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S Mintegui Raso

Publications and source records attributed to S Mintegui Raso.

At least 19 recordsLinked to original sources
PubMed2003

[Diagnostic yield of abdominal ultrasonography in acute appendicitis].

INTRODUCTION: Acute appendicitis (AA) is the first cause of surgical abdomen in childhood but diagnosis continues to be difficult in some cases. Abdominal ultrasonography has been shown to be useful when there is doubt about the diagnosis and can be quickly and easily performed at the patient's bedside. OBJECTIVE: To evaluate the efficacy of abdominal ultrasonography in the diagnosis of acute appendicitis in our hospital. PATIENTS AND METHODS: All patients who visited the emergency department for abdominal pain and who underwent abdominal ultrasonography to rule out AA between January 1, 1999 and December 31, 2000 were retrospectively studied. RESULTS: During the study period, 4217 children were evaluated in our service for abdominal pain. Ultrasonography was performed in 528 children. Of these, the procedure was performed to rule out AA in 308 patients. Of these 308 patients who met the study's inclusion criteria, the results of ultrasonography were compatible with AA in 102 and were normal in 196. Ultrasonographic diagnosis differed from the final diagnosis in 16 patients. In eight children with ultrasonographic findings suggestive of AA, laparotomy revealed normal appendices. In the remaining eight patients, ultrasonographic findings were normal and surgery revealed AA. Based on these findings, the diagnostic yield of abdominal ultrasonography was: sensitivity: 96.6 %; specificity: 95.9 %, positive predictive value: 86 %; negative predictive value: 95.9 %. CONCLUSIONS: The overall diagnostic yield of abdominal ultrasonography in AA our hospital is acceptable. Because ultrasonographic diagnosis is not always accurate, others diagnostic methods such as computed tomography should be used in doubtful cases.

Acute Disease↗
PubMed2002

[Emergency department visits for poisoning: epidemiological changes in the last 10 years].

OBJECTIVE: To study the epidemiological changes observed in pediatric poisonings treated in our Emergency Department between 1988 and 1999. PATIENTS AND METHODS: Descriptive, observational study performed in three 12-month periods (1988, 1993 and 1999). The circumstances surrounding the visit, treatment in the Emergency Department and clinical evolution were registered. RESULTS: Consultations for possible poisoning decreased between 1988 and 1999 (279 vs. 161, p 0). This decrease was noted both in poisonings caused by household products (91 vs. 48, -47 %) and those caused by drugs (112 vs. 87, -22 %). Antipyretics caused one-third of drug poisonings and psychotropics caused approximately 11 %. The most commonly implicated agent is currently paracetamol. Caustic alkali were the most common household products causing poisoning although the number of such poisonings decreased (48 episodes in 1988 and 18 in 1999). Hydrocarbons were the second most frequent cause of household product poisoning (12-16/year). Most episodes occurred at home. The poison, mainly household products, was kept in a container other than the original in nearly 5 % of episodes in 1988 and in 13.7 % in 1999. The number of children receiving treatment in the Emergency Department decreased between 1988 and 1993 and remained stable between 1993 and 1999 (62 % in 1988 and approximately 35 % in 1993 and 1999; p 0.000003). The number of admissions also decreased from 17 children in 1989 (6.0 %) to six in 1999 (3.7 %, p 0.39). No deaths were recorded. CONCLUSIONS: In the last ten years, visits for possible episodes of pediatric poisoning have decreased, mainly those due to mild poisoning caused by household products. Paracetamol has replaced acetyl-salicylic acid as the most frequently implicated drug.

Child, Preschool↗
PubMed2000

[Use of a hospital pediatric emergency department during the night].

