S1409-009019990003 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00901999000300001 Avances en el uso de lípidos en nutrición parenteral y enteral Muñoz Cesar ,CCSS Hospital Nacional de Niños San José Costa Rica 1999 1999 13 96 101 Heims R Overview of parenteral lipid use in Pediatrics in "Lipid Metabolism in Pediatrics": update 1991 P.G. Course Nr 9 Clinical Congress A.S.P.E.N 1991 San Francisco Hamosh M Lipid Metabolism in Pediatric Nutrition Pediatr Clin North Am 1995 42 Uauy R Whad kind of fat do children need?: In "Lipid Metabolism in Infants and Children" Clinical Congress Book A.S.P.E.N 1997 San Francisco Giovanni M Riva E Agostoni C Fatty acids in pediatric nutrition Pediatr Clin North Am 1995 42 Gosttchlich M Selection of Optimal Lipid Sources in Enteral and Parenteral Nutrition Nutr Clin Pract 1992 7 Jensen GL Structured Triglycerides Clinical Congress Book A.S.P.E.N 1992 San Antonio TX Hyltlander A Sandstrom R Lundholm K Metabolic Effects of Structure Triglycerides in Humans Nutr Clin Pract 1995 10 Hamosh M Digestion and Clearance of Lipids with Special Emphasis on the Tiny Baby P.G. Course Nr9 Clinical Congress A.S.P.E.N 1991 San Francisco Novak M Monks EF Chan D Carnitine in the Perinatal Metabolism of Lipids:: I) Relationship between maternal and fetal plasma levels of carnitine and acylcarnitine Pediatrics 1981 67 Schmidt - Sommerfeld E Penn D Wolf H Carnitine blood concentrations and fat utilization in parenterally alimented newborn infants J Pediatr 1983 100 Helms R Mauer EC Hay WW Effect of lntravenous L - carnitine on growth parameters and fat metabolism during parenteral nutrition in neonates JPEN 1990 14/5 Christensen M Heims R Mauer E Plasma carnitine concentracions and lipid metabolism in infants receiving parenteral nutrition J. Pediatr 1989 115 Bonner C DeBrie K Hug G Effect of parenteral L-carnitine supplementation on fat metabolism and nutrition in premature neontaes J. Pediatr 1995 126 Lunderga F The role of carnitine in fat metabolism 21stClinical Congress Book A.S.P.E.N 1997 San Francisco Andrew G Chan G Schiff Lipid metabolismin the neonate J Pediatr 1976 88 Commitee on Nutrition. Use of intravenous fat emulsions in pediatric patients Pediatrics 1981 66 Usmani S Harper R Usmani S Effect of a lipid (intralipid) on polymorphonuclear leukocyte functions in the neonate J Pediatr 1988 113 Dahistrom K Goulet O Roberts R Ricour C Ament M Lipid tolerance in children receiving long-term parenteral nutrition: A biochemical and inmmunologic study J Pediatr 1998 113 Lloyid T Boucek M Effect of lntralipid o the neonatal pulmonary bed: and echographic study J. Pediatr 1986 108 Hammerman C Aramburo MJ Decreased lipid intake reduces morbidity in sick premature neonates J.Pediatr 1988 113 Sper ML Stahl GE Hamosh M Effect of heparin dose and infusion rate on lipid clearance and bilirrubin in premature infants receiving intravenous fat emulsions J Pediatr 1988 112 Haumont D Deckelbaum R Richelle M Carpentier Y Plasma lipid and plasma lipoprotein concentrations in low birth weight infants given parenteral nutrition with twenty o ten percent lipid emulsion J Pediatr 1989 115 Adamkin D. Use of intravenous fat emulsions: part 1 Perinatology - Neonatology May - Ju Freeman J Goldman D Smith NE Association of lipid emulsion and coagulase-negative staphylococcal bacteremia in neonatal intensive care units N Engl J Med 1990 323 Lenssen P Brummer B Bowden R lntravenous lipid dose and incidence of bacteremia and fungemia in patients undergoing bone marrow transplantation Am J Clin Nutr 1998 67 Klein S Miles JM Metabolic effects of Long-chain and Medium-chain Triglyceride emulsions in Humans JPEN 1994 18 Bristrian B Lipids Clinical Congress Book A.S.P.E.N 1992 Mascioli EA Medium - Chain Triglycerides Clinical Congress Book A.S.P.E.N 1994 San Antonio Grimm H Tibbel A Norlind B Immunoregulation by Parenteral Lipids: lmpact of the n-3 to n-6 Fatty Acid Radio JPEN 1994 18 Stouthard J Endert E Romlin J lnfusion of Long Chain or Medium - Chain Triglycerides lnhibits Peripheral Glucose Metabolism in Men JPEN 1994 18 Heird WC Jensen CL Gómez MR Practical aspects of acheving positive energy balance in low birth weight infants J Pediatr 1992 ^s120 Borum P Lipid and the Preterm lnfant: Utilization of Fatty Acids Delivered to the Blood Clinical Congress Book A.S.P.E.N 1994 San Antonio Makrides M Neumann M Simmer K Are longchain fatty acids essential nutrients in infancy? Lancet 1995 345 Lyons R Jeppson R Bartolow L IV Lipids: An Alternative Delivery System for Vitamins and Beyond Clinical Congress Book A.S.P.E.N. San Antonio 1994
