientes pediátricos con cuadro de vómitos...(AU)

2000 CDC or 2007 WHO – What is the most sensitive anthropometric reference for determination of overweight and cardio-metabolic risk in children aged 6–10 years?

Objective To compare the two anthropometric standards for screening of overweight and cardio-metabolic risk in 6–10-year-old children.Subjects and methods This cross-sectional study included 175 subjects attending the Referral Center for the Treatment of Children and Adolescents in Campos, Rio de Janeiro. They were classified according to CDC and WHO BMI z scores as normal-weight (z-score > –1 and < 1), overweight (z-score ≥ 1 and < 2) or obese (z-score ≥ 2). Sensitivities and specificities in predicting systolic (SBP), diastolic (DBP) blood pressure and homeostatic model assessment insulin resistance index (HOMA-IR) alterations were calculated.Results There was a major difference in 11 children who rated overweight by the CDC but were reclassified as obese by the WHO. Their mean z-scores for SBP (1.71 ± 1.54), DBP (2.64 ± 1.83) and HOMA-IR (1.84 ± 0.98) were higher than those classified as overweight by both references (SBP = 0.49 ± 1.34, p < 0.023, DBP = 1.45 ± 0.97, p < 0.04 and HOMA = 1.24 ± 0.67, p < 0.04), but were similar to those classified as obese by both criteria (SBP = 1.25 ± 2.04, p = 0.60, DBP = 1.94 ± 1.19, p = 0.50 and HOMA = 2.09 ± 1.12, p = 0.76).Conclusion the 2007 WHO reference was the most sensitive in screening for overweight and alterations in blood pressure and HOMA-IR in 6–10-year-old children. Arch Endocrinol Metab. 2015;59(3):220-5.

Vômitos em traumatismo cranioencefálico leve na infância / Vomiting in mild traumatic brain injury during childhood

Objetivo: O presente trabalho visa identificar o significado do vômito em crianças com traumatismo cranioencefálico(TCE) leve. Métodos: O presente trabalho foi prospectivo e descritivo em 88 pacientes com idade abaixo de 16 anos, atendidos no setor de urgência do HUSE (Aracaju-Sergipe). Foram analisados idade, gênero, causas do trauma, quadro neurológico, exames complementares e conduta. Resultados: Foram analisados 88 pacientes. O gênero M 74/F 14 casos. A média das idades foi de 5,5 anos. As causas do TCE foram: queda acidental (62 casos), seguida de acidente de trânsito (10 casos), queda de bicicleta (9 casos), maus-tratos (2 casos) e desconhecido (5 casos). A média de episódios de vômitos foi de dois. Outras queixas foram cefaleia e sonolência. Raios x simples de crânio realizados em 84 casos demonstraram fratura linear em dois e afundamento craniano em um. TC realizada em 88 pacientes revelou hematoma extradural (1), hematoma subdural (1), hemorragia subaracnóidea (1) e contusão temporal (1). Tratamento cirúrgico foi instituído em dois casos. Não houve relação entre o número de episódios de vômitos e achados de imagem. Achados anormais do exame de raios x simples associados com vômitos e sonolência foram preditores de lesão cerebral. Não houve óbito. Conclusão: O conhecimento do significado de vômito em TCE leve na infância é imprescindível para evitar a realização desnecessária de exames de imagem que acarretam riscos biológicos e custos adicionais. Não encontramos relação entre vômitos e lesão cerebral em crianças com TCE leve. Ausência de vômitos em crianças com TCE leve não exclui ausência de lesão cerebral...

Objective: This present study aims to show the real importance of vomiting post-traumatic in children who had mild head trauma. Methods: A prospective and descriptive study off 88 patients from birth to 16 years with minor head injury who were presented to as emergency service in the HUSE (Aracaju-Sergipe). Characteristics studied were age, sex, mechanisms of injury, site of impact, neurological on arrival, exams and treatment. Results: Eighty eight patients presented vomiting post traumatic as the most important symptom and this was the study group. Gender male74/female 14 cases. The average age was 5,5 years. Most injuries were caused by a fall (63 cases). The mechanism of injury was a fall in 62, involvement in a road traffic accident in 10, bicycle crash in 9, abuse in 2 and unknown in 5. The average of episodes of vomiting were two. Other complaints were headache and somnolence. A simple skull x-ray performed in 84 cases demonstrated a linear fracture in two and compound fracture of skull in one. CT performed in 88 patients revealed one extradural hematoma, one subdural hematoma, one subarachnoid hemorrhage and one temporal contusion. Surgical treatment was instituted in two cases. There was no finds compared between the number of episodes of vomiting and imaging findings. Abnormal findings on simple x-ray associated with vomiting and somnolence were predictors of brain damage. There was no death. Conclusion: The knowledge of the significance of vomiting in mild head trauma in children is essential to avoid performing unnecessary imaging tests that carries biological risks and additional costs. There was no compared between brain injury and vomiting in children with mild head injuries. No vomiting in children with mild head trauma doesn?t exclude the absence of brain damage...

