Utilidad de la ecografía pulmonar para monitorizar la sobredistensión grave en paciente con displasia broncopulmonar grave / Lung overdistention monitorization by ultrasound in a patient with severe bronchopulmonary dysplasia

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Decreased Retinal Thickness in Type 1 Diabetic Children with Signs of Nonproliferative Diabetic Retinopathy.

The retina functions as a neurovascular unit. How early vascular alterations affect neuronal layers remains controversial; early vascular failure could lead to edema increasing retinal thicknesses, but alternatively neuronal loss could lead to reduced retinal thickness. Objective. To evaluate retinal thickness in a cohort of pediatric patients with type 1 diabetes mellitus (PwT1DM) and to analyze differences according to the presence or absence of nonproliferative diabetic retinopathy (NPDR), poor metabolic control, and diabetes duration. Patients and Methods. We performed retinographies and optical coherence tomography (OCT) (TOPCON 3D1000®) to PwT1DM followed at our center and healthy controls. Measurements of the control group served to calculate reference values. Results. 59 PwT1DM (age 12.51 ± 2.59) and 22 healthy controls (age 10.66 ± 2.51) volunteered. Only two PwT1DM, both adolescents with poor metabolic control, presented NPRD. Both showed decreased thicknesses and retinal volumes. The odds ratio of having decreased retinal thickness when signs of NPDR were present was 11.72 (95% IC 1.16-118.28; p = 0.036). Conclusions. PwT1DM with NPDR have increased odds of decreased retinal thicknesses and volumes. Whether these changes are reversible by improving metabolic control or not remains to be elucidated.

Púrpura de Schönlein-Henoch secundaria a parvovirus B19 / Henoch-Schönlein purpura due to parvovirus B19

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Trombosis del seno sigmoide tras una otitis media / Sigmoid sinus thrombosis following otitis media

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[Twenty years of treating childhood acute lymphoblastic leukemia]. / Veinte años de experiencia en el tratamiento de la leucemia linfoblástica aguda.

BACKGROUND: Conventional prognostic factors for relapse in patients with acute lymphoblastic leukemia (ALL) are the main basis of risk-stratified treatments. OBJECTIVES: To analyze conventional risk factors for relapse and design a predictive model for relapse in our series, after 20 years of experience in treating ALL. PATIENTS AND METHOD: We performed a multivariate analysis of conventional prognostic factors in the treatment of ALL in our unit and compared them with the risk groups in the Berlin-Frankfurt-Münster (BFM-ALL) treatment protocols. RESULTS: Between 1984 and 2004, 232 children were diagnosed with ALL and treated according to the different versions of the BFM protocols (BFM83, BFM86, BFM90 and BFM95) at the Hospital Niño Jesús, Madrid, Spain. The event-free survival for all patients was 79.4 % (95 % CI: 72.7-85.4). Overall survival among patients who relapsed was 10.72 % (95 % CI: 6-27.3). The only significant prognostic factor for relapse identified by multivariate analysis was leukocyte [white blood cell (WBC)] count higher than 80,000/ml at diagnosis (hazard ratio [HR]: 4.63; 95 % CI: 1.61-13.3; p 5 0,004). The sensitivity and specificity of WBC in predicting relapses were 31.4 % and 87.5 %, respectively. The sensitivity and specificity of BFM risk group stratification in predicting relapses were 25 and 85.9 respectively. CONCLUSIONS: A leukocyte count at diagnosis higher than 80,000/ml and BFM risk-stratified treatment have insufficient sensitivity and specificity to identify relapses.

Veinte años de experiencia en el tratamiento de la leucemia linfoblástica aguda / Twenty years of treating childhood acute lymphoblastic leukemia

Antecedentes Los factores pronósticos en el tratamiento de la leucemia linfoblástica aguda (LLA) son la base del tratamiento adaptado al grupo de riesgo. Objetivos Analizar los factores de riesgo convencionales y establecer un modelo predictivo de recaída en nuestra serie, tras 20 años de experiencia en el tratamiento de la LLA. Pacientes y método Realizamos un análisis multivariante de los factores pronósticos convencionales en el tratamiento de la LLA y los comparamos con los grupos de riesgo del protocolo de tratamiento Berlín-Frankfurt-Münster (LLA-BFM), en nuestra unidad. Resultados Entre 1984 y 2004, un total de 232 niños fueron diagnosticados de LLA y tratados siguiendo el protocolo BFM en sus diferentes versiones (BFM83, BFM86, BFM90 y BFM95). La supervivencia libre de episodios de la serie fue de 79,4 % (IC 95 %: 72,7-85,4). La supervivencia global de los pacientes que recayeron fue de 10,72 % (IC 95 %: 6-27,3). La única variable predictora en el análisis multivariante fue el número de leucocitos al diagnóstico mayor de 80.000/ml (hazard ratio [HR]: 4,63; IC 95 %: 1,61-13,3; p 5 0,004). La sensibilidad y especificidad del número de leucocitos al diagnóstico mayor de 80.000/ml para predecir la recaída fue en nuestra serie de 31,4 y 87,5, respectivamente. La sensibilidad y especificidad de los grupos de riesgo BFM para predecir la recaída fue de 25 y 85,9, respectivamente. Conclusiones El número de leucocitos al diagnóstico mayor de 80.000/ml o los grupos de tratamiento adaptados al riesgo según las variables convencionales no tienen suficiente sensibilidad y especificidad para identificar las recaídas

