Federal University of Pernambuco

Universidade Federal de Pelotas

Universidade Federal do Rio Grande do Sul

Universidade Federal de Ciências da Saúde de Porto Alegre

Universidade Federal de São Paulo

Universidad Católica del Norte (Chile)

University of Concepción

Universidad Diego Portales

Pontificia Universidad Católica de Chile

Universidad Catolica

Clinica Alemana

University of Chile

London School of Hygiene and Tropical Medicine

Universidad Nacional de Asunción

Publication of the Sociedad Chilena de Pediatría. Mission: La Revista Chilena de Pediatría recibe para su publicación solamente artículos con temas de investigación clínica o experimental y de medicina social y salud pública, relacionados con el niño y que no hayan sido publicados en otras revistas.

Revista chilena de pediatría

[Not Available].

Pericardial effusion is the main complication of pericarditis, and can create serious consequences depending on the speed of development and etiology. The most common causes are neoplasms and idiopathic, even though viral etiology is a frequently underestimated cause because of the difficulty in its confirmation. In cases of significant pericardial effusion, pericardiocenthesis has demonstrated to be an effective and safe procedure. We present a clinical case of a 14 year old adolescent who complained of persistent abdominal pain, and whose study showed significant pericardial effusion. Pericardiocenthesis was performed, along with installation of a pigtail catheter which drained 500 ml of serohematic pericardial effusion. The etiologic study included an PCR (polymerase chain reaction) positive for Enterovirus. The patient recovered favorably and was dismissed from the hospital in good condition. The objective of this report is to expose a current revision of the clinical management of pericardial effusion and the technical skills of pericardiocenthesis. Knowledge of the technique is fundamental in the treatment of pericardial effusion, especially in situations associated with hemodynamic compromise.

Derrame Pericárdico, Enfrentamiento Clínico

Consenso en el diagnóstico y tratamiento de la diabetes tipo 1 del niño y del adolescente

The purpose of scientific research is to disseminate their results in a publication. Scientists, clinicians, graduate and postgraduate students are judged and are primarily known for their publications. A scientific experiment whilst their results may be outstanding does not end until those results are published. Thus, the scientists not only have to "do" science but also "write" science. A poor wording could prevent or delay the publication of an excellent scientific work. The purpose of this article is to help scientists and students to prepare manuscripts that are likely to be accepted for publication and to be perfectly understood when issued. As the requirements journal vary widely among disciplines, and even within a single discipline, it is not possible to make recommendations that are universally acceptable. Therefore, this article will get its importance, insofar as it is taken as a guide for those professionals who wish to publish their studies in national and international journals.

Algunas claves para escribir correctamente un artículo científico

Caudal regression is a rare congenital malformation which includes a wide spectrum of musculoskeletal abnormalities involving the lumbosacral spine, pelvis and lover limbs. It can be associated to visceral defects (gastrointestinal, genitourinary, cardiac or neurological) in various degrees. The etiology is not yet clear, but maternal diabetes, genetic predisposition, and vascular hypoperfusion are suspected. Objective: Describe a case of exceptional extension, including first year evolution. Clinical Case: Amale newborn, term, was diagnosed before birth. Mother is a Type 2 diabetic. Physical exam and images confirm the diagnosis, show presence of 7 cervical vertebrae, 8 thoracic, agenesia of distal dorsal and lumbosacral spine. No spinal disraphia, medular conus at D2. Conclusion: The reported case shows that early diagnosis and multidisciplinary evaluation of the patient are essential elements to decrease complications and improve prognosis.

Síndrome de Regresión Caudal: Caso Clínico

Advances in the surgical management of pancreatic exocrine tumors in children
Introduction: Pancreatic tumors in childhood are rare and diverse. Among them, pancreatoblastoma is the
most common pancreatic tumor in young children, followed by the solid pseudopapillary tumor (SPT), which
is an uncommon neoplasm characterized by low potential for malignancy that mainly occurs in young women.
Complete surgical resection is the treatment of choice. Following the advances in minimally invasive surgery,
laparoscopic distal pancreatectomy appears to be feasible and safe in children. Objective: To report a case of
a child with SPT to create awareness on this topic and update its surgical management. Case report: The case
of a 10 year old boy carrying a pancreatic tumor, who sought medical attention due to abdominal pain after
minor trauma, is reported. Ultrasonography and CT scan of the abdomen showed an 8 cm tumor in the body
and tail of the pancreas, no metastases. The alpha-fetoprotein was normal. Laparoscopic corporocaudal pancreatectomy
and splenectomy were performed, and the patient was discharged on the sixth postoperative day
without incident. Biopsy confirmed SPT. Discussion: This study exposes the characteristics and classification
of pancreatic tumors in childhood. In particular, SPT is discussed regarding diagnosis and the advantages of
minimally invasive surgery as part of the treatment.
(Key words: Tumor, pancreas, pancreatectomy, laparoscopic, children).
Rev Chil Pediatr 2013; 84 (4): 417-424

Avances en la cirugía de tumores del páncreas exocrino en niños

Introduction: 
Low-flow vascular malformation, which usually develops during the first stage of infancy, is a rare cause of recurrent effusion of the knee. History, laboratory and X-rays are usually non-specific.

