ABSTRACT
El síndrome de Zinner es una alteración en el desarrollo embriológico poco común, que consiste en la asociación de una dilatación quística de la vesícula seminal con agenesia renal ipsilateral. Presentamos el caso de un varón de 14 años diagnosticado de síndrome de Zinner a raíz de un cuadro de orquiepididimitis izquierda y hematuria. Entre los antecedentes personales del paciente destaca una agenesia renal izquierda con función renal conservada. Debido a la sospecha clínica se realizó una resonancia magnética (RM), en la que se objetivó uréter izquierdo dilatado y tortuoso, confirmándose su desembocadura en vesícula seminal izquierda. Clínicamente suele manifestarse con episodios recidivantes de epididimitis, trastornos miccionales o alteraciones eyaculatorias, pudiendo aparecer a cualquier edad, aunque lo más frecuente es durante la segunda y tercera décadas de la vida. La RM es la técnica diagnóstica de elección. El tratamiento depende directamente de la clínica. La cirugía suele reservarse para los pacientes sintomáticos o para aquellos quistes que se detectan a una edad temprana, para evitar posibles complicaciones
Zinner syndrome is a rare embryological development disorder. It is the association of a cystic dilation of the seminal vesicle with ipsilateral renal agenesis. The case is presented as a 14-year-old male diagnosed with Zinner syndrome as a consequence of an orchiepididymitis and hematuria episode. Among his medical history, a left renal agenesis is highlighted with preserved renal function. Due to the clinical suspicion, a MRI was performed in which it was observed a dilated and tortuous left ureter, being able to confirm its opening in the left seminal vesicle. Zinner syndrome is clinically presented with recurrent epididymitis episodes, voiding disorders or ejaculatory alterations, being able to appear at any age, although the most common is during the second and third decade of life. MRI is the diagnostic method of choice. Treatment relies on the clinic. Surgery is usually reserved for symptomatic patients or for those cysts that are detected at an early age, in order to avoid possible complications
Subject(s)
Humans , Male , Adolescent , Genital Diseases, Male/diagnosis , Cysts/diagnosis , Seminal Vesicles/diagnostic imaging , Kidney Diseases/diagnosis , Kidney/abnormalities , Genital Diseases, Male/congenital , Cysts/drug therapy , Genital Diseases, Male/drug therapy , Seminal Vesicles/drug effects , Kidney Diseases/congenital , Syndrome , Anti-Infective Agents, Urinary/administration & dosage , Anti-Bacterial Agents/administration & dosage , Ultrasonography , Magnetic Resonance ImagingABSTRACT
INTRODUCTION: Cluster headache is a rare cause of primary headache in children. We report four cases with a mean age of onset of 8.6, ranged from 2 to 13 years. CASE REPORTS: Three males and one female with onset at 2, 7, 13, and 12 years-old, respectively, were included. The symptoms of all patients fulfill the criteria for the diagnosis of cluster headache according to the International Society of Headache. CONCLUSIONS: Despite being rare during childhood, cluster headache should be part of the differential diagnosis of headache in childhood. This report highlights the variable features of this disorder in children, often misdiagnosed. It can be useful in making a quick diagnosis and starting the appropriate treatment early. Verapamil was more effective than flunarizine in terminating the headache in our patients. Oxygen treatment and triptans resulted the treatments with the best response in acute cluster headache.
TITLE: Cefalea en racimos en edad pediatrica: descripcion de cuatro casos y revision de la bibliografia.Introduccion. La cefalea en racimos es una cefalea primaria de origen trigeminoautonomico cuyo inicio en la infancia es infrecuente. Se presentan cuatro casos en los que el inicio de la sintomatologia se produjo entre los 2 y los 13 años. Casos clinicos. Se incluyen tres varones y una niña con inicio a los 2, 7, 13 y 12 años, respectivamente. Los cuatro pacientes cumplen los criterios propuestos por la tercera edicion de la Clasificacion Internacional de las Cefaleas ICHD-III (beta). Conclusiones. A pesar de ser poco frecuente durante la edad pediatrica, la cefalea en racimos debe formar parte del diagnostico diferencial de un niño que consulta por cefalea. Subrayamos la importancia de conocer sus criterios diagnosticos para evitar el retraso diagnostico que se ha descrito con frecuencia. En nuestros pacientes, el tratamiento con verapamilo resulto mas eficaz que el tratamiento con flunaricina. Los tratamientos con mejor respuesta en fase aguda fueron la oxigenoterapia y los triptanes.
