Evaluación del seguimiento de niños con hallazgo de hipertransaminasemia

Introduction: Although changes in liver function tests can be non-specific in numerous clinical conditions, they can be the first sign of a potentially serious disease in an asymptomatic patient. Material and methods: Retrospective cohort study, performed by reviewing the records of children of a reference hospital central laboratory with alanine aminorransferase enzyme (ALT) elevation during a 6 month aleatory period. Results: 572 blood tests with serum ALT elevation corresponding to 403 patients had been assessed during the period studied. 98 patients were excluded for presenting abnormal liver test before the study period of comorbidity that could produce ALT elevation. The remaining 305 patients, 22.6% were diagnosed with a medical condition during the first blood test that explained the ALT elevation, although only 33.3% of them were followed up until verifying their normalization. Final study sample consists of 236 patients with abnormal liver test without apparent liver disease. Adequate follow-up was found only in 29% of them. From this group, 9 patients (13%) were diagnosed with liver disease. The rest of the sample were not properly monitored. In patients with higher serum ALT levels, follow-up was early and more appropiate. Conclusions: In our area, most children without apparent liver disease are no properly monitored. Therefore, an opportunity to diagnosis and treat a potential liver disease was lost in a great number of children. All children with unexplainedhypertransaminasaemia must be studied

Macrocefalia en lactante secundaria a quiste de la bolsa de Blake

Introduction: Blake’s pouch cyst is an infrequent cystic malformation of the posterior fossa which can cause symptomatic hy-drocephalus. A brain magnetic resonance imaging (MRI) is necessary to confirm the diagnosis. Some of the entities that should be considered in the differential diagnosis are megacisterna magna, arachnoid cyst and Dandy-Walker malformation and its variant. Treatment of Blake’s pouch cysts that produce hydrocephalus can be a ventriculoperitoneal shunt or an endoscopic third ventriculostomy. Case report: A 17-year-old infant with rapid growth of the cephalic perimeter in the last months, up to the >99th percentile. The MRI showed that the macrocephaly is due to hydrocephalus caused by a Blake’s pouch cyst. After an endoscopic third ventriculostomy, the growth of the cephalic perimeter was stabilized, psychomotor development was normal and every follow-up brain MRI showed normalization of ventricular size. Conclusions: This case report is interesting due to the low incidence of Blake’s pouch cyst and to the important advance in the treatment that endoscopic third ventriculostomy has implied.Introducción: el quiste de la bolsa de Blake (QBB) es una malformación quística infrecuente de la fosa posterior que puede producir hidrocefalia sintomática. es necesario realizar una resonancia magnética (Rm) cerebral para confirmar el diagnóstico. Las entidades a valorar en el diagnóstico diferencial son la megacisterna magna, el quiste aracnoideo y la malformación de Dandy-Walker y su variante. el tratamiento de los QBB que producen hidrocefalia puede ser una técnica de derivación o una ventriculostomía endoscópica premamilar (VePm). Caso clínico: Lactante de 17 meses con aumento rápido del perímetro cefálico en los últimos meses hasta el percentil >p99 y torpeza motriz gruesa. La Rm muestra que la macrocefalia es secundaria a una hidrocefalia provocada por un QBB. Tras realizar una VePm, el aumento del perímetro cefálico se estabiliza, el desarrollo psicomotor es normal y en las Rm de control se objetiva disminución del tamaño del sistema ventricular. Conclusiones: el caso es interesante dada la baja frecuencia del QBB sintomático en la infancia y el éxito de su abordaje mediante VePm, que ha demostrado seguridad y eficacia en el tratamiento de casos seleccionados de hidrocefalia en pediatría