Diez años de vacunación frente al virus del papiloma humano. De la dermatología a la oncología a través de la infectología

Human papillomavirus (HPV) was first identified in dermatology, and it was subsequently demonstrated that is was required for the development of uterine cervical cancer and other tumours, after a persistent infection by any of its oncogenic genotypes. Ten years ago, the most common infections and cancers associated with HPV could be prevented by immunisation with 2 vaccines, one bivalent, and another tetravalent, and having just marketed a nonavalent one. During the period 2007-2008, the HPV vaccine was included in the Autonomous Communities vaccination calendar, and it is the second vaccine, after that of Hepatitis B, that prevents cancer. In these 10 years that these vaccines have been available the knowledge has progressed and there have been significant advances in vaccination strategies, as well as in the indications and recommendations. These include, lowering the age in the vaccination schedule, prescribing of 2 doses at 9 years and at 13-14 years, systematic vaccination of the male in some countries, immunisation of the woman after adolescence, implementation of vaccination programmes in developed countries, prevention of other cancers, recommendations for vaccinations for populations at high risk of HPV infection, scientific evidence on the impact and effectiveness of vaccination, and confirmation of the safety of these vaccines, with more than 270 million doses administered, as has already been observed in clinical trials. The role of health professionals is essential to achieve and maintain high vaccine coverage.     

Meconium periorchitis—a rare cause of a paratesticular mass

We report a 9-month-old boy who presented with a hard paratesticular mass. Clinical and ultrasound findings were highly suggestive of malignancy and orchidectomy was performed. Histology confirmed the unexpected diagnosis of meconium periorchitis, a rare, benign condition resulting from intrauterine bowel perforation.     

Magnetic resonance cystography with gadopenetate dimeglumine of a cystic craniopharyngioma in a child – a technical note

Large cystic craniopharyngiomas can be treated with chemotherapy injected directly into the cyst. Chemotherapy is toxic if it leaks from the cyst into the subarachnoid space. We present a child with a cystic craniopharyngioma following surgical placement of a catheter into the cystic component. Computed tomography following iodinated contrast injection into the cyst was inconclusive in determining the cyst wall integrity. Magnetic resonance following dilute gadopentetate dimeglumine injection into the cyst clearly defined a leak into the subarachnoid space. Coronal imaging was especially helpful. This technique is simple to perform and useful for clinical management. Received: 23 April 1999/Accepted: 24 May 1999     

Can a pediatrician effectively treat a 9-year-old obese girl?

CASE:: Maria is a 9-year-old Latina girl who was followed up by her pediatrician since birth with normal developmental milestones, good school achievement, and without significant medical problems. She was not in the pediatric office for the past 3 years. At the age of 9 years, she presented for a health supervision visit. Her pediatrician looked at her growth chart-90 pounds (95th percentile) and height 52 inches (50th percentile)-that confirmed a clinical impression of obesity on physical examination. Her body mass index was 23.4 (>95th percentile for age).During 10 years in primary care pediatric practice, the pediatrician typically prescribed a management plan for obese school-aged and adolescent patients that started with parent and child education about potential health problems associated with obesity followed by a recommendation to decrease the caloric intake and encourage active exercise each day. She then arranged for follow-up visits to monitor weight and adherence to the management plan. However, a moment of self-refection suggested that most of her patients did not follow her advice in a sustained way. Obesity persisted in most cases. The pediatrician wondered if there was an alternative-better yet, evidence-based-approach to pediatric obesity that might provide a better outcome.     

Hipovitaminosis D y factores asociados a los 4 años en el norte de España

Introduction

Vitamin D is an essential prohormone in calcium and phosphorus homeostasis. Recent studies show a high frequency of insufficiency/deficiency of vitamin D in the general population worldwide. Our objective was to estimate the prevalence of circulating vitamin D [25(OH)D3] deficiency and insufficiency in children and examine the associated factors.

Ureteric stents in pyeloplasty: a help or a hindrance?

