Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

Tumor carcinoide apendicular. A propósito de un caso / Appendiceal carcinoid tumor. A case report

Los tumores carcinoides derivan de las células neuroendocrinas de cualquier parte del organismo (más frecuentemente del tubo digestivo, el páncreas y los bronquios). Son los tumores endocrinos gastrointestinales más frecuentes, ya que representan un 75% de estas neoplasias, y el tumor maligno gastrointestinal más frecuente en los niños. Su diagnóstico suele realizarse de manera casual en el 0,3-0,9% de las apendicectomías, y son menos frecuentes en la edad pediátrica. Presentamos el caso de un tumor carcinoide en un niño de 12 años de edad y realizamos una revisión de esta patología (AU)

Carcinoid tumors derive from neuroendocrine cells at different anatomic locations (although they are most commonly found at the gastrointestinal tract, pancreas and bronchial airway) and are the most common gastrointestinal endocrine tumors, of which they represent 75%; being also the most common gastrointestinal malignant tumour in children. Diagnosis is often incidental (in around 0.3 to 0.9% of appendectomies, and less common in children). We report the case of a carcinoid tumor in a pediatric patient aged 12 years, providing aswell a review of this pathology (AU)

Evolución de la prescripción de antibióticos en un servicio de urgencias pediátricas / Evolution of the antibiotics prescription in a pediatric emergency service

Objetivo: Describir la calidad de prescripción antibiótica en un servicio de urgencias pediátrico, antes y después de la realización de dos sesiones formativas sobre el «uso racional de antibióticos». Material y métodos: Estudio descriptivo y retrospectivo de los pacientes dados de alta en urgencias durante el mes de enero de 2008, respecto a diciembre de 2008-enero de 2009. Se recogieron los datos sociodemográficos y relacionados con el diagnóstico y el tratamiento de los pacientes que recibían tratamiento antimicrobiano. Se valoró la posología y la indicación según las vías clínicas validadas de nuestro hospital. Entre ambos periodos, se impartieron dos sesiones formativas sobre el uso racional de antibióticos. Resultados: En enero de 2008 se revisaron 5.989 informes de alta, y se pautaron antibióticos al 13% de los niños. En el segundo periodo se revisaron 6.359 informes, y recibieron antibióticos un 12,7%. Los diagnósticos más frecuentes fueron la faringoamigdalitis aguda (49,6%) en el primer periodo y la otitis media (39%) en el segundo. La indicación fue correcta en el 90,7%en el primer periodo, frente al 84,7% en el segundo (p <0,01), la dosificación fue adecuada en el 79,4 frente al 86% (p <0,01), y la duración fue correcta en el 88,6% en ambos periodos. Se prescribieron más antibióticos durante el turno de noche y en días festivos. Conclusiones: El porcentaje de antibióticos prescritos es similar al de otras series. Tras las sesiones formativas sobre el manejo correcto de la antibioterapia, no ha disminuido su prescripción. Aunque se dosifica mejor, ha aumentado el porcentaje de indicación incorrecta. Serían necesarias más medidas para mejorar la calidad de prescripción antimicrobiana (AU)

Objective: To describe the quality of antibiotic prescription in the pediatric emergency service before and after two educational talks regarding “the rational use of antibiotics”. Material and methods: Descriptive, retrospective study of all the discharged patients evaluated in the emergency service during the month of January 2008 compared to December 2008 and January 2009. Demographic, social, diagnostic and treatment parameters of children who received antimicrobials treatment were analyzed. Dosage and indication were evaluated according to the validated clinical guidelines of the hospital, between both periods’ formative sessions about the rational use of antibiotics. Results: In January 2008 we reviewed 5,989 medical discharge records and found that 13% of the children had received antibiotics. We also reviewed 6,359 records from the second period and found that 12.7% of the children had received antibiotic therapy. The most frequent diagnoses were acute pharyngotonsillitis (49.6%) in the first period and acute otitis media (39%) in the second period. The indication and dosage were correct in 90.7% and 79.4% of the cases in the first period compared to 84.7% and 86% in the second period (p <0.01) respectively. The duration of therapy was correct in 88.6% of cases in both periods. Antibiotics were more frequently prescribed at the night shift and on holidays. Conclusions: The percentage of antibiotic prescription in this study is similar to that of other series and did not decrease after educational talks regarding the rational use of antibiotics. Although there was an increase in the correct dosage prescribed the percentage of incorrect antibiotic indications increased as well. Further actions should be taken to improve the quality of antibiotic prescriptions (AU)

Ictus arteriales isquémicos en niños con cardiopatías / Arterial ischaemic stroke in children with cardiac diseases

