Pólipo antrocoanal. Caso clínico y revisión de la bibliografía / Antrochoanal polyp. Case report and review

La obstrucción nasal es un síntoma frecuente de consulta en otorrinolaringología pediátrica, y su etiología más frecuente es la hipertrofia adenoidea. Los pólipos antrocoanales son una entidad clínica infrecuente que representa el 28-33% de las poliposis nasosinusales en la población infantil. Presentamos el caso clínico de una niña de 8 años de edad, adenoidectomizada, con síntomas de insuficiencia respiratoria nasal, rinorrea en ocasiones purulenta y cefaleas frontoorbitarias sin epistaxis. El estudio endoscópico nasal y las pruebas de imagen diagnosticaron la presencia de una lesión polipoidea que ocupaba ambas fosas nasales y coanas, siendo tratada mediante cirugía endoscópica nasosinusal. El estudio histológico informó de la presencia de un pólipo antrocoanal y el estudio alérgico mediante prick-test descartó la existencia de alergias. Hoy en día aún no disponemos de la suficiente evidencia histológica y/o alergológica que determine la etiología de los pólipos antrocoanales (AU)

Nasal obstruction is a frequent symptom of consultation in pediatric otolaryngology, and its most common etiology is adenoidal hypertrophy. Antrochoanal polyps are an uncommon clinical entity that represents 28-33% of the sinonasal polyposis in children. We report the case of an 8-year-old child, with previous adenoidectomy, with symptoms of nasal obstruction, purulent rhinorrhea, headache frontoorbitarias without epistaxis. The nasal endoscopy and imaging tests diagnosed the presence of a polypoid lesion occupying both nostrils and choanae, being treated by endoscopic sinus surgery. Histology disclosed an antrochoanal polyp and allergy study by prick-test ruled out the existence of allergies. Today, we have not yet sufficient histological and/or allergological evidence to determine the etiology of polyps antrochoanal (AU)

Melatonin and beta-endorphin changes in children sensitized to olive and grass pollen after treatment with specific immunotherapy.

BACKGROUND: Specific immunotherapy for respiratory allergy, a seasonal disease, significantly reduces the inflammatory process, attenuating the clinical symptoms. The mechanism for the clinical beneficial effect of immunotherapy has not yet been clarified. Melatonin shows a circadian and seasonal variation and together with the endogenous opioid system plays an immunomodulatory role acting on both specific and nonspecific immunity responses. Thus, the possibility that immunotherapy involved changes in the melatonin-opioid system was investigated. METHODS: Thirty-five children aged 3-15 years with rhinitis and asthma due to olive + grass pollen sensitization were studied. The patients were treated with depot extracts containing the identified allergens with increasing doses from 1 to 1,000 IU/ml during 3 months. Melatonin, beta-endorphin, total and specific IgE and IgG4 were determined before and after treatment. RESULTS: All children showed a significant improvement of their symptoms at the end of the treatment, coinciding with a significant drop of both melatonin and beta-endorphin levels. Total IgE decreased in most of the cases although the mean values did not show significant changes. Specific IgE and IgG4 were also unchanged. A significant correlation between melatonin and beta-endorphin and between beta-endorphin and IgG4 was found before immunotherapy, and these correlations disappeared when the treatment was finished. CONCLUSIONS: The decrease in the levels of melatonin and beta-endorphin suggests the disappearance of their stimulating influence on the immune system. Thus, hyposensitization after immunotherapy may involve, at least in part, the inhibition of the immunoenhancing properties of the melatonin-opioid system.

[Monitoring of three delayed-release preparations of theophylline in the plasma of children: pharmacokinetic parameters and therapeutic significance]. / Monitorización plasmática de tres preparados de teofilina de liberación retardada en la infancia: parámetros farmacocinéticos e interés terapéutico.

The pharmacokinetic and clinical efficacy of three theophylline slow-release formulations was studied in 29 children suffering chronic bronchial asthma. Theophylline loading dose was of 6 mg/kg; maintenance dose was adjusted according to therapeutic effect and drug plasma concentrations and ranged to 11.1 to 31.3 mg/kg/daily (means = 22.32 +/- 6.6 mg/kg/daily). Peak theophylline plasma levels were 13.38 +/- 4.83 micrograms/ml and through plasma levels were 8.73 +/- 3.78 micrograms/ml. No difference was found among theophylline formulations for clinical response nor kinetic parameters. Drug plasma half-life varied from 2.9 to 18.2 hr (means = 8.85 +/- 3.64 hr). Theophylline total body clearance and apparent volume of distribution exhibited a marked decrease during chronic drug administration in relation to the values observed after intake of the loading dose. Twenty three of the children reached a good degree of control of bronchospasm and did not require any associated medication.

[Function of neutrophilic polymorphonuclear leukocytes in pediatric patients with intrinsic and extrinsic asthma during the intercrisis period]. / Etude de la fonction des polynucléaires neutrophiles chez des patients pédiatriques atteints d'asthme intrinsèque et extrinsèque pendant l'intercrise.

Polymorphonuclear leukocyte function: chemotaxis, NBT and myeloperoxidases activity, was investigated in a group of asthmatic pediatric patients, 26 with intrinsic and 27 with extrinsic asthma, during intercrisis. There was no difference between the extrinsic asthma group and the control one while the group with intrinsic asthma showed an increase of chemotaxis activity (p less than 0.001) and NBT reduction (p less than 0.01); myeloperoxidases activity was similar to the control group. The comparative study of the two types of asthma shows a significant increase of NBT reduction (p less than 0.02) and chemotaxis activity (p less than 0.001) in the intrinsic group. These findings demonstrate that polymorphonuclear function is different in the two main types of asthma during the asymptomatic period.

[Epidemiologic aspects of visceral leishmaniasis in the Province of Granada]. / Aspectos epidemiológicos de la leishmaniosis visceral en la provincia de Granada.

Authors make a retrospective study in 18 children with kala-azar, considering in every case the following epidemiological aspects: age, sex, situation, time of the year and lethality. They have also studied the vector of this disease in some points in Granada and after an adequate study concluded that the main vector of the kala-azar in the investigated zone is "Phlebotomus perniciosus". They have detected as well a new species in Spain, "Plebotomus longicuspis", with a slight epidemiological interest. Finally both investigations are compared finding two zones in Granada (the town and the coast) where most of the cases of kala-azar, are agglutinated and where main species of the vectors were found.