RESUMO
BACKGROUND: Cerebral venous sinus thrombosis (CVST) in children is associated with a high incidence of serious morbidity and mortality. The presenting features are variable. It can be diagnostically challenging and the optimal treatment is uncertain. AIM: To describe the features of a series of children with CVST treated in a single paediatric neurology centre and to discuss the role of local thrombolysis. METHODS: Electronic databases were searched using diagnostic labels and International Classification of Diseases (ICD) codes to identify children aged 1 month to under 17 years with CVST. Their records were reviewed. RESULTS: 21 children were identified over a period of 8.25 years with a median age of 7.1 years. The presenting symptoms included headache (15 children), vomiting (14 children) and visual disturbance (eight children). Signs found included papilloedema (16 children), fever (six children) and sixth nerve palsy (six children). The most common underlying condition was middle ear infection (13 children). All cases received unfractionated heparin and four severe cases received local pharmacological thrombolysis. 48% of cases had an adverse outcome (death, chronic intracranial hypertension, residual hemiparesis or sixth nerve palsy). DISCUSSION: CVST has non-specific presenting features and a high risk of significant morbidity. CVST is typically found in association with a predisposing condition. Although heparin is the mainstay of treatment, thrombolysis may reverse deterioration as seen in three cases in this series. However, there is insufficient evidence to recommend the routine use of thrombolysis at present.
Assuntos
Trombose dos Seios Intracranianos/diagnóstico , Trombose dos Seios Intracranianos/tratamento farmacológico , Terapia Trombolítica/métodos , Adolescente , Anticoagulantes/uso terapêutico , Criança , Pré-Escolar , Feminino , Fibrinolíticos/uso terapêutico , Seguimentos , Transtornos da Cefaleia Secundários/etiologia , Heparina/uso terapêutico , Humanos , Lactente , Masculino , Fatores de Risco , Trombose dos Seios Intracranianos/complicações , Trombofilia/complicações , Trombofilia/diagnóstico , Fatores de Tempo , Ativador de Plasminogênio Tecidual/uso terapêutico , Resultado do Tratamento , Transtornos da Visão/etiologia , Vômito/etiologiaRESUMO
We report a case of pneumothorax as a result of positive pressure ventilation in a child previously treated for empyema. Three months following discharge for successful treatment of empyema our patient received a general anesthetic for an elective MRI of the brain for investigation of nystagmus. During recovery from the anesthetic he developed respiratory distress and was found to have a loculated pneumothorax. We propose that pleural fragility in childhood empyema possibly persists even after clinical resolution and in this case for up to 3 months. The complication of pneumothorax should be considered in all patients receiving positive pressure ventilation following resolved empyema.
Assuntos
Empiema/fisiopatologia , Pleura/fisiopatologia , Pneumotórax/etiologia , Pneumotórax/fisiopatologia , Respiração com Pressão Positiva/efeitos adversos , Anestesia Geral/efeitos adversos , Humanos , Lactente , Masculino , Fatores de TempoAssuntos
Insuficiência Adrenal/induzido quimicamente , Androstadienos/efeitos adversos , Anti-Inflamatórios/efeitos adversos , Asma/tratamento farmacológico , Hipoglicemia/induzido quimicamente , Doença Aguda , Administração por Inalação , Administração Tópica , Criança , Pré-Escolar , Esquema de Medicação , Fluticasona , Glucocorticoides , HumanosRESUMO
In the period from September 1983 until June 1986 a prospective study was carried out to determine the incidence and severity of retinopathy of prematurity in inborn infants of less than 1500 g at birth and the risk factors associated with the development of retinopathy of prematurity in infants of less than 31 weeks' gestation. One hundred and forty four infants were eligible for inclusion in the study. Altogether 140 infants of less than 1500 g birth weight were examined, 42 (30%) of whom developed retinopathy of prematurity. Fifteen of these infants had progression to advanced disease (stage III or stage IV). One hundred and seventeen of the infants were of less than 31 weeks' gestation and 34 (29%) of them developed retinopathy of prematurity. Thirty four risk factors shown previously to be associated with the development of the disease were collected prospectively and analysed using multiple logistic regression analysis to determine the independently significant variables. Three risk factors: acidosis, the number of times that the pH was less than 7.2; hyperoxia, the number of times that arterial oxygen tension was greater than 12 kPa; and gestational age were found to be independently associated with the development of retinopathy of prematurity in these infants. These findings suggest that acidosis may be an important aetiological factor in the pathogenesis of this disease.
