[Attention deficit hyperactivity disorder therapy update: extended-release methylphenidate].

Introduction: Attention deficit hyperactivity disorder (ADHD) is a very common condition in neuropaediatric practice and the most widely used medication is methylphenidate (MPT). We discuss the comorbid disorders, diagnosis, aetiopathology and neurochemical bases, and we also stress the importance of pharmacological action on the dopaminergic and noradrenergic pathways, and the problems and benefits of the different formulations of MPT.

Aims: Since extended-release MPT by means of the OROS technique has only recently been commercialised in Spain, we conducted a comparative analysis of immediate-release MPT and extended-release MPT in a series of 93 patients in order to determine which of them is preferable, to evaluate the reasons why this is so, and to analyse the shortcomings and advantages of the two drugs.

[Mesangial glomerulonephritis and intermediate uveitis].

Uveitis in children are less frequent than in adults. Their prognosis is variable because it may be found as an isolated and idiophatic condition or in association with definite clinical entities. The associated noninfectious diseases with predominantly renal involvement are tubulointerstitial nephritis and uveitis syndrome (TINU syndrome), mesangial glomerulonephritis isolated or in association with Behçet's disease.

Long-term results of high-dose chemotherapy and autologous stem cell rescue for high-risk neuroblastoma patients: a report of the Spanish working party for BMT in children (Getmon).

The authors retrospectively analyzed the long-term outcome of 67 patients over 1 year of age at diagnosis with high-risk neuroblastoma (stage 4 or stage 3 with N-myc amplification) who were treated with megatherapy and stem cell rescue from 1984 to 1998. Median age at transplant was 4 years (range 1.6-15 years).

[Hemorrhagic infarction of the testicle in the newborn infant. A case presentation].

Hemorrhagic infarction of the testicle is an unusual occurrence in the newborn infant. It usually develops as a consequence of torsion of the spermatic cord. We report a case of global testicular infarction in a newborn associated with a tense hydrocele.

[Berdon syndrome (megacystis, microcolon, intestinal hypoperistalsis). Report of our cases].

Berdon syndrome is a rare congenital malformation that consists in megacystis and severe intestinal malformations that condition the prognosis in most of the cases. We report the three cases diagnosticated between 1976-2003. Diagnosis, therapeutics aspects and evolution are discussed.

[Anesthesia and management of recovery for severely burned pediatric patients].

The incidence of burns in children is high. Their severity and high mortality rate, coupled with the complexity of the pathophysiological mechanisms involved mean that burns must be treated exhaustively as soon after injury as possible. The airway must be managed and fluid started in the first hours to preserve vital organ function.

[Pyeloureteral duplicity and intrathoracic kidney].

Intrathoracic ectopia is an unusual ectopia that represents less than 5% of renal ectopia. The association of a duplex system and an intrathoracic renal ectopia is very rare. We report a case of a girl affected from these two anormalities, being the first case published in the literature reviewed.

[The neuropaediatric and pathogenic clinical bases of autistic spectrum disorder].

Introduction: The dimension of the autistic spectrum embraces a considerable degree of clinical complexity which is, in turn, an expression of the numerous systems involved in the functioning of the central nervous system. Every day different biological factors are revealed which put in doubt other factors that, in a more objective way, appear to be involved in a particular aetiology.

Development And Conclusions: It is clear that exactly what causes autistic spectrum disorder is still unknown and it may be useful to analyse cases with a known aetiology and correlate them with other similar cases, as it is likely to be this association between findings and studies in the future that will probably enable us to better define the bases and the underlying causes of the complex and manifold origin of the autistic spectrum.

[Ventilation in special situations. Mechanical ventilation in status asthmaticus].

The indications for mechanical ventilation in status asthmaticus are cardiopulmonary arrest, significant alteration of consciousness, respiratory exhaustion, and progressive respiratory insufficiency despite aggressive bronchodilator treatment. In mechanical ventilation for status asthmaticus, a specific strategy directed at reducing dynamic hyperinflation must be used, with low tidal volumes and long expiratory times, achieved by diminishing respiratory frequency. This ventilatory pattern produces permissive hypercapnia, which is generally well tolerated with suitable sedation.

[Evolution of conservative treatment in traumatic spleen injuries. Report of 54 cases].

The spleen is the organ most frequently affected in abdominal trauma. Conservative treatment of traumatic spleen injuries is already generally accepted, avoiding surgery whenever possible. We present a wide serie (54 cases) of traumatic spleen injuries along a period of ten years (1990-2000) during which 83% of these were solved with conservative therapy we analyse our treatment procedure and post-treatment follow-up of these patients.

[Surgical treatment of pediatric pulmonary metastases].

Objective: We comment and update the surgical treatment for pulmonary metastases (PM) within a multidisciplinary approach for paediatric cancer.

Material And Methods: We analyse patients with PM who have been operated between 1976-1996. Scientific literature published in the last 25 years (Cancerlit and Medline) was reviewed.

[Neuropsychological problems of cerebrovascular pathology in children].

Cerebrovascular pathology in infancy is, unlike in adults, infrequent. However, this must not lead us to think it is unimportant. There are a number of different vascular processes that exert an influence to varying degrees on the neurological and psychological future of our young patients.

[The role played by parents in the development and learning of children with attention deficit hyperactivity disorder].