Subject(s)
Cluster Headache/diagnosis , Cluster Headache/drug therapy , Adolescent , Child , Child, Preschool , Diagnosis, Differential , Female , Flunarizine/therapeutic use , Humans , Male , Tryptamines/therapeutic use , Verapamil/therapeutic useABSTRACT
Introducción. La cefalea en racimos es una cefalea primaria de origen trigeminoautonómico cuyo inicio en la infancia es infrecuente. Se presentan cuatro casos en los que el inicio de la sintomatología se produjo entre los 2 y los 13 años. Casos clínicos. Se incluyen tres varones y una niña con inicio a los 2, 7, 13 y 12 años, respectivamente. Los cuatro pacientes cumplen los criterios propuestos por la tercera edición de la Clasificación Internacional de las Cefaleas ICHD-III (beta). Conclusiones. A pesar de ser poco frecuente durante la edad pediátrica, la cefalea en racimos debe formar parte del diagnóstico diferencial de un niño que consulta por cefalea. Subrayamos la importancia de conocer sus criterios diagnósticos para evitar el retraso diagnóstico que se ha descrito con frecuencia. En nuestros pacientes, el tratamiento con verapamilo resultó más eficaz que el tratamiento con flunaricina. Los tratamientos con mejor respuesta en fase aguda fueron la oxigenoterapia y los triptanes (AU)
Introduction. Cluster headache is a rare cause of primary headache in children. We report four cases with a mean age of onset of 8.6, ranged from 2 to 13 years. Case reports. Three males and one female with onset at 2, 7, 13, and 12 years-old, respectively, were included. The symptoms of all patients fulfill the criteria for the diagnosis of cluster headache according to the International Society of Headache. Conclusions. Despite being rare during childhood, cluster headache should be part of the differential diagnosis of headache in childhood. This report highlights the variable features of this disorder in children, often misdiagnosed. It can be useful in making a quick diagnosis and starting the appropriate treatment early. Verapamil was more effective than flunarizine in terminating the headache in our patients. Oxygen treatment and triptans resulted the treatments with the best response in acute cluster headache (AU)
Subject(s)
Humans , Male , Female , Child , Adolescent , Cluster Headache/diagnosis , Cluster Headache/psychology , Pediatrics/education , Therapeutics/methods , Pharmaceutical Preparations/administration & dosage , Oxygen Inhalation Therapy/methods , SUNCT Syndrome/pathology , Cluster Headache/complications , Cluster Headache/metabolism , Pediatrics , Therapeutics/standards , Pharmaceutical Preparations/metabolism , Oxygen Inhalation Therapy/instrumentation , SUNCT Syndrome/diagnosisABSTRACT
Introducción: Los pediatras estamos muy concienciados sobre nuestro papel en el diagnóstico del maltrato, ya que si éste no se diagnostica y denuncia a tiempo, puede traer graves consecuencias en los niños, tanto físicas como psíquicas. Sin embargo, como médicos, también podemos incurrir en diagnósticos erróneos de maltrato, con la importancia que esta falsa afirmación supone desde el punto de vista legal y familiar. Material y métodos: Revisamos las historias de cuatro pacientes con patologías diversas que fueron diagnosticados inicialmente de maltrato. En todos ellos se encontró una causa médica que explicaba sus patologías y descartaba nuestra hipótesis inicial de maltrato. Conclusiones: Como pediatras, debemos estar alerta sobre los signos y síntomas que pueden hacernos pensar en maltrato. Sin embargo, también debemos conocer las patologías que pueden parecer efectos de un maltrato, y siempre debemos pensar en los posibles diagnósticos diferenciales cuando se nos plantea un posible caso de maltrato (AU)
Backgrounds: Paediatricians are concerned about our role in diagnosis of child abuse, due to the terrible consequences, both physical and psychological, that children can suffer if its not diagnosed and reported on time. However, as doctors, we can fall into misdiagnosis, with the importance of this wrong statement means legally and in their families. Material and methods: We have reviewed four medical records with different diseases. All of them were initially diagnosed of child abuse, but in all we found a medical cause that explained their diseases and child abuse could be ruled out. Conclusions: As paediatricians, we must be alert about signs and symptoms that might make us think about child abuse. However, we also must know diseases that can simulate child abuse and we must consider an alternative diagnoses always than we were thinking about the possibility of physical or sexual child abuse (AU)
Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Battered Child Syndrome/diagnosis , Child Abuse/statistics & numerical data , Child Abuse, Sexual/diagnosis , Diagnosis, Differential , Physical Abuse , Diagnostic Errors/prevention & control , Reproductive Tract Infections/diagnosis , Sexually Transmitted Diseases/diagnosisABSTRACT
OBJECTIVES: The aims of this study were to introduce a paediatric early warning score (PEWS) into our daily clinical practice, as well as to evaluate its ability to detect clinical deterioration in children admitted, and to train nursing staff to communicate the information and response effectively. MATERIAL AND METHODS: An analysis was performed on the implementation of PEWS in the electronic health records of children (0-15 years) in our paediatric ward from February 2014 to September 2014. The maximum score was 6. Nursing staff reviewed scores >2, and if >3 medical and nursing staff reviewed it. Monitoring indicators: % of admissions with scoring; % of complete data capture; % of scores >3; % of scores >3 reviewed by medical staff, % of changes in treatment due to the warning system, and number of patients who needed Paediatric Intensive Care Unit (PICU) admission, or died without an increased warning score. RESULTS: The data were collected from all patients (931) admitted. The scale was measured 7,917 times, with 78.8% of them with complete data capture. Very few (1.9%) showed scores >3, and 14% of them with changes in clinical management (intensifying treatment or new diagnostic tests). One patient (scored 2) required PICU admission. There were no deaths. Parents or nursing staff concern was registered in 80% of cases. CONCLUSIONS: PEWS are useful to provide a standardised assessment of clinical status in the inpatient setting, using a unique scale and implementing data capture. Because of the lack of severe complications requiring PICU admission and deaths, we will have to use other data to evaluate these scales.
