[Meningitis by enterovirus in pediatrics. Clinical characteristics and virologic diagnosis]. / Meningitis por enterovirus en pediatría. Características clínicas y diagnóstico virológico.

BACKGROUND AND METHODS: With the aim of knowing the etiology of aseptic meningitis (pleocytosis in LCR with negative bacterial culture and positive or negative virus culture or without pleocytosis with viral culture in positive LCR), 48 children attending the Emergency Department of our hospital from June to December, 1995 were prospectively studied. Pharyngeal and rectal swab, LCR for bacteria and virus and blood cultures were carried out. The samples were inoculated in fibroblasts MRC-5, RD and BGM. The cytopathic effect was identified by immunofluorescence. Typing was performed in the National Center of Public Health Care Microbiology, Virology and Immunology in Majadahonda (Spain). RESULTS: Isolation of the virus was positive in 40/48 (83.3%) of the children: in 17 (35.5%) of LCR and the remaining 23/40 (47.9%) of pharyngeal and/or rectal swab. In all the cases the cytopathic effect was detected in MRC-5. The viruses found were echovirus 30 and 5. A greater incidence of the disease was observed in November and December. CONCLUSIONS: Meningitis by enterovirus is frequent in our area. Culture of the virus in LCR, the pharynx and stools is useful on suspicion of aseptic meningitis since the virus may be isolated from LCR in more than one third of the patients. Serotyping aids in surveilling the appearance of outbreaks and to know the predominant viruses. Cell culture is the diagnostic treatment of choice, but has a low sensitivity and is slow. The application of other techniques such as PCR which have a greater sensitivity and with high specificity for the diagnosis of these infections is necessary.

Time trends in acute childhood asthma in Basque Country, Spain.

To investigate recent changes in the epidemiology of acute asthma in children in a hospital setting, data from the Basque region of Bizkaia, Spain were reviewed for the period between 1987 and 1992. Over this period there was a 18% drop in hospital emergency visits for asthma in children aged 2-14 years from 1,697/100,000 to 1,382/100,000. It was associated with a decline in the number of annual episodes per patient and in the number of patients needing further hospital treatment for the same episode. Paradoxically, hospital admission rates rose by 35.9% from 298/100,000 to 405/100,000. A trend toward decreasing length of hospital stay, a fall in the number of intensive care unit admissions, and an absence of in-hospital deaths were observed. Comparing data from September 1987 with those of September 1992, a trend has been noticed toward greater intensity of emergency room treatment with increases in the number of doses of nebulized beta 2-agonists administered and in courses of oral prednisolone given. In September 1992 more patients were on maintenance "anti-inflammatory" inhaled therapy than in 1987.

[An imaging and color echo-Doppler study of interventricular defects]. / Estudio de los defectos interventriculares por imagen y ECO-Doppler color.

OBJECTIVE: Evaluation of ventricular septal defect with two-dimensional echocardiography and color flow Doppler. PATIENTS AND METHODS: We had studied by this method 180 patients; 97 males and 83 (mean age 1.5 +/- 1 years) diagnosed of a VSD. Cases with a complex cardiopathy were excluded from the study. The VSD was classified according to its location and relation to the tricuspid anulus and semilunar valves in perimembranous VSD, muscular VSD and subarterial double committed defect. The colour Doppler identified one or two areas of low through the ventricular septum with a zona of proximal acceleration throughout systole. Every group can be evaluated in different views but they all have a selective echocardiographic view except for muscular trabecular VSD. RESULTS: Seventy-six patients had perimembranous VSD (30 inlet, 26 trabecular and 20 infundibular-outlet), 102 had muscular VSD (3 inlet, 97 trabecular and 2 infundibular-outlet) and 2 had a subarterial double committed defect. A ventricular septal aneurysm was associated in 20 patients with muscular or perimembranous defects. Six patients, 2 of the perimembranous trabecular VSD, 2 muscular-trabecular VSD and 2 subarterial were initially misclassified. In this last 2 cases the turbulence created in the pulmonary valve was wrongly interpreted as pulmonary valvular stenosis; subcostal view for both tracts is necessary to avoid such mistake. In conclusion, color Doppler flow mapping is very useful to differentiate the various types as VSD and aids identification of multiples ventricular septal defects.

[Application of bidimensional echocardiography in the diagnosis of ventricular septal defect]. / Aplicación de la ecocardiografía bidimensional en el diagnóstico de la comunicación interventricular.

Between 1985-1990 we studied by means of two-dimensional echocardiography 286 patients with isolated ventricular septal defect (VSD). A hundred and sixty three being male and 123 female, as a mean age of 5 +/- 3 months. Sixty two cases (22.3%) reveales associated anomalies and in other 63 (22.4%) there was in the evolution an aneurysm of the septum membranous. The projections used were apical 4-chamber, with or without aortic root; parasternal long-short axis of great arterias or at ventricular level; subcostal 4-chamber; right oblique outlet right outflow tract and left oblique outlet left and right outflow tracts. Patients with VSD smaller than 3 mm were excluded. Perimembranous defects, 189 cases (66%), were more frequent than muscular, 91 31.8%), and subarterial defects, 6 (2.1%). Only 19 (9 apical muscular, 6 perimembranous outlet and 4 perimembranous trabecular) were initially misclassified. The diameter of the VSD was large in subarterial (0.85 +/- 0.1 cm) and perimembranous outlet VSD (0.75 +/- 0.5 cm) compared with the rest. Each group of defects was more easily shown by one particular projection except trabecular muscular defect. In conclusion, we are able to state that two-dimensional echocardiography enables us to discover the size and situation of isolated ventricular defects.

