Changes in the expression of vascular endothelial growth factor after fetal tracheal occlusion in an experimental model of congenital diaphragmatic hernia.

Introduction. Vascular endothelial growth factor (VEGF), an angiogenic factor secreted by type II pneumocytes, could play a role in congenital diaphragmatic hernia (CDH) pathogenesis. Animal studies suggest that VEGF accelerates lung growth. Aim. To quantify VEGF on fetal lungs in a nitrofen rat model for CDH and to analyze the effect of tracheal occlusion (TO) in VEGF in fetal lung rats after nitrofen and in control rats not exposed to nitrofen. Methods. Pregnant rats received nitrofen on day 9.5 of gestation. Fetuses were divided into 2 groups: those that underwent TO on day 20 and those that did not. On day 21, fetuses were delivered, and the lungs were dissected for subsequent VEGF quantification. Results. CDH was detected in 43% of the fetuses that received nitrofen. Fetuses with CDH showed significantly reduced lung weight/fetal weight ratio and lower VEGF levels than the remainder. A higher VEGF value was observed after TO. Conclusions. VEGF protein was significantly lower in fetuses with CDH. TO induced a significant increase in VEGF compared to the fetuses that did not undergo TO. Although not statistically significant, we observed higher VEGF levels in fetuses with CDH and TO compared to fetuses with CDH and no further intervention.

Estudio de 6 años sobre neumonía por «Mycoplasma pneumoniae» en un hospital terciario pediátrico / Six-year study of Mycoplasma pneumoniae pneumonia in a tertiary care children’s hospital

Objetivos: Determinar la importancia de la incidencia de Mycoplasma pneumoniae en la etiología de las neumonías adquiridas en la comunidad en pacientes pediátricos de edades comprendidas entre los 6 meses y los 16 años. Metodología: Se recogieron, de forma prospectiva, todos los casos diagnosticados de neumonía por Mycoplasma pneumoniae, en el servicio de urgencias del departamento de pediatría del Hospital Materno Infantil Universitario «Gregorio Marañón» de Madrid, desde el 1 de mayo de 1995 hasta el 31 de agosto del 2001. En todos los pacientes se recogieron datos epidemiológicos (edad, sexo, incidencia familiar, asistencia a colegio o guardería, fecha del diagnóstico...), clínicos (síntomas y exploración física en el momento del diagnóstico y seguimiento en la consulta de Infecciosas), hematométricos, serológicos y radiológicos. Resultados: Desde el 1 de mayo de 1995 hasta el 1 de septiembre de 2001 se diagnosticaron en el servicio de urgencias infantiles un total de 715 neumonías en pacientes con edades comprendidas entre los 6 meses y los 16 años. Se confirmó el diagnóstico de neumonía por M. pneumoniae en 240 casos (34%). Casi la mitad de los pacientes tenían una edad igual o inferior a los 5 años de edad. La mayoría de las neumonías fueron tratadas ambulatoriamente; sólo un 4,5% de los pacientes diagnosticados de neumonías por M. pneumoniae precisaron ingreso frente a un 23,15% en el grupo de neumonías por otros agentes etiológicos (p <0,05). La distribución mensual de las neumonías por M. pneumoniae presenta dos picos epidémicos (de diciembre de 1997 a agosto de 1998 y de febrero de 2001 a agosto de 2001). Todos los pacientes diagnosticados evolucionaron satisfactoriamente. Conclusión: M. pneumoniae constituye una causa frecuente de neumonía ambulatoria en la comunidad, incluso en pacientes menores de 5 años, y presenta una excelente evolución tras tratamiento ambulatorio(AU)

Objectives: To determine the importance of the incidence of Mycoplasma pneumoniae in the etiology of community-acquired pneumonias in pediatric patients ranging in age between 6 months and 16 years. Methods: The authors carried out a prospective study of all the cases of pneumonia due to M. pneumoniae diagnosed in the Emergency Service of the Department of Pediatrics of Hospital Materno Infantil Gregorio Marañón in Madrid, Spain, between May 1 1995 and August 31 2001. They collected epidemiological data (age, sex, familial incidence, attendance at school or nursery school, date of diagnosis, etc.), clinical features (symptoms and results of physical examination at the time of diagnosis, and follow-up in the Infectious Disease outpatient unit) and the hematological, serological and radiological findings for all the patients. Results: Between May 1 1995 and September 1 2001, a total of 715 cases of pneumonia were diagnosed in patients between the ages of 6 months and 16 years in the children's emergency service. A diagnosis of pneumonia due to M. pneumoniae was confirmed in 240 cases (34%). Nearly half of the children were five years old or younger. The majority of them were treated in the ambulatory setting; only 4.5% of those patients diagnosed as having M. pneumoniae pneumonia required hospital admission, versus 23.15% in the group with pneumonias due to other etiological agents (p<0.05). The distribution of the cases of pneumonia due to M. pneumoniae on a monthly basis showed two epidemic peaks (from December 1997 to August 1998 and from February 2001 to August 2001. The outcome was satisfactory in all the diagnosed patients. Conclusion: M. pneumoniae is a frequent cause of community-acquired outpatient pneumonia, even in patients under five years of age, and the outcome of treatment in the ambulatory setting is excellent(AU)