Objective: 
To describe a rare disease in pediatrics, emphasizing the correct classification and suspicion.

Case report: 
A case is presented of a two-year-old patient with a history of effusion of the right knee who required multiple hospitalizations and antibiotic treatments. Laboratory work-up was normal. Plain X-rays of the knee revealed no bone changes. MR imaging reported low-flow vascular malformation. Surgical resection was performed, evidencing vascular lesion among the muscle fibers of the vastus lateralis of quadriceps until the capsule of the knee, as well as dissection of the fibers until the vastus lateralis of the right leg. Histology was consistent with low-flow vascular malformation. Due to the benign outcome and favorable evolution, an outpatient management was possible.

Conclusions: 
Although low-flow synovial vascular malformation is a rare disease among the pediatric population, it should be considered in the differential diagnosis of patients with repeated hemarthrosis and no history of either coagulopathy or hemophilia.

Malformación vascular de bajo flujo sinovial de la rodilla (hemangiolinfangioma): Reporte de caso

Introduction: 
Pain and cervical muscle spasm are common reasons why parents bring children to the pediatric emergency department. The first steps are the gathering of medical history of the patient and a physical examination. If musculoskeletal damage is suspected, cervical spine x-rays should be obtained. An intervertebral disc calcification finding, in the absence of other radiological lesions should suggest pediatric intervertebral disc calcification.

Objective: 
To present a case of intervertebral disc calcification, a rare condition that must be considered in the differential diagnosis of torticollis and neck pain in childhood.

Case report: 
A seven-year-old male patient without morbid history and no history of trauma or rough sport practice. He consulted the emergency room for pain and cervical contracture for the last six days. C reactive protein and red cell sedimentatio rates were slightly elevated. Imaging studies showed calcification of the C5-C6 intrvertebral disc and anterior disc protrusion. The patient was hospitalized for evaluation and pain management, with good clinical response and continue afterwards with non-steroidal anti-inflammatory drugs and a soft collar. At the 6-month-follow up, the patient had resolved symptoms and calcifications.

Conclusions: 
Pediatric intervertebral disc calcification is a rare cause of acquired torticollis, with a benign and self-limited outcome. Conservative management, as well as clinical and imaging follow-up is recommended.

[Pediatric intervertebral disc calcification: A rare cause of acquired torticollis. Case report]

Introduction: 
Cutaneous larva migrans (CLM) is the most common tropical dermatitis. It is caused by nematodes hosted by cats and dogs. Humans act as an accidental reservoir. Clinically, it manifests as a slow-growing, elevated linear, erythematous and pruritic plaque, on the sole of the foot. Diagnosis is clinical, based on the morphology of the lesion associated with recent travel to endemic areas.

Objective: 
To present an autochthonous case of CLM in Chile.

Clinical case: 
A 3-year-old boy, presented with a linear lesion on his foot, clinically compatible with CLM. He received a single dose of ivermectin and had complete resolution of the lesion. The patient had no history of travel outside of Chile, but had contact with dogs.

Conclusion: 
CLM is classically described as travellers dermatitis. We present this case, because there are no previous reports of CLM acquired in Chile by children.

[Autochthonous cutaneous larva migrans in Chile. A case report]

Objective: 
To present 2 cases of patients with prepuberal HS. CASE 1: A 10-year old female, Tanner stage I-II and obesity. History of 4 months of evolution with bilateral recurrent groin lesions that occasionally drain pus; HS Hurley stage i was diagnosed, and topical antibiotics and nutritional management were prescribed, with a good response. CASE 2: A 10 years old female, Tanner stage I-II and obesity. Since the age of 6 years, recurrent episodes of lesions in the inner side of the left thigh were observed, and multiple antibiotics with poor response were prescribed. HS Hurley stage i was diagnosed, and photodynamic therapy and nutritional management were used, with good response.

Conclusions: 
The etiology of HS is unclear. Usually the presentation at early age is associated with a family history and more extensive compromise in the future. Treatment is difficult and depends on each case and severity.

Hidradenitis supurativa prepuberal: presentación de 2 casos clínicos

Sobre los criterios de inclusión y exclusión. Más allá de la publicación

Introduction: 
Cleidocraneal dysplasia (CCD) is a rare skeletal autosomal dominant syndrome characterized by dental anomalies and bone abnormalities. These clinical manifestations do not require treatment in most cases. The disease is caused by mutation in the gene RUNX2 (CBAF1), located on the short arm of chromosome 6.

Objective: 
To report a case of CCD and perform a literature review focused on clinical manifestations and diagnosis.