Introducción. Los ictus en la infancia han aumentado significativamente en los últimos años. Las cardiopatías constituyen uno de los factores de riesgo mejor conocidos en niños. Objetivo. Describir las características de los ictus arteriales isquémicos en niños cardiópatas, destacando los factores de riesgo específicos, la clínica inicial, la demora diagnóstica y el manejo posterior. Pacientes y métodos. Estudio retrospectivo de los pacientes con cardiopatía diagnosticados de ictus arterial isquémico en los últimos 10 años en nuestro hospital. Se analizaron: tipo de cardiopatía, posibles factores asociados, como cirugíaso cateterismos recientes, estudio de trombofilias, clínica inicial, demora y método diagnóstico, profilaxis primaria y secundaria, tratamiento administrado y evolución neurológica. Resultados. Veinte pacientes cumplieron los criterios de inclusión (edades: período neonatal a 15 años) de los cuales 18 presentaban cardiopatías congénitas. Once pacientes tenían antecedente de cirugía y/o cateterismo en el mes previo. La forma de inicio más frecuente fueron crisis convulsivas focales. El diagnóstico se retrasó más de 24 horas en el 60% de los casos. El 50% de los pacientes no recibía profilaxis primaria. Se indicó tratamiento en el 70% de los casos, aunque en ningún paciente trombólisis. Conclusiones. Es prioritario pensar en una enfermedad cerebrovascular ante cualquier síntoma neurológico agudo en un niño con cardiopatía. Se deberían establecer medidas para disminuir la demora en el diagnóstico en este tipo de pacientes, así como realizar estudios prospectivos aleatorizados para crear un protocolo de actuación uniforme en los ictus pediátricos (AU)

Introduction. The incidence of cerebral stroke in children has significantly increased in last years. Heart diseases are one of the best known risk factors in pediatric stroke. Aim. To describe the characteristics of the cerebral stroke in children with heart diseases, emphasizing in predisposing conditions, time to diagnosis, management and follow-up of patients. Patients and methods. We performed a retrospective study in children suffering from heart diseases with cerebral stroke admitted to our hospital that comprised 10 years. Type of cardiopathy, associated factors like surgery or catheterization, study of thrombophilia, clinical findings, methods and time to diagnosis, primary and secondary prophylaxis, treatment and longterm neurologic outcome were analyzed. Results. Twenty patients were included in our study (age: from neonatal period to 15 years), eighteen of them were children with congenital cardiac disease. Eleven patients had antecedent of surgery and/or catheterism in the previous month. The most common clinical presentation was focal seizures. Time from clinical onset to diagnosis of stroke was longer than 24 hours in 60% of our patients. Fifty per cent of our patients did not receive any primary prophylaxis. Treatment was initiated in 70% of patients, but no one received thrombolysis. Conclusions. It is crucial to consider stroke when children with heart diseases show any neurologic symptom. Optimal diagnostic strategies must be established to low the delay of diagnosis in these patients, as well as randomised clinical trials in order to establish uniform guidelines in pediatric stroke (AU)

[Arterial ischaemic stroke in children with cardiac diseases]. / Ictus arteriales isquémicos en niños con cardiopatías.

INTRODUCTION: The incidence of cerebral stroke in children has significantly increased in last years. Heart diseases are one of the best known risk factors in pediatric stroke. AIM. To describe the characteristics of the cerebral stroke in children with heart diseases, emphasizing in predisposing conditions, time to diagnosis, management and follow-up of patients. PATIENTS AND METHODS: We performed a retrospective study in children suffering from heart diseases with cerebral stroke admitted to our hospital that comprised 10 years. Type of cardiopathy, associated factors like surgery or catheterization, study of thrombophilia, clinical findings, methods and time to diagnosis, primary and secondary prophylaxis, treatment and long-term neurologic outcome were analyzed. RESULTS: Twenty patients were included in our study (age: from neonatal period to 15 years), eighteen of them were children with congenital cardiac disease. Eleven patients had antecedent of surgery and/or catheterism in the previous month. The most common clinical presentation was focal seizures. Time from clinical onset to diagnosis of stroke was longer than 24 hours in 60% of our patients. Fifty per cent of our patients did not receive any primary prophylaxis. Treatment was initiated in 70% of patients, but no one received thrombolysis. CONCLUSIONS: It is crucial to consider stroke when children with heart diseases show any neurologic symptom. Optimal diagnostic strategies must be established to low the delay of diagnosis in these patients, as well as randomised clinical trials in order to establish uniform guidelines in pediatric stroke.