Subject(s)
Early Diagnosis , Intensive Care Units, Pediatric , Patient Acuity , Quality Improvement , Adolescent , Child , Child, Preschool , Female , Hospitals, University , Humans , Infant , Infant, Newborn , Male , Parents/psychology , Prospective Studies , SpainABSTRACT
El liquen escleroso es un trastorno mucocutáneo que afecta típicamente a mujeres en la etapa posmenopáusica. Aunque es una entidad poco conocida por los pediatras, hasta un 7-15% de los casos se dan en niñas prepuberales. Presentamos 3 casos de niñas diagnosticadas de liquen escleroso. En todos los casos, el diagnóstico inicial fue erróneo; de ahí la importancia de conocer este cuadro (AU)
Lichen sclerosus is a chronic mucocutaneous disorder that affects typically post-menopausical women. Although it's not well known by pediatricians, up to 7-15% of all cases happen in pre-puberal girls. We reported three cases of lichen esclerosus. In all three cases, the initial diagnosis was wrong, so the importance of knowing this cutaneous disorder (AU)
Subject(s)
Humans , Female , Child, Preschool , Lichen Sclerosus et Atrophicus/diagnosis , Genital Diseases, Female/diagnosis , Diagnosis, Differential , Leukorrhea/diagnosisABSTRACT
La litiasis renal es una patología típica del adulto, y menos frecuente en la edad pediátrica, por lo que no siempre se piensa en ella. Presentamos el caso de un niño de 3 años de edad con un cálculo uretral, previamente diagnosticado de infección de orina, que acudió al servicio de urgencias con síntomas de obstrucción urinaria, provocados por la expulsión en ese momento del cálculo (AU)
Urolithiasis is a typically adult disease, infrequent in the paediatric age, so we rarely think about it. We present the case of a 3 years old child with a urethral lithiasis, previously diagnosed of urinary infection, who presented with symptoms of urinary obstruction, caused by the expulsion of a urethral stone at that moment (AU)
Subject(s)
Humans , Male , Child , Urethral Diseases/complications , Urethral Diseases/diagnosis , Calculi/complications , Urolithiasis/complications , Urolithiasis/diagnosis , Urolithiasis/surgery , Diuresis/physiology , Urinary Retention/complications , Urethra/pathology , Urethra , Urolithiasis , Kidney Calculi/complications , Kidney Calculi/diagnosis , Risk FactorsABSTRACT
Los niños con obstrucción aguda o crónica de la vía aérea tienen riesgo de desarrollar edema agudo de pulmón postoobstructivo (EPP) tras la desobstrucción de la vía aérea. Es importante conocer esta patología, habitualmente confundida con patologías más frecuentes como neumonía o broncoespasmo, para realizar un diagnóstico y tratamiento precoces. Presentamos a continuación el caso de un lactante de 7 meses que presentó EPP tras la desobstrucción de la vía aérea provocada por n tapón de plástico (AU)
Children with either acute or chronic upper airway obstruction are at risk of developing post obstructive pulmonary oedema (POPE). It´s important to know about this pathology, often misdiagnosed as brochoespasm or pneumonia, in order to make a correct diagnoses and treatment. We describe a case of a 7-month infant who developed POPE after the relief of an upper airway obstruction caused by a plastic bottle cap (AU)
Subject(s)
Humans , Male , Infant , Foreign Bodies/surgery , Pulmonary Edema/etiology , Airway Obstruction/surgery , Postoperative ComplicationsABSTRACT
Objetivo. Conocer la información percibida por el paciente tras consulta hospitalaria. Material y métodos. Estudio descriptivo de tipo transversal. Emplazamiento. Hospital Nuestra Señora del Prado, Talavera de la Reina. Participantes. Pacientes mayores de 14 años remitidos a consultas externas del hospital de referencia. Se seleccionaron 96 pacientes, colaboraron 87 (90,6%). Se comprobó la coincidencia entre la información percibida por el paciente, obtenida a través de encuesta telefónica, con respecto a la registrada en la historia clínica por el médico. Resultados. Creían conocer el motivo de consulta 80 (94%) pacientes. No recordaban cambios de tratamiento 4 (5%) pacientes, ni consejo sobre hábitos de vida 2 (2%). Contrastando con historia clínica había 89% de coincidencia. No había diferencias significativas (p>0,05) con edad, audición, número de visitas, tiempo, ni especialidades. Conclusión. La mayoría de pacientes comprendió el mensaje transmitido por el médico, aunque convendría optimizar la comunicación para alcanzar el 100% de comprensión (AU)
