Experiencia en traumatismo esplénico cerrado durante 22 años en un hospital comarcal en el área III-IV de la Comunidad de Cantabria / Experience in splenic traumatism closed for 22 years in a regional hospital in área III-IV of the community of Cantabria

Se realiza un estudio retrospectivo de 68 pacientes intervenidos durante 22 años, en el período 1994-2016 por un traumatismo esplénico (TS). Se analizan los siguientes parámetros: edad, sexo, mecanismo de producción del trauma, actitud quirúrgica y terapéutica, complicaciones, estancia y mortalidad. Se analizó el tratamiento médico- quirúrgico según hallazgos pre-intraoperatorios :1-Desgarros esplénicos: con hematomas y sin ruptura capsular: tratamiento conservador sin esplenectomías 2-Rotura masiva de parénquima: requirió esplenectomía de urgencia 3-Rotura de parénquima: requirió esplenorrafía de urgencia . La mayor parte fueron varones (53). Se realizaron 21 ECO/ TAC , 36 TAC abdominales únicos y otros 5 TAC tóraco-abdominal asociados, destacando con ASA II en 2 casos y ASA III en otros 2 casos. En 6 pacientes sólo se realizó una ECO abdominal, del total de las ecografías abdominales que fueron hechas inicialmente en 13 pacientes. En nuestro área III-IV del hospital comarcal, incluye la zona occidental de Cantabria que es geográficamente muy montañosa y hay pueblos muy distantes, incluyendo los Picos de Europa. Esto influye en el tipo de lesión como el esquí en aumento, caídas y accidentes de vehículo a motor. Como conclusiones, la causa más frecuente del traumatismo esplénico cerrado en nuestro área III-IV son las caídas accidentales (45,58%). En nuestra experiencia el traumatismo esplénico grado III-IV precisa de esplenectomía de urgencia. En este estudio se muestra que el tratamiento conservador es poco utilizado en nuestro medio, así como en el resto del territorio nacional de forma mayoritaria, siendo de preferencia la esplenectomía (19)

A retrospective study was conducted of 68 patients operated for 22 years, in the period 1994-2016 for splenic trauma (TS). The following parameters are analyzed: age, sex, mechanism of trauma production, surgical and therapeutic attitude, complications, stay and mortality. Medical-surgical treatment was analyzed according to pre-operative findings: 1-Splenic tears: with hematomas and without capsular rupture: conservative treatment without splenectomies 2-Massive rupture of parenchyma: required emergency splenectomy 3-Parenchyma rupture: required emergency splenerrhaphy. The majority were males (53). A total of 21 ECO / CT, 36 abdominal CT scans and 5 associated thoracic-abdominal CT scans were performed. In 6 patients, only one abdominal ECHO was performed, of the total abdominal ultrasounds that were initially performed in 13 patients. In our area III-IV of the regional hospital, it includes the western area of Cantabria which is geographically very mountainous and there are very distant towns, including the Picos de Europa. This influences the type of injury such as increasing skiing, falls and motor vehicle accidents. As conclusions, the most frequent cause of closed splenic trauma in our area III-IV is accidental falls. In our experience, grade III-IV splenic trauma requires emergency splenectomy. This study shows that conservative treatment is rarely used in our setting, as well as in the rest of the national territory in a majority, with splenectomy being preferred (19)

Modelo de cirugía mayor ambulatoria invasive de gastrostomía laparotómica para alimentación y hospitalización a domicilio / Model of invasive ambulatory major surgery of laparotomic gastrostomy for feeding and home hospitalization

To evaluate the model of early hospital discharge offered by the home hospitalization unit (HAD), with safety and cost-efficiency criteria in patients undergoing minimally invasive ambulatory gastric bypass surgery. With this joint program, invasive surgery can be performed without admission and taking the hospital to the patient's home can be a reality

Evaluar el modelo asistencial de alta temprana hospitalaria que ofrece la unidad de hospitalización a domicilio (HAD), con criterios de seguridad y de costo-eficiencia en pacientes sometidos a cirugía mayor gástrica ambulatoria mínimamente invasiva. Con este programa conjunto se puede realizar la cirugía invasiva sin ingreso y llevar el hospital al domicilio del paciente puede ser una realidad

Clinical presentation of candidaemia in elderly patients: experience in a single institution.

