[Supraventricular tachycardia in infants and children]. / Taquicardia paroxística supraventricular en el niño y el lactante.

INTRODUCTION: Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole. OBJECTIVES: 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used. METHOD: A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers. RESULTS: There were 61 patients and 39 were boys (63.9%). The mean age was 2.1 years (SD +/- 3.1). Twelve patients had congenital heart disease (19.7%); three (4.9%) were admitted after heart surgery, and the remaining patients had no antecedents (60.7%). The mean cardiac frequency was 238 beats/min (SD +/- 42.86). Heart failure (HF) was observed in 14 patients (23%). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9%). Medical treatment was required in 46 patients (75.4%) and response was achieved in 35 (57.4%). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4%) with good response in 21 (36.8%). As maintenance therapy digoxin was used in 29 patients (50.9%) without relapses in 22 (78.6%). Radiofrequency ablation was required in 17 patients (27.9%), and there were three relapses (17.6%). The ages of patients who underwent ablation ranged from 3.5 days to 13 years. CONCLUSIONS: 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year.

Taquicardia paroxística supraventricular en el niño y el lactante / Supraventricular tachycardia in infants and children

Introducción La taquicardia paroxística supraventricular (TPSV) es la arritmia más frecuente en pediatría por detrás de las extrasístoles. Objetivos 1. Determinar las características clínicas y el tratamiento. 2. Objetivar la respuesta al tratamiento y los fármacos utilizados. Método Estudio retrospectivo de 61 casos con ingreso en la unidad de cuidados intensivos pediátrica (UCIP) de 1999 a 2004. Criterio de ingreso: TPSV sin respuesta a maniobras vagales. Resultados Se seleccionaron 61 pacientes, 39 varones (63,9 %). Edad media: 2,1 años (DE ± 3,1). Doce tuvieron antecedentes de cardiopatía congénita (19,7 %); tres (4,9 %) ingresaron poscirugía cardíaca; y los restantes sin antecedentes (60,7 %). La frecuencia cardíaca media fue de 238 lat./min (DE ± 42,86). Catorce pacientes (23 %) presentaron insuficiencia cardíaca (IC). Existieron diferencias estadísticamente significativas entre la presencia de IC y las horas de evolución (p < 0,01) y con la menor edad (p < 0,01). El diagnóstico más frecuente fue TPSV por reentrada (28 casos 45,9 %). Precisaron tratamiento médico 46 pacientes (75,4 %), 35 respondieron (57,4 %). Para tratar la crisis aguda se utilizó trifosfato de adenosina (ATP) en 35 casos (76 %) con buena respuesta en 21 (60 %). Para el mantenimiento se indicó digital en 29 casos (50,9 %), sin recaídas 22 casos (78,6 %). Necesitaron ablación 17 pacientes (27,9 %); recayeron tres (17,6 %). El rango de edades en los que se realizó la ablación fue de 3,5 días hasta 13 años. Conclusiones 1. La insuficiencia cardíaca se presentó preferentemente en lactantes. 2. La mayoría de pacientes respondieron al tratamiento con ATP. 3. La ablación fue necesaria preferentemente en pacientes de edad superior a un año

Introduction Supraventricular tachycardia (SVT) is the second most frequent form of arrhythmia in pediatrics after extrasystole. Objectives 1. To determine the clinical characteristics and treatment of SVT in infants and children. 2. To determine treatment response and the drugs used. Method A retrospective review of 61 cases of SVT requiring PICU admission (1999-2004) was performed. PICU admission was due to persistent SVT after vagal maneuvers. Results There were 61 patients and 39 were boys (63.9 %). The mean age was 2.1 years (SD ± 3.1). Twelve patients had congenital heart disease (19.7 %); three (4.9 %) were admitted after heart surgery, and the remaining patients had no antecedents (60.7 %). The mean cardiac frequency was 238 beats/min (SD ± 42.86). Heart failure (HF) was observed in 14 patients (23 %). Statistically significant differences were found between the presence of HF and time since onset (p < 0.01) and younger age (p < 0.01). The most frequent diagnosis was SVT due to re-entry in 28 patients (45.9 %). Medical treatment was required in 46 patients (75.4 %) and response was achieved in 35 (57.4 %). At crisis the first drug used was adenosine triphosphate (ATP) in 35 patients (61.4 %) with good response in 21 (36.8 %). As maintenance therapy digoxin was used in 29 patients (50.9 %) without relapses in 22 (78.6 %). Radiofrequency ablation was required in 17 patients (27.9 %), and there were three relapses (17.6 %). The ages of patients who underwent ablation ranged from 3.5 days to 13 years. Conclusions 1. HF was observed mainly in infants. 2. Most of the patients had good response to ATP therapy. 3. Radiofrequency ablation was mainly required in patients aged more than 1 year

