Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation.

PURPOSE: To assess skull bone thickness from birth to skeletal maturity at different sites to provide a reference for the correct selection of pin type and pin placement according to age. METHODS: 270 children and adolescents (age: 0-17 years) with a normal CT scan obtained at Emergency Department for other medical reasons were included. Skull thickness was measured on the axial plane CT scans at eight different sites of the vault: midline anterior (A) and posterior (P), right and left lateral (L), antero-lateral (AL), postero-lateral (PL). RESULTS: From birth to skeletal maturity, L thickness was increased significantly less (+ 58%) compared with AL (+ 205%), P (+ 233%), PL (+ 247%), and A (+ 269%) thickness (P < 0.01). At the end of growth, the thickest and thinnest points of the vault (absolute value) were found at the P and L measurement sites, respectively (P < 0.01). Children aged < 4 years exhibited the highest variability in AL and PL skull bone thickness, with thickness < 3 mm observed in 85% (64/75 patients) and 92% (69/75 patients) of cases, respectively. CONCLUSION: We recommend that the tip of the pin should not exceed 2-3 mm in children aged < 4, and 4 mm in children aged 4-6 years, to decrease the risk of inner table perforation. After the age of 7 years and 13 years, standard-sized pin tips (5 and 6 mm, respectively) may be safely used. Children aged < 4 years show significant variability in skull thickness, and therefore a CT scan may be required for this particular age group.

Epidemiology of tuberculosis among healthcare personnel in New York City.

BACKGROUND: We have updated the epidemiology of tuberculosis (TB) among healthcare personnel (HCP) in New York City (NYC), USA, during a period of declining TB burden.METHODS: Using routinely collected Health Department data for NYC TB cases from 2001 to 2014, we conducted a retrospective descriptive analysis. P values were calculated using Pearson's χ² or Fisher's exact test for categorical data; Wilcoxon rank-sum test was used to compare medians. We used the Cochran-Armitage test for trend and linear regression for trend analyses.RESULTS: HCP accounted for 6% of adults with TB throughout the study period and were more likely than other adults to be female (68% vs. 37%, P ≤ 0.0001), have extrapulmonary-only disease (31% vs. 23%, P ≤ 0.0001), have an isolate with multidrug resistance (4% vs. 2%, P = 0.0211), and report a previous history of latent TB infection (LTBI) (51% vs. 23%, P ≤ 0.0001). Compared to non-US-born HCP, US-born HCP were more likely to have HIV infection (18% vs. 8%, P = 0.0011) or a genotypically clustered isolate (67% vs. 37%, P ≤ 0.0001) and less likely to report history of prior LTBI (43% vs. 54%, P = 0.0128).CONCLUSIONS: Further research is needed to explore transmission and occupational risk among HCP. New approaches are needed to optimize completion of prophylaxis for HCP with LTBI.

Correction to: Analysis of skull bone thickness during growth: an anatomical guide for safe pin placement in halo fixation.

Unfortunately, the author group has been incorrectly listed by the first name instead of the family name in the original publication. The complete correct author group should read as follows.

Isolated meniscal injuries in paediatric patients: outcomes after arthroscopic repair.

