Depresión del segmento ST durante la taquicardia supraventricular. ¿Se debe a la isquemia? / ST-segment depression during paroxysmal supraventricular tachycardia, is ischemia involved?

La aparición de alteraciones significativas de la repolarización durante episodios de taquicardia supraventricular no es un hecho infrecuente. A menudo, estos episodios cursan con dolor torácico, lo que puede hacer pensar en una enfermedad coronaria. Se presenta el caso de un paciente de 9 años de edad, tratado en nuestro centro por un episodio de taquicardia supraventricular y dolor torácico, con posterior depresión del segmento ST que no se normalizó hasta horas después del episodio. Se realiza una revisión de las taquicardias paroxísticas supraventriculares por vía accesoria y se discute el valor diagnóstico y la etiología de las alteraciones de la repolarización durante las taquicardias supraventriculares (AU)

Repolarization abnormalities during supraventricular tachycardias are not unusual. They are frequently accompanied by chest pain, this may lead to a false diagnosis of coronary ischemia. We present a 9-year-old child with an episode of supraventricular tachycardia, chest pain and pronounced ST-segment depression treated in our hospital. A review about paroxysmal atrioventricular re-entrant tachycardia is presented. Diagnostic value and aetiology of repolarization abnormalities during supraventricular tachycardias are discussed (AU)

[Evaluation of twenty-three episodes of acute thoracic syndrome in patients with sickle cell anemia]. / Evaluación de veintitrés episodios de síndrome torácico agudo en pacientes con drepanocitosis.

INTRODUCTION: Acute thoracic syndrome (pneumonia and/or lung infarction) is a significant cause of morbidity and mortality in sickle cell anemia. OBJECTIVE: To review the clinical manifestations, management and outcome of episodes of acute thoracic syndrome in our hospital. METHODS: We performed a retrospective review of all the episodes of acute thoracic syndrome diagnosed at our center in patients younger than 18 years of age with sickle cell anemia. Clinical, laboratory and radiological findings, outcome and treatment were analyzed. Data from patients < 3 years and > 3 years of age were compared (Fisher's exact test and the Mann-Whitney U test). RESULTS: Twenty-three episodes of acute thoracic syndrome were evaluated in eight out of 12 patients with sickle cell anemia followed-up in our hospital. These episodes represented 36 % of the total time of admission in these patients. The most frequent cause was infection. The most frequent symptoms were fever (87 %), cough (61 %) and cold (35 %) symptoms. Seventy-four percent of the patients were not diagnosed at admission, either because the chest X-ray was normal (52 %) or because it was not performed (22 %) due to the absence of pulmonary manifestations. Patients aged more than 3 years old had more severe episodes, with greater clinical compromise and radiological involvement and increased use of analgesia. Transfusions were administered in 65 % of the episodes and in five patients (> 3 years) a partial exchange transfusion was performed. In five patients corticoid treatment was associated with febrile relapses. CONCLUSIONS: Acute thoracic syndrome is frequent in sickle cell disease and is more severe in children older than 3 years. Its diagnosis requires a high index of suspicion, due to multiple forms of clinical presentations and normal chest radiology at admission.

Evaluación de veintitrés episodios de síndrome torácico agudo en pacientes con drepanocitosis / Evaluation of twenty-three episodes of acute thoracic syndrome in patients with sickle cell anemia