[Toxic shock syndrome: experience in a pediatric intensive care unit]. / Síndrome de shock tóxico: experiencia en una UCIP.

OBJECTIVES: To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. METHODS: We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. RESULTS: There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. CONCLUSION. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy.

Síndrome de shock tóxico: experiencia en una UCIP / Toxic shock syndrome: experience in a pediatric intensive care unit

Objetivos. Revisar los casos de síndrome de shock tóxico (SST) admitidos en una unidad de cuidados intensivos pediátricos. Métodos. Estudio retrospectivo de los casos de SST ingresados en los últimos 15 años. Se incluyeron aquellos casos que cumplían los criterios clínico-microbiológicos propuestos por el Center for Disease Control and Prevention (CDC). Resultados. Revisión de un total de 9 casos (4 varones). Edad media de 7 años. Hallazgos más frecuentes: fiebre (100 %), hipotensión (100 %), eritrodermia (100 %), fallo multiorgánico (coagulopatía 100 %, depresión del sensorio 89 %, hipertransaminemia 89 %, aumento de creatinfosfocinasa (CPK) 78 %, insuficiencia renal 66 %, etc.) y descamación cutánea (100 %). En la analítica sanguínea se detectaron alteraciones en la fórmula leucocitaria y la proteína C reactiva de forma constante. Etiología: en 6 casos se aislaron Staphylococcus (tres S. epidermidis, tres S. aureus); en 2 casos Streptococcus (uno S. pyogenes, uno S. pneumoniae), tan sólo en un caso no se detectó microorganismo. El origen de la infección se evidenció en 7 casos: seis de origen cutáneo y uno amigdalar. Todos los pacientes recibieron soporte vital y antibioterapia. Recibieron corticoterapia 6 casos y uno gammaglobulina. Los casos secundarios a Streptococcus presentaron mayor gravedad: insuficiencia renal, mayor soporte ventilatorio y vasoactivo. Todos los casos evolucionaron correctamente del cuadro infeccioso, sin existir secuelas de gravedad a largo plazo. Conclusión. Es necesario incluir el SST en el diagnóstico diferencial de aquellos casos que cursan con fiebre, exantema y shock, ya que un diagnóstico precoz ha demostrado mejorar el pronóstico. S. pneumoniae debe incluirse dentro de los microorganismos causantes de SST. El tratamiento se fundamenta en medidas de soporte y antibioterapia

Objectives. To review patients with toxic shock syndrome (TSS) in a pediatric intensive care unit. Methods. We performed a retrospective study of patients with TSS admitted to the intensive care unit in the previous 15 years. The patients included were those that met the clinical and microbiological criteria for TSS proposed by the Centers for Disease Control and Prevention. Results. There were nine patients (four boys). The mean age was 7 years. The most frequent findings were fever (100 %), hypotension (100 %), erythroderma (100 %), multisystem organ failure [coagulopathy (100 %), lethargy (89 %), hypertransaminasemia (89 %), increased creatine phosphokinase levels (78 %), renal failure (66 %)] and cutaneous desquamation (100 %). Laboratory studies showed changes in the leukocyte count and C-reactive protein value in all patients. The etiology was as follows: Staphylococcus was detected in six patients (S. epidermidis in three and S. aureus in three) and Streptococcus was detected in two patients (S. pyogenes in one and S. pneumoniae in one); no microorganisms were detected in only one patient. The origin of the infection was identified in seven patients (cutaneous in six patients and tonsillar in one). All patients received life support and antibiotic treatment. Six patients received corticosteroid treatment and one received intravenous immunoglobulins. Patients with TSS secondary to Streptococcus showed the greatest severity, exhibiting renal failure and requiring greater respiratory and circulatory support. All patients recovered well from the infection, without serious long-term sequelae. Conclusion. TSS should be included in the differential diagnosis of patients with fever, exanthema and shock, since early diagnosis has been shown to improve outcomes. S. pneumoniae should be included among the microorganisms that cause TSS. Treatment is based on life support measures and antibiotic therapy