S1409-009019990003 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00901999000300002 Manejo de la meningitis por Streptococcus pneumoniae en una era de resistencia a la penicilina Odio Carla M. Hernández Rodolfo Avila María Luisa ,CCSS Hospital Nacional de Niños 1999 1999 13 102 106 Schuchat A robinson K Wenger GD Bacterial meningitis in the United States in 1995: Active Surveillance Team N Engl J Med 1997 887 Peftola HE Haemophilus Influenzae type b disease and vaccination in Latin America and the Caribbean Pediatr lnfect Dis J 1997 16 Ward J Antibiotic-resistant Streptococcus pneumoniae relatively resistant to penicillin in a children's hospital: clinical management and outcome Pediatrics 1992 90 Tan QT Mason EO Kaplan SL Systemic infections due to Streptococcus pneunioniae relativety resistant lo penicillin in a children's hospital: clinical management and outcome Pediatrics 1992 90 Jemigan DB Cetron MS Breiman RF Minimizing the impact of drug-resistant Strptococcus pneumoniae (DRSP) JAMA 1996 275 Jacobs RF Thomas TG Steele RW Yamauchi TA A prospective randomized comparison of cefotaxime versus ampicillin and chloramphenicol for bacterial meningitis in children J Pediatr 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Pallares R High dose cefotaxime in treatment of adult meningitis due to Streptococcus pneumoniae with decreased susceptibillies to broad-spectrum cephalosporins Antimierob Ag Chemother 1996 40 Tan TQ Schutze GE Mason EO Kaplan SL Antibiotic therapy and acute outcome of meningitis due to Streptococcus pneumoniae considered intermediately susceptible to broad-spectrum cephalosporins Antimicrob Ag Chemother 1994 38 Lonks JR Dumin MR Meyerhoff AN Medeiros AA Meningitis due to ceftriaxone resistant Streptococcus pneumoniae N Engl J Med 1995 322 Bajarksouzian S Visalli MA Jacobs MR Appelbaum PC Antipneumococcal activities of cefpirome and cefotaxime, alone and in combination vvith vancomycin and teicoplanin, determined by checkerboard and time-kill methods Antimicrob Ag Chemother 1996 40 Klugman KP Dagan R Randomized comparison of meropenem with cefotaxime for treatment of bacterial meningitis Antimicrob Ag Chemother 1995 39 Sangler SK Jacobs MR Applebaum PC Susceptibility of 177 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S1409-009019990003 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00901999000300003 Nuevos conceptos en el manejo de los pacientes pediátricos mordidos por serpientes venenosas Avila-Agüero María L. ,CCSS Hospital Nacional de Niños 1999 1999 13 107 109 Nelson BK Snake Envenomation: lncidence, Clinical Presentation and Management Med Toxicol 1989 4 Seiler JG Sagerman SD Geller RJ Eldridge JC Fleming LL Venomous Snake Bite: Current Concepts of Treatment Orthopedics 1994 8 Gutierrez JM Meier J Wite J Clinical Toxicology of Snakebite in Central América Handbook of Clinical Toxicology of Animal Venoms and Poisons CRS tipo trombina C press Handbook of Clinical Toxicology of Animal Venoms and Poisons CRS tipo trombina C press 1995 Picado Twight Serpientes Venenosas de Costa Rica Obras Completas Obras Completas 1987 III Editorial Tecnológica de Costa Rica Parrish H Goldner J Silberg S Comparation between snakebite in children and adults Pediatrica 1965 36 Warrell DA Fenner PJ Venomous bites and stings Br Med Bull 1993 2 Gold BS Barish RA Venomous Snakebites: Current Concepts in Diagnosis, Treatment and Management Emerg Med Clin North Am 1992 2 Vincent JL Créteur J Morsures de serpent Rev Med Brux 1995 5 Weber RA White RR Crotalidae envenomation in children Ann Plast Surg 1993 2 Lewis JV Portera CA Rattlesnake bite of the