OBJECTIVE: To analyse the clinical presentation of candidaemia in elderly patients. METHODS: A comparison of clinical presentation of candidaemia cases was carried out in a Spanish tertiary hospital between January 2010 and September 2015. RESULTS: Forty-five cases (32%) corresponded to elderly patients (≥ 75 years) and 95 cases (68%) to non-elderly patients (16-74 years). A higher proportion of elderly patients presented solid tumour (51% versus 32%, p=0.026) and a lower proportion had undergone solid or hematopoietic transplantation (0% versus 28%, p<0.001). Fewer elderly patients (16 patients, 36%) had a central venous line inserted than non-elderly patients (81 patients, 85%, p<0.001). Isolation of Candida parapsilosis was significantly lower among elderly (13.3%) than among non-elderly patients (32%, p=0.015). Fundoscopy was carried out in 20 elderly (44%) and in 64 younger patients (67%, p=0.009). The proportion of patients who underwent echocardiography was similar in both groups (56% vs 66%, respectively; p=0.218). Adequate antifungal treatment within the first 48 hours was administered in16 elderly patients (36%) and 58 younger patients (61%, p=0.005). Catheter removal was carried out in 9 elderly patients (68.1%) and in 40 non-elderly patients (49%, p=0.544). Mortality was higher among elderly patients (55.6%) than non-elderly patients (36.8%; p=0.037). CONCLUSIONS: Elderly patients account for a substantial proportion of patients suffering from candidaemia in recent years. The clinical management of these patients was less appropriate than in younger patients with respect to fundus examination and the prescription of appropriate antifungal treatment. Mortality in elderly patients was higher than in younger patients.

Complex terrain experiments in the New European Wind Atlas.

The New European Wind Atlas project will create a freely accessible wind atlas covering Europe and Turkey, develop the model chain to create the atlas and perform a series of experiments on flow in many different kinds of complex terrain to validate the models. This paper describes the experiments of which some are nearly completed while others are in the planning stage. All experiments focus on the flow properties that are relevant for wind turbines, so the main focus is the mean flow and the turbulence at heights between 40 and 300 m. Also extreme winds, wind shear and veer, and diurnal and seasonal variations of the wind are of interest. Common to all the experiments is the use of Doppler lidar systems to supplement and in some cases replace completely meteorological towers. Many of the lidars will be equipped with scan heads that will allow for arbitrary scan patterns by several synchronized systems. Two pilot experiments, one in Portugal and one in Germany, show the value of using multiple synchronized, scanning lidar, both in terms of the accuracy of the measurements and the atmospheric physical processes that can be studied. The experimental data will be used for validation of atmospheric flow models and will by the end of the project be freely available.This article is part of the themed issue 'Wind energy in complex terrains'.

¿Por qué son necesarios los Cuidados Paliativos Pediátricos? Situación actual en España / Why are pediatric palliative cares necessary? Current status in Spain

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Isolation and characterization of genetic variability in bacteria with ß-hemolytic and antifungal activity isolated from the rhizosphere of Medicago truncatula plants.

In the present study, we analyzed the frequency of hemolytic and antifungal activities in bacterial isolates from the rhizosphere of Medicago truncatula plants. Of the 2000 bacterial colonies, 96 showed ß-hemolytic activities (frequency, 4.8 x 10(-2)). Hemolytic isolates were analyzed for their genetic diversity by using random amplification of polymorphic DNA, yielding 88 haplotypes. The similarity coefficient of Nei and Li showed a polymorphic diversity ranging from 0.3 to 1. Additionally, 8 of the hemolytic isolates showed antifungal activity toward plant pathogens, Diaporthe phaseolorum, Colletotrichum acutatum, Rhizoctonia solani, and Fusarium oxysporum. The 16S ribosomal sequencing analysis showed that antagonistic bacterial isolates corresponded to Bacillus subtilis (UM15, UM33, UM42, UM49, UM52, and UM91), Bacillus pumilus (UM24), and Bacillus licheniformis (UM88). The present results revealed a higher genetic diversity among hemolytic isolates compared to that of isolates with antifungal action.

Cuidados paliativos: qué debe saber un pediatra de Atención Primaria / Palliative care: what should a Primary Care paediatrician know?

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Identification and expression analysis of multiple FRO gene copies in Medicago truncatula.