Introducción: El síndrome torácico agudo (neumonía y/o infarto pulmonar) es una causa importante de morbimortalidad en la drepanocitosis. Objetivo: Revisar la sintomatología y el manejo de estos episodios en nuestro medio y estudiar las posibles diferencias por grupos de edad. Métodos: Revisión restrospectiva de todos los episodios de síndrome torácico agudo diagnosticados en nuestro hospital en pacientes menores de 18 años con drepanocitosis, y analizar los hallazgos clínicos, analíticos, radiológicos, evolutivos y de tratamiento. Se compararon los datos entre los menores y mayores de 3 años (test exacto de Fisher y U de Mann-Whitney). Resultados: Se evaluaron 23 episodios en 8 de 12 pacientes controlados por drepanocitosis. Los episodios representaron el 36% del tiempo total de ingreso en estos pacientes. La etiología predominante fue la infección. Los síntomas más frecuentes fueron fiebre (87 %), tos (61 %) y síntomas catarrales (35 %). El 74% de los pacientes no fueron diagnosticados al ingreso, bien porque la radiografía de tórax era normal (52 %) o no se realizó (22 %) al no presentar sintomatología pulmonar. Los mayores de 3 años tuvieron episodios más graves, con mayor compromiso radiológico y clínico y mayor empleo de analgesia. Se administraron transfusiones en el 65 % de los episodios y en cinco (> 3 años) se realizó exanguino-transfusión parcial. El tratamiento con corticoides en 5 pacientes se asoció a recaídas febriles. Conclusiones: El síndrome torácico agudo es frecuente en la drepanocitosis y es más grave en mayores de 3 años. El diagnóstico exige un alto índice de sospecha, debido a las múltiples formas de presentación y a la frecuente normalidad del estudio radiológico inicial

Introduction: Acute thoracic syndrome (pneumonia and/or lung infarction) is a significant cause of morbidity and mortality in sickle cell anemia. Objective: To review the clinical manifestations, management and outcome of episodes of acute thoracic syndrome in our hospital. Methods: We performed a retrospective review of all the episodes of acute thoracic syndrome diagnosed at our center in patients younger than 18 years of age with sickle cell anemia. Clinical, laboratory and radiological findings, outcome and treatment were analyzed. Data from patients 3 years of age were compared (Fisher’s exact test and the Mann-Whitney U test). Results Twenty-three episodes of acute thoracic syndrome were evaluated in eight out of 12 patients with sickle cell anemia followed-up in our hospital. These episodes represented 36 % of the total time of admission in these patients. The most frequent cause was infection. The most frequent symptoms were fever (87%), cough (61%) and cold (35%) symptoms. Seventy-four percent of the patients were not diagnosed at admission, either because the chest X-ray was normal (52%) or because it was not performed (22%) due to the absence of pulmonary manifestations. Patients aged more than 3 years old had more severe episodes, with greater clinical compromise and radiological involvement and increased use of analgesia. Transfusions were administered in 65% of the episodes and in five patients (> 3 years) a partial exchange transfusion was performed. In five patients corticoid treatment was associated with febrile relapses. Conclusions: Acute thoracic syndrome is frequent in sickle cell disease and is more severe in children older than 3 years. Its diagnosis requires a high index of suspicion, due to multiple forms of clinical presentations and normal chest radiology at admission -in 1987 did not increase cases of TM in our hospital; on the contrary, these have decreased. A considerable percentage of children with advanced stages of TM show severe sequels

[Recurrent meningitis as a manifestation of spinal dysraphism in a young adult]. / Meningitis recurrente como manifestación de un disrafismo espinal en un adulto joven.

INTRODUCTION: Dysraphias are a varied set of anomalies affecting neuroectodermic tissue caused by the alteration of the neural tube during embryogenesis. Neuroradiological classification is broad and clinical manifestations are numerous: they affect the skin, osteomuscular tissue and the vascular, urological and nervous systems. We describe the case of a young adult with infrequent spinal dysraphism, which appeared as recurrent meningitis, and we stress the importance of studies using neuroimaging to define dysraphias. CASE REPORT: Male aged 23 with a history of urinary sphincter dysfunction, spina bifida and meningitis in infancy. He was admitted for treatment for recurrent meningitis and neuroradiological exploration revealed a hidden spinal dysraphism associated with spina bifida, sacrococcygeal dermal sinus with a fistular duct and communication with the dural sac, epidural lipoma and anchored spinal cord. The patient was submitted to decompression laminectomy, the abovementioned sinus was cut and the lipoma was removed. CONCLUSIONS: When faced with a case of recurrent meningitis, one of the etiopathogenic mechanisms to be taken into account is the presence of different malformations that can act as a point of entry to the nervous system not only in the cranial area but also, as in our case, in the spinal region. Late diagnosis of the cases is infrequent, but the presence of spina bifida with skin and urological manifestations point to possible malformations of the neural tube. Early surgical treatment must be performed in order to prevent neurological complications, which are potentially serious and give rise to high morbidity and mortality rates.