Assuntos
Recém-Nascido de Baixo Peso , Retinopatia da Prematuridade/etiologia , Acidose/complicações , Olho/patologia , Idade Gestacional , Humanos , Recém-Nascido , Londres , Retinopatia da Prematuridade/epidemiologia , Retinopatia da Prematuridade/patologia , Fatores de RiscoRESUMO
In seven recurrently wheezy infants who were found to be histamine-responsive during bronchial challenge, changes in oxygenation (by oximeter and transcutaneous PO2 electrode) and carbon dioxide tension (by transcutaneous PCO2 electrode) were concurrently measured. The histamine challenge consisted of doubling concentrations administered by nebulizer for 1 min at 5-min intervals, up to a maximum concentration of 8 g/L. The response was determined from maximum expiratory flow using a squeeze technique. Significant mean reductions in transcutaneous oxygen tension of 0.9 +/- 0.7 kPa and 1.5 +/- 0.9 kPa were seen respectively at half the provoking concentration and at the provoking concentration of histamine that caused a significant reduction in maximum expiratory flow rates. The reduction in oxygen saturation of 4.8 +/- 3% was also significant at the provoking concentration. No significant change in transcutaneous carbon dioxide tension was seen. These results suggest that acute histamine-induced airway obstruction causes significant ventilation/perfusion disturbance in wheezy infants. Oxygen monitoring should be performed during bronchial challenge tests in infancy.
Assuntos
Testes de Provocação Brônquica , Histamina , Troca Gasosa Pulmonar , Sons Respiratórios/diagnóstico , Monitorização Transcutânea dos Gases Sanguíneos , Humanos , Lactente , Monitorização Fisiológica , Oximetria , Ventilação Pulmonar , Relação Ventilação-PerfusãoRESUMO
Respiratory inductance plethysmography was used to estimate changes in functional residual capacity (FRC) in seven recurrently wheezy infants undergoing histamine challenge. Inhalations of normal saline and doubling concentrations of histamine were given up to and including the provoking concentration (PC) that caused a significant fall in maximum flow at FRC (Vmax FRC) as measured using the inflatable jacket technique. Below the PC histamine in general caused small increases in FRC [9.4 +/- 7.6 ml (mean +/- SD) at half the provoking concentration]. However, larger increases were seen at the provoking concentration (26.6 +/- 15.6 ml). Inspection of flow-volume curves obtained before and after the larger changes in FRC suggested that the reduction in airflow measured by the change in Vmax FRC was underestimated.
Assuntos
Espasmo Brônquico/fisiopatologia , Histamina , Pulmão/efeitos dos fármacos , Sons Respiratórios/fisiopatologia , Testes de Provocação Brônquica/métodos , Espasmo Brônquico/induzido quimicamente , Capacidade Residual Funcional , Humanos , Lactente , Pulmão/fisiopatologia , Pletismografia/métodos , Recidiva , Respiração/efeitos dos fármacosRESUMO
Sixty-nine infants at risk of developing retinopathy of prematurity (ROP) were entered into a prospective study to assess the incidence and natural history of the disease. Seventeen infants developed ROP, and in six eyes the disease progressed to stage IV ROP. The natural regression of a pupillary membrane and physiological vitreous haze was not influenced by the onset of ROP. Progression from stage I to stage III was rapid and the rate was influenced by the zone affected. Congestion and tortuosity of vessels in the posterior pole always signified stage III ROP. Progression from stage III to stage IV ROP was slower; it was characterised by the development of vitreoretinopathy, signified by the sudden onset of a vitreous haze. Iris congestion associated with poor mydriasis may be a grave sign indicating imminent retinal detachment. Cicatricial ROP can be divided into retinal and vitreoretinal cicatricial disease directly related to the stage of active disease reached. ROP is characterised by its self limiting nature, but the stage at which it becomes inactive varies and will influence the final outcome.
