Can We Do Anything Else before Removing a Button Battery from the Esophagus?-Hyaluronic Acid.

OBJECTIVE: This article tests the protective effect of a commercially available mixture of hyaluronic acid, chondroitin sulfate, and poloxamer 407 on the damage caused by the exposure of esophageal mucosa to button batteries in an animal model. METHODS: Experimental study. Sixty porcine esophageal samples were distributed in three groups: control (CG), exposure (EG), and exposure-protection (EPG). In EG and EPG, one CR2032 button battery per sample was inserted, both were subdivided into 2-, 4-, 6-, and 24-hour exposure subgroups, with subsequent battery removal. EPG samples were irrigated with the solution 1 hour after battery exposure. Esophageal pH and final voltage of the battery were measured. RESULTS: pH in CG remained stable. No significant differences in pH at 1 hour were found between EG and EPG. In EPG, the pH of the mucosa exposed to the anode was lower than in GE at 2 hours (12.44 vs. 11.89, p = 0.203) and 4 hours (13.78 vs. 11.77, p < 0.0001). In the cathode pH was significantly higher in EG at 2 hours (2.5 vs. 4.11, p < 0.0001), 4 hours (2.33 vs. 4.78, p < 0.0001), and 6 hours (2.17 vs. 2.91, p < 0.0001). Significant voltage reduction at 1 hour was found in EG compared to EPG (0.48 vs. 1.08 V, p = 0.004). CONCLUSION: Exposure to hyaluronic acid solution buffers the acidification on the side exposed to the cathode and basification on the anode. This effect can be maintained up to 3 to 5 hours, even after stopping its application. Our results suggest that a solution containing hyaluronic acid could be used as an esophageal protector after accidental ingestion of button batteries.

Recomendaciones para el empleo de probióticos en la diarrea en la infancia / Recommendations for the use of probiotics in childhood diarrhea

La pediatría es una de las especialidades médicas donde los ensayos clínicos aleatorizados con probióticos han demostrado la eficacia y seguridad de éstos en diversas patologías, sobre todo digestivas. La mayor evidencia corresponde al empleo de probióticos en diversos tipos de diarreas, por lo que han sido incluidos en diferentes guías de práctica clínica. El efecto del probiótico debe valorarse en función de la cepa utilizada, la dosis y la duración del tratamiento. Los probióticos son eficaces en el tratamiento de la diarrea aguda infecciosa infantil, ya que acortan la duración media del proceso, el número de deposiciones y el porcentaje de episodios que se prolongan más de 4 días. De igual modo, han sido ampliamente estudiados para prevenir el desarrollo de la diarrea asociada a antibióticos, siendo los que tienen mayor nivel de evidencia la levadura (AU)

Pediatrics is one of the medical specialties where randomized clinical trials with probiotics have demonstrated its efficacy and safety in various pathologies, especially digestive being their use in different types of diarrhea, where more evidence there is for what are included in different clinical practice guidelines. The effect of probiotic should be assessed according to the used strain, dose, administration time and the duration of the same. Probiotics are effective in the treatment of acute infectious diarrhea in children by shortening the average duration of the process, the number of liquid stools, and the percentage that lasts more than 4 days. In the same way, have been widely studied for preventing the development of antibiotic-associated diarrhea being those that have higher level of evidence the yeast Saccharomyces boulardii and strain Lactobacillus rhamnosus GG (AU)

Psoriasis inducida por infliximab en una adolescente con colitis ulcerosa / Infliximab-induced psoriasis in an adolescent with ulcerative colitis

No disponible

Tumor carcinoide apendicular. A propósito de un caso / Appendiceal carcinoid tumor. A case report

Los tumores carcinoides derivan de las células neuroendocrinas de cualquier parte del organismo (más frecuentemente del tubo digestivo, el páncreas y los bronquios). Son los tumores endocrinos gastrointestinales más frecuentes, ya que representan un 75% de estas neoplasias, y el tumor maligno gastrointestinal más frecuente en los niños. Su diagnóstico suele realizarse de manera casual en el 0,3-0,9% de las apendicectomías, y son menos frecuentes en la edad pediátrica. Presentamos el caso de un tumor carcinoide en un niño de 12 años de edad y realizamos una revisión de esta patología (AU)