Case report: 
A 3 year old patient, who was clinically diagnosed with CCD since birth. The patient showed incomplete development of cranial bones, bell-shaped thorax, adequate dentition and presence of clavicles. Molecular analysis reported that the patient is carrying the pathogenic variant c.674G>A in the RUNX2 gene, confirming the diagnosis.

Conclusions: 
The CCD is a rare condition, with special clinical features. It is important to establish early diagnosis in these patients in order to offer a better quality of life, and if necessary, appropriate treatment.

Displasia cleidocraneal: reporte de un caso

Introducción:
Las alteraciones ungueales en niños provocan gran ansiedad en los padres y múltiples consultas en su mayoría innecesarias. La onicomadesis corresponde al despegamiento completo e indoloro de la lámina ungueal desde el pliegue proximal. Este hallazgo ungueal autoresolutivo se ha descrito como una complicación tardía de la enfermedad pie-mano-boca, exantema viral frecuente en la edad pediátrica.

Objetivo:
Reportar un caso pediátrico clásico de enfermedad pie-mano-boca que evolucionó con onicomadesis y revisión de la literatura.

Caso clínico:
Paciente masculino de 3 años de edad, con cuadro agudo de microampollas eritematosas, peribucales en un comienzo, luego brazos y manos, glúteos, muslo y pies, asintomático y sin compromiso del estado general. Se reali za diagnóstico clínico de enfermedad pie-mano-boca. Evoluciona con resolución total de lesiones cutáneas , pero al mes, desprendimiento completo de uñas, las que se recuperan con posterioridad.

Conclusión:
El reconocimiento de la asociación entre enfermedad pie-mano-boca con onicomadesis nos permite orientar a los padres sobre un fenómeno benigno y transitorio que puede ocurrir como parte de la evolución de esta virosis, evitando así la ansiedad, derivación y tratamientos innecesarios.

Onicomadesis secundaria a enfermedad pie-mano-boca: una manifestación frecuente y motivo de preocupación de los padres

Sickle cell disease (SCD) is an autosomal recessive genetic disorder. It is the most frequent structural hemoglobinopathy worldwide, and it is produced by an alteration in the globin chain genes. In Chile, there is no data on the prevalence of SCD since it is considered a very rare condition. The incidence of this disease has been increasing due to migration of people from areas with greater presence of SCD. It is important to know and consider this diagnosis in a selected group of patients with anemia, in order to prevent and treat the different complications of this disease. This article reviews the most recent information that shows new concepts in the knowledge of the physiopathology, and especially publications of guidelines and consensus in relation to the diagnosis and management of this con dition.

Enfermedad de células falciformes: Un diagnóstico para tener presente

Cardiopulmonary Interactions (CPI) refer to the interplay between the respiratory and cardiovascu lar systems during the respiratory and cardiac cycle. These interactions vary depending on whether the patient is in spontaneous or mechanical ventilation and affect the preload and afterload of both ventricles at different levels. Understanding CPI is essential to the management of critically ill pa tients, where preload and afterload manipulations are specialy important to optimize cardiac output and oxygen delivery to the periphery. The present article reviews the physiological principles required to understand CPI in patients both in spontaneous and mechanical ventilation using specific clinical scenarios to facilitate its use as part of day to day clinical practice.

Interacciones cardiopulmonares: De la fisiología a la clínica

Las infecciones osteoarticulares agudas pediátricas constituyen patologías poco frecuentes, siendo de suma importancia realizar un diagnóstico precoz y tratamiento adecuado para evitar las complicaciones agudas o a largo plazo. El absceso de Brodie (AB) es una forma de osteomielitis subaguda de baja incidencia y de difícil diagnóstico, por lo que es imprescindible la sospecha clínica.Objetivo: Presentar un caso de AB y describir las características etiológicas y clínicas de esta patología.Caso Clínico: Paciente 14 años, evaluado por dolor de muslo derecho de un mes de evolución, afebril y sin antecedente de trauma. Al examen físico no presentaba aumento de volumen, el rango de movimiento (ROM) de cadera derecha era doloroso y la sensibilidad estaba aumentada a la palpación superficial de banda iliotibial (BIT) derecha. Estudio radiológico sin alteraciones. Por persistir síntomas se solicitó ecografía de muslo que mostró irregularidad ósea cortical. Resonancia Magnética (RM) evidenció lesión en diáfisis de fémur derecho de probable origen tumoral o infeccioso. Parámetros inflamatorios sin alteraciones. Se realizó toma de biopsia y cultivos, aislando Staphylococcus aureus multisensible. Se procedió a aseo quirúrgico y terapia antibiótica endovenosa, evolucionando favorablemente.Conclusiones: La presentación clínica y laboratorio en AB pueden ser inespecíficas. El clínico no especialista debe tener un alto índice de sospecha de esta patología como posible diagnóstico diferencial en pacientes que persisten con dolor y presentan una alteración radiológica, incluso ante la ausencia de otros síntomas y parámetros inflamatorios normales. Es importante realizar una biopsia ósea para el diagnóstico diferencial de patologías tumorales.

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