[Nursemaid's elbow: diagnosis and treatment in emergency department]. / Pronación dolorosa: diagnóstico y manejo de urgencia.

INTRODUCTION: Painful pronation (PD), also known as "nursemaid's elbow", is a common injury caused by abrupt longitudinal traction of the hand while the forearm is pronated and the elbow extended. OBJECTIVE: to describe a sample of patients diagnosed with painful pronation and the different reduction tech niques used for this pathology. PATIENTS AND METHOD: retrospective study of patients who visited the emergency department of a referral hospital, from January 2018 to September 2019. Patients under 7 years of age consulting due to a condition compatible with PD were included. We recorded demogra phic data, sex, and age, number of previous episodes (defining recurrent as three or more episodes), affected extremity, mechanism of injury, diagnostic images, reduction maneuver used, and success obtained measured through the presence of "click" and decrease in pain. Patients who presented any sign of trauma or fractures were excluded from the study. RESULTS: 172 patients were included, 57.6% were female, and a median age of 25.5 months. The most affected side was the left one and the main mechanism was traction of the extremity, followed by a same-level fall. The hyperpronation method was effective in 66% of the cases, and the remaining 34% required a supination maneuver. CONCLUSIONS: PD is a frequent reason for consultation in pediatric patients around the age of 2 years. The hyperpronation method was the most commonly used for its management. It is important to be aware of this pathology in the context of emergency care.

SWAN-Venule: An Optimized MRI Technique to Detect the Central Vein Sign in MS Plaques.

BACKGROUND AND PURPOSE: Multiple sclerosis lesions develop around small veins that are radiologically described as the so-called central vein sign. With 7T MR imaging and magnetic susceptibility-based sequences, the central vein sign has been observed in 80%-100% of MS lesions in patients' brains. However, a lower proportion ∼50% has been reported at 3T using susceptibility-weighted angiography (SWAN). Our aim was to assess a modified version of SWAN optimized at 3T for sensitive detection of the central vein sign. MATERIALS AND METHODS: Thirty subjects with MS were scanned on a 3T clinical MR imaging system. 3D T2-weighted FLAIR and optimized 3D SWAN called SWAN-venule, were acquired after injection of a gadolinium-based contrast agent. Patients showing >3 focal white matter lesions were included. The central vein sign was recorded by 2 trained raters on SWAN-venule images in the supratentorial brain. RESULTS: Twenty patients showing >3 white matter lesions were included. A total of 380 white matter lesions (135 periventricular, 144 deep white matter, and 101 juxtacortical) seen on both FLAIR and SWAN-venule images were analyzed. Overall, the central vein sign was detected in 86% of the white matter lesions (periventricular, 89%; deep white matter, 95%; and juxtacortical, 78%). CONCLUSIONS: The SWAN-venule technique is an optimized MR imaging sequence for highly sensitive detection of the central vein sign in MS brain lesions. This work will facilitate the validation and integration of the central vein sign to increase the diagnostic certainty of MS and further prevent misdiagnosis in clinical practice.

Brain MRI findings in children and adolescents with Fabry disease.

OBJECTIVE: To evaluate the presence of white matter and hemorrhagic lesions in brain MRI of children and adolescents with Fabry disease (FD). METHODS: Brain MRI studies in 44 consecutive children and teenagers (20 boys, mean age 14.6 years, range 7-21 years) were evaluated using classic sequences as well as, GRE-weighted images, for white matter lesions (WML) and chronic microbleed detection. All patients lacked history of stroke or TIA. Brain MRI findings in 46 consecutive children and adolescents without FD, referred for the evaluation of headaches (36 females, mean age 14.1 years, range 7-21 years) were evaluated as a control group. Additionally, we assessed the clinical manifestations of FD. RESULTS: Seven children (15.9%) with FD had brain MRI evidence of asymptomatic WML (5 girls, mean age 14.8 years, range: 13-20 years) compared with 3 children (6.5%) in the control group (p = 0.01). Brain abnormalities in patients with FD revealed WML, deep gray matter and infratentorial involvement. Three patients presented two lesions each. None of the children showed microbleeds. Regarding clinical manifestations, 90.9% of the patients had signs or symptoms of FD. CONCLUSION: We identified asymptomatic white matter brain lesions in 15.9% of children with FD without clinical history of stroke. FD is a treatable disorder that should be routinely included in the differential diagnosis of both symptomatic and asymptomatic brain lesions in children and adolescents. The detection of brain lesions may foster earlier treatment.