Background Conventional prognostic factors for relapse in patients with acute lymphoblastic leukemia (ALL) are the main basis of risk-stratified treatments. Objectives To analyze conventional risk factors for relapse and design a predictive model for relapse in our series, after 20 years of experience in treating ALL. Patients and method We performed a multivariate analysis of conventional prognostic factors in the treatment of ALL in our unit and compared them with the risk groups in the Berlin-Frankfurt-Münster (BFM-ALL) treatment protocols. Results Between 1984 and 2004, 232 children were diagnosed with ALL and treated according to the different versions of the BFM protocols (BFM83, BFM86, BFM90 and BFM95) at the Hospital Niño Jesús, Madrid, Spain. The event-free survival for all patients was 79.4 % (95 % CI: 72.7-85.4). Overall survival among patients who relapsed was 10.72 % (95 % CI: 6-27.3). The only significant prognostic factor for relapse identified by multivariate analysis was leukocyte [white blood cell (WBC)] count higher than 80,000/ml at diagnosis (hazard ratio [HR]: 4.63; 95 % CI: 1.61-13.3; p 5 0,004). The sensitivity and specificity of WBC in predicting relapses were 31.4 % and 87.5 %, respectively. The sensitivity and specificity of BFM risk group stratification in predicting relapses were 25 and 85.9 respectively. Conclusions A leukocyte count at diagnosis higher than 80,000/ml and BFM risk-stratified treatment have insufficient sensitivity and specificity to identify relapses

Síndrome de Proteus: revisión bibliográfica a propósito de un caso / Proteous Syndrome: bibliographic review in regards to one case

El síndrome de Proteus es una enfermedad poco conocida debido a su baja prevalencia y a la reciente sistematización en su estudio. Se caracteriza por un crecimiento desordenado y focal de distintas regiones y órganos corporales, lo cual general afectación de múltiples sistemas y gran variabilidad clínica. Recientemente se han publicado los criterios diagnósticos de Maryland, lo cual ha hecho que sea más fácil la identificación de estos casos y su agrupación para estudio. Nosotros presentamos a un paciente que está realizando seguimiento en nuestro Hospital, que utilizamos para realizar una búsqueda de la información existente en la literatura sobre esta enfermedad

Proteus disease is a rare disease, with diagnostic criteria created very recently, and with hardly two-hundred cases in teh world. It is caused by overgrowth and asymmetry of diferent regions and systems that makes it have a very wide list of signs and syntoms, which makes diagnosis very difficult. We present the case of a 4-year-old boy and use it to introduce a bibliographic review of this syndrome

Peso al nacimiento y tabaquismo familiar / Birth weight and familial smoking

Introducción: La exposición al tabaco durante la gestación es un importante factor de riesgo para la población infantil, y a corto plazo se ha relacionado con un aumento de niños nacidos con bajo peso. Pacientes y métodos: Llevamos a cabo un estudio de casos y controles retrospectivo entre los niños ingresados en la sección de lactantes del hospital. Se recogen datos de 2.370 lactantes entre 2002 y 2004. Resultados: La odds ratio (OR) para el bajo peso en el grupo de madres fumadoras fue de 1,42 (intervalo de confianza del 95 % [IC 95 %]: 1,017-1,985), y en el grupo de las que su pareja fumaba fue de 1,37 (IC 95 %: 1,014-1,863). La OR para la variable semanas de gestación fue de 0,585 (IC 95 %: 0,545-0,628), mientras que el porcentaje de niños con bajo peso no fue significativamente distinto según sexo (OR: 1,25; IC 95 %: 0,934-1,671). Conclusiones: Nuestros resultados refuerzan la necesidad de hacer mayor hincapié en la prevención del tabaquismo durante y después del embarazo en ambos progenitores conjuntamente, ya que se podrían reducir gran cantidad de complicaciones para la salud de los niños que implican un alto coste médico, social y económico

Introduction: Tobacco smoking during pregnancy is an important risk factor in the pediatric population and has been associated with an increase in low birth weight (LBW) infants. Patients and methods: We carried out a retrospective case-control study of infants admitted to the Infants Department of the Hospital Universitario Infantil Niño Jesús in Madrid. Data from 2370 infants admitted to the hospital between 2002 and 2004 were collected. Results: The odds ratio (OR) for having a LBW infant was 1.42 (95 % CI: 1.017-1.985) among mothers who smoked during pregnancy and was 1.37 (95 % CI: 1.014-1.863) among women whose partners smoked. Gestational age was also a predictive factor of birth weight: the OR was 0.585 (95 % CI: 0.545-0.628). No significant differences for risk of LBW were found between sexes (OR: 1.25; 95 % CI: 0.934-1.671). Conclusions: Our results should reinforce the importance of smoking prevention during and after pregnancy in both parents, which could reduce many complications in children's health with a high medical, social and economic cost