Shock y sintomatología digestiva en un neonato: una forma grave de presentación de la alergia a proteínas de leche de vaca / Shock and digestive symptoms in a neonate: a severe presentation of allergy to cow’s milk proteins

No disponible

[Non-invasive ventilation in neonates with Ondine syndrome: a real indication?]. / Ventilación no invasiva en lactantes afectados de síndrome de Ondine: 'una indicación real?

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Noninvasive ventilation (NIV) has been reported to be effective in the management of these patients, thus avoiding the need for tracheotomy for prolonged mechanical ventilation. We describe our experience of NIV in infants with Ondine's syndrome. Two infants with Ondine's syndrome were transferred to our center for management and adjustment of therapy. On admission NIV (BiPAP VISION) was started with nasal interphase in S/T (spontaneous/timed) mode, which failed to provide suitable ventilation (PCO2 > 70 mmHg). Finally, tracheotomy for continuous mechanical ventilation was performed. Although NIV has been reported to be successful in some patients with Ondine's syndrome, its application in patients younger than 5 years does not seem to be the general norm of treatment.

Ventilación no invasiva en lactantes afectados de síndrome de Ondine: ¿una indicación real? / Noninvasive ventilation in infants with Ondine´s syndrome: a real indication?

El síndrome de Ondine se trata de un síndrome de hipoventilación central congénita secundaria a un trastorno en el control autonómico de la respiración en ausencia de enfermedad primaria que lo justifique. Se ha descrito la eficacia de la ventilación no invasiva (VNI) en lactantes afectados del síndrome de Ondine, evitando así la necesidad de una traqueostomía para ventilación mecánica. Se describe nuestra experiencia en VNI en lactantes con síndrome de Ondine. Se describen 2 lactantes afectados del síndrome de Ondine que son trasladados a nuestro centro para control y adecuación terapéutica. A su ingreso se inicia VNI mediante ventilador presurométrico (BiPAP vision®) con interfase nasal en modalidad S/T (espontánea/controlada) con imposibilidad de conseguir una adecuada ventilación (PCO2 > 90 mmHg). Finalmente se realiza traqueostomía reglada para ventilación mecánica continua. La aplicación de VNI en pacientes menores de 5 años con síndrome de Ondine, aunque se ha realizado con éxito en algunos casos, no parece ser la norma general de tratamiento

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Noninvasive ventilation (NIV) has been reported to be effective in the management of these patients, thus avoiding the need for tracheotomy for prolonged mechanical ventilation. We describe our experience of NIV in infants with Ondine's syndrome. Two infants with Ondine's syndrome were transferred to our center for management and adjustment of therapy. On admission NIV (BiPAP VISION®) was started with nasal interphase in S/T (spontaneous/timed) mode, which failed to provide suitable ventilation (PCO2 > 70 mmHg). Finally, tracheotomy for continuous mechanical ventilation was performed. Although NIV has been reported to be successful in some patients with Ondine's syndrome, its application in patients younger than 5 years does not seem to be the general norm of treatment

[Septo-optic dysplasia]. / Displasia septóptica.

INTRODUCTION: Septo optic syndrome, described by De Morsier in 1956, consists in the hypoplasia of one or both optic nerves, mid line brain malformations and hypothalamohypophysial dysfunction, which is inconstant. It is an infrequent, but treatable, cause of hepatic and neurological damage, and it is important to obtain an early diagnosis and to begin hormone replacement therapy. CASE REPORT: We report the clinical case of a female baby who was diagnosed early on as suffering from septo?optic dysplasia, after discovery of the existence of cholestatic jaundice. In our case the three components of the syndrome were present: hypothalamohypophysial dysfunction, bilateral hypoplasia of the optic nerves and brain malformations with dysplasia of the transparent septum. All this gives rise to complex clinical features and the predominance of hypernatraemic dehydration secondary to insipid diabetes, nystagmus and serious psychomotor retardation. Our patient died, as in other cases reported in the literature, from an episode of sudden death. DISCUSSION: Despite the importance of an early diagnosis of this disorder, it is usually late. Most children who present hypopituitarism traits in the neonatal period are not diagnosed at that time, with the subsequent risk of death or brain damage. Some clinical findings, which appear early on and can provide clues which aid us to reach a diagnosis, are the appearance of episodes of hypoglycaemia in the neonatal period, the existence of micropenis and cryptorchidism with hypoplasic testes, jaundice or the appearance of clinical manifestations of insipid diabetes. Later on nystagmus and neurological symptoms may appear. The final diagnosis is performed through the use of neuroimaging techniques (CT or MRI) and hormonal studies.