Vía aérea fisiológicamente difícil: nuevo concepto a considerar: Caso clínico vía aérea difícil fisiológica / Physiologically difficult airway: new concept to consider: case report

Airway management in the ICU scenario is a real challenge due to instability imposed by illness severity. Some of these patients may also suffer from other diseases associated to difficult airway. Rheumatoid arthritis represents a special condition because not only can limit access to the hypopharynx, but also can hamper laryngoscopy. Among many options for difficult airway management, only a few can be safely applied to intubate the trachea while preserving physiologic stability in an emergency setting. We chose awake fiberoptic intubation as the first and safest approach for this combined difficult patient. This approach requires not only individual skills but also a plan in advance and a well coordinated team to be successful. A case is presented as an example of difficulties imposed by physiologic instability added to anatomic difficult.

El manejo de la vía aérea en la UCI representa un desafío debido a la inestabilidad derivada de la severidad de la patología. Además, algunos de estos pacientes pueden presentar condiciones preexistentes asociadas a vía aérea difícil. La artritis reumatoide representa una condición especial debido a que no sólo limita el acceso a la hipofaringe, sino que también puede dificultar la laringoscopía. Entre las diferentes opciones para manejar la vía aérea, sólo algunas pueden ser aplicadas para intubar la tráquea de manera segura y al mismo tiempo preservar la estabilidad fisiológica en un contexto de urgencia. Este abordaje requiere no sólo habilidades individuales, sino que también trabajo en equipo coordinado y planificación. Se presenta un caso como ejemplo de dificultades impuestas por la inestabilidad fisiológica agregada a dificultad anatómica.

Ventilación no invasiva en el paciente con falla respiratoria aguda / Noninvasive ventilation in acute pediatric respiratory failure

Although most cases of respiratory failure resolve with medical treatment and are self-limited, some of them may require a higher level of ventilatory support. Noninvasive ventilation (NIV) is an alternative to improve gas exchange in selected patients and may prevent intubation, the use of invasive ventilation and its associated risks. This article describes the use of noninvasive ventilation in acute respiratory pathology.

Aunque la mayoría de los casos de falla respiratoria son de evolución favorable y autolimitados algunos pueden requerir soporte ventilatorio de mayor nivel. La ventilación no invasiva (VNI) es una alternativa que mejora el intercambio gaseoso en pacientes seleccionados y puede prevenir la intubación y uso de ventilación invasiva con sus riesgos asociados. Este artículo describe el uso de la ventilación no invasiva en la patología respiratoria aguda.

Displasia cortical focal: hallazgos en imágenes de tensor de difusión

Objetivo: La displasia cortical focal (DCF) es una anomalía del desarrollo cortical. Representa una de las causas más frecuentes de epilepsia refractaria, siendo fundamental la resonancia magnética (RM) para su diagnóstico. Dada la importancia que ha cobrado la secuencia de tensor de difusión (DTI), el objetivo de este trabajo fue evaluar retrospectivamente los hallazgos en el mapa de fracción de anisotropía del DTI en pacientes con DCF. Observaciones: Se buscó retrospectivamente a pacientes con diagnóstico anatomopatológico de DCF en la base de datos de nuestro hospital. De un total de 74, se seleccionaron 8 casos con diagnóstico aislado de DCF y estudio de RM prequirúrgico con DTI. El foco de displasia se identificó en las imágenes anatómicas convencionales de la RM. Se evaluó el mapa de fracción de anisotropía (FA) y se definieron las alteraciones en la región de la DCF. Se observó una disminución de la FA en la sustancia blanca adyacente a la DCF en 7 de los 8 pacientes (87,5%). Discusión: Los hallazgos con el DTI brindan información complementaria en relación con la RM. En la mayoría de nuestros pacientes no hubo cambios de señal en la sustancia blanca en las imágenes convencionales, pero sí se identificó una disminución de la FAen el DTI. Se desconoce si esto refleja cambios estructurales o únicamente funcionales, secundarios a la lesión primaria. Creemos que el DTI puede agregar información complementaria de valor para el diagnóstico y valoración de la extensión de esta patología.

