ABSTRACT
INTRODUCTION: Intrapleural fibrinolytic instillation has been used in the treatment of loculated pleural effusions and empyemas and has reduced the need for surgical intervention. Currently, the most commonly used fibrinolytic is urokinase, although the doses have not yet been standardized in children. The aim of the present study was to evaluate the utility of urokinase in the treatment of infectious pleural effusions in children. MATERIAL AND METHODS: A retrospective study was performed of children with infectious pleural effusions admitted to the pediatric intensive care unit (PICU) between January 2000 and December 2003. Age, sex, clinical features, laboratory tests, response to urokinase treatment and clinical course during hospital stay were analyzed. RESULTS: Thirty-one children were treated. The mean age was 38.1 months (SD: 22). There were 18 boys and 13 girls. The most frequent month of diagnosis was November and the number of admission significantly increased from 2002 onwards. The most frequent antibiotic therapy used before admission to the PICU was cefotaxime associated with vancomycin (41 %), followed by cefotaxime alone (16 %). Positive cultures for Streptococcus pneumoniae were found in 11 patients (35 %). Pleural loculation was found in 14 patients (45 %). Treatment with intrapleural urokinase was used in 23 patients (74 %). The mean chest tube drainage was 140 ml (SD: 175) in the 24 hours before urokinase instillation and was 406 ml (SD: 289) in the 48 hours after fibrinolytic therapy (p < 0.05). Twenty-one patients (91 %) who received urokinase treatment had a good response. There were no complications during the treatment. The mean length of stay in the PICU was 5.8 days (SD: 2.6). CONCLUSIONS: The incidence of complicated pleural effusions due to S. pneumoniae has increased in the last few years, despite antibiotic therapy. Intrapleural urokinase is an effective treatment, including in empyemas without loculation. None of our patients required thoracotomy and there were few adverse effects.
Subject(s)
Empyema, Pleural/therapy , Plasminogen Activators/therapeutic use , Pleura/metabolism , Pleural Effusion/therapy , Urokinase-Type Plasminogen Activator/therapeutic use , Child, Preschool , Combined Modality Therapy , Empyema, Pleural/epidemiology , Empyema, Pleural/microbiology , Exudates and Transudates/microbiology , Female , Humans , Incidence , Male , Plasminogen Activators/administration & dosage , Pleural Effusion/epidemiology , Pleural Effusion/microbiology , Retrospective Studies , Seasons , Streptococcus pneumoniae/isolation & purification , Suction/methods , Urokinase-Type Plasminogen Activator/administration & dosageABSTRACT
Introducción: La instilación intrapleural de agentes fibrinolíticos se ha utilizado como tratamiento de derrames pleurales tabicados y de empiemas, disminuyendo la necesidad de intervención quirúrgica. La urocinasa es el fibrinolítico más utilizado aunque en pediatría las dosis no están claramente estandarizadas. El objetivo del estudio fue evaluar la utilidad de la urocinasa intrapleural como tratamiento de los derrames pleurales complicados. Material y métodos: Se realizó un estudio retrospectivo de los derrames pleurales ingresados en la unidad de cuidados intensivos pediátricos (UCIP) entre enero de 2000 y diciembre de 2003. Se recogieron las variables de edad, sexo, sintomatología, pruebas complementarias, respuesta al tratamiento con urocinasa y evolución durante su ingreso. Resultados: Se estudiaron 31 casos, la edad media fue de 38,1 meses (desviación estándar [DE]: 22); 18 varones y 13 mujeres. El mes de mayor incidencia fue noviembre, y existió un aumento significativo del número de ingresos a partir del año 2002. El tratamiento antibiótico más frecuente antes del ingreso en UCIP fue la asociación de cefotaxima y vancomicina (41 %), seguido de cefotaxima (16 %). Se obtuvieron cultivos positivos a S. pneumoniae en 11 casos (35 %). Se demostró derrame tabicado en 14 casos (45 %). El tratamiento con urocinasa intrapleural se realizó en 23 casos (74 %), observándose un aumento significativo del drenaje pleural tras su aplicación, con un drenaje medio 24 h previo a la urocinasa de 140 ml (DE: 175) frente a 406 ml (DE: 289) 48 h después (p < 0,05). Respondieron favorablemente al tratamiento 21 casos (91 %) y no existieron complicaciones importantes durante su administración. La duración media del drenaje torácico fue de 5,2 días (DE: 2,97). La estancia media en la UCIP fue de 5,8 días (DE: 2,6). Conclusiones: Existe una mayor incidencia en los últimos años de derrames pleurales complicados secundarios a S. pneumoniae a pesar del tratamiento antibiótico. La urocinasa intrapleural es un tratamiento efectivo incluso en empiemas no tabicados, no precisando en ningún caso la intervención quirúrgica y con escasos efectos secundarios