Características bucais da perimólise e episódios recorrentes de vômitos: relato de caso / Features Oral of Perimolysis Recurrent Vomiting: Case Report

O presente trabalho teve o propósito de abordar, por meio de relato de caso clínico, aspectos relevantes sobre o diagnóstico, tratamento e acompanhamento de uma criança de 10 anos de idade portadora de perimólise. Ao exame clínico, a paciente apresentou IHO-S igual a 0,16 e ISG de 26,0%. Foram verificadas alterações do esmalte em vários elementos dentários (superfície palatina dos dentes anteriores superiores). O tratamento consistiu de 08 aplicações em intervalos semanais de verniz fluoretado a 5% NaF. Orientações de higiene e dieta também foram condutas adotadas. Após a realização das intervenções, foi constatada a redução da sensibilidade dentária.

This paper aims to address, through clinical case, the relevant aspects on the diagnosis, treatment and monitoring of a 10 year old carrier perimolysis. On clinical examination, the patient had OHI-S equal to 0.16 and 26.0% of ISG. Enamel alterations were noted in several dental elements (palatal surface of maxillary anterior teeth). Treatment consisted of 08 weekly applications at intervals of 5% NaF fluoride varnish. Guidelines hygiene and diet behaviors were also adopted. After completion of the interventions, was found to reduce tooth sensitivity.

Tooth wear in patients submitted to bariatric surgery

Bariatric surgery may cause frequent vomiting episodes and gastroesophageal reflux, which promote the contact of gastric acids with the teeth leading to irreversible loss of tooth structure. The aim of this study was to assess prevalence of tooth wear in bariatric patients. One hundred and twenty-five patients were examined at a Public Hospital in São Luis, MA, Brazil, between July and October 2010, being patients who had already been submitted to the bariatric surgery at least 6 months previously (Bariatric group), morbidly obese patients who were on the waiting list for this surgery (Obese group) and patients who were waiting for ambulatory medical care in other sectors (Control group). The patients answered an investigative questionnaire and were clinically examined using the Basic Erosive Wear Examination (BEWE) scoring system, which allows the classification of the severity of noncarious dental lesions (NCDL) and evaluation of risk. All patients presented some degree of tooth wear at different levels. However, the presence of NCDL was associated with the group to which the patient belonged. The bariatric patients showed higher prevalence and a statistically significant level of risk with regard to NCDLs when compared with the other patients, followed by the obese and control groups. Reflux and vomiting did not seem to influence NCDL positively.

Cirurgia bariátrica pode provocar freqüentes episódios de vômito e refluxo gastroesofágico o que promove o contato dos ácidos gástricos com os dentes fazendo que haja perda irreversível de estrutura dental. Este estudo teve como objetivo avaliar a prevalência de desgaste dentário em pacientes bariátricos. Foram examinados 125 pacientes em um Hospital Público de São Luís, MA no período de julho a outubro de 2010, distribuídos em pacientes que já tinham sidos submetidos à cirurgia bariátrica há pelo menos 6 meses (Grupo bariátrico), obesos mórbidos que estavam na lista de espera para esta cirurgia (Grupo obeso) e por pacientes que esperavam por consulta médica ambulatorial em outros setores (Grupo controle). Os pacientes responderam a um questionário investigativo e foram examinados clinicamente utilizando o “Basic Erosive Wear Examination” - BEWE (Índice Básico do Desgaste Erosivo) que permite a classificação da severidade das lesões não-cariosas e avaliação de risco. Todos os pacientes apresentaram algum grau de desgaste dentário em diferentes níveis. No entanto, a presença de LDNC (lesão dental não-cariosa) estava associada ao grupo que o paciente pertencia. O grupo bariátrico apresentou maior prevalência e nível de risco em relação às LDNC’s estatisticamente significante quando comparado aos outros grupos, seguido pelo grupo de obeso e controle. Refluxo e vômito parecem não influenciar positivamente nas LDNC.

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.

Semiología digestiva / Digestive semiology

La semiología digestiva pediátrica, al igual que todos los sistemas del cuerpo humano, incluyen la Inspección, la Auscultación, la Palpación y la Percusión del abdomen y sus órganos anexos. La historia clínica continúa siendo la principal herramienta con que contamos para orientar el diagnóstico y así proponer un plan terapéutico y de promoción y prevención, con el fin de evitar comorbimortalidades posibles. El presente artículo revisa algunas de las patologías más frecuentes que afectan el sistema gastrointestinal, hepático y nutricional en niños.