Objective: Focal cortical dysplasia (DCF) in an anomaly of cortical development. It represents one of the most frequent causes of drug resistant epilepsy and the magnetic resonance imaging (MRI) is trivial for its diagnosis. In the last years the use of diffusion tensor imaging (DTI) has increased in this kind of pathology. The purpose of this work was to evalúate retrospectively DTI findings on fractional anisotropy maps in patients with FCD. Observations: We retrospectively searched patients with confirmed anatomo-pathological diagnosis of FCD in our hospital datábase. From a total of 74, 8 patients, with isolated diagnosis of FCD and preoperative MRI with DTI, were selected. The FCD was identified in conventional anatomical MRI in all patients. Fractional anisotropy (FA) maps were evaluated and changes in the región of FCD were defined. Decreased FA was observed in white matter adjacent to the FCD, in 7 of 8 patients (87.5%). Discussion: Findings of DTI gives us complementary information to those of conventional MRI. Most of our patients showed no signal changes of white matter in conventional sequences and they presented decreased FA in DTI. We don't actually know if these DTI findings represent structural changes in white matter or just functional changes secondary to the adjacent FCD. We think DTI can give valuable complementary information for the diagnosis and determination of the extensión of this pathology.

La cinética de la citrulina y la arginina y su valor como factor pronóstico en pacientes pediátricos críticamente enfermos. Respuesta de los autores / The value of the kinetics of citrulline andarginine as a prognostic factor in critically ill paediatric patients. Author's reply

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La cinética de la citrulina y la arginina y su valor como factor pronóstico en pacientes pediátricos críticamente enfermos / Citrulline and arginine kinetics and its value as a prognostic factor in pediatric critically ill patients

INTRODUCCIÓN: Se han documentado bajas concentraciones de citrulina y arginina plasmáticas en niños en diversas condiciones patológicas. Hipótesis: La cinética de citrulina y arginina plasmáticas durante la enfermedad crítica pediátrica se correlaciona con parámetros evolutivos clínicos y bioquímicos. PACIENTES Y MÉTODOS: Estudio observacional unicéntrico prospectivo en pacientes de 7 días a 14 años ingresados en Unidad de Cuidados Intensivos Pediátricos (PICU). Los datos bioquímicos y clínicos fueron recogidos al ingreso, a las 12 h, a las 24 h, al 3.er y al 7.° día. RESULTADOS: Un total de 44 pacientes críticamente enfermos fueron incluidos y un grupo control de 51 niños sanos. La citrulina desciende de forma significativa (p < 0,05) a las 12 h de ingreso con niveles bajos mantenidos hasta el día 7, comenzando un aumento progresivo después. La arginina ya está descendida a las 6h, aunque tiene una subida más precoz (día 3). La disminución de citrulina al tercer día se correlaciona directamente con la arginina. Hay correlación entre la elevación de la citrulina al 7.° día con menor duración de ventilación mecánica, menor estancia en PICU y menos complicaciones. Los niveles de citrulina bajos al 7° día aún descendidos el día 7 se asocian con un mayor aumento de PCR y procalcitonina en primeras 24 h. La disminución de arginina en las primeras 12 h se correlaciona inversamente con estancia más larga, mayor número de complicaciones y aumento de reactantes de fase aguda en día 3. CONCLUSIONES: Hay disminución de arginina y citrulina en los primeros días de la enfermedad crítica, con recuperación al 3.er y 7.° día, respectivamente, y existe una relación entre mayor disminución y peor evolución