Introduction: Intrapleural fibrinolytic instillation has been used in the treatment of loculated pleural effusions and empyemas and has reduced the need for surgical intervention. Currently, the most commonly used fibrinolytic is urokinase, although the doses have not yet been standardized in children. The aim of the present study was to evaluate the utility of urokinase in the treatment of infectious pleural effusions in children. Material and methods: A retrospective study was performed of children with infectious pleural effusions admitted to the pediatric intensive care unit (PICU) between January 2000 and December 2003. Age, sex, clinical features, laboratory tests, response to urokinase treatment and clinical course during hospital stay were analyzed. Results: Thirty-one children were treated. The mean age was 38.1 months (SD: 22). There were 18 boys and 13 girls. The most frequent month of diagnosis was November and the number of admission significantly increased from 2002 onwards. The most frequent antibiotic therapy used before admission to the PICU was cefotaxime associated with vancomycin (41 %), followed by cefotaxime alone (16 %). Positive cultures for Streptococcus pneumoniae were found in 11 patients (35 %). Pleural loculation was found in 14 patients (45 %). Treatment with intrapleural urokinase was used in 23 patients (74 %). The mean chest tube drainage was 140 ml (SD: 175) in the 24 hours before urokinase instillation and was 406 ml (SD: 289) in the 48 hours after fibrinolytic therapy (p < 0.05). Twenty-one patients (91 %) who received urokinase treatment had a good response. There were no complications during the treatment. The mean length of stay in the PICU was 5.8 days (SD: 2.6). Conclusions: The incidence of complicated pleural effusions due to S. pneumoniae has increased in the last few years, despite antibiotic therapy. Intrapleural urokinase is an effective treatment, including in empyemas without loculation. None of our patients required thoracotomy and there were few adverse effects
Subject(s)
Child, Preschool , Humans , Empyema, Pleural/therapy , Plasminogen Activators/therapeutic use , Pleural Effusion/therapy , Empyema, Pleural/epidemiology , Empyema, Pleural/microbiology , Urokinase-Type Plasminogen Activator/therapeutic use , Pleural Effusion/epidemiology , Pleural Effusion/microbiology , Combined Modality Therapy , Exudates and Transudates/microbiology , Incidence , Plasminogen Activators/administration & dosage , Pleura/metabolism , Retrospective Studies , Seasons , Streptococcus pneumoniae/isolation & purification , Suction/methods , Urokinase-Type Plasminogen Activator/administration & dosageSubject(s)
Brain Diseases/complications , Shock, Hemorrhagic/complications , Brain Diseases/diagnostic imaging , Disseminated Intravascular Coagulation/complications , Disseminated Intravascular Coagulation/diagnosis , Female , Humans , Infant , Neuroradiography , Shock, Hemorrhagic/diagnostic imaging , Syndrome , Tomography, X-Ray ComputedSubject(s)
Bacterial Infections/epidemiology , Meningitis/epidemiology , Virus Diseases/epidemiology , Child , Child, Preschool , Female , Humans , Infant , Male , Meningitis/etiology , SpainABSTRACT
Eleven cases of non-immune hydrops fetalis (NIHF) are presented. Incidence was 1.8 out of 10,000 births. NIHF became more common than immune hydrops fetalis (1.4/10,000 births). Mortality was of 81% and complications were frequent. NIHF is associated with prematurity, neonatal anoxia, polyhydramnios, hypoalbuminemia and hypoproteinemia. Considerable emphasis must be placed on antenatal diagnosis to achieve a precocious treatment and so improve the present poor prognosis.
Subject(s)
Edema/etiology , Fetal Diseases/etiology , Edema/diagnosis , Edema/epidemiology , Female , Fetal Diseases/diagnosis , Fetal Diseases/epidemiology , Humans , Infant, Newborn , Pregnancy , Prenatal Diagnosis , PrognosisABSTRACT
First case reported in our country with infant botulism is described in a 5 month old infant. Clinical and electrodiagnostic abnormalities are the only relatively specific findings in infant botulism, which were seen in this infant, but it requires isolation of "C. botulinum" for diagnosis confirmation. "C. botulinum" type B spores were identified in stool samples from this infant. It has been described frequently isolation of "C. botulinum" from honey specimens that had been fed to infants who subsequently developed infant botulism. They are now studying honey samples with appropriate methods (MDL-10), obtained from alimentation of this infant.
Subject(s)
Botulism/diagnosis , Botulism/complications , Botulism/physiopathology , Clostridium botulinum/isolation & purification , Humans , Infant , Male , Muscle Hypotonia/etiologyABSTRACT
Authors present their adopted measures, in the different clinical stages of endotoxic shock with a phisiological approach, paying special attention to those secondary to meningococcal infections.