Assuntos
Retinopatia da Prematuridade/patologia , Oftalmopatias/complicações , Fundo de Olho , Humanos , Recém-Nascido , Estudos Prospectivos , Descolamento Retiniano/complicações , Vasos Retinianos/patologia , Retinopatia da Prematuridade/complicações , Retinopatia da Prematuridade/epidemiologia , Corpo Vítreo/patologiaRESUMO
The response of the bronchi to nebulised salbutamol was measured in five recurrently wheezy infants. Changes in oxygenation (measured by pulse oximeter and transcutaneous PO2 electrodes) and carbon dioxide (measured by transcutaneous PCO2 electrode) were recorded at the same time. Neither nebulised saline nor salbutamol caused any changes in the measurements of airway function. A significant drop in mean oxygen saturation of 2% and of transcutaneous oxygen tension of 1.3 kPa occurred after nebulised salbutamol. No significant change occurred in measurements of transcutaneous carbon dioxide tension, nor was there any significant change in any of these measurements after 2.5 ml of nebulised saline had been given as a control. These results suggest that nebulised salbutamol may cause significant hypoxaemia, in wheezy infants probably by inducing ventilation/perfusion disturbance.
Assuntos
Albuterol/efeitos adversos , Hipóxia/induzido quimicamente , Sons Respiratórios/fisiopatologia , Albuterol/uso terapêutico , Dióxido de Carbono/sangue , Humanos , Lactente , Oxigênio/sangue , Pressão Parcial , RecidivaRESUMO
The airway response to nebulised ipratropium bromide was studied in 17 chronically or recurrently wheezy infants aged 4-15 months. The peripheral airway response was assessed by the change in maximum flow at functional residual capacity (Vmax FRC) and the upper and central airway response by the change in specific airways resistance. The significant reduction in specific airways resistance after treatment with ipratropium bromide signified an improvement in central and upper airway function. No change was found, however, in Vmax FRC and hence in peripheral airway function. It seems that, as in older subjects, inhaled antimuscarinic, anticholinergic drugs have their maximum effect on the large airways, and this may explain their lack of effect in the management of acute bronchiolitis.
Assuntos
Derivados da Atropina/uso terapêutico , Ipratrópio/uso terapêutico , Pneumopatias Obstrutivas/tratamento farmacológico , Resistência das Vias Respiratórias/efeitos dos fármacos , Humanos , Lactente , Ipratrópio/administração & dosagem , Ipratrópio/farmacologia , Pulmão/fisiopatologia , Pneumopatias Obstrutivas/fisiopatologia , Nebulizadores e Vaporizadores , Pico do Fluxo ExpiratórioRESUMO
Lower airway responses to nebulised bronchodilators were studied in 18 chronically or recurrently wheezy infants, aged 3-15 months, by means of partial forced expiratory flow-volume manoeuvres performed with an inflatable jacket. Maximum flow at functional residual capacity (FRC) (VmaxFRC) was used as the index of intrathoracic airways function. Peak expiratory flow rate was also measured. Baseline airways resistance and lung volume were determined during quiet breathing in an infant whole body plethysmograph. Measurements were made on separate days before and after nebulised salbutamol 2.5 mg with nebulised saline as control. The results were paradoxical: there was no change in VmaxFRC after saline, but a significant decline in VmaxFRC was found after salbutamol. Peak expiratory flow remained unchanged. These observations suggest that under conditions of forced expiration intrathoracic airways function may be further impaired by nebulised bronchodilator treatment in wheezy infants. When nebulised bronchodilator drugs are used to treat severe airways obstruction in infancy, careful monitoring is essential.
Assuntos
Albuterol/farmacologia , Sons Respiratórios/fisiopatologia , Capacidade Vital/efeitos dos fármacos , Resistência das Vias Respiratórias/efeitos dos fármacos , Albuterol/administração & dosagem , Humanos , Lactente , Pulmão/efeitos dos fármacos , Pulmão/fisiopatologia , Nebulizadores e Vaporizadores , Pico do Fluxo ExpiratórioRESUMO
Little is known about airway responsiveness in infancy. The bronchial response to incremental doses of nebulised histamine (to a maximum dose of 8 g/l) was measured in 11 wheezy infants with a mean age of 8.7 months. The study was repeated after a 30-40 minute recovery period in seven infants and again on a separate day in 10. The index of response was the provoking concentration of histamine that produced a 30% fall in the maximum expiratory flow at functional residual capacity (PC30), taken from partial forced expiratory flow-volume curves produced in a pressure jacket. Nine of 11 infants had a PC30 of less than 8 g/l. The response was consistent between tests in both the nine responders and the two who failed to respond at 8 g/l. The PC30 was lower in infants with more severe baseline airway obstruction. Spontaneous recovery after challenge was complete in 30 minutes in seven of eight infants studied. The highest doses of histamine caused changes in the configuration of the flow-volume curves and symptomatic cough and wheeze in addition to a change in forced flow rates. This study provides clear evidence of intrathoracic airway responsiveness to histamine in infancy.
