[The diagnostic value of echography in appendicitis in children]
Galindo Gallego M. Calleja Lopez S. Nieto MA. Fadrique Fernandez B. Gonzalez Fernandez AM. Manzanares Sacristan J.
Servicio de Cirugia General, Hospital General de Segovia.
OBJECTIVE: The purpose of this study was to analyze the possible usefulness of ultrasonography for the diagnosis of acute appendicitis in children and to compare this technique with the clinical signs classically employed in the evaluation of pain in the right lower quadrant (RLQ) in the emergency ward. PATIENTS AND METHODS: We prospectively analyzed 112 patients younger than 14 years with suspected appendicitis. After a careful clinical record and physical and complementary studies were performed, we performed a ultrasonography of the RLQ on all patients a tubular, non-mobile, non-compressible image with a target image measuring 6 mm or more on the cut section was considered suggestive of appendicitis. After the initial clinical-radiological evaluation, the patients were either operated or included in a follow-up group. None of them were dismissed. The confirmation of the diagnosis of appendicitis was histological. RESULTS: Only 4 of the 14 factors analyzed showed a significant association with acute appendicitis (leukocytosis, left shift, abdominal RX film suggesting inflammation in the RLQ and ultrasonography positive for appendicitis), with ultrasonography being the technique with the highest diagnostic reliability (77.7% sensitivity and 94.8% specificity). The age of the patients with appendicitis was significantly lower than that of the patients without appendicitis. Nevertheless, we did not find any relationship between advanced appendicitis and factors such as age or time of evolution. CONCLUSIONS: After a clinical-ultrasonography evaluation, our negative appendectomy rate was 7% and the perforation/gangrenous appendicitis rate was 29%. We conclude that ultrasonography performed by trained professionals is a useful tool in the differential diagnosis of appendicitis in children.
[Conservative treatment of neurogenic fecal incontinence. Our experience with children]
Fernandez Eire P. Varela Cives R. Castro Gago M.
Servicio de Cirugia Pediatrica, Hospital General de Galicia, Santiago de Compostela.
OBJECTIVE: The objective of this study was to present the use of retrograde colon enema in myelodysplasic patients with fecal incontinence. PATIENTS AND METHODS: Thirty-three patients, 16 males and 19 females, 5 to 22 years old (average age 11.9 years) with spina bifida and fecal incontinence which obliged them to use a diaper. Retrograde colon enema procedures were performed in all of them. RESULTS: With the use of the retrograde enema the best rectal emptying was achieved and kept 32 children (97%) diaper free after a follow-up period of more than two years. Only one girl (3%) needed pads because she was not able to defecate in an appropriate place after administering the enema. CONCLUSIONS: The retrograde enema is the best conservative treatment for children with neurogenic fecal incontinence. This method achieves good rectal emptying allowing the children to be diaper free, resulting in better social adaptation and integration.
[Effect of nucleotides as dietary supplement on diarrhea in healthy infants]
Lama More RA. Gil-Alberdi Gonzalez B.
Servicio de Gastroenterologia Infantil, Hospital Universitario La Paz, Madrid.
OBJECTIVE: The objective of this study was to evaluate the effect of nucleotide supplements on the incidence, duration and severity of diarrhea in healthy infants. PATIENTS AND METHODS: A total of 3,243 cases were studied. This was an observational cohort study with a 1:1 ratio between infants receiving a nucleotide supplemented/unsupplemented diet. From the start of the study until the infant reached 6 months of age, the infant's mother recorded the duration and severity of each episode of diarrhea. The infant's height and weight were measured at the beginning and at the end of the follow-up period and the nutritional index (NI) was calculated [NI = (actual weight/actual height)/(ideal weight/ideal height)/100]. Data collection was performed during the months of June through December 1996 at 340 pediatric clinics distributed throughout Spain. RESULTS: The study groups were found to be homogeneous and there were no significant differences in age, gender, duration of follow-up, referring pediatric offices, number of siblings, usual residence, habitat or nursery attendance. The incidence of diarrhea was significantly lower (p < 0.001) in the nucleotide supplemented group (11.1%) versus the unsupplemented group (17.4%). Similarly, both the maximum duration of diarrhea (p < 0.05) and the severity of episodes of diarrhea (p < 0.001) were significantly lower in the nucleotide supplemented group. No significant differences were found between the initial and final nutritional indexes within a group nor when comparing the two groups. CONCLUSIONS: Nucleotide supplemented starter formulas reduce the incidence, duration and severity of diarrhea in healthy infants, but weight and height were not affected.
