Conductas de riesgo: entrevista al adolescente en el Servicio de Urgencias / Risk behaviours: interview of the adolescent in the Emergency Service

Objetivos. Determinar los hábitos tóxicos y sexuales de los adolescentes que acuden a Urgencias. Métodos. Estudio prospectivo realizado del 1/1/2010 al 31/12/2011, basado en encuestas a adolescentes y que incluye preguntas dirigidas a conocer su hábitos tóxicos y sexuales. Resultados. Se realizan 279 encuestas (2,8% de adolescentes atendidos). El 51,3% son mujeres. La edad media es 14,5 años (DE: 1,5). El 22,2% son inmigrantes. La distribución de los adolescentes según edad, sexo y origen no presenta diferencias significativas entre grupos. El 51,6% (IC95%: 45,8-57,4%) de los adolescentes refiere contacto con alguna sustancia psicoactiva; el 47% alcohol, 24% tabaco, y 12,5% cannabis. La proporción de consumidores de las 3 sustancias aumenta progresivamente con la edad (de 4,9%, 4,9% y 0% a los 12 años a 95,8%, 58,3% y 45,8%, respectivamente, a los 17 años: p<0,001). No se hallan diferencias significativas ene l consumo de las tres sustancias según el origen del paciente. El 20,4% (IC95%: 15,8-25,1%9 manifiesta tener relaciones sexuales, el 17,6% de ellos sin método anticonceptivo. Conclusiones. Los hábitos tóxico y sexuales hallados en los adolescentes atendidos en Urgencias son superponibles a los referidos en encuestas realizadas a este grupo de edad en otros ámbitos, pudiendo ser Urgencias un buen sitio para la promoción de hábitos saludables (AU)

Objectives. To describe the toxic and sexual behavior of adolescents who are seen in the Emergency Department (ED). Methods. Prospective study from 1/1/2009 to 31/12/2011, based on surveys of adolescents. The study includes questions to know their toxic habits and sexual behavior. Results. We perform 279 surveys (2.8% of adolescents seen), 51,3% are women. The mean age is 14.5 years (SD 1.5). 22,2% are immigrants. The distribution of adolescents according to age, gender and origin do not present significant differences between groups. The 51,6% (CI95%: 45.8-57.4%) of adolescents refer contact which any psychoactive substance, 47% alcohol, 24% tobacco and 12,5% cannabis. The proportion of consumers of the 3 substances increases progressively with age (since 4.9%, 4.9% and 0% at 12 years, to 95,8% , 58,3% and 45,8% at 17 years, p<0.001). No significant differences were found in the consumption of the three substances according to the origin of the patient. The 20.4% (CI95%: 15.8-25.1%) manifested having sexual intercourse, 17.6% without contraceptive method. Conclusions. The toxic habits and sexual behavior found in adolescents seen at the ED are similar to those reported in surveys of this age group in other fields. ED may be a good place to promote healthy habits (AU)

Tratamiento endovascular del secuestro pulmonar con dispositivos tipo Amplatzer® / Endovascular treatment of pulmonary sequestration with Amplatzer® vascular plugs

El secuestro pulmonar es una malformación poco frecuente, que se caracteriza por tejido pulmonar sin conexión con la vía aérea y con vascularización sistémica. El tratamiento tradicional ha sido la cirugía, pero en los últimos años la embolización endovascular es una técnica cada vez más utilizada. Los materiales de embolización usados en la actualidad son los coils y los tapones vasculares tipo Amplatzer®. El tapón vascular Amplatzer® es un dispositivo de malla cilíndrico, autoexpandible, particularmente útil para la embolización de vasos grandes y de alto flujo. Presentamos a continuación 3 casos de secuestro pulmonar tratados mediante embolización con dispositivos de oclusión vascular tipo Amplatzer®. En los 3 casos se realizó el procedimiento sin incidencias, y se comprobó la oclusión total de la colateral aórtico-pulmonar. Nuestra serie aporta nuevos datos sobre la seguridad y eficacia de la embolización de los secuestros pulmonares con tapones vasculares tipo Amplatzer®, y de su preferencia sobre los coils en la embolización de vasos nutricios grandes(AU)

Pulmonary sequestration is a rare malformation characterised by non-functioning lung tissue, separated from the tracheobronchial tree and with arterial supply from the systemic circulation. The classical therapeutic approach is surgical resection. In recent years, the endovascular embolisation technique is increasingly being used for the treatment of this disease. The embolisation materials used are coils and vascular plugs. The Amplatzer® vascular plug is a self-expandable cylindrical mesh device, particularly useful for the embolisation of large vessels with high flow. Three cases of pulmonary sequestration were treated by embolisation with Amplatzer® vascular plugs. In all cases the procedure was performed without complications, and the aortopulmonary collateral vessels were completely occluded.Our study provides new data on the safety and efficacy of pulmonary embolisation with Amplatzer® vascular plugs, and its preference over coils in the embolisation of large vessels(AU)