INTRODUCTION: Low concentrations of plasma citrulline and arginine have been reported in children under various pathological conditions. Hypothesis: Plasma citrulline and arginine levels undergo different kinetics during the early days of critical illness in children according to the severity of symptoms and can be correlated with other clinical and laboratory parameters associated with the SIR. PATIENTS AND METHODS: A single-center prospective observational study in patients 7 days to 14 years admitted to pediatric intensive care unit (PICU). Citrulline and arginine blood levels (blood in dry paper, analysis by mass spectrometry in tandem), acute phase reactants and clinical data were collected on admission, at 12 h, 24 h, 3 and 7 days. RESULTS: A total of 44 critically ill patients were included and control group was formed by 42 healthy children. The citrulline and arginine kinetic analysis showed: 1) Citrulline falls significantly (P<.05) at 12 h of admission; levels remain low until day 7 and begin progressive increase again. 2) Arginine is already lowered at 6h, although an earlier rise occurs (3rd day). 3. The decrease of citrulline in the first 3 days of admission positively correlates with arginine kinetics. Bivariate analysis showed: 1) Correlation of elevated citrulline on the 7th day with shorter duration of mechanical ventilation, lower PICU stay and lower occurrence of complications. The levels of citrulline still descended at day 7 are associated with increased CRP/procalcitonin elevation at first 24 h. 2) The greatest decrease of arginine in the first 12 h is associated with a longer PICU stay and greater number of complications and increase of acute phase reactants at 3 days. CONCLUSIONS: There are decreased levels of arginine and citrulline in the first days at PICU, with recovery at the 3rd and 7th day respectively, and a relationship between a greater decrease and a worse outcome and between a longer income and a higher serum CRP/procalcitonin

Cirugía laparoscópica de quistes adrenales: resultados de una serie de 18 pacientes / Laparoscopic surgery of adrenal cysts: results of a series of 18 patients

Introduction: Adrenal cysts have an incidence of 0.064 percent to 0.18 percent at autopsy. Aim: To show our experience in 18 patients with an adrenal cyst operated by laparoscopy. Material and Methods: The series consisted of 18 patients operated, in a series of 344 laparoscopic adrenalectomy performed between 1993 and 2011. The age range was 20 to 61 years with an average of 38 years, 11 women and 7 men. Results: Thirteen cysts were left and 5 were right sided. The lesion size varied between 4.5 and 12.5 cm, with an average of 9.2 cm. Eight patients complained of abdominal discomfort and in the remaining 12 patients there were no signs or symptoms of clinical suspicion. The surgery performed was a laparoscopic decortication-marsupialization in 11 patients, laparoscopic adrenalectomy in 8 cases and partial adrenalectomy in 1 case. Mean operative time was 83.1 minutes (30-180 minutes), and mean hospital stay was 36 hours. Intraoperative complications occurred in 2 patients: 1 diaphragm injury and one renal vein injury, repaired in the same surgery. Postoperative complications occurred in 2 patients, both Clavien 3a, treated by conservative management. Conclusion: Small and non-functional lesions require observation. Partial or total laparoscopic adrenalectomy is indicated in large lesions or in functional and suspected malignant lesions.

Introducción: Los quistes suprarrenales tienen una incidencia de 0,064 por ciento a 0,18 por ciento en autopsias. El objetivo de este trabajo es mostrar nuestra experiencia en 18 pacientes portadores de un quiste adrenal operados por vía laparoscópica. Material y Métodos: La serie está constituida por 18 pacientes, de una serie de 344 adrenalectomías laparoscópicas realizadas entre los años 1993 y 2011. El rango de edad fue de 20 a 61 años, con un promedio de 38 años, 11 mujeres y 7 hombres. Resultados: Trece quistes eran del lado izquierdo y 5 del derecho. El tamaño de la lesión varió entre 4,5 y 12,5 cm, con un promedio de 9,2 cm. En 8 pacientes hubo molestias abdominales vagas y en los restantes 12 pacientes no hubo signos ni síntomas de sospecha clínica. La cirugía realizada fue una decorticación-marsupialización laparoscópica en 11 pacientes, adrenalectomía laparoscópica en bloque en 8 casos y adrenalectomía parcial en 1 caso. El tiempo operatorio promedio fue de 83,1 min (30-180 min), y el tiempo medio de hospitalización fue de 36 h. Complicaciones intraoperatorias ocurrieron en 2 pacientes: 1 lesión de diafragma y 1 lesión de vena renal, reparadas en el mismo acto quirúrgico. Complicaciones postoperatorias ocurrieron en 2 pacientes, ambas Clavien 3a y de manejo conservador. Conclusión: Las lesiones pequeñas y no funcionantes requieren observación. La adrenalectomía laparoscópica parcial o total está indicada en lesiones de gran tamaño, con importante compromiso de la glándula o ante la sospecha de lesión funcionante o malignidad.