Assuntos
Brônquios/efeitos dos fármacos , Histamina/farmacologia , Sons Respiratórios/fisiopatologia , Brônquios/fisiopatologia , Relação Dose-Resposta a Droga , Capacidade Residual Funcional , Histamina/administração & dosagem , Humanos , Lactente , Nebulizadores e Vaporizadores , Pico do Fluxo ExpiratórioRESUMO
The effect of nebulised salbutamol on the bronchial response to nebulised histamine was studied in five wheezy infants aged 3-12 months. The response to doubling concentrations of up to 8 g/l of histamine was assessed by the change in the maximum flow at FRC (VmaxFRC), measured by flow-volume curves produced during forced expiration with a pressure jacket. The concentration of histamine required to provoke a 30% fall in VmaxFRC (PC30) was measured. All of the infants responded to low concentrations of histamine during control tests before and after nebulised saline (mean PC30 1.07 and 0.51 g/l). On a separate day there was a similar response to histamine before salbutamol (PC30 0.57 g/l), but after salbutamol the response was completely abolished up to the maximum concentration of histamine in all subjects (PC30 greater than 8 g/l). Thus wheezy infants have highly effective beta 2 adrenoceptors in intrathoracic airways.
Assuntos
Albuterol/farmacologia , Brônquios/efeitos dos fármacos , Antagonistas dos Receptores Histamínicos , Sons Respiratórios/fisiopatologia , Albuterol/administração & dosagem , Brônquios/fisiopatologia , Relação Dose-Resposta a Droga , Interações Medicamentosas , Capacidade Residual Funcional , Histamina/administração & dosagem , Humanos , Lactente , Nebulizadores e Vaporizadores , Receptores Adrenérgicos beta/fisiologiaRESUMO
Measurements of the resistance, time constant, and compliance of the respiratory system were made in 25 mechanically ventilated, preterm babies on 32 occasions, using the single breath technique. Patients were classified according to the level of respiratory resistance by reference to a population of 36 babies studied over the first two days of life before airway secretions had become apparent. There was a highly significant fall in both the resistance and time constant measurements after tracheobronchial suction or lavage for infants whose pretreatment values of resistance were greater than the reference mean. When tracheobronchial toilet was effective in removing secretions the changes in resistance and time constant values were again significant. No changes in compliance values were noted. Severe but clinically inapparent mucous obstruction of the airways was revealed in two infants by a progressively rising respiratory system resistance during continuous monitoring. The need for and efficacy of tracheobronchial suction and lavage could be determined by such techniques for monitoring the resistance of the respiratory system during mechanical ventilation.
Assuntos
Resistência das Vias Respiratórias , Recém-Nascido Prematuro/fisiologia , Pulmão/fisiologia , Respiração Artificial , Humanos , Doença da Membrana Hialina/fisiopatologia , Recém-Nascido , Pulmão/fisiopatologia , Monitorização Fisiológica/métodos , Muco/metabolismo , Sucção , Irrigação TerapêuticaRESUMO
We have constructed a simple pressure-jacket with which to produce passive forced expiration in sleeping, supine infants by thoraco-abdominal compression. During expiration, flow and volume were measured at the airway opening with a face-mask and pneumotachograph. From partial expiratory flow-volume (PEFV) curves, peak expiratory flow rate (PEFR) and maximum expiratory flow at a lung volume equal to the functional residual capacity (VmaxFRC) were obtained. Using the jacket in groups of normal and wheezy infants, we have assessed the effects on PEFR and VmaxFRC of variable inflation pressure, rate and duration of jacket inflation, timing of chest compression in relation to the breathing cycle and subject interaction with the compression manoeuvre. The within-subject reproducibility of PEFR and VmaxFRC was measured. Consistent values were produced by inflating the jacket within 100 ms at end inspiration to a pressure of 3-4 kPa and maintaining the inflation (in wheezy infants) for at least 1 s. The median within-subject coefficients of variation of PEFR and VmaxFRC for both normal infants and wheezy infants were 9 and 12% respectively. The technique is clearly reproducible and can provide information about intrathoracic airway function in infancy.