face: case report and review of the literature Am Surg 1994 60 Sutherland SK Leonard RL Snakebite deaths in Australia 1992-1994 and a management update Med J Aust 1995 11-12 Mead HJ Jelinek GA Suspected snakebite in children: a study of 156 patients over 10 years Med J Aust 1996 8 Hanson LA What is inflammation? Chaos? Introduction to "Symposium on the Monitoring of Allergy Inflammation" Introduction to "Symposium on the Monitoring of Allergy Inflammation" Sept em be Uppsala Arroyo O Bolaños R Muñoz G The Bacterial Flora of Venoms and Mouth Cavities of Costa Rican Snakes Buil Pan Am Health Organ 1980 3 Bolaños R Brunker T Bacteriología del Veneno y de las glándulas veneníferas de Bothrops asper y Crotalus durissus durissus de Costa Rica Rev Cost Cienc Med 1983 4 Jorge MT De Mendoca JS Ribeiro LA Bacterial Flora of the Oral Cavity, Fangs and Venom of Bothrops jacaraca: Possible source of lnfection at the Site of Bite Rev Inst Med Trop Sao Paulo 1990 1 de Andrade JG Pinto RN de Andrade AL Bacteriologic Study of Abscesses Caused by Bites of Snakes of the Genus Bothrops Rev lnst Med Trop Sao Paulo 1989 6 Jorge MT Adriano L Da Silva ML Uro EJ Silva J Microbiological Studies of Abscesses Complicating Bothrops Snakebite in Humans: A Prospective Study Toxicom 1994 6 Forks TP Evaluation and Treatment of Poisonous Snakebites Am Fam Physician 1994 1 Wagner CW Golladay ES Crotalid Envenomation in children: selective conservatve management J Pediatr Surg 1989 24 Bush SP Jansen PW Severe rattlesnake envenomation with anaphylaxis and rhabdomyolisis Ann Emerg Med 1995 6 Anderson PC Snake bites South Med J 1994 87 Mars M Hadley GP Aitchison JM Direct intracompartment pressure measurement in the management of snakebites in children S Afr Med J 1991 5 Wagner CW Golladay ES Crotalid envenomation in children: selective conservative management J Pediatr Surg 1989 1 Avila-Agüero M.L París MM Hu S Faingezicht I Peterson PK Inflammatory response in pediatric patients bitten by snakes Inflammatory response in pediatric patients bitten by snakes lnterscience Congress Antimicrobial Agent and Chemotherapy Set 1999 San Diego California
S1409-009019990003 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00901999000300004 Estreñimiento y encopresis: epidemiología y terapéutica actual Rojas Jader Jiménez Carlos Mora Alfredo Calzada Alejandro ,CCSS Hospital Nacional de Niños San José Costa Rica 1999 1999 13 110 114

Objetivo: Describir las características, epidemiología, tratamiento y evolución del estreñimiento y la encopresis en una población pediátrica. Proponer un protocolo de manejo adaptado a nuestras necesidades y recursos. Métodos: se diseñó un estudio prospectivo, de carácter descriptivo para seleccionar niños menores de 12 años que presentaran estreñimiento funcional y/o encopresis. Los pacientes fueron de la consulta externa de nuestro hospital y venían referidos de los diferentes centros de atención periférico del país. Resultados: Se incluyeron a 91 pacientes durante un período de 6 meses. El 69% de los casos procedían de la meseta central, con una edad entre los 0 a 10 años (promedio de 4.3). El 62% tenía antecedentes familiares de estreñimiento y 89% ingería una dieta inadecuada. La mayoría (83%) de los pacientes recibieron leche materna exclusiva por 1 mes y al final del segundo mes al 70% se le había introducido una fórmula láctea variable. El 53% de los pacientes presentó mejoría al corregir los factores dietéticos y mejorar los hábitos en el uso del sanitario. En un 22% de los casos no hubo respuesta adecuada y fueron referidos al especialista, siendo la mayoría incluidos en un estudio paralelo utilizando Cisapride como terapia básica. Conclusiones: Los hábitos dietéticos familiares al igual que la suspensión de la lactancia materna temprana con introducción de fórmulas lácteas y alimentos en forma inadecuada, fueron los principales factores asociados al desarrollo de estreñimiento en nuestro medio. El estreñimiento puede manejarse con buenos resultados a nivel de atención primaria si se siguen programas educativos en la comunidad y un tratamiento ordenado.