Displasia septóptica / Septo-optic dysplasia

Introducción. El síndrome septóptico, descrito por De Morsier en 1956, consiste en la hipoplasia de uno o ambos nervios ópticos, malformaciones cerebrales de línea media y disfunción hipotalamohipofisaria, la cual es inconstante. Es una causa poco frecuente, pero tratable, de daño hepático y neurológico, y es de gran importancia su diagnóstico precoz e instauración de tratamiento hormonal substitutivo. Caso clínico. Presentamos el caso clínico de una lactante que se diagnosticó precozmente de displasia septoóptica, a partir de la existencia de ictericia colestática. En nuestro caso se presentan los tres componentes del síndrome: disfunción hipotalamohipofisaria, hipoplasia bilateral de nervios ópticos y malformaciones cerebrales con displasia del septum pellucidum. Todo ello da lugar a una florida clínica, y predomina la deshidratación hipernatrémica secundaria a diabetes insípida, nistagmo y grave retraso psicomotor. Nuestra paciente falleció, como otros casos descritos en la bibliografía, por un episodio de muerte súbita. Discusión. Pese a la importancia del diagnóstico precoz de esta entidad, éste suele ser tardío. La mayoría de niños que presentan rasgos de hipopituitarismo en el período neonatal no se diagnostican en ese momento, con el consecuente riesgo de muerte o daño cerebral. Algunos hallazgos clínicos, que aparecen tempranamente y que pueden darnos la pista para llegar al diagnóstico, son la aparición de episodios de hipoglucemia en el período neonatal, la existencia de micropene y criptorquidia con testes hipoplásicos, ictericia o aparición de manifestaciones clínicas de diabetes insípida. Más adelante, pueden aparecer nistagmo y síntomas neurológicos. El diagnóstico definitivo se realiza mediante técnicas de neuroimagen (TAC o RM) y estudios hormonales (AU)

Síndrome adenitis-celulitis por estreptococo del grupo B en lactantes. Un indicador de bacteriemia / Group B streptococcus cellulitis-adenitis syndrome in neonates. Is it a marker of bacteremia?

Se presenta el caso de una lactante en la que inicialmente sólo se observó celulitis facial como única manifestación de infección sistémica por estreptococo del grupo B (EGB). El síndrome adenitis-celulitis es una expresión clínica poco frecuente de la infección por EGB en los primeros meses de vida. La presencia de un foco infeccioso local, sin olvidar la fiebre, puede constituir el único signo de bacteriemia en recién nacidos y lactantes de corta edad (AU)

[Group B streptococcus cellulitis-adenitis syndrome in neonates. Is it a marker of bacteremia?]. / Síndrome adenitis-celulitis por estreptococo del grupo B en lactantes. Un indicador de bacteriemia.

We report the case of an infant in whom facial cellulitis was the only initial sign of a group B streptococcal bacteriemia. Adenitis-cellulitis syndrome is a rare clinical manifestation of group B streptococcal infection in infants. Local infection together with the onset of fever can be the only signs of bacteriemia in newborns and infants.

[First urinary tract infection in healthy infants: epidemiology, diagnosis and treatment]. / Primera infección urinaria en el lactante sano: epidemiología y pautas de diagnóstico y tratamiento.