[A protocol for the treatment of retinopathy of prematurity in Spain]. / Protocolo de tratamiento de la retinopatía del prematuro en España.

OBJECTIVE: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. MATERIAL AND METHOD: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. RESULTS: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. CONCLUSIONS: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Protocolo de tratamiento de la retinopatía del prematuro en España / A protocol for the treatment of retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de tratamiento de la retinopatía del prematuro (ROP) consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el tratamiento de la ROP, incluyendo criterios de tratamiento, metodología de actuación, calendario de actuación y seguimiento. Conclusiones: Es importante disponer de un protocolo de actuación común en el tratamiento de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica, es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a protocol for the treatment of retinopathy of prematurity (ROP) agreed by the majority of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and up to date publications. This draft was corrected by all the ophthalmologists participating in the project, and the final document was agreed by all of them. Results: We present general guidelines as an aid for the treatment of ROP, including treatment criteria, treatment methods, a calendar of action, and follow-up. Conclusions: It is important to have a common working protocol for the treatment of ROP to improve care and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Programa de cribado para la retinopatía del prematuro en España / Screening program for retinopathy of prematurity in Spain

Objetivo: Realizar un protocolo de cribado de la retinopatía del prematuro (ROP), consensuado por la mayor parte de oftalmólogos españoles dedicados al tema. Material y método: Se realizó un borrador del protocolo según la experiencia de los participantes y las publicaciones actualizadas. Este borrador fue corregido por los participantes en el protocolo y se llegó al documento final consensuado por todos los participantes. Resultados: Se presentan las directrices generales para realizar el cribado de la ROP, incluyendo criterios de inclusión y exclusión, metodología de exploración y calendario de actuación. Conclusiones: Es importante disponer de un protocolo de actuación común en el cribado de la ROP para mejorar la actuación y evitar errores. Aunque cada centro hospitalario deba adaptar el protocolo a su actividad clínica es recomendable que existan un mínimo de procedimientos consensuados por todos los oftalmólogos dedicados a la ROP (AU)

Objective: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. Material and method: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. Results: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. Conclusions: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain (AU)

Screening program for retinopathy of prematurity in Spain.

OBJECTIVE: To prepare a retinopathy of prematurity (ROP) screening program as agreed by most of Spanish ophthalmologists dedicated to this topic. MATERIALS AND METHODS: A draft of the protocol was produced taking into account the experience of the participants and current publications. This draft was corrected by all the ophthalmologists participating in the project and the final document produced was agreed by all of them. RESULTS: We present general guidelines to help in the screening of ROP, including treatment criteria, treatment methods, and a calendar of action. CONCLUSIONS: It is important to have a common working protocol in the screening of ROP to improve the action and to avoid mistakes. Although individual Hospitals may adapt the protocol to their daily activity, it is recommended that there is a minimal working protocol agreed by most of professionals dedicated to pediatric ophthalmology in Spain.

Asma agudo severo en niños: ¿fenotipo diferente? / Severe asthma in children: a different phenotype?