BACKGROUND: The management of isolated meniscal tears in paediatric patients is poorly standardised, and few published data are available. Nevertheless, there is widespread agreement that meniscectomy, even when partial, produces poor outcomes including the premature development of osteoarthritis. HYPOTHESIS: Arthroscopic repair of isolated meniscal tears in paediatric patients yields good outcomes and should be attempted routinely. MATERIALS AND METHODS: We retrospectively assessed 19 arthroscopic repair procedures performed between 2006 and 2010 by a single surgeon in 17 patients with a mean age of 14 years. In every case, the knee was stable and the meniscus normal before the meniscal tear, which was the only injury. Mean follow-up was 22 months. In all 19 cases, the evaluation included a physical examination, pre-operative magnetic resonance imaging (MRI), and determination of the Tegner and Lysholm scores. Post-operative MRI was performed in 10 cases. RESULTS: The outcome was good in 12/17 (70%) patients with significant improvements in the mean Tegner score, from 3.9 to 7.1, and mean Lysholm score, from 55.9 to 85.4, between the pre-operative and post-operative assessments. The clinical outcomes were not significantly associated with time to arthroscopic repair, gender, lesion site, or lesion type. Neither was any correlation demonstrated between clinical outcomes and meniscal healing as assessed by MRI. DISCUSSION: The known poor outcomes after meniscectomy in paediatric patients, the results of our study, and previously published data support routine arthroscopic repair of isolated meniscal tears in this age group, regardless of the site and type of injury. In addition, in asymptomatic patients, clinical follow-up is sufficient and post-operative MRI unnecessary. LEVEL OF EVIDENCE: Level IV. Retrospective study.

Percutaneous correction of congenital overlapping fifth toe in paediatric patients.

The various available surgical methods for correcting congenital overlapping fifth toe deformity consistently require a skin plasty step, which can result in complications (necrosis, tight scar, unbecoming appearance). Here, we describe a percutaneous technique involving extensor tenotomy combined with release of the dorso-medial capsule and ligaments. No skin plasty is required. Percutaneous osteotomy of the first phalanx can be performed if needed. From 2006 to 2010, we used this technique in 16 patients (27 toes) with a mean age of 12.6years (range, 6-17years). Mean follow-up at last evaluation was 2.1 years. Osteotomy of the first phalanx was performed for 13 toes. The outcome was very good for 21 toes and good for six toes. No relapses or complications were recorded. This simple and safe technique deserves consideration in children with congenital overlapping fifth toe.

La punción-aspiración es una técnica segura y eficazen el tratamiento del neumotórax espontáneo primario / Needle aspiration is safe and effective for treating primary spontaneous pneumothorax

Objetivo: Demostrar la eficacia y seguridad de la técnica de punción-aspiración (PA) en el tratamiento del neumotórax espontáneo primario (NEP).Método: Estudio retrospectivo basado en una base de datos prospectiva de pacientes con neumotórax espontáneo primario que acudieron al servicio de urgencias (10 años).Se compara a los pacientes en los que se ha realizado la punción-aspiración (PA) frente a los que no. Además, se compara en términos de recidivas, reingresos, necesidad de cirugía o complicaciones, el grupo con un manejo ambulatorio frente al grupo de manejo hospitalario, y se analizan las variables asociadas al éxito de la técnica. Resultados: Se observan características similares en cuanto a las variables descriptivas(sexo, lado del neumotórax, hábito tabáquico, volumen aspirado) entre los dos grupos. La PA parece ser un factor protector en cuanto a la necesidad de ingreso con una OR0,7 (IC95: 0,62-0,78). No se observan diferencias significativas en cuanto a recidivas, reingresos o necesidad de intervención quirúrgica. Ninguna variable descriptiva ha mostrado relación con el éxito o fracaso de la técnica. La incidencia de complicaciones condicha técnica ha sido del 2,4%.Conclusiones: La técnica de PA es segura y eficaz como primer escalón en el tratamiento del NEP y reduce los ingresos hospitalarios sin aumentar el riesgo de reingreso o recidiva (AU)

Objective: Our main aim was to demonstrate the efficacy and safety of needle aspiration for treating primary spontaneous pneumothorax. Methods: Retrospective study of data collected prospectively for patients who came to the emergency department with primary spontaneous pneumothorax over a 10-year period. We compared patients who underwent needle aspiration to those who did not. Patients who were hospitalized were compared to those managed as outpatients in terms of recurrences, readmissions, need for surgery, and complications. Variables that might be related to the success of the procedure were explored. Results: Patients who underwent needle aspiration were similar to those who did not with respect to sex, side affected, and pneumothorax size (volume), and smoking status. Needle aspiration seems to be a protective factor against hospitalization (odds ratio, 0.7; 95% CI, 0.62-0.78). No significant between-group differences were detected with respect to recurrence, readmission, or need for surgery. None of the descriptive variables were related to success or failure of needle aspiration. The incidence of complications of needle aspiration was 2.4%Conclusions: Needle aspiration is a safe, effective first-line treatment for primary spontaneous pneumothorax and does not increase risk for readmission or recurrence (AU)