BACKGROUND: Urinary tract infection (UTI) is one of the most common infections in infants. It presents certain peculiarities compared with other pediatric age groups in terms of symptomatology, diagnosis and the therapeutic approach employed to prevent sequels. OBJECTIVE: To analyze the epidemiology, clinical and laboratory findings, etiology, diagnosis and treatment of first-time UTI in healthy infants. MATERIAL AND METHODS: Between January and December 1999, we performed a retrospective study of 131 previously healthy infants admitted to our hospital with a diagnosis of first-time UTI. Demographic data, clinical characteristics, urine dipstick, urinalysis and urine culture (vesical catheterization), blood cell count and PCR, kidney ultrasonography, voiding cystourethrogram and DMSA scintigraphy were reviewed. RESULTS: We studied 131 patients (median age: 90 days). In infants younger than 30 days, UTI was more prevalent in males. The most frequent symptom was fever (73.3 %). Seventy-one patients fulfilled the criteria for acute pyelonephritis. The presence of nitrituria was low. Escherichia coli was isolated in 90.1 % of the patients. Voiding cystourethrogram detected vesicoureteric reflux in 18.4 % of the patients. Scintigraphy revealed renal scarring in 15.1 %. No significant correlations were found between renal scarring in late scintigraphy and a diagnosis of acute pyelonephritis and/or alterations in the cystourethrogram. CONCLUSIONS: Fever was the main symptom. E. coli was the most commonly isolated microorganism. Nitrituria had low sensitivity in infants. Ultrasonography had low specificity. Scintigraphy showed the highest sensitivity and specificity in the detection of renal scarring. Predictability improved when scintigraphy was performed a few months after acute infection.

Primera infección urinaria en el lactante sano: epidemiología y pautas de diagnóstico y tratamiento / First-time urinary tract infection in healthy infants: epidemiology, diagnosis and treatment

Antecedentes: La infección del tracto urinario (ITU) es una de las infecciones bacterianas más comunes del lactante, que presenta unas peculiaridades respecto a otras edades pediátricas en cuanto a síntomas, diagnóstico y actitud terapéutica para la prevención de secuelas. Objetivo: Analizar la epidemiología, hallazgos clínico-analíticos, etiología y procedimientos diagnóstico-terapéuticos en una primera ITU en el lactante sano. Material y métodos: Estudio retrospectivo de 131 lactantes previamente sanos, ingresados en nuestro hospital por ITU entre enero y diciembre de 1999. Se recogieron filiación, síntomas, tira reactiva, sedimento de orina y urocultivo (sondaje uretral), determinaciones analíticas sanguíneas, ecografía renal, cistouretrografía miccional seriada (CUMS) y gammagrafía renal. Resultados: Se estudiaron 131 pacientes (mediana de edad 90 días). En las edades tempranas (menores de 30 días de vida) predominó el sexo masculino. El motivo de consulta más frecuente fue la fiebre (73,3 %). Un total de 71 pacientes cumplían criterios de pielonefritis aguda (PNA). La presencia de nitrituria fue baja. Se aisló Escherichia coli en el 90,1%. La CUMS detectó reflujo vesicoureteral en el 18,4% de pacientes. En el 15,1% de pacientes se objetivó una cicatriz renal en la gammagrafía. No se encontró una relación estadísticamente significativa entre la detección de alteraciones en la gammagrafía renal tardía y el diagnóstico de PNA y/o alteraciones en la CUMS. Conclusiones: La fiebre fue el motivo principal de consulta. El germen más común fue E. coli. La nitrituria tiene una sensibilidad baja en lactantes. La ecografía es una prueba de reducida especificidad. El método más sensible y específico para la detección de lesiones renales es la gammagrafía renal. La predicibilidad de secuelas mejora si la gammagrafía se retrasa unos meses después de la infección (AU)

Traumatismo craneoencefálico grave en el paciente pediátrico. Evaluación de la neuroimagen y monitorización de la presión intracraneal como factores pronóstico / Severe head injury among children: omputerised tomography evaluation and intracranial pressure monitoring as prognostic factors