Background: The magnitude of response to treatment of asthma exacerbations is variable and a significant proportion of them need hospitalization. Objectives: to define the profile of children that were hospitalized for severe asthma and the possible indicators and determinants of their poor responsiveness. Methods: a prospective study in 60 children 4 years or more of age with a search of the ethiology of the exacerbation and a study of the inflammatory profile in sputum. Results: 60 children between 4 and 15 years. 50 percent had a previous diagnosis of asthma without regular use of inhaled corticosteroids in two thirds. 40 percent had previous admissions for asthma. Etiology of the exacerbation was identified in 52 percent with Rhinovirus, human Metapneumovirus, RSV and Mycoplasma pneumoniae as the most frequent agents. Inflammatory profile was determined in 33 children: eosinophilic in 36 percent, eosinophilic/ neutrophilic in 64 percent. Conclusions: Severe asthma with serious exacerbations may be a phenotype whose outstanding aspects in this cohort were: previous hospitalizations, lack of prophylactic treatment, viral infections as frequent trigger, and combined inflammatory cell profile in sputum.

La magnitud de la respuesta al tratamiento de una exacerbación de asma es variable entre los pacientes y una proporción significativa de ellos debe hospitalizarse. Objetivos: Definir el perfil de los niños que se hospitalizaron por asma grave y los posibles indicadores y determinantes de la respuesta desfavorable al tratamiento. Método: Estudio prospectivo en niños de 4 años o más, con búsqueda etiológica de la exacerbación y estudio de perfil inflamatorio en esputo. Resultados: 60 niños entre 4 y 15 años. El 50 por ciento tenía diagnóstico previo de asma sin uso regular de corticoesteroides inhalados en dos tercios. Hospitalizaciones previas por asma en el 40 por ciento. La etiología de la exacerbación fue identificada en el 52 por ciento siendo los agentes más frecuentes Rhinovirus, Metapneumovius, VRS y Mycoplasma pneumoniae. El perfil inflamatorio fue determinado en 33 niños: eosinofílico en 36 por ciento y eosinoflico/neutroflico en 64 por ciento. Comentario: El asma severa con exacerbaciones graves sería un fenotipo cuyos aspectos destacados en esta cohorte serían: niños con hospitalizaciones previas, falta de tratamiento profiláctico, infección viral como desencadenante frecuente, patrón inflamatorio combinado del esputo y rinitis atópica.

Diseño de una base de datos informatizada para la gestión clínica y básica del melanoma uveal / Design of computerised database for clinical and basic management of uveal melanoma

Propósito: El melanoma uveal es el tumor intraocular primario más frecuente en la edad adulta. El objetivo de este trabajo es mostrar cómo se ha construido una base de datos informatizada con aplicaciones, tanto clínicas como de investigación concretas, a un grupo extenso de pacientes diagnosticados de melanoma de la úvea. Métodos: Para el diseño de la base de datos se realizó una selección de categorías, atributos y valores basándose en las clasificaciones y parámetros dados por diferentes autores en artículos que han tenido gran relevancia en el campo del melanoma uveal en los últimos años. Resultados: La base de datos cuenta en la actualidad con más de 250 registros de pacientes, con información específica sobre su clínica, diagnóstico, tratamiento y evolución. Nos permite realizar búsquedas sobre cualquier parámetro del registro y hacer estudios estadísticos de estos de una forma rápida y sencilla. Conclusión: Los modelos de bases de datos se han convertido en un arma fundamental para la práctica clínica, pues constituyen una forma eficaz tanto de almacenamiento como de recopilación y búsqueda selectiva de información. A la hora de realizar una base de datos es muy importante la definición de una estrategia común y el uso de un idioma normalizado (AU)

Purpose: The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma. Method: For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years. Results: The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them. Conclusion: The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language (AU)

[Design of computerised database for clinical and basic management of uveal melanoma]. / Diseño de una base de datos informatizada para la gestión clínica y básica del melanoma uveal.

PURPOSE: The uveal melanoma is the most common primary intraocular tumour in adults. The objective of this work is to show how a computerised database has been formed with specific applications, for clinical and research use, to an extensive group of patients diagnosed with uveal melanoma. METHOD: For the design of the database a selection of categories, attributes and values was created based on the classifications and parameters given by various authors of articles which have had great relevance in the field of uveal melanoma in recent years. RESULTS: The database has over 250 patient entries with specific information on their clinical history, diagnosis, treatment and progress. It enables us to search any parameter of the entry and make quick and simple statistical studies of them. CONCLUSION: The database models have been transformed into a basic tool for clinical practice, as they are an efficient way of storing, compiling and selective searching of information. When creating a database it is very important to define a common strategy and the use of a standard language.