Iron (Fe) is an essential element for plant growth. Commonly, this element is found in an oxidized form in soil, which is poorly available for plants. Therefore, plants have evolved ferric-chelate reductase enzymes (FRO) to reduce iron into a more soluble ferrous form. Fe scarcity in plants induce the FRO enzyme activity. Although the legume Medicago truncatula has been employed as a model for FRO activity studies, only one copy of the M. truncatula MtFRO1 gene has been characterized so far. In this study, we identified multiple gene copies of the MtFRO gene in the genome of M. truncatula by an in silico search, using BLAST analysis in the database of the M. truncatula Genome Sequencing Project and the National Center for Biotechnology Information, and also determined whether they are functional. We identified five genes apart from MtFRO1, which had been already characterized. All of the MtFRO genes exhibited high identity with homologous FRO genes from Lycopersicon esculentum, Citrus junos and Arabidopsis thaliana. The gene copies also presented characteristic conserved FAD and NADPH motifs, transmembrane regions and oxidoreductase signature motifs. We also detected expression in five of the putative MtFRO sequences by semiquantitative RT-PCR analysis, performed with mRNA from root and shoot tissues. Iron scarcity might be a condition for an elevated expression of the MtFRO genes observed in different M. truncatula tissues.

Ventilación no invasiva en problemas respiratorios en niños oncohematológicos inmunocomprometidos / Non-invasive ventilation in respiratory problems in immunocompromised oncohematologic children

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Physiological response to drought in radiata pine: phytohormone implication at leaf level.

Pinus radiata D. Don is one of the most abundant species in the north of Spain. Knowledge of drought response mechanisms is essential to guarantee plantation survival under reduced water supply as predicted in the future. Tolerance mechanisms are being studied in breeding programs, because information on such mechanisms can be used for genotype selection. In this paper, we analyze the changes of leaf water potential, hydraulic conductance (K(leaf)), stomatal conductance and phytohormones under drought in P. radiata breeds (O1, O2, O3, O4, O5 and O6) from different climatology areas, hypothesizing that they could show variable drought tolerance. As a primary signal, drought decreased cytokinin (zeatin and zeatin riboside-Z + ZR) levels in needles parallel to K(leaf) and gas exchange. When Z + ZR decreased by 65%, indole-3-acetic acid (IAA) and abscisic acid (ABA) accumulation started as a second signal and increments were higher for IAA than for ABA. When plants decreased by 80%, Z + ZR and K(leaf) doubled their ABA and IAA levels, the photosystem II yield decreased and the electrolyte leakage increased. At the end of the drought period, less tolerant breeds increased IAA over 10-fold compared with controls. External damage also induced jasmonic acid accumulation in all breeds except in O5 (P. radiata var. radiata × var. cedrosensis), which accumulated salicylic acid as a defense mechanism. After rewatering, only the most tolerant plants recovered their K(leaf,) perhaps due to an IAA decrease and 1-aminocyclopropane-1-carboxylic acid maintenance. From all phytohormones, IAA was the most representative 'water deficit signal' in P. radiata.

Calidad de vida y funcionalidad en pacientes pediátricos intervenidos de tumores óseos en miembros inferiores: cirugía reconstructiva versus amputación / Quality of life and functionality in pediatric patients operated on for lower limb bone tumors: limb salvage surgery versus amputation

Objetivo. Analizar las diferencias en cuanto a funcionalidad y calidad de vida relacionadas con la salud en pacientes intervenidos de un tumor óseo maligno en edad infantil según el tipo de cirugía practicada. Material y método. Estudio descriptivo transversal de pacientes mayores de 14 años tratados por osteosarcoma o sarcoma de Ewing en miembro inferior y que recibieron tratamiento quirúrgico en edad infantil tras una evolución mínima de 2 años. Se realizó una evaluación de funcionalidad y calidad de vida utilizando las escalas de Enneking y Medical Outcomes Study Short-Form 36. Comparamos los resultados funcionales según la técnica quirúrgica. Resultados. Nuestra muestra quedó formada por 17 pacientes (8 hombres y 9 mujeres) con una edad media actual de 22 años. El tumor más frecuente fue el osteosarcoma, y la localización, el tercio distal del fémur y proximal de la tibia. En relación a la técnica quirúrgica, en 8 pacientes se colocó endoprótesis, 4 se trataron mediante injerto y/u osteosíntesis y 5 fueron amputados en cirugía inicial. Cinco pacientes tuvieron que ser amputados en un segundo momento debido a complicaciones. La puntuación expresada en mediana y percentiles obtenidos en la escala de Enneking sobre la totalidad de la muestra fue del 83,33% (66,66-88,33%). En pacientes no amputados fue del 83,33% (73,33-86,66%), frente al 90% (80-93,33%) en pacientes amputados inicialmente. En los que se realizó amputación posterior tras complicación, la puntuación fue de 56,66% (51,66-73,33%). Conclusiones. En nuestra muestra no encontramos diferencias significativas en cuanto a funcionalidad y calidad de vida de los pacientes tratados mediante cirugía reconstructiva en comparación con amputación inicial, aunque sí peores resultados en los pacientes que sufren una amputación tardía debido a una complicación tras cirugía de salvamento inicial (AU)