All inside transtibial arthroscopic posterior cruciate ligament reconstruction in skeletally immature: surgical technique and a case report.

UNLABELLED: Posterior cruciate ligament (PCL) tears are rare in children and may cause posterior instability of the knee. We present an original reconstruction technique. An 11-year-old boy sustained a PCL rupture. Despite initial immobilization followed by physiotherapy, he could not resume his previous sporting activities at the pre-injury level and complained of anterior knee pain. We performed an arthroscopic PCL reconstruction using a single bundle four-strand hamstring autograft. The femoral tunnel was drilled through the epiphysis and the tibial tunnel went through the physis under both arthroscopic and fluoroscopic control. The graft was secured using absorbable interference screws. At 2 years follow-up, the patient was asymptomatic and resumed sports at the same level as before the injury. Clinical examination was normal. There was no sign of growth disturbance. PCL injury is extremely rare in children. This original technique seemed appropriate in a symptomatic patient. LEVEL OF EVIDENCE: IV.

Estudio de la ingesta de yodo en los niños de 6 meses a 3 años de edad de Guipúzcoa / Study of iodine intake in children from 6 months to three years-old in Guipúzcoa

Objetivo: Evaluar si existe deficiencia de yodo en niños sanos con edades comprendidas entre los 6 meses y los 3 años, mediante cuantificación de yoduria. Diseño: Estudio descriptivo transversal, con muestreo intencional de niños que acuden a sus centros de salud para una revisión de salud rutinaria, en 10 centros de salud de Guipúzcoa. Sujetos: Ciento treinta niños de edades comprendidas entre los 6 y los 36 meses, sanos, 61 (46.9%) eran niñas y 69 (53.7%) niños. Mediciones: Edad en meses, procedencia, sexo, encuesta nutricional (en especial ingesta de sal yodada, pescado de mar y lácteos) y yoduria en micción aislada. Resultados: La mediana de yoduria es de 127μg/l. Aproximadamente, un tercio (36.9%) de los niños presentaban yoduria inferior a 100μg/l. No hemos encontrado asociación entre la yoduria y las variables de la encuesta nutricional. Conclusión: La ingesta de yodo en los niños estudiados es adecuada de acuerdo a las recomendaciones de la Organización Mundial de la Salud(AU)

Objective: To assess whether iodine deficiency exists in healthy children aged 6 months to 3 years by measuring urinary iodine. Design: A descriptive, cross-sectional study using purposeful sampling of children who attended 10 Primary Health Care centres in Guipúzcoa for routine health examinations. Subjects: A total of 130 healthy children aged between 6 and 36 months, of whom 61 (46.9%) were girls and 69 (53.1%) boys. Measurements: Age in months, origin, sex, nutritional survey (particularly intake of iodised salt, sea fish and dairy products) and urinary iodine excretion in a random urine sample. Results: The median urinary iodine was 127μg/L. About one third (36.9%) of children had a urinary iodine below 100μg/L. No relationship was found between urinary iodine and nutritional survey variables. Conclusion: Iodine intake in the children studied is adequate according to WHO recommendations(AU)

[Study of iodine intake in children from 6 months to three years-old in Guipúzcoa]. / Estudio de la ingesta de yodo en los niños de 6 meses a 3 años de edad de Guipúzcoa.

