Ecografía clínica: ¿prueba complementaria o una parte más de la exploración rutinaria? / Clinical ultrasound: a diagnostic test or a part of the routine exam?

La ecografía ha sido considerada una prueba complementaria que deben realizar los especialistas en imagen. Desde su inicio, determinados especialistas como obstetras o cardiólogos la han utilizado en su campo con grandes resultados. En los últimos años, los médicos generales y de otras especialidades se van acercando a la técnica, que es rápida, inocua, accesible, barata y que, sobre todo, permite completar en tiempo real la exploración del paciente. Muchos son los países y las sociedades donde los médicos no especialistas en Radiología realizan ecografía a diario y cada vez más estudios muestran la utilidad de la misma en la práctica clínica habitual (AU)

Ultrasound has been considered an additional test to be carried out by specialists in image. Since its inception some specialists as obstetricians or cardiologists have used it in its field with great results. Now, the general practitioners and other specialties are approaching this technique which is quick, safe, accessible, inexpensive, and above all allows you to complete real-time exploration of the patient. Many are beginning to be the countries and societies where the non-specialist physicians in the field of radiology ultrasound performed on a daily basis and more and more studies show the utility of the same in normal clinical practice (AU)

[Acute pancreatitis in children]. / Pancreatitis aguda en la infancia.

INTRODUCTION: Lately, there has been an increase in incidence of acute pancreatitis in childhood. Fortunately, 80% of cases are mild and do not require surgical approach. Several etiologic factors have been implicated, such as infections, trauma, congenital anomalies, drugs, biliary diseases. The aim of this study was to assess etiology, clinical features and outcomes of children with acute pancreatitis treated at our center. MATERIALS AND METHODS: A retrospective chart review of our cases of acute pancreatitis in patients younger than 16 years old was performed. RESULTS: 24 cases of acute pancreatitis were found from 1998 to 2010. Mean age was 8.75 years. There were 7 boys and 17 girls. The main clinical manifestations were abdominal pain, vomiting and abdominal distention. Mean amylase level was 1565 UI/L. There was one patient with normal serum amylase levels. Serum lipase was required in two patients (239 UI/L and 5,980 UI/L). Ultrasound showed pancreatic lesion in 79.2% of cases. Severe pancreatitis was presented in two cases, due to renal failure and pancreatic necrosis. Surgery was performed in 6 cases (3 cholecystectomies, 1 choledocal cyst resection, 1 percutaneous pseudocyst drainage and 1 necrosectomy) Pancreatic complications were found in 20.8% of cases (4 pseudocysts y 1 pancretic necrosis) Several causes were found: idiophatic, secondary to ERCP, congenital anomalies, drugs, infections, biliary disease and trauma. Mean hospital stay was 25.65 days. There were no deaths due to acute pancreatitis. CONCLUSIONS: There are several causes of acute pancreatitis in children. Some cases may present normoamilasemia, situation, in which serum lipase and clinical and radiological criteria are pivotal. Prospective studies evaluating etiological factors and incidence are required.

Pancreatitis aguda en la infancia / Acute pancreatitis in children

Introducción. La pancreatitis aguda en la infancia ha presentado un incremento en su incidencia. El 80% de los casos es leve y no requiere cirugía. Su etiología es diversa, destacándose los casos secundarios a traumatismos, infecciones, anomalías estructurales y medicamentos. El objetivo del presente estudio fue determinar la distribución etiológica, las características clínicas y los resultados de los casos de pancreatitis aguda en los niños tratados en nuestro centro. Materiales y métodos. Se efectuó una revisión retrospectiva de los casos de pancreatitis aguda en pacientes menores de 16 años atendidos en nuestro hospital entre los años 1998 a 2010. Resultados. Se presentaron 24 casos de pancreatitis aguda durante un período de 12 años. La edad media fue de 8,75 años. El síntoma principal fue dolor abdominal, seguido de vómitos y distensión abdominal. El valor medio de amilasa al inicio del episodio fue de 1.565 UI/L. Una paciente presentó pancreatitis aguda con normoamilasemia. El 79,2% de los casos tuvieron hallazgos ecográficos compatibles con pancreatitis aguda y seis casos requirieron intervención quirúrgica. El porcentaje de complicaciones pancreáticas fue del 20,8%. La distribución etiológica fue múltiple, siendo la idiopática la más común, seguida de secundaria a colangiopancreatografía, a malformaciones congénitas y de origen medicamentoso. No hubo mortalidad atribuible a la pancreatitis aguda. Conclusiones. La pancreatitis aguda en la infancia presenta una etiología muy variada. Algunos casos pueden debutar con normoamilasemia, situación en la que la determinación de la lipasa sérica es fundamental. Se requieren estudios prospectivos para evaluar la distribución etiológica y la incidencia de la pancreatitis aguda en la infancia (AU)