Objective. To analyze the differences in functionality and quality of life related with outcome of a malignant bone tumor intervention in childhood age according to type of surgery performed. Material and methods. A descriptive, cross-sectional study of patients over 14 years treated for osteosarcoma or Ewing's sarcoma in lower limb during childhood after a minimum of two years evolution. Functionality and quality of life were evaluated with the Enneking and Medical Outcomes Study Short-Form 36 scales. The functional results were compared according to surgical technique. Results. Our sample consisted of 8 men and 9 women, with a current average age of 22 years. The most common type of tumor was osteosarcoma and most common location was distal third of the femur and proximal tibia. In relation to the surgical technique, stent was placed in 8 patients, 4 were treated by graft and/or osteosynthesis and 5 patients underwent amputation as initial surgery. Five more patients had to under amputation at a second time due to complications. The score, expressed as median and percentiles obtained in the scale of Enneking on the entire sample, was 83.33% (66.66%-88.33%). In non-amputees, it was 83.33% (73.33%-86.66%), compared with 90% (80%-93.33%) in patients who were initially amputees. In those in whom the amputation was performed later after a complication, the median Enneking score was 56.66% (51.66%-73.33%). Conclusions. In our sample, we did not find significant differences in terms of functionality and quality of life of patients treated by reconstructive surgery compared with initial amputation although there were worse results in those patients who underwent a later amputation due to a complication after the initial life-saving surgery (AU)

Pérdida de espacio en la arcada dentaria según el tiempo trancurrido entre la exodoncia prematura de un diente temporario y la colocación de un mantenedor de espacio / Loss of space in the dental arch according to the time elapsed between the premature extraction of a deciduous tooth and placing a space maintainer

Una de las funciones vitales de la dentición temporaria es conservar el espacio necesario para la erupción natural correcta de los dientes permanentes. Los dientes temporarios son mantenedores de espacio naturales; el cuidado del espacio de la arcada dental es fundamental desde el nacimiento hasta completar el recambio dentario para lograr la estética y la funcionalidad del sistema estomatognático. Se realizó un estudio experimental con el objetivo de determinar la pérdida del espacio en la arcada dentaria luego de la exodoncia prematura de molares temporarios y la colocación de mantenedores de espacio en tiempo diferente de tres grupos en 10 niños cada uno. La muestra estuvo constituida por 30 niños de ambos sexos de 4 a 10 años con indicación de extracción prematura de molares temporarios, que acudieron a la Facultad de Odontología de la Universidad Nacional de Asunción, durante el año 2009; se manipuló el tiempo transcurrido entre la exodoncia y la colocación de mantenedores de espacio, el primer grupo recibió inmediatamente el mantenedor, el segundo una semana después y el tercero al cabo de dos semanas. Se utilizó la prueba de Kruskal-Wallis para comparar la pérdida del espacio entre los grupos. Se concluyó que al realizar la exodoncia existe pérdida de espacio, aún en los casos de colocación inmediata y que los milímetros perdidos son proporcionales al tiempo transcurrido entre la exodoncia y la colocación del mantenedor

Rasburicasa versus alopurinol como tratamiento de la hiperuricemia en el síndrome de lisis tumoral / Rasburicase versus allopurinol in the treatment of hyperuricaemia in tumour lysis syndrome