[Heart malformations in trisomy 13 and trisomy 18]. / Malformaciones cardíacas en las trisomías 13 y 18.

Congenital heart diseases were studied in children diagnosed of trisomy 13 and trisomy 18 in our hospital between January 1973 and July 1990. Twenty patients with trisomy 18 were diagnosed (18 females and two males). All had cardiac malformations. The findings were: ventricular septal defect in 16 cases (80%), valvular anomalies in 12 (63%), patent ductus arteriosus in nine (47%) and atrial septal defect or patent foramen ovale in 7 cases (36%). We found some complex congenital cardiac diseases: one atrioventricular canal, one tetralogy of Fallot, one hypoplastic left ventricle with mitral atresia and double outlet right ventricle, one case of univentricular heart with aortic outlet from a rudimentary cavity, a right ventricular atresia with pulmonary and tricuspid valves atresia. Nine cases of trisomy 13 were diagnosed (seven females and two males). We found: ventricular septal defect in 7 cases (77%), valvular disease in five (100% of the necropsy studies), secundum atrial septal defect in 4 patients (80%) and patent ductus arteriosus in two. Two cases presented hypoplastic left ventricle with aortic arch hypoplasia, one of them had subaortic stenosis and left superior vena cava being connected to the right atrium via coronary sinus; one case showed fibroelastosis. Our results have been similar to the previously reported and confirm the invariably presence of cardiac malformations in these syndromes. These malformations are an important sign of suspicion in fetal ultrasonography.

[Aortic coarctation in the first 3 months of life. Surgical results]. / Coartación de aorta en los primeros 3 meses de vida. Resultados quirúrgicos.

Between January 1973 and September 1989, 51 patients younger than 3 months with coarctation of the aorta underwent surgery. All of them had atrio-ventricular and ventriculo-arterial concordance with well developed ventricular cavities. Thirty-four were male and 17 female. Thirty five had associated anomalies and catheterism was done in 36 before surgical correction. The surgical procedures we used were 19 subclavian plasty (Waldhausen), 13 end-to-end anastomosis, 13 Alvarez technique and three goterex parch. Twelve died (23.5%), three during surgery and the others in a period of 3 to 20 days after surgery. Eight were younger than 17 days, seven had aortic arch hypoplasia associated and six had ventricular septal defect (five with pulmonary hypertension). Other ten developed recoarctation (gradient greater than 20 mmHg) between 10 days and 8 months after first intervention (media = 3 months). Five had previously end-to-end correction (41.6%), two angioplasty with parch (66%), two Alvarez (20%) and one Waldhausen (7%). The correction of the recoarctation required surgery in 4 patients (three with angioplasty with parch and one with end to end correction), and the other six underwent angioplasty with catheter-balloon. None of the 15 patients without previous catheterism died, and neither did those who underwent surgery during the last 4 years. The associated anomalies required a second time surgery. We conclude that morbimortality is related to the aortic arch hypoplasia, pulmonary hypertension and surgery during the first 2 weeks. We recommend surgery without previous catheterism. The recoarctation is more frequent in patients with end to end correction, without an increase of the mortality.

[Fixed subaortic stenosis in childhood. The surgical correction of 28 cases]. / Estenosis subaórtica fija en la infancia. Corrección quirúrgica de 28 casos.

Between January 1976 and December 1989, 28 patients with fixed subaortic stenosis underwent surgical correction. Twenty-one were male and seven female. The mean age when surgery was performed was 7.4 years (range 14 months to 14 years). Angiography was not done in 8 patients (28.5%). Fourteen had a subaortic stenosis due to a fibrous shelf and the other 14 to a fibromuscular one. Fifteen had associated anomalies, seven aortic stenosis, three aortic regurgitation and four mitral disturbances. Three surgical procedures were carried out: resection in 16 patients (57.1%), resection and myotomy in ten (35.7%), and resection with myectomy in two (7.1%). In 5 patients a residual stenosis was detected, one of whom required repeated surgery, and 2 other patients developed recidive of the stenosis (both required repeated surgery). Prosthetic valves (five aortic and one mitral) were inserted in 6 patients (21.4%). One of these required an aortic valve conduct. Pacemaker was placed in other 4 patients (two with prosthesis). No patient died and 20 (71.4%) are normal, nowadays, with a mean follow-up of 5.5 years. We conclude that fixed subaortic stenosis is a serious disease which requires correction at the time of diagnosis, independently of gradient. The type of surgical procedure influences in recidive. The older patients with the fibromuscular type and associated anomalies are candidates for a prosthetic valve.