Carcinoid tumors derive from neuroendocrine cells at different anatomic locations (although they are most commonly found at the gastrointestinal tract, pancreas and bronchial airway) and are the most common gastrointestinal endocrine tumors, of which they represent 75%; being also the most common gastrointestinal malignant tumour in children. Diagnosis is often incidental (in around 0.3 to 0.9% of appendectomies, and less common in children). We report the case of a carcinoid tumor in a pediatric patient aged 12 years, providing aswell a review of this pathology (AU)

Empleo de probióticos y prebióticos en los trastornos digestivos funcionales / No disponible

No disponible

Pancreatitis aguda: nuestra experiencia / Acute pancreatitis: our experience

Introducción: La pancreatitis aguda es un cuadro de dolor abdominal poco frecuente en la infancia. Nuestro objetivo es describir las características de los pacientes ingresados entre1988 y 2008 en un hospital terciario con este diagnóstico. Métodos: Estudio observacional retrospectivo por revisión de historias clínicas. Se recogen datos epidemiológicos, etiológicos, clínicos, de laboratorio, radiológicos, de manejo terapéutico y evolución clínica. Resultados: Incluimos 27 pacientes (un 66% varones), con una media de edad de 7,2 años (rango: 6 meses-16 años). El52% presenta enfermedades crónicas relevantes. El mecanismo etiológico más frecuente fue el estructural (37%), aunque hubo otros agentes causales, como ingesta de fármacos, infecciones, shock e inmunodeficiencias. Un 26% de los casos fueron catalogados como idiopáticos. El síntoma guía en todos los pacientes estables fue el dolor abdominal, de localización y características variables, acompañado de vómitos (55%), fiebre(33%), anorexia (19%) y otros síntomas relacionados con el agente causal. En todos se observó un aumento de las enzimas pancreáticas. La prueba de imagen más realizada fue la ecografía (patológica en un 74% de los casos), y el aumento del tamaño de la glándula fue el hallazgo más común. En el 89%de los pacientes el tratamiento fue médico, con dieta absoluta durante una mediana de 48 horas. Dos pacientes precisaron la realización de una colangiopancreatografía retrógrada endoscópica para el tratamiento de una coledocolitiasis. La duración media del ingreso fue de 9 días, y el 40% de los casos evolucionó favorablemente. Tres pacientes evolucionaron hacia pancreatitis crónica y 6 fallecieron por causas extradigestivas. Conclusiones: La pancreatitis aguda es una entidad poco frecuente en la edad pediátrica, con una amplia variedad de factores etiológicos que condicionan un pronóstico muy heterogéneo(AU)

Introduction: Acute pancreatitis is an unusual disorder in childhood that commonly onsets with sudden abdominal pain. Our goal is to describe the features of the patients diagnosed of acute pancreatitis between 1988 and 2008 who were admitted to our hospital. Methods: Retrospective observational study by review of medical records. We collected data referred to epidemiology, aetiology, clinical symptoms, analytical (amylase, lipase) and radiological findings, medical treatment administered and outcome. Results: We included 27 patients (66% males), with a mean age of 7.2 years (range: 6 months-16 years). 52% of them suffered from chronic diseases. The most common cause was a structural anomaly (37%). Other aetiologies included: drugs, infections, shock and immunodeficiencies. 26% of cases were catalogued as idiopatic. The presenting symptom in non-critical patients was abdominal pain, in different areas and with diverse features, associated with vomiting (55%), fever (33%),anorexia (19%) and other symptoms related to the a etiological agent. Pancreatic enzyme levels were elevated in all patients. The most widely used radiological test was ecography (abnormalin 74%), being the most common image the enlargement of the gland. 89% of patients were managed conservatively with complete bowel rest during a median of 48 hours. ERCP was indicated in 2 patients to treat coledocolitiasis. Median hospital stay was 9 days, with favourable outcome in 40% of patients. Recurrence was described in 3 patients and 6 died because of non-digestive causes. Conclusions: Acute pancreatitis is an unusual disease in childhood with a great variety of aetiological factors that determine different prognosis(AU)

Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria / Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders

Introducción: El RGE se asocia a sintomatología respiratoria; se ha demostrado la relación entre el RGE no ácido y su etiopatogenia. La impedancia intraluminal multicanal esofágica (MII) es capaz de detectar RGE no ácido y alcalino, así como la altura de ascenso del reflujo. Objetivo: Comparar la eficacia en el diagnóstico de reflujo gastroesofágico ácido y no ácido de la pH-metría bicanal y la MII en pacientes con patología respiratorio. Pacientes y métodos: Estudio longitudinal, prospectivo de pacientes con diagnóstico de asma persistente al tratamiento, tos crónica o laringitis de repetición. Se realizó monitorización continua durante 24 h mediante MII-pH-metría doble canal y análisis descriptivo de los datos comparando ambas técnicas entre sí. Se realizó un análisis descriptivo y comparativo mediante la prueba de la t de Student y el test de MacNemar como prueba no paramétrica. Resultados: Entre septiembre 2008 y abril 2010 se incluyó a 49 pacientes con patología respiratoria (79,6% asma crónica, 10,2% tos crónica y 10,2% laringitis). La media de reflujos detectados por pH-metría fue de 18,3 (rango 0-93) y por MII de 39,2 (11-119) (p<0,001). El índice sintomático fue 6,7% por pH-metría y 13,9% por MII (p<0,05). El número de niños diagnosticados de RGE ácido por pH-metría fue de 7 y mediante MII se diagnosticaron 25 niños (8 ácidos, 10 alcalinos y 7 mixtos). La media de reflujos proximales detectados por MII fue de 21. Conclusiones: La MII es capaz de diagnosticar mayor número de reflujos tanto ácidos como alcalinos que la pH-metría convencional en los niños con patología respiratoria resistente al tratamiento, así como detectar reflujos proximales(AU)

Introduction: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. Patients and methods: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. Results: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. Conclusions: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes(AU)

[Comparison between conventional ph measurement and multichannel intraluminal esophageal impedance in children with respiratory disorders]. / Comparación entre pH-metría convencional e impedanciometría intraluminal multicanal en niños con patología respiratoria.

INTRODUCTION: Gastroesophageal reflux (GER) is associated with respiratory symptoms. The link between non-acid GER and the pathogenesis of respiratory disease has been demonstrated. Esophageal multichannel intraluminal impedance (MII) is able to detect non-acid and alkaline GER, as well as reflux height. The objective of the study was to compare the diagnostic effectiveness of dual-channel pH-meter and MII. PATIENTS AND METHODS: A prospective study was conducted on patients diagnosed with uncontrolled asthma, persistent cough, or chronic laryngitis. Patients were monitored continuously for 24 hours using a combination of MII and a dual-channel pH-meter. A descriptive and comparative analysis of the techniques was performed using the t test for comparison between groups and McNemar test for non-parametric data. RESULTS: A total of 49 patients with respiratory disease between September 2008 and April 2010 (79.6% uncontrolled asthma, 10.2% persistent cough, and 10.2% chronic laryngitis) were included in the study. The mean number of refluxes detected was 18.3 (range 0-93) using the pH-meter and 39.2 (11-119) using MII (P<.001). Acid GER was detected using pH in 7 children and using MII in 25 children (8 acid, 10 alkaline and 7 mixed). A mean of 21 proximal refluxes were detected using MII. CONCLUSIONS: MII makes it possible to diagnose a greater number of refluxes, whether acid or alkaline, than conventional pH measurement in children with respiratory disease that is poorly controlled with their usual treatment. MII can also detect proximal refluxes.

