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A Palomeque Rico

Publications and source records attributed to A Palomeque Rico.

At least 19 recordsLinked to original sources
PubMed2006

[Pediatric acute spinal cord injury].

INTRODUCTION: Pediatric acute spinal cord injury is rare but is often associated with significant disability and prolonged stay in the intensive care unit (ICU). OBJECTIVES: The main objective of this study was to determine the epidemiology, initial clinical abnormalities, diagnostic studies, treatment and outcome of acute spinal cord injuries in a tertiary level pediatric hospital. A second objective was to analyze whether early tracheostomy allows earlier discharge of these patients. PATIENTS AND METHODS: A retrospective analysis of patients with acute spinal cord injuries admitted to our pediatric ICU since 1992 was performed. RESULTS: We included 16 patients in the study, 12 of whom were boys (75 %). The patients were aged from birth to 19 years on admission to the ICU. The length of stay in the ICU was between 12 hours and 6 years. The cause of the lesion was birth trauma in four patients; one died and the remaining three live at home under mechanical ventilation. Traumatic injuries occurred in seven patients, two of whom died; a further two live in a long-term care facility and the remaining three live at home. Vascular spinal malformation occurred in two patients, and the three remaining injuries occurred during the acute postoperative period following spinal surgery. Of the 16 children, 56.2 % were tracheostomized and 83 % of the survivors live at home. CONCLUSIONS: Early tracheostomy, the availability of invasive ventilation for home use and parent education permit earlier discharge of these patients and allow more of them to live at home.

Acute Disease↗
PubMed2005

[Non-invasive ventilation in neonates with Ondine syndrome: a real indication?].

Ondine's syndrome is a congenital central hypoventilation syndrome due to a disorder in the autonomic control of breathing in the absence of any primary disease that would explain it. Noninvasive ventilation (NIV) has been reported to be effective in the management of these patients, thus avoiding the need for tracheotomy for prolonged mechanical ventilation. We describe our experience of NIV in infants with Ondine's syndrome. Two infants with Ondine's syndrome were transferred to our center for management and adjustment of therapy. On admission NIV (BiPAP VISION) was started with nasal interphase in S/T (spontaneous/timed) mode, which failed to provide suitable ventilation (PCO2 > 70 mmHg). Finally, tracheotomy for continuous mechanical ventilation was performed. Although NIV has been reported to be successful in some patients with Ondine's syndrome, its application in patients younger than 5 years does not seem to be the general norm of treatment.

Female↗
PubMed2003

[Coronary ischemia secondary to congenital anomaly of the left coronary artery].

Coronary artery anomalies constitute 2.2 % of congenital malformations of the heart. The most common abnormality is anomalous origin of the left coronary artery from the pulmonary trunk, also known as Bland-White-Garland syndrome. Clinical manifestations are due to myocardial ischemia caused by the creation of an arteriovenous shunt. The childhood type of this anomaly presents high mortality from heart failure. The adult type develops myocardial infarction, arrhythmias, sudden cardiac death or signs of congestive heart failure. Surgical repair is essential. Various surgical approaches are available and the treatment of choice is direct left coronary artery reimplantation in the aorta. An alternative technique is to create an aortopulmonary tunnel (Takeuchi technique). Marked improvement is usually observed after surgical repair. We report two cases of myocardial ischemia due to coronary anomalies.

Adolescent↗
PubMed2002

[Postraumatic lesion of the carotid artery].

Postraumatic lesions of the carotid artery are very unusual in the general population and are especially rare in children due to the elasticity of their vessels. Because clinical expression of these lesions is mild, diagnosis can be delayed until the development of neurological signs, which are frequently irreversible. Neurological signs can be those of Horner's syndrome, drop attack, headache, vertigo, visual disorders, aphasia or transitory ischemic accidents. Carotid arterial lesion should be ruled out when the patient shows injuries in the soft tissue of the neck, when the neurological examination is incompatible with the findings of computed tomography (CT), when late neurological deficits develop or when the patient has Horner's syndrome. The patient reported herein presented partial motor seizures and hemiplegia 3 days after trauma. The most sensitive diagnostic test is angiography. Because this technique is aggressive, it is performed when suspicion is based on the results of Doppler sonography, CT or angiomagnetic resonance imaging. Treatment must be individualized. Standard therapy is anticoagulation but when this is contraindicated or the patient is asymptomatic anti-aggregating drugs are used. Thrombolytic treatment is reserved for the first few hours after injury. Surgical repair is the treatment of choice in patients with pseudoaneurysm. Because inaccessibility is one of the major difficulties in this type of surgery, intravascular stents can be a good therapeutic alternative in lesions unresponsive to medical treatment.

