Intoxicaciones pediátricas atendidas en el Hospital Clínico de Santiago de Compostela (1993-1996) / Cases of pediatric poisoning treated at the clinical hospital of Santiago de Compostela (1993-1996)

Se estudiaron 193 intoxicaciones pediátricas atendidas en el Hospital Clínico de Santiago de Compostela desde enero de 1993 a diciembre de 1996, ambos inclusive. Se observó un ligero predominio del sexo masculino (54,4 por ciento), siendo la edad media de 5,57+/-5,00 años. La incidencia fue máxima en el intervalo de 0-4 años (116 casos) y los tóxicos más frecuentemente implicados fueron los medicamentos (106 casos), con un lugar preferente para los analgésicos (40 por ciento), seguidos de las benzodiacepinas (30 por ciento). Los lunes y los miércoles fueron los días de la semana en donde se dió un mayor número de intoxicaciones, no encontrándose diferencias significativas entre los doce meses del año. El 72 por ciento de los pacientes presentaban clínica al ingreso, siendo mayoritaria en el grupo de 10-14 años, con predominio de las manifestaciones neurológicas. Entre todos los tratamientos aplicados destacó el lavado gástrico (84 casos) y, aunque 135 pacientes tuvieron que ser ingresados, la evolución clínica fue siempre favorable. En el 47 por ciento de la población estudiada se detectaron todos o parte de los tóxicos sospechados y en el 26 por ciento se encontraron otros tóxicos. De los niveles plasmáticos calculados, 77 resultaron subtóxicos y 52 tóxicos, relacionándose los primeros con intoxicaciones por fármacos y los segundos con sobredosis por drogas de abuso (AU)

[Prevalence pneumococcal meningitis in Spanish children]. / Prevalencia de meningitis neumocócica en niños españoles.

OBJECTIVE: To determine the prevalence of pneumococcal meningitis in the pediatric population in Spain. Material and methods Retrospective multicenter study performed in five autonomous communities (Catalonia, Galicia, Madrid, Navarre and the Basque Country) between January 1998 and December 2000. All patients aged between 0 and 14 years old with a diagnosis of pneumococcal meningitis (Streptococcus pneumoniae isolation or presence of Gram-positive diplococcus in the cerebrospinal fluid (CSF) and CSF with more than 20 cells) in all the hospitals of the five autonomous communities were included in the study. The pediatric population in these communities aged between 0 and 14 years old was 2,327,079. RESULTS: We detected 107 cases in 64 boys and 43 girls with a mean age of 1.19 years old (p 25-0.57; p 75-3.34). The incidence was higher in the first 2 years of life [72/107 (67 %)]. The overall annual prevalence in the five autonomous communities in the first 24 months of life was 8.26 per 100,000 children aged under 2 years (95 % CI: 3.45-15.76). The highest number of cases was detected in Catalonia and Madrid but the highest annual prevalence was found in the Basque Country with 15.52 cases per 100,000 children younger than 2 years old (95 % CI: 8.38-24.74). In the first 12 months of life the prevalence was high in all the autonomous communities, especially in the Basque Country with 22.76 cases per 100,000 newborn infants aged under 12 months (95 % CI 14.58-34.5). In the first 5 years of life the annual global adjusted prevalence per 100,000 children was as follows: Catalonia 3.21 (95 % CI: 1.31-5.11), Galicia 2.65 (95 % CI: 0.35-5.64), Madrid 3.49 (95 % CI: 1.36-5.61), Navarre 3.36 (95 % CI 5,08-11,81), the Basque Country 5.63 (95 % CI: 1.08-10.18). CONCLUSION: The prevalence of pneumococcal meningitis in children from different autonomous communities is high and is greatest in the Basque Country and in children aged under 2 years. This prevalence is similar to that of other European countries and the USA.

Usefulness of the head-upright tilt test for distinguishing syncope and epilepsy in children.

PURPOSE: Episodic loss of consciousness in children, whether or not associated with hypertonia or short-duration clonic movements, presents a diagnostic challenge to the pediatrician and child neurologist. We provide some evidence of the usefulness of the head-upright tilt test for investigating the causes of transient loss of consciousness in children, and for distinguishing between syncope, convulsive syncope, and epilepsy. METHODS: We studied nine children previously diagnosed as epileptic on the basis of compatible clinical events and epileptiform findings in routine EEGs who were treated over the long term with antiepileptic drugs, but whose clinical records suggested syncope or convulsive syncope rather than epilepsy on reevaluation. All subjects underwent head-upright tilt testing. RESULTS: The tilt-test result was positive in all nine cases, with the patients reporting the same symptoms as in the previously considered epileptic attacks. CONCLUSIONS: Inadequate histories and misuse/overinterpretation of EEG results often lead to misdiagnosis of epilepsy in children. The head-upright tilt test is a useful and reliable diagnostic technique, allowing syncopal events to be induced and evaluated under controlled conditions. In a subset of patients, it may help to distinguish epilepsy from simple or convulsive syncope.