 Estreñimiento Encopresis Dieta rica en fibra Adel Abi-Hanna MD Alan M Lake MD Constipation and Encopresis in Childhood Pediatrics in Review 1998 19 Loening-Baucke Vera Encopresis e incontinencia fecal Encopresis e incontinencia fecal 1996 1 Clínicas Pediátricas de Norte América Howe E Allizon C Behavioral management of toilet training, enuresis and encopresis Clin Pediatrics N.A 1992 39 James L Sutphen M.D Stephen M Borowitz Rachel L Hutchison Long-Term Follow-up of Medically Treated Childhood Constipation Clinical Pediatrics 1995 11 lacona G Carrioccio A Chronic Constipation as a symtom of cow milk allergy J. Pediatric 1995 126 Benninga M.A. Buller H ls encopresis aiways the result of constipation? Arch.Dis Child 1994 71 Stern HP Prince mt Stroh St Encopresis responsive interventions Clin Pediatr 1998 27 lssenman RM Hewson S Pirhonen D Are chronic digestive complaints the result of abnormal dietary patterns? Am Dis child 1987 141 Barbara O Schneeman Lesley F Tinker RD Fibra de alimentos Clínicas de nutrición de N. A 1994 340 Cucchiara S Cisapride therapy for gastrointestinal disease J Pediatr Gastroenterol Nutr 1996 22 Serious cardiac side effects in patients taking Propulsid in conbination with other drugs NEJM 1996 335 Tack J Coremans G Janssens J A risk-benefit assessment of Cisapride in the treatment of gastrointestinal disorders Drugs Saf 1995 12 ^s6 Mendoza O Mora G Jiménez H Eficacia de Cisapride en niños con estreñimiento crónico funcional refractario al tratamiento convencional ( lnpress). to non-psychiatric Eficacia de Cisapride en niños con estreñimiento crónico funcional refractario al tratamiento convencional ( lnpress). to non-psychiatric 1988 27
S1409-009019990003 Acta Pediátrica Costarricense Acta pediátr. costarric 1409-0090 Asociación Costarricense de Pediatría S1409-00901999000300005 Miastenia en niños Kozakova Alia Brian Roberto ,CCSS Hospital Nacional de Niños San José Costa Rica 1999 1999 13 115 117

Objetivo: Revisar los casos de miastenia que se han diagnosticado en el HNN. Tipo de estudio: retrospectivo. Métodos: Se realizó una revisión de 16 casos de miastenia diagnosticados en el Hospital Nacional de Niños, encontrándose que si bien son trastornos poco frecuentes en pediatría, su diagnóstico clínico debe complementarse con las pruebas de Jolly y Tensilón y la determinación de anticuerpos contra receptores de acetilcolina. Resultados: Nuestra serie incluye 4 miastenias congénitas de evolución estable aún sin tratamiento y 12 formas autoinmunes, iniciándose la mayoría antes del ano de edad y con manifestaciones oculares. Siete niños timectomizados obtuvieron pocos beneficios, continuando, la mayoría de ellos con tratamiento inmunosupresor. Consideramos que la timectomía está indicada en aquellos niños con miastenia generalizada inmunológica, sin respuesta a los esteroides o a la Gammaglobulina y evitando realizarla tempranamente por el riesgo de inmunodeficiencia.

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