OBJECTIVE: To determine the characteristics of children younger than 14 years visiting our pediatric emergency department between 0:00 and 8:00 hours. PATIENTS AND METHODS: Retrospective review of 300 children visiting our emergency department at night. RESULTS: Between March 1 and 22 1999 we recorded 300 episodes from 0:00-8:00 hours (1.7 patients/hour) and 2350 episodes from 8:00-24:00 hours (6. 6 patients/hour). Of the 300 episodes registered at night, 132 children (44%) came between 0:00 and 2:00. The most common complaints were: respiratory symptoms in 116 patients (38.6%), fever in 61 (20.3%) and digestive symptoms in 61 (20.3%). We carried out at least one complementary test in 111 patients (37.0%). Five children (1.7%) were admitted to the hospital (80 between 8:00 and 24:00, 3.4%, p = 0.15) and 25 (8.3%) were admitted for a few hours to the observation ward (123 of the 2350 who came between 8:00 and 24:00, 5.2%, p = 0.06). Final diagnoses were: ear nose and throat infection in 91 (30.3%), fever without source in 38 (12.6%), asthma in 29 (9.6%), acute gastroenteritis in 27 (9%), croup in 22 (7.3%), vomiting in 14 (4.6%), abdominal pain in 13 (4.3%), febrile convulsion in 6 (2%), pneumonia in 5 (1.6%), bronchiolitis in 5 (1. 6%), bacteremia in 1 (0.3%), and other diagnoses in 46 (16.3%). CONCLUSIONS: The number of visits to our emergency department diminished at night, particularly between 0:00 and 2:00. The night-time admission rate was less than the daytime rate, although this difference was not statistically significant. Admission for a few hours to the observation ward was more common at night. The percentage of patients with respiratory illnesses was higher during the night.

Child↗
PubMed2000

[Children's unscheduled return visits to an emergency department].

OBJECTIVE: To study the patients who make unscheduled return vi-sits in less than week to a pediatric emergency department (ED). PATIENTS AND METHOD: Retrospective review of 495 episodes in 233 children who were attended at our ED in November 1999. RESULTS: In November 1999, we registered 3667 episodes at our ED (495 corresponding to 233 children who made repeat visits, 13.4%). The most common chief complaints among children who revisited were fever and respiratory symptoms. The most common diagnoses were fever with-out apparent source, ORL infections, asthma and acute gastro-enteritis. The diagnoses made at the initial and fi-nal visits were the same in 131 cases (56.2%), a complication was detected in 18 (7.7%) and 84 (36.1%) were given a different diagnosis. The percentage of patients who received a symptomatic diagnosis was lower in the final visit. The admission rate of children who revisited was higher than that of children who visited our ED once (6.4% vs. 3.0%, p = 0.009), caused by the group of patients who received a different diagnosis when they revisited our ED. CONCLUSIONS: Patients who revisit a pediatric ED within a week are more likely to be admitted to the hospital, especially if the diagnosis they receive varies.

Child↗
PubMed2000

[Efficacy of early administration of nebulized ipratropium bromide in children with asthmatic crisis].

AIM: To determine the efficacy of adding ipratropium bromide to nebulized salbutamol in the treatment of children with moderate-to-severe acute asthma attacks. METHODS: A total of 102 patients aged between 5 months and 16 years were included in a double-blind randomized trial. All patients were given nebulized salbutamol (0.2 mg/kg) and oral steroids (1 mg/kg). Patients in group A received two doses of nebulized ipratropium bromide (250 mg per dose) and patients in group B were given placebo. Oxygen saturation (SaO2) and a clinical score (heart rate, respiratory rate, dyspnea, retraction of the intercostal spaces, and wheezing) rated from 0 to 5 were measured before treatment and at 120 min. RESULTS: Patients in both groups showed similar SaO2 values and clinical scores at baseline (group A, 93.05% and 4.45; group B, 92.78% and 4.43) and at 120 min (group A, 94.33% and 2.45; group B, 94.03% and 2.74), but the percentage of patients admitted to the hospital was higher in group B than in group A (53% vs 35%, p = 0.07). In the subset of patients with the most severe attacks (baseline score 5), the clinical score after treatment and the percentage of admissions were significantly higher in group B (n = 22) than in group A (n = 23) (3.32 vs 2.69 and 73% vs 39%, p < 0.05). CONCLUSIONS: Coadministration of ipratropium bromide and repeat doses of nebulized salbutamol produced a small beneficial clinical effect compared with administration of nebulized salbutamol alone. This beneficial effect was related to a decrease in the hospitalization rate, particularly in patients with severe asthma attacks.

Administration, Inhalation↗
PubMed2000

[Outpatient management of children with viral meningitis].

