ABSTRACT
El síndrome de dumping (SD) es un conjunto de síntomas gastrointestinales y vasomotores que se produce como consecuencia de la cirugía gástrica. En pediatría se ha descrito fundamentalmente tras la cirugía antirreflujo. El diagnóstico es clínico, pero la sobrecarga oral de glucosa puede ser de utilidad si existen dudas. Se presentan los casos de 8 pacientes afectados de SD, 6 varones y 2 mujeres, con edades comprendidas entre 13 meses y 9 años en el momento del diagnóstico. Cuatro pacientes tenían como enfermedad de base una atresia de esófago intervenida, 2 un reflujo gastroesofágico, 1 una hernia diafragmática congénita y 1 un tumor gástrico. Todos fueron sometidos previamente a algún tipo de cirugía gástrica. En 7 de ellos se realizó una funduplicatura, y en 4 una piloroplastia. Todos los pacientes tenían clínica de SD temprano, y 6 asociaban clínica de SD tardío. En todos ellos se realizó una sobrecarga oral de glucosa, que confirmó el diagnóstico. El tratamiento dietético fue efectivo en 7 pacientes, y 1 paciente precisó además tratamiento con acarbosa. El tratamiento dietético es efectivo en la mayoría de los pacientes con SD (AU)
Dumping syndrome (DS) is a condition where gastrointestinal and vasomotor symptoms happen as a consequence of gastric surgery. In pediatrics it has been described primarily after anti-reflux surgery. The diagnosis is clinical, but the oral glucose tolerance test can be useful if there are doubts. We present the cases of 8 patients with DS, 6 men and 2 women, aged between 13 months and 9 years old. Four patients had atresia of esophagus, 2 gastroesophageal reflux disease, 1 patient a congenital diaphragmatic hernia, and 1 a gastric tumor. All were treated with gastric surgery. In 7 of them fundoplication was performed, and in 4 piloroplastia. All patients had early dumping, and 6 had late dumping. In all patients oral glucose tolerance test confirmed the diagnosis. Dietary treatment was effective in 7 patients; 1 patient also required treatment with acarbose. Dietary treatment is effective in most patients with DS (AU)
Subject(s)
Humans , Male , Female , Child , Infant , Child, Preschool , Adolescent , Stomach/surgery , Postoperative Complications , Digestive System Surgical Procedures/adverse effects , Fundoplication/adverse effects , Glucose/therapeutic use , Sweetening Agents/therapeutic use , Diet TherapyABSTRACT
OBJECTIVES: A study was made of head injuries among children treated in hospital emergency services, along with an analysis of the corresponding health care pressures, type of treatment and possibilities of prevention. MATERIAL AND METHODS: A retrospective analysis was made of the last 152 pediatric head injuries seen in our center, with an evaluation of patient age, the cause and place of injury, and the individuals present at the time of the injury. When, where and what form of first aid was provided was also studied, along with the time elapsed before the arrival at the center, the reason for the consultation, severity of the injury and the treatment dispensed. The costs entailed are also evaluated. RESULTS: During the study period, pediatric head injuries accounted for 5.25% of healthcare demands. A large majority of the injuries took place at home, in parks or at school (95.39%), in the presence of relatives or tutors, and with a male predominance of 2:1. In terms of age and sex distribution, two well differentiated groups were established, corresponding to ranges of 0-7 and 7-14 years. On the average, 30-40 minutes elapsed between the injury and arrival at the Emergency Room with most cases (80.27%) corresponding to minor injuries. Moderate head trauma accounted for 19.73% of the cases. Evaluation in the form of anamnesis and clinical exploration, with a 24 hour guided observation period, proved to be the most effective approach. Only 1.97% of the patients required cranial CAT exploration, with head X-rays proving to be ineffective and to generate unnecessary costs in all cases. CONCLUSIONS: The management of pediatric head injuries should be returned to the charge of the primary healthcare areas. The adoption of such measure would improve prevention and treatment, while curbing costs. Cranial radiological exploration should be discarded as a complementary evaluation parameter. Within each particular healthcare area, common protocols should be established to facilitate the follow-up of these patients from the time of first arrival, including a 24 hour guided observation period even in the case of only slight head injuries.
