[Therapeutic education in asthma management]. / La educación terapéutica en el asma.

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.

La educación terapéutica en el asma / Therapeutic education in asthma management

Todas las recomendaciones, guías y protocolos establecen el papel de la educación terapéutica como elemento clave en el manejo y control del asma, disponiéndose de evidencias que demuestran su eficacia y efectividad. Tanto los profesionales sanitarios como los pacientes y sus familias pueden y han de ser formados y educados, con dos objetivos fundamentales: conseguir una óptima calidad de vida y una capacidad suficiente para manejar el asma de una forma autogestionada. Ello se puede conseguir a través de un proceso educativo que ha de ser individualizado, continuo, progresivo, dinámico y secuencial. En este proceso han de superarse no pocas dificultades, relacionadas con el paciente, con los profesionales y con el propio sistema sanitario. Es preciso conocer los diferentes aspectos psicológicos que pueden relacionarse con el paciente asmático, así como aquellos que están relacionados con el fenómeno tan prevalente de la falta de adherencia. El conocimiento de los factores que inciden en la comunicación médico-paciente-familia es de enorme importancia para conseguir los objetivos que se plantean en la educación terapéutica. El proceso educativo conduce, no sólo a la adquisición de conocimientos y habilidades, sino también a un cambio de actitudes y creencias. Es necesario proveer al paciente y a sus cuidadores de un plan de acción por escrito individualizado, basado en síntomas y/o flujo espiratorio máximo (FEM), ligado siempre a revisiones periódicas

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required

[Prevalence of current asthma in Majorca. Value of a bronchial hyperresponsiveness test in combination with a questionnaire]. / Prevalencia actual de asma en Mallorca. Utilidad de la prueba de hiperreactividad bronquial y un cuestionario asociado.

BACKGROUND: The prevalence of asthma shows marked variability and consequently it should be determined in different geographical areas. Standardized questionnaires are reliable for identifying and comparing the prevalences of asthma among areas. However, asthma prevalence based on the use of questionnaires alone could overestimate the true prevalence of this illness. Therefore, the use of other methods such as determination of bronchial hyperresponsiveness is useful as an adjunct to questionnaires in asthma screening and epidemiological studies. OBJECTIVE: To assess the prevalence of current asthma among schoolchildren in Majorca. PATIENTS AND METHODS: A total of 608 schoolchildren aged 8-15 years in the island of Majorca were studied. Participants answered a questionnaire on symptoms and performed a free running test for measuring bronchial responsiveness. RESULTS: The prevalence of wheezing during the previous 12 months was 18.1% (11.5% for the group aged 12-15 years). A fall in forced expiratory volume in one second (FEV1) greater than 15% after exercise testing was found in 61 children (10.5%). An association between bronchial responsiveness and the results of the written questionnaire referring to wheezing was found, but not between bronchial responsiveness and nocturnal coughing. The prevalence of "current asthma" (recent wheezing and bronchial responsiveness) was 3.4%. CONCLUSION: The prevalence of current asthma in our area is lower than that reported for other Spanish areas. The use of questionnaires and a free running test can be useful in identifying children at greatest risk.

Prevalencia actual de asma en Mallorca. Utilidad de la prueba de hiperreactividad bronquial y un cuestionario asociado / Prevalence of current asthma in Majorca. Value of a bronchial hyperresponsiveness test in combination with a questionnaire