[Kawasaki disease: a clinical serie]. / Enfermedad de Kawasaki: una serie clínica.

INTRODUCTION: Kawasaki disease (KD) is a serious disease in children due to its potential complications and sequelae if not promptly and adequately managed. OBJECTIVES: To describe clinical and epidemiological characteristics of children hospitalized due to KD at a tertiary care center and identify risk factors for poor outcome. PATIENTS AND METHODS: Retrospective and descriptive study of 32 medical records of patients hospitalized with diagnosis of KD at a tertiary care center of Santiago, Chile between February 1999 and May 2007. RESULTS: The annual frequency was of 5 cases, mainly boys and during spring. The median age at diagnosis was 1.5 years and 87.5% of the children were younger than 5 years. Typical presentation prevailed in all ages (68,7%). Coronary artery affection, including dilatation or aneurisms, occurred in 21.9% of the cases, with aneurysms in 3 cases. All patients were treated with aspirin and intravenous immunoglobulin (IVIG); 4 patients required a second dose. No deaths were reported. The identified risk factors for poor outcome were age older than 5 years and hypoalbuminemia. CONCLUSIONS: KD is an infrequent disease that mainly occurs in children younger than 5 years and with a typical presentation. There are risk factors associated with poor outcome.

Enfermedad de Kawasaki: una serie clínica / Kawasaki disease: a clinical serie

Introduction: Kawasaki disease (KD) is a serious disease in children due to its potential complications and sequelae if not promptly and adequately managed. Objectives: To describe clinical and epidemiological characteristics of children hospitalized due to KD at a tertiary care center and identify risk factors for poor outcome. Patients and Methods: Retrospective and descriptive study of 32 medical records of patients hospitalized with diagnosis of KD at a tertiary care center of Santiago, Chile between February 1999 and May 2007. Results: The annual frequency was of 5 cases, mainly boys and during spring. The median age at diagnosis was 1.5 years and 87.5 percent of the children were younger than 5 years. Typical presentation prevailed in all ages (68,7 percent). Coronary artery affection, including dilatation or aneurisms, occurred in 21.9 percent of the cases, with aneurysms in 3 cases. All patients were treated with aspirin and intravenous immunoglobulin (IVIG); 4 patients required a second dose. No deaths were reported. The identified risk factors for poor outcome were age older than 5 years and hypoalbumin-emia. Conclusions: KD is an infrequent disease that mainly occurs in children younger than 5 years and with a typical presentation. There are risk factors associated with poor outcome.

Introducción: La enfermedad de Kawasaki (EK) es una afección grave en pediatría, por sus eventuales complicaciones y secuelas si no es tratada adecuada y precozmente. Objetivos: Describir el perfil clínico-epidemiológico de los niños hospitalizados en una clínica de la Región Metropolitana e identificar factores de riesgo para evolución desfavorable. Pacientes y Métodos: Estudio descriptivo, retrospectivo, de 32 pacientes hospitalizados en la Clínica Santa María con diagnóstico de egreso de EK entre febrero de 1999 y mayo de 2007. Resultados: La frecuencia anual fue de 5 casos, con predominio en primavera y en el sexo masculino. La mediana para la edad fue de 1,5 años, 87,5 por ciento tenían menos de 5 años. Predominó la presentación típica (68,7 por ciento). Hubo dilatación y/o aneurisma de arterias coronarias en 21,9 por ciento, con 3 casos de aneurismas. El tratamiento se realizó con inmunoglobulina intravenosa (IGIV) y ácido acetilsalicílico. Cuatro pacientes requirieron una segunda dosis de IGIV. No hubo fallecidos. Como factores de riesgo para mala evolución se encontraron la edad de presentación sobre 5 años y la hipoalbuminemia. Conclusiones: La EK es una patología poco frecuente, predominante en niños bajo 5 años de edad y con presentación típica. Sugieren evolución de mayor gravedad la presentación sobre los 5 años y la hipoalbuminemia a cualquier edad.