Introducción: La hiperuricemia secundaria al síndrome de lisis tumoral (SLT) es una complicación importante en neoplasias con rápida proliferación y destrucción celular. Introducción: El objetivo del estudio fue comparar la eficacia de la rasburicasa con la del alopurinol en la reducción de los niveles plasmáticos de ácido úrico, creatinina y fósforo en niños con SLT. Pacientes y método: Se realizó un estudio comparativo observacional no aleatorizado del tratamiento con alopurinol o rasburicasa en 32 niños con enfermedad oncohematológica ingresados en la unidad de cuidados intensivos pediátricos con SLT establecido o alto riesgo de desarrollarlo. Desde enero de 1991 hasta enero de 2003 16 pacientes recibieron alopurinol (10mg/kg/día cada 8h) y desde febrero de 2003 hasta junio de 2009 16 pacientes recibieron rasburicasa (0,2mg/kg/día, una dosis diaria). Se determinaron los niveles plasmáticos de ácido úrico, creatinina y fósforo previo al tratamiento y a las 4, 12, 24, 36, 48, 72 y 96h. Resultados: Los niveles basales de ácido úrico fueron similares en ambos grupos. A las 4h tras la primera dosis del fármaco los pacientes tratados con rasburicasa comparados con alopurinol tuvieron una mayor reducción (p<0,0001) de los niveles plasmáticos de ácido úrico, al igual que en las determinaciones posteriores. Los niveles de creatinina fueron más elevados en el grupo de alopurinol que en el de rasburicasa. Los niveles de fósforo fueron similares en ambos grupos. El 56% de los pacientes tratados con alopurinol requirió hemodiálisis, mientras que ningún paciente del grupo de rasburicasa la precisó. Conclusiones: Este estudio demuestra un control más rápido y niveles significativamente menores de ácido úrico tras tratamiento con rasburicasa comparado con alopurinol en el SLT así como niveles más bajos de creatinina y menor necesidad de hemodiálisis (AU)

Introduction: Hyperuricaemia accompanying tumour lysis syndrome (TLS) is a serious complication in neoplasias with rapid proliferation and cellular destruction. The aim of the study was to evaluate the effects of rasburicase versus allopurinol on plasma uric acid, creatinine and phosphorus levels in paediatric patients with TLS. Patients and method: A comparative study of treatment with rasburicase or allopurinol was performed in 32 paediatric patients with haematological-oncological malignancies and with established TLS or a high risk of developing it, admitted to the Paediatric Intensive Care Unit (PICU). Allopurinol (10mg/kg/day every 8h) was administered to 16 patients between January 1991 and January 2003, and 16 patients received rasburicase (0.2mg/kg/day, once daily), from February 2003 to June 2009. Plasma uric acid, creatinine and phosphorus levels were measured at baseline and 4, 12, 24, 36, 48, 72 and 96h after therapy in both study groups. Results: Baseline uric acid levels were similar in both groups. Four hours after the first dose, patients treated with rasburicase achieved a greater reduction (p<0.0001) of initial plasma uric acid levels compared to allopurinol, as in the other serial determinations. Creatinine levels were higher in the allopurinol group than in the rasburicase one. Plasma phosphorus levels were similar in both groups. Haemodialysis was required in 56% of patients in the allopurinol group, whereas none of rasburicase group needed this. Conclusion: This study demonstrated that there is more rapid control and lower plasma uric acid levels in patients at high risk for tumour lysis syndrome who received rasburicase compared to allopurinol, as well as lower levels of creatinine and a lower percentage of haemodialysis (AU)

Effect of co-inoculation with mycorrhiza and rhizobia on the nodule trehalose content of different bean genotypes.

Studies on Rhizobium-legume symbiosis show that trehalose content in nodules under drought stress correlates positively with an increase in plant tolerance to this stress. Fewer reports describe trehalose accumulation in mycorrhiza where, in contrast with rhizobia, there is no flux of carbohydrates from the microsymbiont to the plant. However, the trehalose dynamics in the Mycorrhiza-Rhizobium-Legume tripartite symbiosis is unknown. The present study explores the role of this tripartite symbiosis in the trehalose content of nodules grown under contrasting moisture conditions. Three wild genotypes (P. filiformis, P. acutifolis and P. vulgaris) and two commercial genotypes of Phaseolus vulgaris (Pinto villa and Flor de Mayo) were used. Co-inoculation treatments were conducted with Glomus intraradices and a mixture of seven native rhizobial strains, and trehalose content was determined by GC/MS. The results showed a negative effect of mycorrhizal inoculation on nodule development, as mycorrhized plants showed fewer nodules and lower nodule dry weight compared to plants inoculated only with Rhizobium. Mycorrhizal colonization was also higher in plants inoculated only with Glomus as compared to plants co-inoculated with both microsymbionts. In regard to trehalose, co-inoculation negatively affects its accumulation in the nodules of each genotype tested. However, the correlation analysis showed a significantly positive correlation between mycorrhizal colonization and nodule trehalose content.