OBJECTIVE: To describe our experience in the extrahospitalary management of children with suspected viral meningitis (YM). METHOD: Between April and July 1997. 156 children were diagnosed of YM in our hospital and 150 managed as outpatients, after being a few hours in our emergency department. All of them were suspected to have VM attending usual clinical and laboratory findings and were discharged with cautious instructions to demand a new assessment. We contacted telephonically with them one month and six months later. RESULTS: All the children with suspected viral meningitis and managed as outpatients had negative blood and CSF cultures and all of them did well. Telephonically, 104 children (69.3%) referred transient headache or back pain. and 20 of these (13.3% of all the 150) came again to our hospital, and 4 required rest for a few hours (4-12 hours) in our observation setting. Children with suspected VM didn't go to school during 5.9 x 6.1 days (1-30 days) and 71 (47.3%) were absent less than 3 days. CONCLUSION: Outpatient management of most of the children with suspected VM is possible. When a patient is sent home, detailed instructions must be given to the family.

Adolescent↗
PubMed1999

[Lumbar puncture in a pediatric emergency department: something more than a diagnostic technic].

OBJECTIVE: The aim of this study was to know the incidence of serious bacterial infections (SBI) in children without sepsis or intracranial infection in which spinal puncture (LP) was performed in an Emergency Department. PATIENTS AND METHODS: A retrospective study of all 471 previously healthy children between 1 month and 14 years of age in which a lumbar puncture was performed between July 1995 and March 1997 in the Emergency Department of our hospital was performed. RESULTS: Two hundred and three children (43%) had sepsis, meningitis or encephalitis (aseptic meningitis 149, 31.6%; sepsis-bacterial meningitis 26, 5.5%; nonspecific meningitis 26, 5.5%; encephalitis 2, 0.4%) and 14 (5.2%) had pneumonia. Of the other 254 children, 36 (14.1%) had a SBI: 19 urinary tract infections (E. coli), 11 bacteremia (Streptococcus pneumoniae 8, Salmonella enteritidis 1, Proteus mirabilis 1, E. coli 1, the latter two also having a positive urine culture) and 6 bacterial gastroenteritis (salmonella 5, Campylobacter jejuni 1). The incidence of SBI was significantly higher in the group of children younger than 5 years old (32/175, 18.2%) than in the older group (4/79, 5.0%, p = 0.009). Two patients died (one with pneumococcal meningitis and one with meningococcal sepsis). CONCLUSIONS: Children with fever and a normal result in the LP must be carefully examined and, especially in younger patients, urine, blood and stool (if stool abnormalities) cultures should be collected. These children must be closely observed in the hospital or at home and must be re-evaluated by their pediatrician in the following 24 hours.

Adolescent↗
PubMed1998

[Head injuries in children: can clinical features identify patients with high or low risk for intracranial injury?].

OBJECTIVE: The objective of this study was to assess the clinical features that might reliably identify the presence of an intracranial injury. PATIENTS AND METHODS: A prospective study of 1,128 children with head injury over a one year period was carried out. Information regarding each patient was documented, including demographic data, physical examination findings, neurologic status, diagnostic studies and the patient's outcome. RESULTS: Of the 1.128 patients, traumatic intracranial abnormalities identified on CT of the head was found in 11 (1%). Four patients of this group (36%) required surgery. Two children subsequently died. Loss of consciousness, amnesia. Glasgow Coma Scale less than 15 and focal neurological deficits were significantly more common in the group with intacranial injury. The negative predictive values were high for all features. CONCLUSIONS: Patients with symptoms of head injury should undergo head CT because a small number will require surgery. After a minor head trauma, children who are neurologically normal and without symptoms may be discharged from the emergency department and sent home after careful physical examination alone.

Adolescent↗
PubMed1998

[Diagnostic value of reactive C protein in suspected acute appendicitis in children].