Manifestaciones dermatológicas de la infección por Mycoplasma pneumoniae / Cutaneous manifestations of Mycoplasma pneumoniae infection

Mycoplasma pneumoniae es una de las causas más importantes de neumonía adquirida en la comunidad, aunque también se han descrito casos de manifestaciones extrapulmonares (bien asociadas a neumonía o como localizaciones independientes de ella) en que las lesiones dermatológicas ocupan una de focalizaciones predominantes. A continuación presentamos diversos cuadros clínicos donde se muestran algunos de los múltiples aspectos que pueden presentar dichas alteraciones dermatológicas, y que consisten en síndrome de Kawasaki, lesiones purpúricas, eritema nodoso, exantema maculo papuloso y exantema vesiculoso. Todos ellos fueron diagnosticados de infección por Mycoplasma, mediante serología con títulos de anticuerpos por fijación de complemento iguales o superiores a 1/80 y/o aumento de 4 veces el titulo de los mismos en dos muestras tomadas en paralelo, con al menos cuatro semanas de intervalo entre muestra y muestra

Mycoplasmpa neumoniae, one of the most common causes of community-acquired pneumonia, can also involve extrapulmonary sites, either in association with pneumonia or independently. The skin is one of the most frequent targets. We present several case reports in which skin lesions compatible with Kawasaki syndrome, purpuric lesions, erythema nodosum, erythematous maculopapula eruption and vesicular erruption were documented. In every case, the diagnosis of mycoplasma infection was based on serological studies, with complement fixation titers of 1/80 or more and/or titers four-fold higher thant he base line titers in studies separated by an interval of at least our weeks

[Rescue treatment with inhaled nitric oxide in preterm newborns with respiratory failure]. / Oxido nítrico inhalado como rescate en insuficiencia respiratoria del recién nacido inmaduro.

Inhaled nitric oxide (iNO) is indicated in near-term (> 34 weeks' gestation) and term newborns with hypoxemic respiratory failure and persistent pulmonary hypertension, decreasing the need for extracorporeal membrane oxygenation support in at least 40 %. Currently the use of iNO has not been approved for premature neonates, and its therapeutic efficacy in this group remains controversial. However, it has been suggested that iNO may be helpful by improving oxygenation and reducing the need for aggressive mechanical ventilation in some cases of severe hypoxemic respiratory failure in preterm infants with inadequate response to conventional treatment. We report the cases of three hypoxemic preterm neonates unresponsive to conventional treatment in whom the use of iNO was effective in the management of hypoxemic respiratory failure.

Óxido nítrico inhalado como rescate en insuficiencia respiratoria del recién nacido inmaduro / Rescue treatment with inhaled nitric oxide in preterm newborns with respiratory failure

El empleo de óxido nítrico inhalado (ONi) está indicado en el tratamiento de recién nacido de más de 34 semanas de edad gestacional con insuficiencia respiratoria hipoxémica asociada a hipertensión pulmonar, reduciendo la necesidad de oxigenación por membrana extracorpórea (ECMO) en estos pacientes en al menos el 40 %. Actualmente su uso en el recién nacido pretérmino no está aprobado, y su eficacia terapéutica en este grupo es controvertida. Sin embargo, se ha sugerido que en ciertas situaciones de insuficiencia respiratoria hipoxémica en niños pretérmino, con escasa respuesta al tratamiento convencional, el empleo de ONi puede mejorar la oxigenación y reducir la necesidad de ventilación mecánica agresiva. Presentamos 3 casos de recién nacidos pretérmino en los que el empleo de ONi fue eficaz en el manejo de insuficiencia respiratoria hipoxémica refractaria al tratamiento convencional

Inhaled nitric oxide (iNO) is indicated in near-term (> 34 weeks’ gestation) and term newborns with hypoxemic respiratory failure and persistent pulmonary hypertension, decreasing the need for extracorporeal membrane oxygenation support in at least 40 %. Currently the use of iNO has not been approved for premature neonates, and its therapeutic efficacy in this group remains controversial. However, it has been suggested that iNO may be helpful by improving oxygenation and reducing the need for aggressive mechanical ventilation in some cases of severe hypoxemic respiratory failure in preterm infants with inadequate response to conventional treatment. We report the cases of three hypoxemic preterm neonates unresponsive to conventional treatment in whom the use of iNO was effective in the management of hypoxemic respiratory failure