The pediatric gastrointestinal symptomatology, like all human body systems, including inspection, auscultation, palpation and percussion of the abdomen and its organs annexes. The clinical history remains the main tool we have to guide the diagnosis and thus to propose a treatment plan and health promotion and prevention, in order to avoid possible co morbilities and mortalities. This article reviews some of the most common diseases affecting the gastrointestinal system, liver and nutrition in children.

After more than 300 defibrillation shocks, patient still alive 12 years later refractory torsade de pointes due to polypharmacy and persistent vomiting

Acquired torsade de pointes ventricular tachycardia [TdP] is a rare but serious lifethreatening arrhythmia caused by an array of cardiac and non-cardiac drugs. It is often refractory to pharmacological therapy and may result in death or require frequent defibrillations. In our case study a young female patient with no underlying heart disease developed very frequent sustained TdP requiring frequent defibrillations without which she would have certainly died. The ventricular arrhythmia in this patient was of multifactorial origin-cisapride, drug-drug interaction and persistent vomiting resulting in electrolyte disturbance and malnutrition. The patient survived after more than 300 defibrillation shocks over a period of 5 days and she is still alive 12 years later

Un caso de neumomediastino espontáneo que simula un síndrome de Boerhaave / A case of spontaneous pneumomediastinum that simulates a Boerhaave's syndrome

The spontaneous pneumomediastinum is the presence of air inside the mediastinum without a traumatic or iatrogenic reason associated. It is a slightly frequent entity and as the spontaneous pneumotorax it is given especially in young males. In rare occasions it associates to an episode of vomits and in this case it is necessary to make a differential diagnosis with Boerhaave's syndrome because at the first moment the clinic can be similar in both cases. Nevertheless, while the spontaneous pneumomediastinum is quite often to be a benign entity with good prediction, Boerhaave's syndrome has a mortality of 80 percent-90 percent if the diagnosis is produced after 24-48 hours.

El neumomediastino espontáneo es la presencia de aire dentro del mediastino sin que exista una causa traumática o iatrogénica asociada. Es una entidad poco frecuente que, al igual que el neumotorax espontáneo, se da sobre todo en varones jóvenes. En raras ocasiones se asocia a un episodio de vómitos y, en este caso, es necesario hacer un diagnóstico diferencial con el síndrome de Boerhaave ya que en un primer momento la clínica puede ser similar en ambos cuadros. Sin embargo, el neumomediastino espontáneo suele ser una entidad benigna con buen pronóstico y el síndrome de Boerhaave es un cuadro de mal pronóstico y que, de diagnosticarse después de 24-48 horas, puede tener hasta un 80 por ciento-90 por ciento de mortalidad.

Ruptura pós-emética do esôfago: a síndrome de Boerhaave / Postemetic rupture of the esophagus: Boerhaave's syndrome

A ruptura pós-emética do esôfago, também chamada ruptura espontânea ou síndrome de Boerhaave, foi descrita pela primeira vez em 1724 por Herman Boerhaave. Trata-se de uma doença grave, de alta mortalidade e de difícil diagnóstico, tanto por ser rara como por ser freqüentemente confundida com quadros graves mais comuns, como o infarto agudo do miocárdio, a úlcera péptica perfurada e a pancreatite aguda. Descrevemos, a seguir, três casos de pacientes com esta síndrome. Dois foram submetidos ao reparo primário da lesão e um foi submetido à esofagectomia com posterior reconstrução. Houve um óbito por choque séptico no pós-operatório imediato. Os outros dois casos tiveram boa evolução a longo prazo.

Postemetic rupture of the esophagus, also known as spontaneous rupture or Boerhaave's syndrome, was first described by Herman Boerhaave in 1724. This is a severe disease that causes high mortality rates and is difficult to diagnose not only because it is rare but also because it is frequently confused with other severe clinical conditions, such as acute myocardial infarction, perforated peptic ulcer, and acute pancreatitis. Herein, we describe three cases of patients with this syndrome. Two underwent primary repair of the rupture, and one underwent esophagectomy followed by reconstruction. There was one death due to septic shock in the immediate postoperative period. The other two patients presented favorable long-term evolution.

Síndrome de Boerhaave, revisión bibliográfica y presentación de un caso / Boerhaave syndrome, literature review and case report

Introducción: El Síndrome de Boerhaave se define como la rotura del esófago no relacionada con traumatismos, exploraciones invasivas, patología esofágica previa o cuerpos extraños. Es una ruptura barogénica y postemética.Objetivo: Revisión bibliográfica y presentación de caso.Lugar de Aplicación: Hospital Polivalente de Alta complejidad.Caso Clínico: masculino de 70 años ingresa por melena y hematemesis de escasa cantidad. Presenta rápidamente descompensación hemodinámica. Se constata enfisema subcutáneo. El paciente pasa a UTI en mal estado general requiriendo ARM. Se realiza RX de Tórax evidenciándose neumomediastino y opacidad difusa en ambos campos pulmonares. Se produce el óbito del paciente a las 24 hs. de su ingreso.Conclusión: La perforación espontánea de esófago es una patología poco frecuente con un curso rápido y de mal pronóstico sin un diagnóstico y una terapéutica precoz. Tiene un alto índice de mortalidad (36%) y el factor pronóstico más importante es el tiempo empleado en el tratamiento quirúrgico, ya sea con cierre primario, cierre reforzado, resección esofágica, exclusión o colocación de endoprótesis.