OBJECTIVE: The aim of this study was to evaluate the accuracy of C-reactive protein (CRP) measurements in the diagnosis of suspected acute appendicitis (AA) during childhood. PATIENTS AND METHODS: A prospective study of 195 consecutive children, aged between 2 and 14 years and suspected of having AA, that attended a pediatric emergency room was carried out. We obtained a careful patient history, physical signs, blood test results, final diagnosis and the histological findings in the cases who underwent appendectomy (classified as normal appendix, simple appendicitis (SA) or gangrenous appendicitis (GA). RESULTS: The final diagnoses and their frequencies were: AA (94), non-specific abdominal pain (80), mesenteric lymphadenitis (6) and others (15). Appendectomies were performed in 103 cases with 94 cases being AA (91.3%) and of these 51 SA and 43 GA. The average values of CRP (mg/l) were: AA: 30, SA: 16, GA: 67, non-specific abdominal pain: 15, and mesenteric lymphadenitis: 44 (p < 0.01). The values of AG were statistically higher than those of SA (p = 0.0000). The ROC curve of these data determined the best cut-off levels for AA to be 30 (sensitivity: 0.43, specificity: 0.92, predictive value of a positive result: 0.87 and predictive value of a negative result: 0.58). CONCLUSIONS: 1) The value of CRP in AA is higher than in other abdominal pain etiologies. Nevertheless, this value should not be used to deny surgery since it is often normal in SA. 2) When a CRP value > 40 mg/L is found in a suspected AA, one should think about GA and therefore, initiate prophylactic antibiotics and perform surgery immediately.

Acute Disease↗
PubMed1998

[Recent changes in emergency room visits and hospitalization for asthma in childhood].

OBJECTIVE: The purpose of this study was to investigate recent changes in the emergency room visits and hospital admission rates between 1993 and 1997 in our hospital. PATIENTS AND METHODS: From January 1, 1993 until December 31, 1997, the 12,848 patients between 0 and 14 years of age whose discharge diagnosis was coded as asthma (ICD9) and who were managed in the emergency room of our hospital were included in the study. RESULTS: During the study period, the number of emergency room visits for asthma (EA) remained unchanged. However, in children between 0 and 5 years of age the number of EA showed a significant increase from 1305 in 1993 (53.5% of all EA) to 1849 in 1997 (68.9% of EA), with an increase of the repeat visits in this age group from 46 (35.8% of all EA in this age group) in 1993 to 791 (42.8%) in 1997 (p < 0.01). In the same period of time, the admission rates for asthma decrease from 7.2% to 2.9% (p < 0.01). There was a trend towards more intense treatment of asthma in the emergency observation unit. CONCLUSIONS: There has been an upward trend in the number of acute asthma episodes between 1993 and 1997 in children between 0 and 5 years of age. It was associated with an increase in the number of repeat visits per patient. The use of a more intense treatment in the emergency observation unit was associated with a reduction in the hospitalization rate for asthma.

Adolescent↗
PubMed1996

[Urinary tract infection in infants: use of urine specimens obtained by suprapubic bladder aspiration in order to determine the reliability of culture specimen of urine collected in perineal bag].

OBJECTIVE: To determine if culture specimens of urine collected in perineal bags is reliable in detecting urinary tract infections in infants. MATERIAL AND METHODS: A prospective study was carried out in a pediatric emergency room of an urban teaching hospital. Forty-eight infants, 12 months old or less, requiring an uncontaminated urine specimen due to the evaluation of febrile illness, suspected urinary tract infection or to a previously contaminated urine culture specimen. Two consecutive urine specimens were collected for culture. A urine specimen was collected in a perineal bag and afterwards all patients underwent suprapubic bladder aspiration. Cultures were considered positive if pure growth of more than 1.000 colonies/ml developed in the suprapubic aspiration urine specimen. RESULTS: Thirty-two infants had coincident cultures in both urine specimens. A positive culture specimen of urine collected in a perineal bag (pure growth of more than 100,000 colonies/ml) had high sensitivity (100%) and high specificity 88.6% in predicting positive cultures from urine obtained by suprapubic aspiration. CONCLUSION: A urine culture specimen meticulously collected with a perineal bag is a good screening method for detecting urinary tract infection in low risk infants.

Escherichia coli↗
PubMed1996

[Usefulness of oxygen saturation and peak expiratory flow in the management of acute asthma].

