[Clinical and radiological features of cerebral venous thrombosis in a children cohort]. / Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal.

INTRODUCTION: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. OBJECTIVES: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. METHODOLOGY: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). RESULTS: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. CONCLUSIONS: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Características clínicas y radiológicas de una cohorte de niños con trombosis venosa intracraneal / Clinical and radiological features of cerebral venous thrombosis in a children cohort

Resumen: Introducción: La trombosis venosa intracraneal (TVI) es una condición infrecuente y poco estudiada en población pediátrica. Objetivos: Describir y comparar características clínicas/radiológicas de ni ños no neonatos con TVI según edad y analizar la asociación de estas variables con deterioro funcio nal al alta o mortalidad aguda. Metodología: Estudio observacional de una cohorte de niños > 30 días con una primera TVI diagnosticada con imágenes/venografía por resonancia magnética encefálica. Medimos funcionalidad con la escala modificada de Rankin definiendo compromiso funcional mar cado con 3 a 5 puntos. Comparamos los promedios de edades entre grupos con y sin las diferentes variables estudiadas con la prueba U-Mann-Whitney (significancia < 0,05). Realizamos análisis de regresión logística para estimar el riesgo de resultado adverso de cada variable expresado en Odds Ra tios (ORs) e intervalos de confianza (IC) al 95%. Resultados: De 21 pacientes, 42.8% eran niñas, me diana de edad 6,27 años (rango intercuartil: 0,74-10). El promedio de edad fue menor en niños con retardo diagnóstico > 48 h (p = 0,041), puntaje < 12 en la escala coma de Glasgow (p = 0,013), crisis epilépticas (p = 0,041), trombosis de seno recto (p = 0,011) y hemorragia intracraneal (p = 0,049); mientras que fue mayor en niños con síndrome de hipertensión endocraneal (p = 0,008). La presen cia de alguna condición crónica sistémica (OR = 11,2; IC = 1,04-120,4), TVI profunda (OR = 14; IC = 1,3-150,8) e infarto encefálico (OR = 15,8; IC = 1,4-174,2) se asoció a compromiso funcional marcado o mortalidad al alta. Conclusiones: Las características clínicas/radiológicas de la TVI varían según la edad. Las patologías crónicas, compromiso del sistema venoso profundo e infarto encefálico predicen mal pronóstico a corto plazo.

Abstract: Introduction: Cerebral venous thrombosis (CVT) is an uncommon and poorly studied condition in the pediatric population. Objectives: To describe and compare the clinical and radiological features of non-neonatal children with CVT according to age and to analyze their association with functional impairment or mortality at hospital discharge. Methodology: An observational cohort study of chil dren older than 30 days with a first CVT diagnosed with imaging/venography by magnetic resonance (IMR/VMR). We measure functionality with the modified Rankin scale defining marked impairment with 3 to 5 points. We used U-Mann-Whitney test to compare ages averages between groups with and without the different studied variables (significance < 0.05). We used logistic regression analyses to estimate the risk of adverse outcome for each variable expressed in Odds Ratios (ORs) and 95% confidence intervals (CI). Results: Among 21 patients recruited, 42.8% were girls, median age 6.27 years (Interquartile range: 0.74-10). The average age was lower in children with diagnostic delay > 48 hours (p = 0.041), score < 12 in the Glasgow coma scale (p = 0.013), seizures (p = 0.041), sinus rectus thrombosis (p = 0.011), and intracranial hemorrhage (p = 0.049); while it was significantly higher in children with intracranial hypertension syndrome (p = 0.008). The presence of some chro nic systemic condition (OR = 11.2; CI = 1.04-120.4), deep CVT (OR = 14; CI = 1.3-150.8), and brain ischemia (OR = 15.8; CI = 1.4-174.2) was associated with marked functional impairment or mor tality at discharge. Conclusions: Clinical and radiological features of CVT are age-related. Chronic illnesses, deep venous system involvement, and brain ischemia predict adverse short-term outcomes.