Antecedentes: Existe una marcada variabilidad en la prevalencia del asma, por lo que resulta imprescindible determinar ésta en las diferentes zonas geográficas. La utilización de cuestionarios estandarizados permite conocer y comparar la prevalencia en distintas áreas. Debido a la posible sobreestimación de asma mediante el uso único de cuestionarios, la asociación con otros métodos como la determinación de la hiperreactividad bronquial (HRB) inducida por el ejercicio puede resultar útil para un cribado de asma en la población. Objetivos: Establecer la prevalencia de asma actual en nuestra área. Material y métodos: Se estudiaron 608 niños de 8-15 años de la isla de Mallorca. Los participantes respondieron a un cuestionario de síntomas y realizaron una prueba de provocación bronquial inducida por carrera al aire libre. Resultados: La prevalencia de sibilancias en los últimos 12 meses fue del 18,1 % (11,5 % para el grupo de 12-15 años). Se encontró una disminución del volumen espiratorio forzado en el primer segundo (FEV1) tras el ejercicio mayor o igual al 15 % en 61 niños (10,5 %). La HRB inducida por el ejercicio se asoció a las preguntas del cuestionario referidas a sibilancias, pero no a la tos nocturna. La prevalencia de asma actual (HRB más sibilancias recientes) fue del 3,4 %. Conclusión: La prevalencia de asma actual en nuestra área es inferior a la referida para otras áreas de España. El empleo de un cuestionario asociado a una prueba de HRB puede ayudar a la identificación del grupo de mayor riesgo

Background: The prevalence of asthma shows marked variability and consequently it should be determined in different geographical areas. Standardized questionnaires are reliable for identifying and comparing the prevalences of asthma among areas. However, asthma prevalence based on the use of questionnaires alone could overestimate the true prevalence of this illness. Therefore, the use of other methods such as determination of bronchial hyperresponsiveness is useful as an adjunct to questionnaires in asthma screening and epidemiological studies. Objective: To assess the prevalence of current asthma among schoolchildren in Majorca. Patients and methods: A total of 608 schoolchildren aged 8-15 years in the island of Majorca were studied. Participants answered a questionnaire on symptoms and performed a free running test for measuring bronchial responsiveness. Results: The prevalence of wheezing during the previous 12 months was 18.1 % (11.5 % for the group aged 12-15 years). A fall in forced expiratory volume in one second (FEV1) greater than 15 % after exercise testing was found in 61 children (10.5 %). An association between bronchial responsiveness and the results of the written questionnaire referring to wheezing was found, but not between bronchial responsiveness and nocturnal coughing. The prevalence of "current asthma" (recent wheezing and bronchial responsiveness) was 3.4 %. Conclusion: The prevalence of current asthma in our area is lower than that reported for other Spanish areas. The use of questionnaires and a free running test can be useful in identifying children at greatest risk

Contribución de la fibrobroncoscopia al diagnóstico de las enfermedades de la vía aérea superior / Contribution of flexible bronchoscopy to the diagnosis of upper airway alterations

Introducción: La fibrobroncoscopia es una técnica diagnóstica y terapéutica con un campo de aplicación creciente en pediatría, que constituye en la actualidad una técnica indispensable en las unidades de neumología infantil. La facilidad con la que se puede realizar bajo sedación y con anestesia tópica, evitando el área quirúrgica y anestesia general necesaria para la broncoscopia rígida, ha permitido incrementar de forma considerable la endoscopia de la vía aérea en la infancia y disminuir los riesgos del paciente.Objetivo: Analizar la contribución de la fibrobroncoscopia en el diagnóstico de enfermedades de la vía aérea superior y conocer la incidencia de las distintas alteraciones halladas a dicho nivel.Material y métodos: Se han revisado las fibrobroncoscopias realizadas en nuestro centro entre enero de 1993 y marzo de 2003 en niños menores de 14 años.Resultados: Se han realizado un total de 456 fibrobroncoscopias en 378 niños. La indicación otorrinolaringológica se ha recogido en 111 exploraciones (24,5 % del total de endoscopias), correspondiendo al estridor el 55,8 %. En el 30,7 % (n = 140) del total de exploraciones se encontraron alteraciones de la vía aérea superior. En ningún caso se presentaron complicaciones graves.Conclusión: La fibrobroncoscopia es una técnica útil en el diagnóstico de enfermedades de la vía aérea superior. El estridor es la indicación más frecuente de fibrobroncoscopia por sospecha de alteración de la vía aérea superior y la laringomalacia el hallazgo más frecuente