Evolución de la prescripción de antibióticos en un servicio de urgencias pediátricas / Evolution of the antibiotics prescription in a pediatric emergency service

Objetivo: Describir la calidad de prescripción antibiótica en un servicio de urgencias pediátrico, antes y después de la realización de dos sesiones formativas sobre el «uso racional de antibióticos». Material y métodos: Estudio descriptivo y retrospectivo de los pacientes dados de alta en urgencias durante el mes de enero de 2008, respecto a diciembre de 2008-enero de 2009. Se recogieron los datos sociodemográficos y relacionados con el diagnóstico y el tratamiento de los pacientes que recibían tratamiento antimicrobiano. Se valoró la posología y la indicación según las vías clínicas validadas de nuestro hospital. Entre ambos periodos, se impartieron dos sesiones formativas sobre el uso racional de antibióticos. Resultados: En enero de 2008 se revisaron 5.989 informes de alta, y se pautaron antibióticos al 13% de los niños. En el segundo periodo se revisaron 6.359 informes, y recibieron antibióticos un 12,7%. Los diagnósticos más frecuentes fueron la faringoamigdalitis aguda (49,6%) en el primer periodo y la otitis media (39%) en el segundo. La indicación fue correcta en el 90,7%en el primer periodo, frente al 84,7% en el segundo (p <0,01), la dosificación fue adecuada en el 79,4 frente al 86% (p <0,01), y la duración fue correcta en el 88,6% en ambos periodos. Se prescribieron más antibióticos durante el turno de noche y en días festivos. Conclusiones: El porcentaje de antibióticos prescritos es similar al de otras series. Tras las sesiones formativas sobre el manejo correcto de la antibioterapia, no ha disminuido su prescripción. Aunque se dosifica mejor, ha aumentado el porcentaje de indicación incorrecta. Serían necesarias más medidas para mejorar la calidad de prescripción antimicrobiana (AU)

Objective: To describe the quality of antibiotic prescription in the pediatric emergency service before and after two educational talks regarding “the rational use of antibiotics”. Material and methods: Descriptive, retrospective study of all the discharged patients evaluated in the emergency service during the month of January 2008 compared to December 2008 and January 2009. Demographic, social, diagnostic and treatment parameters of children who received antimicrobials treatment were analyzed. Dosage and indication were evaluated according to the validated clinical guidelines of the hospital, between both periods’ formative sessions about the rational use of antibiotics. Results: In January 2008 we reviewed 5,989 medical discharge records and found that 13% of the children had received antibiotics. We also reviewed 6,359 records from the second period and found that 12.7% of the children had received antibiotic therapy. The most frequent diagnoses were acute pharyngotonsillitis (49.6%) in the first period and acute otitis media (39%) in the second period. The indication and dosage were correct in 90.7% and 79.4% of the cases in the first period compared to 84.7% and 86% in the second period (p <0.01) respectively. The duration of therapy was correct in 88.6% of cases in both periods. Antibiotics were more frequently prescribed at the night shift and on holidays. Conclusions: The percentage of antibiotic prescription in this study is similar to that of other series and did not decrease after educational talks regarding the rational use of antibiotics. Although there was an increase in the correct dosage prescribed the percentage of incorrect antibiotic indications increased as well. Further actions should be taken to improve the quality of antibiotic prescriptions (AU)

Ictus arteriales isquémicos en niños con cardiopatías / Arterial ischaemic stroke in children with cardiac diseases