Objetivo. Evaluación de la neuroimagen (mediante la escala del Traumatic Coma Data Bank) y de la presión intracraneal como factores pronóstico en pacientes pediátricos con traumatismo craneoencefálico grave. Material y método. Revisión de los pacientes ingresados en una unidad de cuidados intensivos pediátricos con traumatismo craneoencefálico grave y monitorización de la presión intracraneal entre enero de 1995 y junio de 1998. Resultados. De los 242 pacientes con traumatismo craneoencefálico ingresados en nuestra unidad, 64 precisaron monitorización de la presión intracraneal. La edad osciló entre 3 y 18 años. El patrón de neuroimagen más frecuente en la primera tomografía axial computarizada (TAC) es la lesión encefálica difusa (LED) II (43,8 por ciento) seguida de LED III (29,7 por ciento), VI (12,5 por ciento) y I (9,4 por ciento). Se ha encontrado la existencia de una asociación lineal entre los patrones de neuroimagen y los valores de presión intracraneal máxima y presión de perfusión cerebral mínima en las primeras 2 horas de monitorización. Estos parámetros se correlacionan con el pronóstico y se demuestra una relación directa entre la primera TAC y la evolución (p < 0,001). La mayoría de los pacientes (73,5 por ciento) tuvo una evolución favorable, sin secuelas (18,8 por ciento) o con trastornos psicológicos o motores menores. La mortalidad fue del 10,9 por ciento y el porcentaje de secuelas incapacitantes, del 15,6 por ciento. Conclusiones. La neuroimagen y monitorización de la presión intracraneal son fuertes predictores pronóstico del traumatismo craneoencefálico grave en el paciente pediátrico. El Traumatic Coma Data Bank permite una precoz identificación de los pacientes con riesgo elevado de hipertensión intracraneal también en edad pediátrica. La ausencia de enfermedad visible en la primera TAC no descarta la aparición de hipertensión endocraneal y está indicado monitorizar la presión intracraneal si la puntuación de Glasgow ha sido inferior o igual a ocho, incluso con una primera TAC normal (AU)

[Moyamoya disease. A cause of vascular occlusion in childhood]. / Enfermedad de Moya-Moya. Una causa de oclusión vascular en la infancia.

OBJECTIVE: The objective of this study was to review the cases of Moya-Moya diagnosed in our center. PATIENTS AND METHODS: We reviewed the Moya-Moya cases diagnosed from 1979 to 1997. We evaluated the following elements: age of clinical onset, sex, clinical features, complementary examinations, neuroimage, treatment and follow-up. RESULTS: Six patients were diagnosed. The first case appeared in 1979 and the last in 1997. These included four boys and 2 girls, with ages between 5 months and 14 years. The initial clinical feature in all six cases was acute hemiparesis, noting that in one case this was preceded by homolateral seizures. Neuroimaging revealed ischaemic infarction areas in brain CT or MNR. The diagnosis was based on angiography, where in four cases there appeared bilateral occlusion of the internal carotid, or of the anterior or middle cerebral arteries and in the other two there was a unilateral occlusion of the interior carotid and middle cerebral arteries. Regarding etiology, in four patients the dysfunction was due to either fibromuscular dysplasia of the carotid, neurofibromatosis, cranial trauma or to Down's syndrome. In the other two cases no other primary cause was found. CONCLUSIONS: Acute stroke is an infrequent disease of pediatric age patients, however it is necessary to do a thorough angiography study to rule out the Moya-Moya like vascular anomalies.

[Outbreak of respiratory syncytial virus in a neonatal unit]. / Brote de infección por virus respiratorio sincitial en una unidad neonatal.

Described is an outbreak of nosocomial RSV infection, following the admission of a 20-day-old and 11-day-old newborn with lower respiratory infections, diagnosed as being caused by RSV through detection of viral antigens by direct FAT (fluorescent antibody test) of nasopharyngeal samples. Later on, 5 of the other 20 newborn in patients in the same care unit also showed positive results in direct FAT, for RSV. The clinical manifestations of these patients were mild even in those cases with underlying PHT and cardiac disease and consisted of: cough (5/5), nasal discharge (3/5), poor feeding (1/5), sneezing (1/5), distress (1/5) and irritability (1/5). The rapid diagnosis of RSV though the direct FAT enables us to establish hygienic restrictions and patients isolation to keep the virus from spreading.

[Syphilitic nephropathy. Apropos of 3 cases]. / Nefropatía luética. A propósito de tres casos.

Three cases of luetic nephropathy are presented. The authors review the literature on the subject stressing the current clinical and etiopathogenic concepts. They also emphasize, as a conclusion, the need for an early diagnosis and treatment and the consideration of this entity in the differential diagnosis of the nephrotic syndrome of the infant.