OBJECTIVE: To assess whether iodine deficiency exists in healthy children aged 6 months to 3 years by measuring urinary iodine. DESIGN: A descriptive, cross-sectional study using purposeful sampling of children who attended 10 Primary Health Care centres in Guipúzcoa for routine health examinations. SUBJECTS: A total of 130 healthy children aged between 6 and 36 months, of whom 61 (46.9%) were girls and 69 (53.1%) boys. MEASUREMENTS: Age in months, origin, sex, nutritional survey (particularly intake of iodised salt, sea fish and dairy products) and urinary iodine excretion in a random urine sample. RESULTS: The median urinary iodine was 127 µg/L. About one third (36.9%) of children had a urinary iodine below 100 µg/L. No relationship was found between urinary iodine and nutritional survey variables. CONCLUSION: Iodine intake in the children studied is adequate according to WHO recommendations.

Arthroscopic treatment of calcaneonavicular coalition in children.

Calcaneonavicular coalition is a common source of pain and more or less severe flat and stiff foot in children. Classically, treatment consists in resecting the coalition using a dorsolateral approach. Good quality resection and interposition can prevent recurrence. The most common complications are infection, hematoma and neuroma. Arthroscopy offers a minimally invasive alternative, but the optimal approach remains undetermined. We describe a surgical technique with an approach based on the anterolateral process of the calcaneus, in three cases with 12 months' follow-up. Arthroscopic resection has certain advantages: recovery is quicker, and the esthetic result is better. For the instrumental portal, skin incision should be superficial, followed by blunt dissection of subcutaneous tissue to avoid superficial peroneal nerve injury. Although longer term follow-up is needed, arthroscopy seems to be an attractive minimally invasive technique in this kind of pathology.

Arthroscopic treatment of discoid meniscus in children: clinical and MRI results.

INTRODUCTION: Treatment of symptomatic discoid meniscus in children is saucerization performed under arthroscopy. The strategy to adopt for associated meniscus lesions is discussed, from partial meniscectomy to meniscal repair. The latter was applied in the series studied herein. The objective was to assess this surgical strategy. PATIENTS: This was a retrospective study of 20 discoid menisci (18 patients) operated between 2004 and 2007. METHOD: The patients first underwent arthroscopic saucerization and then, a procedure that depended on the residual meniscus: no additional procedure if there was no lesion, suturing or reinsertion in cases with a repairable lesion, and partial meniscectomy in cases of a non repairable lesion. All patients were assessed clinically and with postoperative MRI. RESULTS: The mean follow-up was 37 months. Five discoid menisci presented no lesion and were treated with isolated saucerization. Fifteen discoid menisci presented a lesion. In four cases, saucerization removed this lesion. In eight cases, we performed meniscal repair after saucerization. In three cases, partial meniscectomy was necessary. The Lysholm score ranged from 67 to 88. Sixteen patients were satisfied or very satisfied in 16 cases. The mean Tegner score was 5.9. Postoperative MRI showed no signs of chondral degeneration. The mean measurements of the residual meniscus corresponded to the guidelines. Patients having undergone saucerization associated with meniscal repair had better results than those who had partial meniscectomy or meniscus repair alone (P=0.007, Fisher test). DISCUSSION: No other study having evaluated discoid meniscus surgery with postoperative MRI has been reported and few studies have been published on saucerization associated with repair. This approach spares the meniscus, as confirmed by MRI, with the size of the residual meniscus within the guidelines. We obtained good clinical and anatomic results, with good healing of the meniscus and satisfactory measurements.