Study of paediatric intensive care units in Spain. Spanish Society of Paediatric Intensive Care.

OBJECTIVE: To describe the organisation of paediatric intensive care units in Spain and the medical assistance provided during 1996. METHODS: A written questionnaire was sent to all the paediatric ICUs linked to or within the Spanish public health system. RESULTS: Thirty-one of the 34 paediatric ICUs replied. All are medico-surgical units. Eighteen treat only paediatric patients, 12 paediatric and neonatal patients, and one paediatric and adult patients. Fifteen units have fewer than seven beds, eight have between 7 and 12 beds, and eight between 13 and 18 beds. Of the paediatric ICUs, 83.8 % are staffed by paediatricians specialised in paediatric intensive care. The mean number of on-call on site periods of duty for each member of the medical staff was 5.1 +/- 1.7 per month. Thirty of the 31 units undertake paediatric resident training, 13 train residents specialising in paediatric intensive care and 12 participate in medical student training. In 1996 there were 9,585 admissions (309 +/- 182 patients per ICU) signifying 35.3 +/- 14 patients/bed. Of the patients, 65.9 % were medical and 34.1 % surgical. The mean duration of stay was 5.6 +/- 2.1 days. The mortality rate was 5.4 +/- 3.2 %. The main causes of death were multiple organ failure and brain death. CONCLUSIONS: In Spain, paediatric intensive care is principally performed by specialised paediatricians. Although the general results for 1996 are similar to those of other European countries, efficiency studies are necessary to plan and re-organise the paediatric intensive care units in Spain.

Cerebral oxygenation in children with syncope during head-upright tilt test.

The pathophysiology of neurocardiogenic syncope remains incompletely known. In this entity, besides abnormal systemic hemodynamic regulation, potential cerebral circulatory abnormalities have been reported. In this setting, cerebral saturation assessment could detect cerebral blood flow changes and estimate the sufficiency of brain oxygenation during the event. A head-upright tilt test was performed in 25 children aged between 6 and 16 years. In addition to the standard protocol, cerebral oxygen saturation was determined noninvasively by means of a near-infrared spectrophotometry device. In the 19 children with a positive tilt test, significant impairment of cerebral saturation was detected both at the start of the patient's complaints (without hemodynamic modifications) and during syncope. Our results support the hypothesis of the presence of abnormal cerebral hemodynamic autoregulation in children with neurocardiogenic syncope.

Glucocorticoid deficiency with achalasia of the cardia and lack of lacrimation.

Four recent reports describe a multisystem disorder in which ACTH insensitivity is associated with achalasia and alacrima. We report studies on a male patient with this rare triad. The patient had alacrima from birth; isolated glucocorticoid deficiency had been diagnosed at 3.5 years of age and achalasia at age 6. The possibility that this syndrome could be due to a parasympathetic degeneration has already been proposed; the cause of the glucocorticoid deficiency, however, remains unclear. Parasympathetic function in other areas was investigated to determine whether there might be a more generalized abnormality. Specific cardiac tests of parasympathetic function showed that parasympathetic input to the heart was affected in the patient, while the same tests in an Addisonian child were normal. We show, then, a hitherto undetected parasympathetic abnormality in a patient with this syndrome, suggesting a generalized disturbance of this system. On this basis we may hypothesize that the glucocorticoid failure may be a consequence of the loss of parasympathetic input to the adrenal gland, although this remains to be demonstrated experimentally.

[Dystonia and carbamazepine (author's transl)]. / Distonía por carbamacepina. A propósito de cuatro observaciones en el niño.

Appearance of dystonic movements in four epileptics children, while carbamazepine administration, is the object of this publication. Human material is formed by four patients in pediatric ages of 4.5, 5, 6 and 7 years old, which presented dystonia after the administration of carbamazepine. Clinical, neuroradiological, psychometric and bioelectric explorations were performed, also serum determinations of anticonvulsant levels. Three of the children presented serious psychomotor retardation. The electroencephalograms showed no uniform changes. Serum levels of carbamazepine were in therapeutics limits. From this personal experience and bibliography data it is deduced that dystonia is not a toxic phenomena, establishing the possibility of an interaction between carbamazepine and dopaminergic system.