Nevo melanocítico congénito gigante / Giant congenital melanocytic nevus

Los nevos melanocíticos congénitos son lesiones cutáneas benignas frecuentes en el recién nacido. Además del riesgo de desarrollo de melanoma y melanocitosis neurocutánea, estas lesiones antiestéticas pueden originar trastornos psicológicos y ansiedad familiar. La tasa de complicaciones se correlaciona con el tamaño de los nevos. La actuación frente a un nevo melanocítico congénito (observación y extirpación quirúrgica) debe ser individualizada y valorada de forma multidisciplinar. La cirugía reduce la lesión, pero es prácticamente imposible eliminar todas las células névicas de un nevo gigante (AU)

Congenital melanocytic nevi are common benign lesions in neonates. Besides the risk of developing melanoma and neurocutaneus melanocitosis, congenital melanocytic nevus may be a source of psychological distress and family anxiety associated with the unsightly lesions. The rate of complications correlates best with the size of the nevi. The management (observation and/or surgical removal) for a congenital melanocytic nevus requires individualization and a multidisciplinary approach. Surgical removal reduces the lesions, but it is impossible remove all the nevus cells associated with giant nevi (AU)

Infant twin mortality and hospitalisations after the perinatal period - a prospective cohort study from Guinea-Bissau.

OBJECTIVE: To examine mortality and hospitalisations among infant twins and singletons after the perinatal period in Guinea-Bissau. METHODS: The study was conducted from September 2009 to November 2012 by the Bandim Health Project (BHP). Newborn twins and unmatched singleton controls were included at the National Hospital Simão Mendes in the capital Bissau. Children were examined clinically at enrolment. Maternal, pregnancy and obstetric information was collected and HIV testing offered at birth. Follow-up occurred at home at 2, 6 and 12 months and through linkage with the paediatric admission register at the National Hospital. RESULTS: About 495 twins and 333 singletons were alive on day 7 after birth. In total, 36 twins and 12 singletons died during follow-up, the post-perinatal infant mortality rate being 91/1000 person-years for twins and 42/1000 for singletons (HR = 2.11, 95% CI: 1.09-4.07). In a multivariable analysis among twins only, birth weight <2000 g [3.32, (1.36-8.07)], death of the cotwin perinatally [2.54, (1.16-5.57)] and severe maternal illness during pregnancy [2.35, (1.00-5.51)] were significant risk factors for twin death. In the subgroup with available HIV status, maternal HIV infection was strongly associated with twin mortality [3.16, (1.24-8.05)]. Death occurred at home for 60% of twins and 67% of singletons. During follow-up, 90 first-time hospital admissions were registered, with similar rates observed for twins (139/1000) and singletons (143/1000) [0.97, (0.61-1.52)]. CONCLUSION: The post-perinatal infant mortality rate of twins was double that of singletons. No excess in twin hospitalisations was observed, possibly implying obstacles to hospital admission for twins in case of severe illness.

Hemangiomas múltiples gigantes: respuesta al tratamiento con corticoides / Multiple giant hemangiomas: response to treatment with corticosteroids

La historia natural de los hemangiomas infantiles suele presentar una primera fase de crecimiento rápido seguida de otra con involución lenta y espontánea. Por este motivo el tratamiento no está indicado en la mayoría de los casos. Sin embargo, el tratamiento está justificado cuando estas lesiones interfieren con las funciones vitales del niño o producen daños estéticos importantes. En la actualidad existen diferentes opciones terapéuticas, pero los corticoides son el tratamiento más utilizado en la práctica clínica, con resultados bastante efectivos. Presentamos el caso de una niña de 7 meses que sufría una grave desfiguración por la presencia de hemangiomas múltiples gigantes y que fue tratada con éxito con corticoides sistémicos(AU)