Introducción. Los ictus en la infancia han aumentado significativamente en los últimos años. Las cardiopatías constituyen uno de los factores de riesgo mejor conocidos en niños. Objetivo. Describir las características de los ictus arteriales isquémicos en niños cardiópatas, destacando los factores de riesgo específicos, la clínica inicial, la demora diagnóstica y el manejo posterior. Pacientes y métodos. Estudio retrospectivo de los pacientes con cardiopatía diagnosticados de ictus arterial isquémico en los últimos 10 años en nuestro hospital. Se analizaron: tipo de cardiopatía, posibles factores asociados, como cirugíaso cateterismos recientes, estudio de trombofilias, clínica inicial, demora y método diagnóstico, profilaxis primaria y secundaria, tratamiento administrado y evolución neurológica. Resultados. Veinte pacientes cumplieron los criterios de inclusión (edades: período neonatal a 15 años) de los cuales 18 presentaban cardiopatías congénitas. Once pacientes tenían antecedente de cirugía y/o cateterismo en el mes previo. La forma de inicio más frecuente fueron crisis convulsivas focales. El diagnóstico se retrasó más de 24 horas en el 60% de los casos. El 50% de los pacientes no recibía profilaxis primaria. Se indicó tratamiento en el 70% de los casos, aunque en ningún paciente trombólisis. Conclusiones. Es prioritario pensar en una enfermedad cerebrovascular ante cualquier síntoma neurológico agudo en un niño con cardiopatía. Se deberían establecer medidas para disminuir la demora en el diagnóstico en este tipo de pacientes, así como realizar estudios prospectivos aleatorizados para crear un protocolo de actuación uniforme en los ictus pediátricos (AU)

Introduction. The incidence of cerebral stroke in children has significantly increased in last years. Heart diseases are one of the best known risk factors in pediatric stroke. Aim. To describe the characteristics of the cerebral stroke in children with heart diseases, emphasizing in predisposing conditions, time to diagnosis, management and follow-up of patients. Patients and methods. We performed a retrospective study in children suffering from heart diseases with cerebral stroke admitted to our hospital that comprised 10 years. Type of cardiopathy, associated factors like surgery or catheterization, study of thrombophilia, clinical findings, methods and time to diagnosis, primary and secondary prophylaxis, treatment and longterm neurologic outcome were analyzed. Results. Twenty patients were included in our study (age: from neonatal period to 15 years), eighteen of them were children with congenital cardiac disease. Eleven patients had antecedent of surgery and/or catheterism in the previous month. The most common clinical presentation was focal seizures. Time from clinical onset to diagnosis of stroke was longer than 24 hours in 60% of our patients. Fifty per cent of our patients did not receive any primary prophylaxis. Treatment was initiated in 70% of patients, but no one received thrombolysis. Conclusions. It is crucial to consider stroke when children with heart diseases show any neurologic symptom. Optimal diagnostic strategies must be established to low the delay of diagnosis in these patients, as well as randomised clinical trials in order to establish uniform guidelines in pediatric stroke (AU)

[Arterial ischaemic stroke in children with cardiac diseases]. / Ictus arteriales isquémicos en niños con cardiopatías.

INTRODUCTION: The incidence of cerebral stroke in children has significantly increased in last years. Heart diseases are one of the best known risk factors in pediatric stroke. AIM. To describe the characteristics of the cerebral stroke in children with heart diseases, emphasizing in predisposing conditions, time to diagnosis, management and follow-up of patients. PATIENTS AND METHODS: We performed a retrospective study in children suffering from heart diseases with cerebral stroke admitted to our hospital that comprised 10 years. Type of cardiopathy, associated factors like surgery or catheterization, study of thrombophilia, clinical findings, methods and time to diagnosis, primary and secondary prophylaxis, treatment and long-term neurologic outcome were analyzed. RESULTS: Twenty patients were included in our study (age: from neonatal period to 15 years), eighteen of them were children with congenital cardiac disease. Eleven patients had antecedent of surgery and/or catheterism in the previous month. The most common clinical presentation was focal seizures. Time from clinical onset to diagnosis of stroke was longer than 24 hours in 60% of our patients. Fifty per cent of our patients did not receive any primary prophylaxis. Treatment was initiated in 70% of patients, but no one received thrombolysis. CONCLUSIONS: It is crucial to consider stroke when children with heart diseases show any neurologic symptom. Optimal diagnostic strategies must be established to low the delay of diagnosis in these patients, as well as randomised clinical trials in order to establish uniform guidelines in pediatric stroke.