Derivaciones directas vs. indirectas a rehabilitación desde atención primaria / Direct vs. indirect referrals to rehabilitation from primary care

Se estudia la derivación a rehabilitación de pacientes afectos de algias y entesopatías directamente desde atención primaria (AP) o a través del servicio de traumatología, con el objetivo de comparar el tiempo de espera tras la derivación directa desde el médico de AP a rehabilitación, con derivación indirecta (DI), esto es, llegar a rehabilitación tras haber pasado por consulta de traumatología y analizar qué aporta la consulta de traumatología, además del aumento en la demora. El objetivo último de este trabajo es comparar la efectividad de las derivaciones. Material y métodos. Se seleccionan 787 pacientes remitidos a rehabilitación entre julio de 2007 y julio de 2008 por patología del aparato locomotor, que se agrupan en dos categorías, 239 corresponden a procesos cuya derivación a través de traumatología es incuestionable y 548 que llamamos «algias y entesopatías». Material y métodos. De esas 548, un 66% proceden de traumatología (DI) y un 34% han sido derivadas directamente desde AP. Material y métodos. Se describen las características de los pacientes y se analiza qué le aporta la consulta de traumatología a los de DI. Resultados y conclusión. La derivación directa desde AP a rehabilitación para algias y entesopatías puede contribuir a evitar demoras innecesarias y consultas duplicadas (AU)

We studied the referral to rehabilitation of patients affected by joint pain and enthesophatiy directly from Primary Care or by an orthopaedist. The aim of the study is to compare waiting times following direct referral from a primary care physician to rehabilitation, with those following indirect referral, that is, arriving at Rehabilitation after orthopaedist consultation. We also studiet the orthopaedist consultation contribution apart from increased delay. The goald of this paper is to seek improved effectiveness of referral. Material and methods. We selected 787 patientes referred to Rehabilitation between July 2007 and July 2008 due to musculoskeletal pathology. These were then grouped into two categories, 239 related to patients whose referral via orthopaedist is irrefutable, and 548 wich we call "Joint and Enthesophaty". Of these 548, 66% came from orthopaedist (Indirec referral) and 34% were referred directly from Primary Care. Material and methods. We described the patients charactheristics and discussed the orthopaedist consultation contribution to those patients who were indirectly referred. Results and conclusion. Direct referral from Primary care to Rehabilitation for Joint Pain and Enthesophaty can help avoid unnecessary delais and duplicateds consultation (AU)

[Pre-, peri- and postpartal depression]. / Prä-, peri- und postpartale Depressivität.

INTRODUCTION: Postpartal affective disorders are with a prevalence between 8 % and 15 % highly frequent maternal diseases after childbirth. An undetected and untreated postpartum depression causes a wide range of negative consequences such as risk of a chronic manifestation of a major depression, social retreat, limitations in the bonding behavior, and behavioral disorders of the child. Therefore, an early detection of pregnant women at risk is warranted. METHODS: Within a prospective study (FRAMES: Franconian Maternal Health Evaluation Studies), 1,100 pregnant women were interviewed with standardized questionnaires at three points of time: Prepartal (U1): from the 30 (th) week of pregnancy onwards, 48 - 72 hours (U2) postpartum (pp) und 6 - 8 months pp (U3). 554 women were included in the substudy Blue FRAMES, where an additional telephone interview at the 10 (th) day pp was conducted with a focus on symptoms relating to Baby Blues such as mood instability, irritability and concentration deficits. The Edinburgh Postnatal Depression Scale (EPDS) and the Hamilton Rating Scale For Depression (HAMD) were used for quantification of depressivity at each point of time. RESULTS: EPDS values differed significantly (Friedman Test; chi (2) = 110.8; df = 2, p < 0,001) between the different examination points (Wilcoxon Test; U1 - U2: Z = -11.0; p < 0.001; U1 - U3: Z = -6.6; p < 0.001; U2 - U3: Z = -4,5; p < 0,001). Regarding EPDS values, higher values were observed prepartum (U1). After a decrease after two to three days postpartum (U2), values increased again. However, EPDS values six months postpartum (U3) were still lower than prepartum (U1). DISCUSSION: The observed EPDS values postpartum are comparable to results of other studies. The higher EPDS values prepartum have a good predictive value. There is a great need and possibility for improved prevention of postpartal disorders, when appropriately addressed in the prepartum period.