Introduction: The parents of children with attention deficit hyperactivity disorder (ADHD) undergo high levels of stress, frequent quarrels amongst themselves and limitations in their social life, which are factors that exert an influence on the progress of the disorder and constitute a high priority therapeutic goal.

Aims: 1. To analyse the impact ADHD has on family life: economy, the relations between parents and children and between brothers and sisters, social life, and the feelings and attitudes parents have towards their child.

[The pharmacological approach to the autistic spectrum].

Objective: To describe our experience of the drug treatment of children within the autistic spectrum.

Development: We analyze some neuroleptic drugs, the serotonin uptake inhibitors and antiepileptic drugs, emphasizing the most suitable drugs for each symptom we wish to treat and how to do so.

Conclusions: The treatment of children within the autistic spectrum should be specific, meticulous and well controlled by the neuropaediatrician.

The role of surgery in stage IV neuroblastoma.

Background/purpose: The importance of primary tumor resection in stage IV neuroblastoma is controversial. The authors analyzed prospectively the role of surgery in a multicentric series of stage IV neuroblastoma patients.

Methods: Patients were studied according to the International Neuroblastoma Staging System (INSS) recommendations.

[The effects of psychostimulants on the cognitive results and behaviour of children with the combined subtype of attention deficit with hyperactivity].

Introduction: Many studies have shown the efficacy of methylphenidate in treating children with attention deficit and hyperactivity to reduce the main symptoms of the disorder and problems of behaviour: behaviour which is disruptive, antisocial, negative and aggressive.

Objectives: 1. Analyze the therapeutic effects of methylphenidate on the cognitive function of children with TDAH, combined subtype, evaluated by means of neuropsychological tests of attention and inhibitory control.

[Preoperative fasting regimens and premedication to reduce the risk of pulmonary aspiration].

Our greater understanding of gastric physiology and the epidemiology of Mendelson's syndrome has allowed the traditional guidelines for preoperative fasting (nothing by mouth after midnight or 6 hours before surgery) to be changed, based on the results of many scientific studies. The stomach is not emptied of liquids and solids in the same way, and therefore preoperative fasting should not be the same for both. Human milk leaves the stomach more rapidly than infant formulas, and the emptying of non-human milk is similar to that of solids.

Assessment of profilin as an allergen for latex-sensitized patients.

Background: The presence of the actin-binding protein, profilin, has been demonstrated in natural latex extracts; but the clinical significance of this molecule as an allergen for latex-allergic patients is not clear. We studied the allergenic relevance of isolated latex natural and recombinant profilin, by in vivo and in vitro techniques, in two populations of spina bifida children (SB) and adults allergic to latex (AL).

Methods: Profilin is present in small amounts in latex extracts obtained from low ammoniated (LA) natural latex.

[Total plasma homocysteine levels. Relationship with plasmatic folic acid levels and 677C T polymorphism of 5,10-methylenetetrahydrofolate reductase].

Background: Moderately increased plasma homocysteine (Hcy) in children has been associated with stroke and venous thrombosis and with a parental history of cardiovascular disease (CVD). Evaluation of Hcy concentrations during childhood and study of the factors determining its concentrations could play an important role in the primary prevention of CVD. Objective To detect cases of hyperhomocystinemia and to examine the association between Hcy levels and plasma folic acid levels and 677C T polymorphism of 5,10-methylenetetrahydrofolate reductase (MTHFR).

[Peculiarities of latex allergy and preventive measures in the pediatric age group].

Latex allergy can be considered a problem of public health in at-risk populations. Although the figures on prevalence vary, approximately 1 % of the general population is sensitized to latex. To date, two determining factors for latex sensitization have been identified: an atopic predisposition and the number of operations.

[Anti-CD25 monoclonal antibody against polyclonal antibodies in pediatric renal transplantation].

Unlabelled: Although usually reversible, acute rejection of kidney graft is a negative factor in long-term graft survival. Commonly used in pediatric renal transplantation, immunosuppresive induction therapy is established to prevent it. New immunosuppressive agents have been developed in recent years and among them anti-CD25 monoclonal antibody appears to be specially interesting.

Herpesvirus-6 encephalitis complicated by Wernicke-Korsakoff syndrome in a pediatric recipient of unrelated cord blood transplantation.

A 10-year-old girl with M2 acute myeloid leukemia underwent an unrelated cord blood transplantation in refractory first relapse. On day +13, after 48 hours with fever, she showed a measles-like rash, and on day +15, she began experiencing neurologic symptoms (headache, tremors, weakness, nystagmus, mild confusion, speaking, taste, and behavior disturbances, and focal seizures). She also had amnesia for recent events with disability to learn, mimicking Wernicke-Korsakoff syndrome.

[Pyriform sinus fistulae].

Pyriform sinus fistulae (PSF) are rare branchial pouch anomalies. In most previously described cases the anomaly is located on the left side. PSF should be suspected in cervical inflammatory processes (cervical abscesses and types of suppurative thyroiditis).

[Spontaneous resolution of a congenital depressed skull fracture].

Congenital depressed skull fracture is rare and in most cases its etiology remains unclear. We present a female newborn infant with a congenital depressed skull fracture and no evidence of antepartum or intrapartum traumatism. The baby had normal neurological status and the depressed fracture healed spontaneously in a few weeks.