Introduction: Flexible bronchoscopy (FB) is becoming an increasingly common diagnostic and therapeutic technique and is currently an essential procedure in pediatric pulmonology departments. Because the procedure is easy to perform under sedation and topical anesthesia, avoiding surgery with general anesthesia, which is required for rigid bronchoscopy, it has allowed the use of airway endoscopy in infants and children to be increased and has reduced patient risks. Objective: To analyze the contribution of FB to the diagnosis of upper airway alterations and to characterize the frequency and type of upper airway anomalies. Patients and methods: We retrospectively reviewed the FB performed in our center between January 1993 and March 2003 in children aged less than 14 years old. Results: A total of 456 FB were performed in 378 children. One hundred eleven FB (24.5 % of all endoscopies) were required for suspected upper airway anomalies and 55.8 % corresponded to stridor. Upper airway inspection revealed abnormality in 30.7 % (140 FB). There were no severe complications. Conclusion: FB is useful in the diagnosis of upper airway abnormalities. The main indication for FB is stridor and the most common abnormal finding of the upper airway is laryngomalacia

[Contribution of flexible bronchoscopy to the diagnosis of upper airway alterations]. / Contribución de la fibrobroncoscopia al diagnóstico de las enfermedades de la vía aérea superior.

INTRODUCTION: Flexible bronchoscopy (FB) is becoming an increasingly common diagnostic and therapeutic technique and is currently an essential procedure in pediatric pulmonology departments. Because the procedure is easy to perform under sedation and topical anesthesia, avoiding surgery with general anesthesia, which is required for rigid bronchoscopy, it has allowed the use of airway endoscopy in infants and children to be increased and has reduced patient risks. OBJECTIVE: To analyze the contribution of FB to the diagnosis of upper airway alterations and to characterize the frequency and type of upper airway anomalies. PATIENTS AND METHODS: We retrospectively reviewed the FB performed in our center between January 1993 and March 2003 in children aged less than 14 years old. RESULTS: A total of 456 FB were performed in 378 children. One hundred eleven FB (24.5 % of all endoscopies) were required for suspected upper airway anomalies and 55.8 % corresponded to stridor. Upper airway inspection revealed abnormality in 30.7 % (140 FB). There were no severe complications. CONCLUSION: FB is useful in the diagnosis of upper airway abnormalities. The main indication for FB is stridor and the most common abnormal finding of the upper airway is laryngomalacia.

Masa infraclavicular / Infraclavicular mass

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Tumor de Wilms bilateral metacrónico / Metachronous bilateral Wilms' tumor

La incidencia del tumor de Wilms bilateral es entre el 5 y 10% de los casos de nefroblastoma. La forma metacrónica representa el 2-3%. El 96,2% de las formas metacrónicas aparecen durante los primeros 5 años tras el tumor primario. Las malformaciones asociadas son más frecuentes en las formas bilaterales. La aparición de un tumor metacrónico constituye una dificultad terapéutica. Se describe el caso de una niña de 11 años con hemihipertrofia izquierda diagnosticada de recidiva metacrónica de tumor de Wilms tras 7 años del primer diagnóstico. Recibió 5 ciclos de quimioterapia preoperatoria. Se realizó tumerectomía. Por complicación posquirúrgica se realizó nefrectomía del único riñón. La paciente se encuentra en insuficiencia renal crónica por su condición de anéfrica, dependiente de hemodiálisis. Se continuó el tratamiento posquirúrgico con carboplatino y etopósido. Actualmente se encuentra en remisión completa. Es excepcional la presentación de las formas metacrónicas del tumor de Wilms después de los primeros 5 años del tumor primitivo. Cuando aparece el tumor contralateral la quimioterapia debe mantenerse hasta conseguir la reducción del tamaño tumoral para poder preservar la función renal y evitar la diálisis. En los casos de insuficiencia renal crónica secundaria a una nefrectomía bilateral la elección de los quimioterápicos efectivos y el conocimiento de la farmacocinética y farmacodinámica de éstos hace posible continuar el tratamiento en estos pacientes con el soporte adecuado de hemodiálisis (AU)

[Metachronous bilateral Wilms' tumor]. / Tumor de Wilms bilateral metacrónico.