Irradiation facility at the TRIGA Mainz for treatment of liver metastases.

The TRIGA Mark II reactor at the University of Mainz provides ideal conditions for duplicating BNCT treatment as performed in Pavia, Italy, in 2001 and 2003 [Pinelli, T., Zonta, A., Altieri, S., Barni, S., Braghieri, A., Pedroni, P., Bruschi, P., Chiari, P., Ferrari, C., Fossati, F., Nano, R., Ngnitejeu Tata, S., Prati, U., Ricevuti, G., Roveda, L., Zonta, C., 2002. TAOrMINA: from the first idea to the application to the human liver. In: Sauerwein et al. (Eds.), Research and Development in Neutron Capture Therapy. Proceedings of the 10th International Congress on Neutron Capture Therapy, Monduzzi editore, Bologna, pp. 1065-1072]. In order to determine the optimal parameters for the planned therapy and therefore for the design of the thermal column, calculations were conducted using the MCNP-code and the transport code ATTILA. The results of the parameter study as well as a possible configuration for the irradiation of the liver are presented.

Tratamiento quirúrgico de la escoliosis congénita por hemivértebra aislada. A propósito de una serie de 27 casos / Surgical treatment of congenital scoliosis resulting from an isolates hemivertebra: 27 cases

Objetivolas escoliosis congénitas evolutivas por hemivértebras pueden ser tratadas quirúrgicamente mediante resección o epifisiodesis convexa. Nuestro objetivo fue evaluar los resultados de una serie de niños operados según una u otra modalidad. Material y métodose realizó una revisión clínica y radiológica de una serie no comparativa de 27 hemivértebras aisladas de las cuales 16 habían sido tratadas por resección y 11 por epifisiodesis. La media de edad en el momento de la intervención fue 50 (24-132) meses y el ángulo de Cobb fue de 33° (20°¿75°). La resección para las hemivértebras lumbares se hizo por una vía de abordaje anterior y posterior y como instrumentación se utilizó el material Baby CD a compresión. La epifisiodesis para las hemivértebras torácicas necesitó de un tiempo anterior de escisión a dos niveles, seguido de un tiempo posterior de descorticación a cuatro niveles: en 6 casos fueron instrumentadas y en 5 casos, escayoladas en posición de reducción. Resultadosno se constató ninguna complicación neurológica. Respecto a las 16 resecciones, la reducción media fue del 75% en postoperatorio y del 73% al final del estudio. Para las 11 epifisiodesis la corrección media obtenida fue del 25% en el postoperatorio y del 39% a los 4 años de seguimiento medio (1¿8 años). Hubo 2 casos de fracaso a largo plazo en ausencia de instrumentación. Conclusionesla resección de las hemivértebras proporciona resultados satisfactorios inmediatos y estables en el tiempo. Sin embargo, en las localizaciones torácicas y a causa del riesgo neurológico, las epifisiodesis convexas con instrumentación garantizan el resultado a largo plazo

Purpose: Congenital scoliosis resulting from hemivertebrae can be treated surgically through resection or convex epiphysiodesis. Our purpose was to assess the results obtained in a series of children operated using both methods. Materials and methodsA clinical and radiological review was carried out of a non-comparative series of 27 isolated hemivertebrae of which 16 had been treated by means of resection and 11 by means of epiphysiodesis. Mean age at surgery was 50 months (24-132) and Cobb's angle was 33° (20°¿75°). In the case of lumbar hemivertebrae, resection was performed through an anterior and posterior approach; compressive CD instruments were used. Epiphysiodesis for the thoracic vertebrae required a prior excision phase at two levels, followed by a subsequent 4-level decortication phase: in 6 cases they were instrumented and in 5 a plaster cast was applied in the reduced position. ResultsNo neurological complication was found. With respect to the 16 resections, mean reduction was 75% postoperatively and 73% at the end of the study. For the 11 epiphysiodeses mean correction obtained was 25% postoperatively and 39% at 4 years¿ mean follow-up (1¿8 years). There were 2 cases of long-term failure in the absence of instrumentation. ConclusionsResection of hemivertebrae provides immediate and stable satisfactory results. However, in the thoracic area, and given the neurological risk involved, instrumented convex epiphysiodesis guarantees a good long-term result (AU)

Estudios por imagen en la primera infección urinaria con fiebre del lactante. ¿Es necesaria la cistografía miccional? / Imaging studies in the first urinary infection with fever in infants: is voiding cystourethrography necessary?