Infección estafilocócica diseminada con manifestaciones clínicas Kawasaki-like / Disseminated staphylococcal infection resembling Kawasaki disease

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[Endovascular treatment of pulmonary sequestration with Amplatzer® vascular plugs]. / Tratamiento endovascular del secuestro pulmonar con dispositivos tipo Amplatzer®

Pulmonary sequestration is a rare malformation characterised by non-functioning lung tissue, separated from the tracheobronchial tree and with arterial supply from the systemic circulation. The classical therapeutic approach is surgical resection. In recent years, the endovascular embolisation technique is increasingly being used for the treatment of this disease. The embolisation materials used are coils and vascular plugs. The Amplatzer® vascular plug is a self-expandable cylindrical mesh device, particularly useful for the embolisation of large vessels with high flow. Three cases of pulmonary sequestration were treated by embolisation with Amplatzer® vascular plugs. In all cases the procedure was performed without complications, and the aortopulmonary collateral vessels were completely occluded. Our study provides new data on the safety and efficacy of pulmonary embolisation with Amplatzer® vascular plugs, and its preference over coils in the embolisation of large vessels.

Ingesta de cáusticos: situación actual y puesta al día de las recomendaciones / Caustic ingestion: local situation and review of updated recommendations

Introducción: La ingesta de productos domésticos es la segunda causa de consulta por sospecha de intoxicación en la edad pediátrica, y entre éstos destacan los productos cáusticos por su potencial toxicidad y riesgo de secuelas. Objetivo: Describir las características epidemiológicas y clínicas de los pacientes que ingresan desde urgencias por sospecha de ingesta de cáusticos. Analizar los factores de riesgo de lesiones esófago gástricas. Revisar las recomendaciones actuales de manejo .Material y métodos: Estudio retrospectivo de los pacientes ingresados desde urgencias por sospecha de ingesta de cáusticos entre enero de 2005 y abril de 2010. Resultados: Se obtuvo una muestra de 78 pacientes, 45 de ellos varones (57,7%), mediana de edad de 2,2 años (rango: 1-17,3 años). En 13 casos el producto se encontraba fuera de su envase original y en 36 niños la familia había inducido el vómito o administrado algún líquido como diluyente. Presentaron síntomas 52 niños y la exploración física fue anormal en 46 pacientes. Se realizaron 39 endoscopias digestivas, objetivando lesiones en 7 pacientes. Al comparar los pacientes con endoscopia normal y alterada, se identifican como factores de riesgo de lesiones digestivas la realización de algún vómito (p=0,01) y la presencia de al menos 2 síntomas (p=0,03). Ningún paciente sin endoscopia presentó complicaciones posteriores. Conclusiones: Es necesario mejorar la educación sanitaria informando a las familias sobre medidas preventivas y de manejo inmediato, evitando maniobras que pueden agravar la situación. Algunos pacientes podrían beneficiarse de una observación clínica sin medidas de tratamiento más agresivas (AU)

Background: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae. Objectives: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations. Materials and methods: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded. Results: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy. Conclusions: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures (AU)

[Caustic ingestion: current situation and review of updated recommendations]. / Ingesta de cáusticos: situación actual y puesta al día de las recomendaciones.

BACKGROUND: Household product ingestion is the second cause of visiting an Emergency Department for poisoning in children. Among these products, caustics are of great interest because of their potential toxicity and risk of sequelae. OBJECTIVES: To describe the epidemiological and clinical features of patients admitted to our hospital due to possible caustic ingestion. To analyse the risk factors associated with oesophageal or gastric injury. To review the latest treatment recommendations. MATERIALS AND METHODS: Retrospective review of all patients admitted with suspicion of caustic ingestion between January 2005 and April 2010. Epidemiological, clinical and therapeutic aspects were recorded. RESULTS: A total of 78 patients were admitted, 45 (57.7%) were male, with a median age of 2.2 years (range: 1-17.3 years). In 13 cases the product was kept in a container different than the original. In 36 children, the family had induced vomiting or had given a liquid to dilute the product. Fifty two patients were symptomatic, and 46 of them had some sign on physical examination. Thirty nine oesophagoscopies were performed, and 7 oesophageal or gastric lesions were observed. When patients with normal and abnormal endoscopic findings were compared, the factors associated with an increased risk of mucosal injury were vomiting (P=0.01), and two or more symptoms at admission (P=0.03). No complication was described in patients without endoscopy. CONCLUSIONS: Family education about preventive and initial measures after caustic ingestion must be improved in an attempt to prevent wrong actions which can be harmful. Some patients might benefit from clinical observation without aggressive therapeutic measures.