Accidents, Traffic↗
PubMed2002

[End-of-life decision-making in critical care].

Introduction Termination of artificial life-support in critically-ill patients without chance of recovery or with severe damage is frequent in the intensive care unit (UCI). Patients and methodsWe studied the present situation concerning the withdrawal of life support in Spain using data collected over 10 years in referral hospitals with pediatric ICUs. Forty-nine patients were included, of which 43 had chronic diseases.ResultsThe most frequent causes of admission to the pediatric ICU in this type of patiens was respiratory failure followed by cardiovascular surgery. The family seemed to be a key element when taking a decision although in a few cases the medical team acted paternalistically. The most common ways of limiting life-support were withholding or withdrawing some treatments (mainly mechanical ventilation and vasoactive drugs) and implementing do-not-resuscitate orders. Sedation and suitable pain management were widely used in terminal care. After the decision to limit life-support was made, six patients were discharged from the pediatric ICU. ConclusionsAlthough each case should be treated individually, because of the wide variation found in the limitation of life-support, we suggest the need for common guidelines that could help the decision-making process.

Critical Care↗
PubMed1999

[Moyamoya disease. A cause of vascular occlusion in childhood].

OBJECTIVE: The objective of this study was to review the cases of Moya-Moya diagnosed in our center. PATIENTS AND METHODS: We reviewed the Moya-Moya cases diagnosed from 1979 to 1997. We evaluated the following elements: age of clinical onset, sex, clinical features, complementary examinations, neuroimage, treatment and follow-up. RESULTS: Six patients were diagnosed. The first case appeared in 1979 and the last in 1997. These included four boys and 2 girls, with ages between 5 months and 14 years. The initial clinical feature in all six cases was acute hemiparesis, noting that in one case this was preceded by homolateral seizures. Neuroimaging revealed ischaemic infarction areas in brain CT or MNR. The diagnosis was based on angiography, where in four cases there appeared bilateral occlusion of the internal carotid, or of the anterior or middle cerebral arteries and in the other two there was a unilateral occlusion of the interior carotid and middle cerebral arteries. Regarding etiology, in four patients the dysfunction was due to either fibromuscular dysplasia of the carotid, neurofibromatosis, cranial trauma or to Down's syndrome. In the other two cases no other primary cause was found. CONCLUSIONS: Acute stroke is an infrequent disease of pediatric age patients, however it is necessary to do a thorough angiography study to rule out the Moya-Moya like vascular anomalies.

Adolescent↗
PubMed1999

[Non-traumatic cerebral hemorrhage in childhood: etiology, clinical manifestations and management].

OBJECTIVE: Non-traumatic intracranial hemorrhage is a rare occurrence in children, with the most frequent etiology being vascular malformation. Our aim was to review the etiology and management of spontaneous cerebral hemorrhage in children. PATIENTS AND METHODS: We have reviewed the patients admitted to our intensive care unit (ICU) with spontaneous intracranial hemorrhage from 1980 to 1998. The etiology, symptoms and their clinical management were analyzed. RESULTS: Forty patients with non-traumatic intracranial hemorrhage were admitted during this time period. The mean age was 6.8 years and the male/female ratio was 2.4/1. This condition presented with a sudden onset in 83%. The most common form of presentation was headache, vomiting and altered consciousness. The most frequent etiology was vascular malformation (32.2%). Initial management was symptomatic and addressed the prevention or treatment of intracranial hypertension and seizures. Mortality was 38% and there were sequelae in 35%. CONCLUSIONS: Management of critical non-traumatic intracranial hemorrhage consists in preventing or treating cerebral hypertension. The monitoring of intracranial pressure, jugular oxygen saturation and transcranial Doppler allows an indirect measurement of cerebral blood flow. Prompt excision of the hematoma improves the outcome. In vascular malformations, endovascular embolization or radiosurgery are possible.