Introducción: En el lactante con infección del tracto urinario (ITU), no es necesaria la presencia de reflujo vesicoureteral (RVU) para que se produzca una lesión renal adquirida. Sólo los reflujos graves pueden ser un factor que favorezca su aparición. Objetivos: Valorar si en los lactantes diagnosticados por primera vez de una ITU con fiebre, una gammagrafía renal con ácido dimercaptosuccínico (DMSA) inicial normal puede ser utilizado como método de cribado para detectar los reflujos graves y sustituir a la cistouretrografía miccional seriada(CUMS). Pacientes y métodos: Hemos estudiado retrospectivamente 162 lactantes menores de 2 años controlados en nuestro hospital por haber presentado la primera manifestación de una ITU con fiebre (92 varones y 70 mujeres). En todos los casos se habían practicado, a los pocos días del diagnóstico, una ecografía renal, una DMSA y una CUMS. Resultados: De los 162 pacientes, 62 (38 %) tenían RVU, de los cuales56 (90 %) eran leves y seis (10 %), graves. El DMSA era anormal en 26 de 100 pacientes sin RVU (26 %), en 12 de56 con RVU leve (21 %) y en 6 de 6 casos de los que tenían RVU grave (100 %). La sensibilidad del DMSA para detectarlos reflujos graves era del 100 % y la especificidad del 76%.El valor predictivo positivo y el valor predictivo negativo eran del 14 y el 100 %, respectivamente. El cociente de probabilidad positivo era de 4,17 y el cociente de probabilidad negativo de 0. Conclusiones: En el lactante con una primera manifestación de una ITU, una DMSA inicial negativa hace innecesaria la realización de la CUMS (AU)

Introduction: The presence of vesicoureteral reflux (VUR) in an infant with urinary tract infection (UTI), does not necessarily lead to an acquired renal injury. Only serious reflux can be a factor in fostering its appearance. Objectives: To assess whether in infants diagnosed for the first time with a UTI with a fever, a routine initial DMSA can be used as a screening method for detecting severe reflux and replace voiding cystourethrography (VCUG). Patients and methods: We retrospectively studied 162 infants under 2 years old admitted to our hospital due to having a ITU with fever for the first time (92 males and 70 females). In all cases, arenal ultrasound, DMSA and VCUG had been performed a few days after the diagnosis. Results: Of the 162 patients, 62 (38 %) had VUR, of which 56(90 %) were mild and 6 (10 %) were severe. The DMSA was abnormal in 26/100 patients without VUR (26 %), 12/56 with mild VUR (21 %) and 6/6 of those with severe VUR (100 %). DMSA sensitivity for detecting severe reflux was 100 % and specificity was 76 %. The positive predictive value and negative predictive value was 14 % and 100 % respectively. The positive likelihood ratio was 4.17 and the negative likelihood ratio was 0. Conclusions: It is unnecessary to carry out VCUG in an infant with an initial UTI, and a negative DMSA (AU)

Revisión sistemática sobre la eficacia de racecadotrilo en el tratamiento de la diarrea aguda / Systematic review of the efficacy of racecadotril in the treatment of acute diarrhoea