ObjectiveTo examine whether routine ureteric stenting influences outcome of pyeloplasty for pelvi-ureteric junction obstruction (PUJO).Patients and methodsA 10-year review was conducted of 105 consecutive open Anderson–Hynes dismembered pyeloplasties performed for PUJO, covering two periods: (1) pyeloplasties performed without ureteric stents (1994–1998) and (2) pyeloplasties performed with ureteric stents (1999–2003). Outcomes (expressed as means ± SEM) of unstented patients (UPs; n = 47) and stented patients (SPs; n = 58) were compared and results analysed using ANOVA and chi-square tests.ResultsFifty-five patients (53.9%) presented with antenatal hydronephrosis, whilst 47 (46.1%) presented postnatally (at mean age 88.4 ± 7.1 months) with one or more of the following: pain (n = 30, 63.8%), urinary tract infection (n = 16; 34.0%), haematuria (n = 3, 6.4%), abdominal mass (n = 3, 6.4%), acute renal failure (n = 2, 4.3%), incidental finding (n = 4, 8.5%). Pyeloplasty was performed (at mean age 58.9 ± 5.3 months) for one or more of the following: pain (n = 40, 38.1%), haematuria (n = 6, 5.7%), urinary tract infection (n = 18, 17.1%), poor initial or deteriorating function (n = 29, 27.6%), severe or deteriorating hydronephrosis (n = 41, 39.0%), calculus (n = 1, 0.95%). Recognised complications of surgery were significantly higher in UPs (5 of 47; 10.6%) than SPs (0 of 58); P = 0.016. These were leakage (n = 4, 8.5%) and obstruction by blood clot (n = 1, 2.1%). Nine SPs (15.5%) developed stent-related complications, including stent migration (n = 5, 8.6%), infection (n = 3, 5.2%) and calculus (n = 1, 1.7%). SPs had significantly shorter hospital stay (2.71 ± 0.25 days) than UPs (4.30 ± 0.38 days); P < 0.01. Preoperative renal pelvis antero-posterior diameter in SPs (3.24 ± 0.25 cm) and UPs (3.21 ± 0.28 cm) was comparable (P = 0.80). Following pyeloplasty, a significant improvement from these preoperative baselines occurred earlier in SPs (at 3.10 ± 0.46 months) than UPs (at 15.71 ± 3.05 months); P < 0.01.ConclusionStented pyeloplasty significantly reduces complications from surgery, particularly leakage, and results in shorter hospital stay and earlier resolution of hydronephrosis, but at the expense of stent-related complications which could be avoided in future by the use of external stents.     

Pseudoseizures in a preadolescent: does this case have a bite?

We report a preadolescent girl with acquired complete heart block most likely caused by viral myocarditis. The diagnosis was supported by endomyocardial biopsy and several immunohistological panels. A temporary pacemaker was used, and the child responded well to therapy with full recovery of cardiac conduction.     

Bilateral Wilms’ tumour in a developing country: a descriptive study

Purpose

To present our experience of 20 children with bilateral Wilms’ tumour seen in a resource-challenged environment over a 10-year period.

Method

All patients with a diagnosis of bilateral synchronous Wilms’ tumour were identified and recruited.

Results

Study patients represented 11 % of a cohort of 177 new patients with Wilms’ tumour seen over the same period. Three patients had a syndromic predisposition to Wilms’ tumour. Metastatic disease was seen at presentation in four patients (20 %) and three children presented with unilateral tumour rupture. One patient presented with paraplegia and one with obstruction of the duodenum. All children received neoadjuvant chemotherapy. One HIV-infected child died of IRIS after neoadjuvant treatment, but before surgery. One child died of progressive disease after unilateral nephrectomy. Nephron-sparing surgery was performed in 22 kidneys and 15 kidneys were removed in toto. Following enucleation of tumours, three children had positive margins. Discordant histopathology was seen in 53 % of patients. Overall survival at 2 years is 85 %.

Conclusion

Despite significant co-morbidity and advanced disease, bilateral Wilms’ tumour is a treatable disease in a resource-constrained environment.     

Intramural bladder-wall abscess: a late complication arising after a urethrocystoscopy?

Intramural bladder-wall abscesses are serious but rather rare. In the few reported cases, their aetiology has not been explicitly explained. In our case, we found a traumatic outcome induced by a urethrocystoscopy that had taken place 4 years prior to the diagnosis of abscess. To date, there has not been much published on these bladder-wall abscesses or urinary tract infections from urethrocystoscopies and Burkholderia cepacia bacteria. As a result, their pathogenesis and aetiology have not been fully explained. In this paper we report on the clinical as well as the subjective well-being of a female child who was diagnosed with a massive full-blown intramural bladder-wall abscess that developed 4 years after she had undergone a urethrocystoscopy.     

Epidemiología de la diabetes mellitus tipo 1 en menores de 15 años en España

IntroductionEpidemiological studies in many regions and countries have contributed to determining the epidemiology of type 1 diabetes (T1DM) in children less than 15 years old. Studies in many regions of Spain have been published, but the national incidence is not really known.Material and methodsA review was made of the publications on the epidemiology of T1DM in Spain, selecting the references on patients less than 15 years old.ResultsMany epidemiological studies on T1DM in almost all regions in Spain have been published. The methodology of these studies is heterogeneous, with variations in geographical definition, duration, period of study, limit of age, and data collection. The incidence rates are variable, from 11.5 cases per 100,000/year in Asturias to 27.6 in Castilla-La Mancha. Some studies report the percentage of diabetic ketoacidosis at the time of diagnosis, which is usually in the range of 25-40%.ConclusionsAlthough there have been various epidemiological studies on T1DM in almost all regions in Spain, the methodology is heterogeneous. The mean incidence of T1DM in children less than 15 years old in Spain, stimated from the selected studies is 17,69 cases per 100,000/year. T1DM registers need to be created and updated, using standardized methodology, to get more reliable data of the epidemiology of T1DM in Spain in the near future.