[The value of C-reactive protein in the diagnosis of acute appendicitis in children]
Calvo Rigual F. Sendra Esteve S. Mialaret Lahiguera A. Montagud Beltran E. Llanes Domingo S. Medrano Gonzalez J.
Servicio de Pediatria, Hospital Lluis Alcanyis, Valencia.
OBJECTIVE: The aim of this study was to evaluate the usefulness of C-reactive protein values in the diagnosis of acute appendicitis, either as a single test or in combination with total white cell count. PATIENTS AND METHODS: Two hundred and thirty-one children with suspected appendicitis were analyzed. C-reactive protein and total white cell counts were measured and compared with the duration of symptoms and histological diagnosis. Both tests were compared by receiver-operating characteristic curves and the probability for the use of both tests together was calculated. RESULTS: Ninety out of 231 patients had abdominal pain that did not demand surgery. One hundred and forty-one children had histologically confirmed appendicitis (subgroups: 101 acute, 25 gangrenous and 15 perforated appendices). Mean C-reactive protein levels at admission were 25.1, 55 and 66.7 mg/L, respectively in these histological subgroups and 14.9 mg/L in the non-appendicitis group (p < 0.001). The total white cell count was also statistically significant. Both tests were equally valuable in patients whose symptoms had a duration of more than 12 hours. The total white cell count was more valuable in patients with less than 12 hours of symptoms. The likelihood ratio for appendicitis was 2.72 for a C-reactive protein greater than 20 mg/l and a total white cell count above 15,000/mm3. The likelihood ratio of not having appendicitis was 0.37 when both tests were below these values. CONCLUSIONS: Measurement of C-reactive protein is useful in the diagnosis of acute appendicitis, mainly in cases with more than 12 hours of evolution. The combined tests improved the predictive values.
[Quadrivalent vaccine against diphtheria, tetanus, B. pertussis and hepatitis B: experience in Spain]
Gonzalez Lopez A. Aristegui Fernandez J. Diez-Delgado J. Dal-Re Saavedra R.
Departmento Medico, SmithKline Beecham Pharmaceuticals, Madrid, Espana.
OBJECTIVE: The objective of this study was to perform a pooled analysis of the immunogenicity and reactivity results obtained in 2 trials carried out in Spain with a combined DTP-HB vaccine. PATIENTS AND METHODS: Vaccine was administered according to one of two existing vaccination schedules: 2-4-6 and 3-5-7 months of age. Blood samples for antibody determination were obtained 3-6 weeks after the third dose. Anti-diphtheria, anti-tetanus and anti- B. pertussis antibodies were measured by ELISA and anti-HB by radioimmunoassay. Local and general signs and symptoms were recorded by the parents on diary cards for a 4-day follow-up period after each vaccination. RESULTS: A total of 231 infants received three doses of DTP-HB vaccine. All of these doses were accompanied by the corresponding diary card (693 data points for the evaluation of reactogenicity). Two-hundred and nineteen subjects ere included in the analysis of immunogenicity. After the full vaccination course, all subjects had sero-protective titers against diphtheria, tetanus and hepatitis B and were sero-positive of B. pertussis. Geometric mean titers of anti-HB antibodies was 1986 mIU/ml. Pain at the injection site (64%) and unusual crying (71.5%) were the most frequently reported local and general symptoms, respectively. Fever (rectal temperature > or = 38 degrees C) was reported after 46% of the doses, but was considered as severe (> 39.5 degrees C) only in 5 cases. CONCLUSIONS: These results show that this combined DTP-HB vaccine induced a strong immune response to all vaccine components. The safety profile of this DTP-HB is similar to that of classical DTP vaccines.