Objetivo: Obtener un estimador de la eficacia del racecadotrilo en el tratamiento de la diarrea aguda mediante revisión sistemática y metaanálisis. Material y métodos: Se seleccionaron ensayos clínicos de calidad realizados en niños en los que se compara la eficacia del racecadotrilo frente a placebo en cuanto a duración de los síntomas, cantidad de deposiciones y efectos secundarios. La búsqueda se ha realizado en bases electrónicas (Med-line, EMBASE, CENTRAL, CINAHL, mRCT, Pascal), en las referencias de los artículos recuperados y mediante contacto con el fabricante, hasta diciembre de 2007. Dos evaluadores independientes han evaluado la calidad. Resultados: Se seleccionaron dos ensayos de muestra pequeña (135 y 172 niños, todos hospitalizados) y de calidad media. Éstos incluyen a niños de edades comprendidas entre 3 meses y 4 años con diarrea aguda de menos de 5 días de evolución a quienes al tratamiento habitual se añade racecadotrilo o placebo. No existen diferencias en la proporción de niños enfermos al quinto día (riesgo relativo [RR] = 0,73; intervalo de confianza [IC] del 95 %, 0,29-1,81). Se demuestra una eficacia leve en el volumen de las deposiciones en las primeras 48 h (diferencia estandarizada de medias [DEM] = -0,65; IC 95 %, -0,88 a -0,42). No se observan diferencias en los efectos secundarios (vómitos, RR = 1,16; IC 95 %, 0,64-2,12). Conclusión: La proporción de curados al quinto día no mejora añadiendo racecadotrilo al tratamiento habitual, si bien disminuye el volumen de deposiciones en las primeras 48 h. Sería interesante estudiar la eficacia en atención primaria valorando el número y volumen de las deposiciones y la duración y número de ingresos (AU)

Objective: To estimate, through a systematic review of the literature, the efficacy of racecadotril in the treatment of acute diarrhoea. Material and methods: Randomised trials carried out in children comparing racecadotril with placebo in terms of diarrhoea recovery, stools output and adverse effects were selected. Electronic databases (Medline, EMBASE, CENTRAL, CINAHL, mRCT, Pascal) and bibliographies of retrieved articles were searched, and the drug developer was contacted. Two authors independently assessed the quality of the retrieved articles and extracted the data. Results: Two small sample size randomised trials (135 and 172 children) of moderate quality were selected. They included children with less than five days diarrhoea and aged between 3 months and 4 years. There was no difference in the proportion of children who recovered by day 5 (RR = 0.73, CI95 % 0.29 to 1.81), although the stools volume during the first 48 hours was less in the racecadotril group (SMD = -0.65, CI95 % -0.88 to -0.52). There is no difference in the risk of vomiting (RR = 1.16, CI95 % 0.64 to 2.12). Conclusion: The proportion of recoveries by the 5th day is the same, although the stool volumes during the first 48 hours are less in the racecadotril treated children. It would be interesting to study the efficacy in a primary care setting assessing the cure rate, the stool volumes and the admission rate to elucidate if there is room for this drug (AU)

[Fractional exhaled nitric oxide: validation of a 6 second exhalation time with two different analysers]. / Fracción exhalada de óxido nítrico: validación de la medida con tiempo de espiración de 6 s con dos analizadores diferentes.

OBJECTIVE: To validate the measurement of fractional exhaled nitric oxide concentration (FE(NO)) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX, Aerocrine) and a portable electrochemical analyser (NIOX-MINO, Aerocrine). MATERIAL AND METHODS: FE(NO) was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX analyser), three valid FE(NO) measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO), a single valid measurement of FE(NO) was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FE(NO) and the number of attempts with both exhalation times in each analyser. Agreement between FE(NO) assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen's kappa. RESULTS: The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FE(NO) values obtained with both exhalation times and with both devices. Cohen's kappa, also demonstrated good agreement (NIOX, kappa = 1; NIOX-MINO, kappa = 0.93). CONCLUSIONS: A 6-sec exhalation time is valid for measuring FE(NO) with both analysers in children aged over 5 years.