Wilms' tumor occurs in 5-10 % of all cases of nephroblastoma. The metachronous form represents 2-3 % of cases. Most (96.2 %) metachronous tumors appear within the first 5 years of the primary tumor. Associated malformations are more common in bilateral cases. Metachronous tumors are a therapeutic challenge. We describe the case of an 11-year-old girl with left hemihypertrophy. The diagnosis was metachronous relapse of Wilms' tumor 7 years after the first diagnosis. The patient received five courses of preoperative chemotherapy and tumorectomy was performed. Because of post-surgical complications, nephrectomy was performed on her only kidney. Since she is anephric, the patient is in chronic renal failure and is dependent on dialysis. Treatment with carboplatin and etoposide was continued after surgery and the patient is currently in complete remission. The appearance of a metachronous Wilms' tumor 5 years after that of the primary tumor is rare. When a contralateral tumour develops, chemotherapy must be given until the size of the tumor is reduced in order to preserve renal function and avoid dialysis. In patients with chronic renal failure caused by bilateral nephrectomy, ongoing treatment with dialysis support can be achieved through the choice of effective drugs and knowledge of their pharmacokinetics and pharmacodynamics.

[An increase in gamma-delta T-lymphocytes in the peripheral blood of cystic fibrosis patients]. / Incremento de linfocitos T gamma-delta en sangre periférica de pacientes afectos de fibrosis quística.

The function of the T gamma-delta cells of the human immune system is not well known at present. Only 3-10% of the T cells express the heterodimer composed of the gamma-delta chains. Recent studies have demonstrated a role of the T gamma-delta cells in the immunopathogenesis of autoimmune and infectious diseases. The present study was designed to evaluate the quantity of T gamma-delta cells in patients with cystic fibrosis with P. aeruginosa infections. These results were compared to blood levels of T cells found in patients with acute pulmonary infections, chronic pulmonary infections and healthy control patients. The cellular phenotype was determined by flow cytometry. Monoclonal antibodies against the different cell types studied were employed. The means of each group were compared by a Student's T test of Mann Whitney. We found that the percentage of T gamma-delta cells (TCR 1+) was significantly increased in patients with cystic fibrosis when compared to the pathological controls and healthy children. We conclude that our results demonstrate that children with cystic fibrosis infected with Pseudomonas aeruginosa demonstrate and increase in the subclass of T cells with the gamma-delta receptor.

[Bacterial meningitis in children. Analysis of 181 cases]. / Meningitis bacteriana en el niño. Análisis de 181 casos.

Clinical records of 181 children, aged between one month and seven years, admitted in a four year period, from 1978 through 1982, with the diagnosis of bacterial meningitis are revised. Peak incidence occurred in the age group between six months and three years, and during the months of January to May. N. meningitidis (35%), pneumococcus (4.9%) and H. influenzae (2.7%) were the most frequently isolated bacteria. CSF culture was negative in 56% of the children. All of them had previously taken antibiotics. Complications were present in 6.4%, with highest incidence in the known-agent group, on the following order: septic shock, 11%, seizures, 6.6%, and subdural effusion, 2.2%. Permanent sequelae were present in 3.8%, being deafness predominant. Twelve (6.3%) out of the 181 died, and death was result of fulminant meningococcal sepsis with endotoxic shock in ten of these patients. Clinical and psychological followed-up of twenty-nine children with isolated causal agent, were compared with a control group, finding no statistically-significant difference.

[Inflammatory pseudotumor of the lung in infancy (histiocytoma) (author's transl)]. / Pseudotumor inflamatorio de pulmón en la infancia (histiocitoma)

A four year old boy with a clinical picture of acute pneumonia is presented. Antibiotic therapeutic improved the clinical and analytic symptomatology but a round, radiologic shadow persisted after three months of evolution. Thoracotomy was performed and by histopathologic examination histiocytoma of lung diagnosed. Literature is reviewed and the clinical, radiologic, pathologic and etiopathogenetic features are commented. These lesions should be considered as benign to avoid extensive resection.