RESUMO
Kidney abscess is an unusual entity in childhood with few studies about its clinical characteris tics. OBJECTIVE: To report the clinical presentation, diagnosis, and therapy used in a cohort of 20 children with kidney abscess. PATIENTS AND METHOD: retrospective study of cases of kidney abscess during a 10-year period at the Hospital Roberto del Río. The analysis of clinical, laboratory, and imaging characteristics were evaluated as well as the treatment usedfor this condition. RESULTS: 20 cases were reported among which 65% were women with a median age of 3.6 years. The most com mon clinical presentation was fever, vomit, and dysuria. Eighty percent of patients presented an increase of inflammatory parameters, 88% presented positive urine culture, and the most common organism identified was Escherichia Coli (77.8%). The diagnosis was mostly made through kidney ultrasound (75%) followed by an abdominal CT scan (35%). 93% of abscesses were unilateral. About 95% of the patients only required antibiotic treatment. Vesicoureteral reflux was diagno sed in 28% of the patients with no sphincter control, and only one of them presented high-grade reflux. In patients with sphincter control, bladder and bowel dysfunction (BBD) was diagnosed in 90% of the cases. Forty four percent of the patients with late DMSA renal scintigraphy presented renal scarring. CONCLUSIONS: In this series, pediatric kidney abscess appears with persistent fever despite the treatment, requiring prolonged antibiotic therapy and rarely surgical drains. We su ggest a study aimed at detecting modifiable factors, such as vesicoureteral reflux in patients with no sphincter control and BBD in patients with sphincter control, as well as identifying renal paren chymal sequels in all patients.
Assuntos
Abscesso Abdominal , Nefropatias , Infecções Urinárias , Refluxo Vesicoureteral , Abscesso Abdominal/complicações , Abscesso Abdominal/tratamento farmacológico , Abscesso/complicações , Abscesso/diagnóstico , Abscesso/tratamento farmacológico , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Feminino , Humanos , Nefropatias/complicações , Nefropatias/diagnóstico , Masculino , Estudos Retrospectivos , Infecções Urinárias/complicações , Infecções Urinárias/diagnóstico , Infecções Urinárias/tratamento farmacológico , Refluxo Vesicoureteral/complicações , Refluxo Vesicoureteral/tratamento farmacológicoAssuntos
Humanos , Recém-Nascido , Lactente , Pré-Escolar , Criança , Adolescente , Diálise Peritoneal/efeitos adversos , Peritonite/diagnóstico , Peritonite/microbiologia , Peritonite/terapia , Antibacterianos/uso terapêutico , Cateterismo/efeitos adversos , Cateterismo/métodos , Diálise Peritoneal/métodos , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Negativas/tratamento farmacológico , Guias de Prática Clínica como Assunto , Peritonite/prevenção & controleRESUMO
It is commonly thought that the longer the time since last earthquake, the larger the next earthquake's slip will be. But this logical predictor of earthquake size, unsuccessful for large earthquakes on a strike-slip fault, fails also with the giant 1960 Chile earthquake of magnitude 9.5 (ref. 3). Although the time since the preceding earthquake spanned 123 years (refs 4, 5), the estimated slip in 1960, which occurred on a fault between the Nazca and South American tectonic plates, equalled 250-350 years' worth of the plate motion. Thus the average interval between such giant earthquakes on this fault should span several centuries. Here we present evidence that such long intervals were indeed typical of the last two millennia. We use buried soils and sand layers as records of tectonic subsidence and tsunami inundation at an estuary midway along the 1960 rupture. In these records, the 1960 earthquake ended a recurrence interval that had begun almost four centuries before, with an earthquake documented by Spanish conquistadors in 1575. Two later earthquakes, in 1737 and 1837, produced little if any subsidence or tsunami at the estuary and they therefore probably left the fault partly loaded with accumulated plate motion that the 1960 earthquake then expended.
RESUMO
El hematoma subdural puede ocasionar una imagen tomográfica de aspecto normal, lo que causa confusión en la práctica clínica. Como la clínica de esta entidad es variable y poco típica, discutimos un caso de cefalea, por hematoma subdural atendido en las urgencias; resaltando la importancia de usar la clasificación de la Sociedad Internacional de Cefaleas y de emplear las resonancia magnética en el diagnóstico del dolor de cabeza en la práctica diaria de la neurología y la neurocirugía