[Rasburicase versus allopurinol in the treatment of hyperuricaemia in tumour lysis syndrome]. / Rasburicasa versus alopurinol como tratamiento de la hiperuricemia en el síndrome de lisis tumoral.

INTRODUCTION: Hyperuricaemia accompanying tumour lysis syndrome (TLS) is a serious complication in neoplasias with rapid proliferation and cellular destruction. The aim of the study was to evaluate the effects of rasburicase versus allopurinol on plasma uric acid, creatinine and phosphorus levels in paediatric patients with TLS. PATIENTS AND METHOD: A comparative study of treatment with rasburicase or allopurinol was performed in 32 paediatric patients with haematological-oncological malignancies and with established TLS or a high risk of developing it, admitted to the Paediatric Intensive Care Unit (PICU). Allopurinol (10mg/kg/day every 8h) was administered to 16 patients between January 1991 and January 2003, and 16 patients received rasburicase (0.2mg/kg/day, once daily), from February 2003 to June 2009. Plasma uric acid, creatinine and phosphorus levels were measured at baseline and 4, 12, 24, 36, 48, 72 and 96h after therapy in both study groups. RESULTS: Baseline uric acid levels were similar in both groups. Four hours after the first dose, patients treated with rasburicase achieved a greater reduction (p<0.0001) of initial plasma uric acid levels compared to allopurinol, as in the other serial determinations. Creatinine levels were higher in the allopurinol group than in the rasburicase one. Plasma phosphorus levels were similar in both groups. Haemodialysis was required in 56% of patients in the allopurinol group, whereas none of rasburicase group needed this. CONCLUSION: This study demonstrated that there is more rapid control and lower plasma uric acid levels in patients at high risk for tumour lysis syndrome who received rasburicase compared to allopurinol, as well as lower levels of creatinine and a lower percentage of haemodialysis.

[Presenting signs and symptoms of central nervous system tumors according to age]. / Clínica de presentación de los tumores de sistema nervioso central en función de la edad.

INTRODUCTION: Central nervous system tumors are the second most frequent group of neoplasms in children and are the main cause of cancer-related deaths in the pediatric population. There are no specific clinical findings. Consequently clinical data that would aid diagnosis are required. OBJECTIVE: To establish the presenting signs and symptoms of brain tumors in childhood according to age and identify their influence on diagnostic delay. PATIENTS AND METHODS: We retrospectively studied 69 patients with central nervous system tumors diagnosed between January 1997 and December 2002 in the Virgen del Rocío children's hospital. RESULTS: At diagnosis, 60.9 % of the patients were in the most advanced clinical stages. The most commonly found signs were papilledema, ataxia and squint, with no differences among age groups. The most frequent symptoms were vomiting, headache and behavior changes (irritability in children aged less than 5 years and unhappiness in children aged more than 5 years). Diagnostic delay was longer in older children. CONCLUSIONS: The diagnostic signs and symptoms of central nervous tumors are non-specific. A high index of suspicion is required for early diagnosis.

Clínica de presentación de los tumores de sistema nervioso central en función de la edad / Presenting signs and symptoms of central nervous system tumors according to age