Evaluation of gastrointestinal symptoms as primary sign of severe invasive group A streptococcal infections.

BACKGROUND & OBJECTIVES: Severe invasive infections caused by group A Streptococcus (GAS) are often associated with shock and organ failure. We describe epidemiological and disease related data from the national surveillance of invasive GAS infection in Denmark in addition to three fatal cases that occurred in Denmark in 2002 with gastrointestinal (GI) symptoms as the dominating preliminary signs. METHODS: As the National Streptococcal Reference Centre The Streptococcus Unit, Statens Serum Institut (SSI) receives the vast majority of the invasive GAS isolates from patients admitted to all the hospitals in Denmark. The isolates were T-typed by slide agglutination test emm-squencing and pulsed field gel electrophoresis (PFGE) were also performed. RESULTS: During January 2002 three patients died at home and GAS were found at autopsy. Cases 1 (12 yr) and 3 (25 yr) had been ill for less than two days with nausea, diarrhoea and vomiting. Case 2 (25 yr) had the same symptoms for two weeks. None of the three had any underlying diseases. The GAS isolates from cases 1 and 2 were T-type 3-13-B3264, emm89 and SpeA-, SpeC-. The third isolate was Ttype 1, emm1 and SpeA+, SpeC-. PFGE could not discriminate between the two isolates with T-type 3-13-B3264. The PFGE patterns of the three isolates were similar to those identified from GAS isolated elsewhere in Denmark at different times and from non-fatal cases. In 1999-2002, SSI received 409 isolates from patients with invasive GAS infection, and the mortality rate was 18 per cent. In 40 patients the primary symptoms were gastrointestinal, and in 30 per cent of these the outcome was fatal. INTERPRETATION & CONCLUSION: The various early clinical manifestations of severe GAS infections are still a major challenge for clinicians because of the importance of a fast and appropriate diagnosis and immediate start of treatment.

Hiponatremia / Hyponatremia

Se define a la hiponatremia como la concentración de sodio plasmático menor de 130 mmol/L. Se puede presentar en las siguientes situaciones: trastornos en la eliminación renal de agua (pérdidas en aparato digestivo, pérdidas renales por hipoaldosteronismo, enfermedades renales perdedoras de sal, pérdidas por piel, estados edematosos, depleción de potasio), insuficiencia renal y por uso de diuréticos, hipotiroidismo o en la pseudohiponatremia. Existen 3 posibles estados del organismo con respecto al contenido de sodio: a) disminución del contenido total de sodio, b) normalidad en el contenido total de sodio y c) aumento en el contenido total de sodio. Estos 3 estados pueden acompañarse de otras 3 situaciones cada uno: disminución, normalidad y aumento en el contenido total del agua. La hiponatremia puede ser aguda o crónica. El tratamiento de los síndromes que producen hiponatremia se basa en 3 principios que pueden aplicarse por separado o juntos: la administración de soluciones de NaCl para elevar la concentración del sodio sérico, aplicable en los pacientes con depleción del sodio total; restricción de la ingesta de agua en los pacientes normovolémicos o edematosos; y tratamiento de la causa subyacente

Consulta de vómitos en el Centro de Diagnóstico del Hospital Nacional de Niños / Consultation of vomiting in Diagnosis Center, Hospital Nacional de Niños

El lactante es muy frecuente el vómito, la mayoría de las veces puede considerarse normal, pero en algunas ocasiones es una manifestación de un reflujo gastroesofágico. En niños con reflujo gastroesofático demostrado si se dejan evolucionar, 60 por ciento estarán libres de síntomas a los dieciocho meses, y tan solo 10 por ciento presentará complicaciones mayores. Se presenta un análisis de los pacientes atendidos por vómitos en el Centro de Diagnóstico del Hospital Nacional de Niños, Costa Rica durante el período enero a junio de 1991. En este estudio se encontró que las dos terceras partes de los pacientes provenían de San José. La edad precoz : 67,6 por ciento niños menores de tres meses. No hubo relación entre la paridad de las madres y la consulta por vómitos. De ciento dos pacientes, solo doce (11,8 por ciento) ameritaron seguir control en el Hospital Nacional de Niños; lo que significa que el 88 por ciento fueron dados de alta o no regresaron, aún cuando treinta y cuatro presentaron algún grado de reflujo gastroesofático en el esofagograma.