[Burns produced by lighters]. / Quemaduras por manipulación de encendedores.

OBJECTIVE: To describe the characteristics of patients requiring hospitalization for burns produced by lighter flame and to review current knowledge about their prevention. PATIENTS AND METHODS: We performed a retrospective, descriptive study through a review of the medical records of children (0-14 years) admitted to our hospital for more than 24 hours with burns and/or smoke inhalation from 2000-2004. Of these, accidents related to the handling of lighters were selected. The variables studied were: age, sex, mechanism, extent of body surface area (BSA) burned, degree of burn, length of hospital stay, the need for skin grafts, mortality, and sequelae. RESULTS: Twenty-two patients were evaluated. Seventy-six percent were boys. Age ranged from 1.5 years to 14 years. Ten patients (45 %) were aged less than 6 years old and 12 were aged 6 years old or older (55 %). The percentage of BSA burned varied: 65 % presented burns of less than 10 % BSA. Twenty-seven percent (6 patients) suffered major burns (> 20 %BSA). The mean length of hospital stay was 25 days (range:4-58 days). Seventy-seven percent of patients required surgery, mainly wound debridement and skin autografting and 33 % showed sequelae. The most severe was hypoxic-ischemic encephalopathy due to smoke and CO inhalation in 1 patient, who developed severe psychomotor sequelae and died 3 months later from infectious complications related to severe encephalopathy. Overall, 2 patients (9 %) died. CONCLUSIONS: Because of the frequency and severity of burns associated with lighter handling by children, pediatricians should increase their efforts to educate families. Effective legislation should be passed in Spain aimed at incorporating childproof safety devices in lighters.

Quemaduras por manipulación de encendedores / Burns produced by lighters

Objetivo: Describir las características de los pacientes que han precisado hospitalización por quemaduras producidas por llama en relación con la manipulación de encendedores, y revisar el estado actual de su prevención. Pacientes y métodos: Estudio retrospectivo de historias clínicas de los pacientes afectados de quemaduras por llama y/o inhalación de humo (de 0 a 14 años) ingresados durante más de 24 h en nuestro Hospital entre el año 2000 y 2004. De ellos, seleccionamos los accidentes producidos en relación con la manipulación de encendedores. Se estudiaron las siguientes variables: edad, sexo, mecanismo, superficie corporal quemada (SCQ), grado de profundidad, duración del ingreso, pacientes que requirieron injerto cutáneo, mortalidad y secuelas. Resultados: Se ha evaluado 22 pacientes, por parte de los niños. El 76 % eran varones. El rango de edad fue desde 1,5 años hasta los 14 años. Diez fueron menores de 6 años (45 %) y 12 tenían 6 o más años (55 %). El porcentaje de SCQ fue variable, siendo el grupo más numeroso, con el 64 %, el que presentaba quemaduras en menos del 10 % de SCQ y encontrado un porcentaje del 27 % (6 pacientes) con superficie de gran quemado (> 20 % SCQ). La estancia media fue de 25 días (límites: 4-58 días). El 77 % precisaron cirugía, principalmente desbridamiento y autoinjerto cutáneo. El 33 % presentaron secuelas, siendo la más grave la de un paciente con encefalopatía hipóxico-isquémica, por inhalación de humos y CO que desarrolló secuelas psicomotoras graves y falleció, posteriormente, al cabo de 3 meses por complicaciones infecciosas relacionadas con su encefalopatía de grado profundo. En total fallecieron 2 pacientes (9 %). Conclusiones: La producción de quemaduras por la manipulación de encendedores en los niños origina una morbilidad importante que justifica establecer una mejor prevención de estos accidentes, mediante la educación de la población. Deberían existir medidas de tipo legislativo en España, al objeto de incorporar dispositivos de seguridad en los encendedores, para niños menores de 5 años

Objective: To describe the characteristics of patients requiring hospitalization for burns produced by lighter flame and to review current knowledge about their prevention. Patients and methods: We performed a retrospective, descriptive study through a review of the medical records of children (0-14 years) admitted to our hospital for more than 24 hours with burns and/or smoke inhalation from 2000-2004. Of these, accidents related to the handling of lighters were selected. The variables studied were: age, sex, mechanism, extent of body surface area (BSA) burned, degree of burn, length of hospital stay, the need for skin grafts, mortality, and sequelae. Results: Twenty-two patients were evaluated. Seventy-six percent were boys. Age ranged from 1.5 years to 14 years. Ten patients (45 %) were aged less than 6 years old and 12 were aged 6 years old or older (55 %). The percentage of BSA burned varied: 65 % presented burns of less than 10 % BSA. Twenty-seven percent (6 patients) suffered major burns (> 20 %BSA). The mean length of hospital stay was 25 days (range:4-58 days). Seventy-seven percent of patients required surgery, mainly wound debridement and skin autografting and 33 % showed sequelae. The most severe was hypoxic-ischemic encephalopathy due to smoke and CO inhalation in 1 patient, who developed severe psychomotor sequelae and died 3 months later from infectious complications related to severe encephalopathy. Overall, 2 patients (9 %) died. Conclusions: Because of the frequency and severity of burns associated with lighter handling by children, pediatricians should increase their efforts to educate families. Effective legislation should be passed in Spain aimed at incorporating childproof safety devices in lighters

[Thyroid cancer in childhood: review of 7 cases]. / Carcinoma de tiroides en la infancia: revisión de 7 casos.

Thyroid carcinoma in childhood is a rare, but nevertheless malignant disease, with a high incidence of nodal metastasis. Seven children, 6 boys and 1 girl, aged 4 to 9 years with thyroid carcinoma were treated at the Hospital Infantil Valle de Hebrón of Barcelona between 1965 and 1990. The diagnosis was established by cervical nodal biopsy in all cases except one. Papillary carcinoma was found in 4 cases, follicular type in 2 cases and one case of mixed carcinoma was diagnosed. Surgical treatment consisted in lobectomy on the affected side, followed by total thyroidectomy on the opposite side and bilateral resection of involved nodes one or more times. In two patients, treatment with sodium-iodine I131 showed active tissue in the thorax and wound. Both were treated effectively. All patients are alive without recurrences during a follow-up period of 1 to 23 years. Main complications were: temporary recurrence of the nerve injury in two patients and a controlled hypoparathyroidism in another two cases. In all cases, treatment with L-thyroxine was required. Thyroid carcinoma in children carries a considerably better prognosis than in adult patients. We must suspect thyroid carcinoma and indicate biopsy in all cases of cervical nodes resistant to antibiotic treatment. Early diagnosis, total thyroidectomy, radioiodine treatment and hormone administration permit radical cure even in the case of metastatic disease.

[Piriform sinus fistula, a new disease]. / Fístula del seno piriforme, una nueva patología.

Pyriform sinus fistula has recently been described as a new, rare and little known pathology. The process develops as latero-cervical suppurative adenitis or acute suppurative thyroiditis, usually on the left side. Radical surgery is mandatory to avoid recurrence. This congenital malformation must be present in the differential diagnosis of recurrent infectious cervical processes, especially in acute thyroiditis. The only curative treatment is complete exeresis of the fistula after meticulous dissection of the fistulous tract. We present three cases of this pathology. The diagnostic approach and surgical treatment are discussed. The recent literature on this topic is reviewed.