Factores de riesgo para accidente vascular encefálico en un hospital universitario. Respuesta de los autores / Risk factors for cerebrovascular accident in a university hospital. Author's response

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Factores de riesgo para accidente vascular encefálico en un hospital universitario / Cerebrovascular risk factors seen in a university hospital

INTRODUCCIÓN: Los factores de riesgo (FR) para accidente vascular encefálico (AVE) pediátrico difieren del adulto e incluyen un amplio rango de enfermedades, como pueden ser cardiopatías, infecciones, leucemias y errores congénitos del metabolismo. OBJETIVOS: Describir FR en AVE isquémico en población pediátrica y explorar asociación de los FR con edad, sexo y tipo de AVE. Pacientes y método: Se analizaron 114 casos pediátricos con AVE isquémico ocurridos entre enero del 2003 y julio del 2012. Los FR se estratificaron en 6 categorías, los AVE isquémicos se clasificaron como arterial y venoso. Se compararon los FR con edad, sexo y tipo de infarto (chi al cuadrado y odds ratio). RESULTADOS: La mediana de edad fue 2,5 años, 74 (62,2%) hombres. El 7,9% de los pacientes no tenía FR identificable y el 67% tenía más de uno. La mayor frecuencia de FR fue: enfermedades sistémicas agudas (56,1%), cardiopatías (35,1%) y enfermedades crónicas sistémicas (29,8%). Hubo asociación estadísticamente significativa entre FR enfermedad sistémica aguda y edad menor de 5 años (p < 0,001) y entre enfermedad crónica sistémica y edad mayor o igual a 5 años (p < 0,02). El FR cardiopatía se asoció a infarto arterial (p < 0,05) y el FR enfermedad aguda de cabeza y cuello con infarto venoso (p < 0,05). CONCLUSIONES: Los FR de AVE isquémico en la población pediátrica son múltiples y algunos de ellos se asocian a edades específicas y tipo de AVE. La detección de estos factores permitirá la prevención primaria en la población de riesgo así como un diagnóstico y tratamiento precoz, haciendo igualmente posible la prevención de recurrencias

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<0.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<0.05), and the acute head and neck disease RF was associated with venous infarction (P<0.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences

[Cerebrovascular risk factors seen in a university hospital]. / Factores de riesgo para accidente vascular encefálico en un hospital universitario.

INTRODUCTION: Risk factors (RF) in pediatric stroke differ from those of adults, and they include a wide range of diseases such as heart disease, infections, leukemias, and inborn errors of metabolism. OBJECTIVES: To describe RF for ischemic stroke in a pediatric population, and to examine the relationship of RF with age, sex and type of stroke. PATIENTS AND METHODS: An analysis was made of database of 114 children and adolescents with ischemic stroke from January 2003 to July 2012. Risk factors were stratified into 6 categories and ischemic strokes were classified as arterial and venous. We compared the RF with age, sex, and type of stroke (chi2 and OR). RESULTS: The median age was 2.5 years, with 74 (62.2%) males. No RF was identified in 7.9% of patients, and 67% had more than one RF. The most common RF were acute systemic diseases (56.1%), heart disease (35.1%), and chronic systemic diseases (29.8%). There was a statistically significant association between acute systemic disease and age less than 5 years (P<.001), and between chronic systemic disease and age 5 years or more (P<.02). The RF of heart disease was associated with arterial infarction (P<.05), and the acute head and neck disease RF was associated with venous infarction (P<.05). CONCLUSIONS: The RF for ischemic stroke are multiple in the pediatric population, and some of them are associated with a specific age and type of stroke. The detection of these factors may help in the primary prevention of people at risk, an early diagnosis, and treatment and prevention of recurrences.

[Cervical isthmus myomatosis]. / Miomatosis istmico-cervical.

Ten patients with isthmico-cervical leiomyoma as the only one localization, were surgically treated, from Jan, 1989 to May, 1990. It was 2.8% of all treated myomatosis. Average age was 42.4 years, with gestation of 1.1 per patients. Nine cases were treated by the abdominal via. One case presented with a recurrence. These cases represent a technico-surgical difficulty, due to tumor localization and size, as well as an ample knowledge about pelvic structures, in order to avoid digestive tract lesions, urinary and vascular. The present series confirms that this type of surgery is justified considering morbi-mortality, so it would be possible a definite histopathological evaluation.

[Dextranomer in the postoperative of anorectal surgery]. / Dextranómero en el postoperatorio de cirugía anorrectal.

Twenty patients were treated with the usual hemorrhoidectomy and fistulectomy techniques; from the nature of the region it was assumed that the postoperative wounds developed infection. Dextranomer was applied locally on 10 patients and the other 10 served as controls. It was observed that the medicament was easy to apply and the patient adapted himself to it quickly enough; none of the group under study presented collateral effects which might contraindicate its use. The healing period was considerably reduced in the problem-group and the patients went back to their usual tasks before expected. Photographic series were taken from all of them during postoperative days until healing. There were not complications in any of the groups under study.