Objective. To determine the information received by the patient after a hospital consultation. Material and methods. A descriptive cross-sectional study. Location. Hospital Nuestra Señora del Prado, Talavera de la Reina (Spain). Participants. Patients over 14 years referred to hospital outpatient clinics. We selected 96 patients, of which 87 (90.6%) took part. Measurements. Checking the agreement between the information received by the patient, obtained via telephone survey, and that in the history by the physician. Results. A total of 80 (94%) patients thought they knew the reason for visit. Four (5%) patients did not remember changes in treatment, and 2 (2%) forgot advice on changes in lifestyle. In contrast to clinical history there was 89% agreement. There were no significant differences (P>0.05) with age, hearing problems, number of visits, time allocations, or specialties. Conclusion. Most patients understood the message conveyed by the physician, although the communication must be optimised to achieve 100% comprehension (AU)
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Physician-Patient Relations/ethics , Physician's Role , Patients/psychology , Patients/statistics & numerical data , Family Practice/methods , Truth Disclosure , Cross-Sectional Studies , Socioeconomic Survey , Telephone/statistics & numerical data , Telephone , Surveys and Questionnaires , 28599ABSTRACT
La colocación de un tubo de drenaje torácico no está exenta de riesgos. Presentamos a continuación un caso de parálisis diafragmática en un recién nacido pretérmino tras la colocación de un tubo de tórax (AU)
The placement of a thoracic drain is not free of risks. We presented a case of diaphragmatic paralysis in a preterm newborn after the collocation of a thoracic tube (AU)
Subject(s)
Humans , Male , Infant, Newborn , Respiratory Paralysis/etiology , Intubation, Intratracheal/adverse effects , Infant, Premature , Asphyxia Neonatorum/complicationsSubject(s)
Jugular Veins/pathology , Pharyngeal Diseases/diagnosis , Pharyngeal Diseases/microbiology , Pulmonary Embolism/diagnostic imaging , Thrombophlebitis/pathology , Anticoagulants/therapeutic use , Child , Female , Humans , Jugular Veins/diagnostic imaging , Pulmonary Embolism/drug therapy , Syndrome , Thrombophlebitis/diagnostic imaging , Thrombophlebitis/drug therapy , Tomography, X-Ray ComputedABSTRACT
No disponible
Subject(s)
Female , Child , Humans , Thrombophlebitis/complications , Thrombophlebitis/diagnosis , Pulmonary Embolism/complications , Fusobacterium Infections/complications , Fusobacterium Infections/diagnosis , Fusobacterium Infections/therapy , Anti-Bacterial Agents/therapeutic use , Anticoagulants/therapeutic use , Oropharynx/pathology , Oropharynx , Jugular Veins/microbiology , Jugular Veins/pathology , Jugular Veins , Radiography, Thoracic/methods , Hyperemia/complications , Fusobacterium/isolation & purification , Streptococcus/isolation & purification , Eikenella corrodens/isolation & purificationABSTRACT
No disponible
Subject(s)
Male , Infant, Newborn , Humans , Sepsis/complications , Sepsis/diagnosis , Sepsis/therapy , Cronobacter sakazakii/isolation & purification , Cronobacter sakazakii/pathogenicity , Enteral Nutrition , Imipenem/therapeutic use , Ceftazidime/therapeutic use , Vancomycin/therapeutic use , Microbial Sensitivity Tests/methods , Microbial Sensitivity TestsABSTRACT
No disponible