Introduction. Lately, there has been an increase in incidence of acute pancreatitis in childhood. Fortunately, 80% of cases are mild and do not require surgical approach. Several etiologic factors have been implicated, such as infections, trauma, congenital anomalies, drugs, biliary diseases. The aim of this study was to assess etiology, clinical features and outcomes of children with acute pancreatitis treated at our center. Materials and methods. A retrospective chart review of our cases of acute pancreatitis in patients younger than 16 years old was performed. Results. 24 cases of acute pancreatitis were found from 1998 to 2010. Mean age was 8.75 years. There were 7 boys and 17 girls. The main clinical manifestations were abdominal pain, vomiting and abdominal distention. Mean amylase level was 1565 UI/L. There was one patient with normal serum amylase levels. Serum lipase was required in two patients (239 UI/L and 5,980 UI/L). Ultrasound showed pancreatic lesion in 79.2% of cases. Severe pancreatitis was presented in two cases, due to renal failure and pancreatic necrosis. Surgery was performed in 6 cases (3 cholecystectomies, 1 choledocal cyst resection, 1 percutaneous pseudocyst drainage and 1 necrosectomy) Pancreatic complications were found in 20.8% of cases (4 pseudocysts y 1 pancretic necrosis) Several causes were found: idiophatic, secondary to ERCP, congenital anomalies, drugs, infections, biliary disease and trauma. Mean hospital stay was 25.65 days. There were no deaths due to acute pancreatitis. Conclusions. There are several causes of acute pancreatitis in children. Some cases may present normoamilasemia, situation, in which serum lipase and clinical and radiological criteria are pivotal. Prospective studies evaluating etiological factors and incidence are required (AU)

Síndrome de bilis espesa en un neonato con isoinmunización anti-c / Inspissated bile syndrome in a neonate with anti-c isoimmunization

De los antígenos del sistema Rh, la isoinmunización anti-c es la segunda más frecuente, después de la anti-D, como causa de una enfermedad hemolítica grave en el feto y el recién nacido. A pesar de que la isoinmunización anti-c suele mostrar una afectación leve en el recién nacido, presentamos un caso clínico de un neonato con diagnóstico prenatal de isoinmunización anti-c con afectación severa, que requirió tanto transfusiones intrauterinas como posnatales. En su evolución posnatal desarrolló un síndrome de bilis espesa, entidad poco conocida, asociada a todas aquellas enfermedades que pueden afectar a la composición de la bilis y/o a la secreción biliar, y que para su resolución suele requerir tratamiento quirúrgico. Sin embargo, este neonato evolucionó de forma favorable exclusivamente con tratamiento médico(AU)

Anti-c isoimmunization is a common cause of severe hemolytic disease in the fetus and newborn. Usually has a mild impairment in the newborn. Here we describe a clinic case of a neonate with prenatal diagnosis of severe anti-c isoimmunization, requiring both intrauterine and postnatal transfusions. The newborn developed an inspissated bile syndrome, a little known entity associated with diseases that can affect the composition of bile and/or biliary secretion, and often require surgery as treatment. Nevertheless our infant responded favorably with full recorvery to medical treatment, phenobarbital and ursodeoxycholic acid(AU)