Introducción Los tumores del sistema nervioso central suponen el segundo conjunto de neoplasias más frecuentes en niños y constituyen la primera causa de muerte relacionada con el cáncer en la edad infantil. No existen hallazgos clínicos patognomónicos, por lo que es preciso definir datos clínicos que ayuden en el diagnóstico. Objetivos Establecer los signos y síntomas de presentación de los tumores cerebrales infantiles según la edad y su influencia en la demora diagnóstica. Pacientes y métodos Se estudian retrospectivamente 69 pacientes con tumores de sistema nervioso central diagnosticados entre enero de 1997 y diciembre de 2002 en el Hospital Infantil Virgen del Rocío. Resultados El 60,9 % de los pacientes se encontraban en los estadios clínicos más avanzados en el diagnóstico. Los signos exploratorios más encontrados fueron el papiledema, la ataxia y el estrabismo, sin diferencias entre los grupos de edad. Los síntomas más hallados en el diagnóstico fueron los vómitos, cefalea y alteraciones del comportamiento (irritabilidad en los menores de 5 años, y la apariencia infeliz en los mayores de 5 años). La demora diagnóstica fue mayor en los pacientes mayores de 5 años. Conclusiones Los signos y síntomas en el diagnóstico de los tumores cerebrales infantiles son muy inespecíficos y es preciso tener en cuenta su posible existencia para un diagnóstico lo más precoz posible

Introduction Central nervous system tumors are the second most frequent group of neoplasms in children and are the main cause of cancer-related deaths in the pediatric population. There are no specific clinical findings. Consequently clinical data that would aid diagnosis are required. Objective To establish the presenting signs and symptoms of brain tumors in childhood according to age and identify their influence on diagnostic delay. Patients and methods We retrospectively studied 69 patients with central nervous system tumors diagnosed between January 1997 and December 2002 in the Virgen del Rocío children's hospital. Results At diagnosis, 60.9 % of the patients were in the most advanced clinical stages. The most commonly found signs were papilledema, ataxia and squint, with no differences among age groups. The most frequent symptoms were vomiting, headache and behavior changes (irritability in children aged less than 5 years and unhappiness in children aged more than 5 years). Diagnostic delay was longer in older children. Conclusions The diagnostic signs and symptoms of central nervous tumors are non-specific. A high index of suspicion is required for early diagnosis

Cirugía minimamente invasiva del radio distal / Minimally invasive surgery of the distal radial metaphysis

Las fracturas del radio distal son lesiones frecuentes. Es importante valorar el tipo de fractura y la edad de los pacientes, para realizar el tratamiento más adecuado para cada caso. Existen múltiples tipos de tratamientos que van desde el tratamiento ortopédico mediante reducción cerrada y yeso, a tratamientos quirúrgicos con mayor o menor agresividad. Nosotros nos vamos a centrar en las técnicas de tratamiento quirúrgico mínimamente invasivas que existen en este momento para las fracturas del radio distal, describiendo cual es la técnica quirúrgica de cada sistema, sus indicaciones, y cuales son las ventajas e inconvenientes de cada una de ellas

Distal radial fractures are common injuries. It is important to evaluate the fracture type and the patient’s age in order to determine the best treatment for each individual case. There are many treatment options, ranging from orthopaedic management with closed reduction and plaster casting to surgical techniques of greater or lesser aggressivity. We address the minimally invasive surgical options for distal radius fractures, describing the surgical technique corresponding to each system, its indications, and respective advantages and inconveniences

[Clinical findings in thoracic neuroblastomas]. / Semiología inicial del neuroblastoma torácico.

OBJECTIVES: To analyze clinical onset and other epidemiological findings in a group of children diagnosed with thoracic neuroblastoma. PATIENTS AND METHODS: We reviewed 46 non-metastatic thoracic neuroblastomas diagnosed and treated from January 1984 to December 1998 at the Pediatric Oncology Unit. Abdominal neuroblastomas were excluded. RESULTS: Mean age was 2 years and 5 months (range, 0-12 years). Eighty-five percent of the patients were infants (aged less than 1 year). Neuroblastoma was more frequent in males than in females. Fifty-seven percent of the patients were symptomatic and 43% were asymptomatic. The most frequent clinical findings were cough (18%) and palpable tumor or adenopathy (9%). Mean lag-time to diagnosis was 10 weeks in symptomatic patients. Thoracic x-ray was the most useful diagnostic method (89%). Previous family history of neoplasias was present in 26%. Four patients (9%) had personal antecedents of other diseases. At the time of the study the event-free survival for the 46patients was 90% at 5 years (1-14 years). CONCLUSIONS: Thoracic neuroblastoma was more prevalent in male infants aged less than 6months. Most symptomatic patients were diagnosed in the 2first months after onset, and asymptomatic cases were common. The most frequent symptom was cough and most of the patients were diagnosed by thoracic x-ray.