OBJECTIVE: The aim of the present study was to determine the usefulness of oxygen saturation (SaO2) and peak expiratory flow (PEF) in the assessment of severity of acute asthma and the discriminatory quality of their initial values in predicting the patient's hospitalization. PATIENTS AND METHODS: A prospective observational design was used. The study was carried out in the Emergency Department (ED) of an urban pediatric hospital with a 1993 census of 170,000 children. One hundred twenty-three children with previously diagnosed asthma, who presented to the ED with wheezing were included in the study. SaO2 and PEF levels were recorded upon arrival at the ED and after receiving initial treatment, prior to deciding the child's discharge or hospitalization. Children were treated according to the current practice guidelines. RESULTS: The mean SaO2 before and after the treatment was lower for the children who required admission to the hospital, 91.8 +/- 2% and 92.9 +/- 2%, respectively, than for those who were sent home, 96.1 +/- 3.2% and 96.5 +/- 1.8%, respectively (p < 0.01). The same happened with the PEF values, 41.3 +/- 17.8% and 54.8 +/- 17.9% for the admitted patients versus 68.3 +/- 17.9% and 90.1 +/- 10.6% for those sent home. An initial SaO2 of 95% had a sensitivity of 83% and a specificity of 79%. The optimal cut-off point for the PEF was 50%, with a sensitivity and a specificity of 81%. CONCLUSIONS: Our study shows that SaO2 and PEF can satisfactorily assess the seventy of acute asthma in children and that their initial values can predict the patient's outcome.

Acute Disease↗
PubMed1996

[Tracheobronchial aspiration of foreign bodies in children].

OBJECTIVE: Our objective was to study the characteristics and follow-up of children admitted to our Pediatric Emergency Room (PER) due to tracheobronchial inhalation of foreign bodies (FB). PATIENTS AND METHODS: We have reviewed retrospectively the 55 cases admitted over the last five years to our PER in whom the diagnosis of FB inhalation was confirmed. RESULTS: Mean age was 4 years with the peak incidence (25) occurring between 1 and 2 years of age. The second risk group was 11 years (8). In 84% of the patients (46), there was a history of FB aspiration. Twenty-five percent of the children (14) presented at the hospital within 24 hours, and 18% (10) more than 1 week after inhaling the FB. Physical examination was normal in 5%. The X-ray findings were: air trapping (74%), atelectasis (13%), in cases admitted more than 1 week after aspiration, and were normal in 13%. Rigid bronchoscopy and subsequent removal of the FB was the treatment instituted in 53 cases. There were no deaths. The FB was located at the right bronchus in 67%. The ingestion of nuts accounted for the highest incidence (72%), occurring mainly in younger children. Inorganic bodies constituted the majority of the cases in children older than 9 years (p = 0.0000). CONCLUSIONS: 1. Tracheobronquial inhalation of FB continues to not alarm the general population since only 25% presented at the hospital within 24 hours. 2. There are two risk groups, the second year of life (the largest) and the eleventh year, and they are different in the type of FB inhaled. 3. It is necessary to keep insisting on the methods of prevention.

Bronchoscopy↗
PubMed1996

[Mononucleosis syndromes with serology doubly positive to Epstein-Barr virus and cytomegalovirus].

OBJECTIVE: The objective of this study is to present cases of infectious mononucleosis syndromes (i.m.) with dual rises in antibodies towards Epstein-Barr virus (EBV) and cytomegalovirus (CMV). PATIENTS AND METHODS: A prospective study of 49 children that fulfilled Sumaya's clinical criteria was carried out. RESULTS: Fifteen cases of i.m. were serologically positive for EBV, 12 for CMV, 2 for toxoplasma and 10 were serologically negative. The other ten had dual antibody rises to EBV and CMV. The symptoms were similar in the different groups. Significant differences were found only for the age at the time of presentation where below 4 years of age i.m. is rarely due to EBV (p < 0.01). Analytically, only elevated serum transaminase concentrations suggested the etiology of EBV (p < 0.05). Although i.m. with dual antibody rises towards EBV and CMV are more similar to cases due to EBV, they present characteristics from both viruses. CONCLUSIONS: 1. There are i.m. with dual antibody rises to EBV and CMV 2. The meaning still remains unknown, but there are two hypotheses: coinfection or "endogenous reinfection". 3. Cases of EBV-i.m. and CMV-i.m. are clinically similar, except at the age of presentation and the rising of serum transaminase concentrations.

Adolescent↗