Adolescent↗
PubMed1998

[Complications of cerebrospinal fluid shunt].

OBJECTIVE: The objective of this study was to know the incidence, mode of presentation, clinical and microbiological aspects, as well as the management of ventriculo-peritoneal shunt malfunction. PATIENTS AND METHODS: A retrospective study was carried out where thirty-seven children with malfunctioning shunts were studied. The mechanical causes of shunt malfunction included disconnection, fracture and obstruction, while infection was considered as either a clinical or analytical change (blood and/or CSF). RESULTS: The mean age of the patients was 5.5 years. The most common indication for the insertion of the ventriculoperitoneal shunt was congenital hydrocephalus. The average stay in the ICU was 8.2 days. Mechanical dysfunction was detected in 25 patients (68%) and infectious etiology in 12. The most common clinical manifestations were vomiting, fever and headache. CSF biochemical alteration was found in 8 of the infected group. Staphylococcus was isolated in six of the 8 cases. The ventriculoperitoneal shunt was changed during the first 24 hours in 17 of 25 patients (68%) with mechanical malfunction, while 11 cases with an infective cause (92%) were managed with an external shunt. The interval between the insertion of the ventriculoperitoneal shunt and the malfunction was over 6 months in 20 cases (54%). CONCLUSIONS: Ventriculoperitoneal shunts are the main method for treating hydrocephaly, although they are not without complications which may require surgical procedures. Appropriate surgical technique, asepsis, as well as prophylactic antibiotics are essential to decrease the incidence of complications.

Cerebrospinal Fluid Shunts↗
PubMed1997

[Epidural hematoma in children. Prognostic factors. Analysis of 70 cases].

OBJECTIVE: The aim of this study was to analyze the causes of epidural hematoma in order to know its incidence in craneoencephalic trauma and establish prognostic criteria. PATIENTS AND METHODS: A retrospective study of 70 children with the diagnosis of epidural hematoma between 1990 and 1995 were studied. Clinical, radiological, chronologic variables and evolution were analyzed. RESULTS: The diagnosis was made during the first 4 years in 63% of the cases. Neurologic impairment was present at admission in only 33% of the patients. Ages ranged between 7 days and 17 years (mean age: 8 years). Of these patients, 82% were admitted to the PICU, 53% were ventilated and 19% needed ICP monitorization. Radiological findings on the first CT were skull fracture (68%) and temporoparietal epidural hematoma (66%), right-sided (63%). Other kinds of lesions were also recorded in the first and subsequent CTs. Three patients died, 63% recovered fully, 10% had serious sequelae and 23% had some degree of neurodisability. CONCLUSIONS: The following data correlated with death or neurological impairment: Multiple cerebral contusion (p = 0.002), brain edema (p = 0.05), GCS less than 8 on admission (p = 0.002), and shock (p = 0.003). On the other hand, neither surgical drainage volume, age, location of the hematoma, nor ICP values correlated with a poor prognosis.

Child↗
PubMed1993

[Guillain-Barre syndrome: a study of 13 children].

A group of 13 children, aged 2 to 14 years, and diagnosed with Guillain-Barré syndrome has been analyzed. Clinical features and outcome were retrospectively studied. In 75% of the patients there was an infectious illness previous to the neurologic symptoms and in four children the etiologic agent was demonstrated. Motor deficits affecting the limbs and muscle stretch reflexes were absent in all thirteen patients. Cranial nerve involvement showed-up in 46%. Meningitic symptoms occurred in 62% of the cases. One of the children developed the Fisher syndrome variant. Two patients required assisted ventilation. Three children showed associated immunologic abnormalities, with one of the patients having a selective IgA deficiency, another child showing an increment in IgE and the other Kawasaki syndrome. We have not demonstrated differences in the outcome between the patients with corticoid treatment.

Adolescent↗