RESUMO
BACKGROUND: Nicotine and alcohol consumption have been associated with premature delivery and adverse neonatal outcome. We wanted to analyze the influence of self-reported nicotine and alcohol consumption on outcome of VLBW infants. MATERIAL AND METHODS: In an ongoing multicenter study 2475 parents of former very low birth weight (VLBW) infants born between January 2009 and December 2011 answered questionnaires about maternal smoking habits and alcohol consumption during pregnancy. 2463 (99.5%) completed questions on alcohol consumption and 2462 (99.5%) on smoking habits. These infants were stratified to reported maternal smoking and alcohol consumption during pregnancy. We compared the reasons for premature delivery, neonatal outcome and parental reports on bronchitis during the first year of life, as well as growth and development at age 2 years to pregnancy exposure. RESULTS: In nicotine exposed infants intrauterine growth restriction (31 vs. 21%, p<0.01), a birth weight below the 10th percentile (26 vs. 17%, p<0.01) and placenta abruption (9.2 vs. 5.8%, p<0.05) was seen more often. Premature rupture of membranes (24 vs. 30%, p<0.05) or HELLP syndrome (6 vs. 11%, p<0.01) was less frequent. A birth weight below the 3rd percentile was seen more frequently in mothers with reported alcohol consumption (13 vs. 6%, p<0.05). We noted an increased rate of BPD and ROP if mothers reported smoking during pregnancy (p<0.05). Growth parameters and scores on Bayley Sscales of infant development at age 2 years did not differ. CONCLUSION: Smoking during pregnancy results in a high rate of growth restricted VLBW infants. Prenatal exposition to nicotine seems to increase postnatal complications such as BPD und ROP.
Assuntos
Consumo de Bebidas Alcoólicas/epidemiologia , Bronquite/epidemiologia , Displasia Broncopulmonar/epidemiologia , Retardo do Crescimento Fetal/epidemiologia , Recém-Nascido de muito Baixo Peso , Efeitos Tardios da Exposição Pré-Natal/epidemiologia , Fumar/epidemiologia , Causalidade , Pré-Escolar , Feminino , Alemanha/epidemiologia , Humanos , Lactente , Recém-Nascido , Gravidez , Prevalência , Retinopatia da Prematuridade/epidemiologia , Fatores de RiscoRESUMO
In all known congenital imprinting disorders an association with aberrant methylation or mutations at specific loci was well established. However, several patients with transient neonatal diabetes mellitus (TNDM), Silver-Russell syndrome (SRS) and Beckwith-Wiedemann syndrome (BWS) exhibiting multilocus hypomethylation (MLH) have meanwhile been described. Whereas TNDM patients with MLH show clinical symptoms different from carriers with isolated 6q24 aberrations, MLH carriers diagnosed as BWS or SRS present only the syndrome-specific features. Interestingly, SRS and BWS patients with nearly identical MLH patterns in leukocytes have been identified. We now report on the molecular findings in DNA in three SRS patients with hypomethylation of both 11p15 imprinted control regions (ICRs) in leukocytes. One patient was a monozygotic (MZ) twin, another was a triplet. While the hypomethylation affected both oppositely imprinted 11p15 ICRs in leukocytes, in buccal swab DNA only the ICR1 hypomethylation was visible in two of our patients. In the non-affected MZ twin of one of these patients, aberrant methylation was also present in leukocytes but neither in buccal swab DNA nor in skin fibroblasts. Despite mutation screening of several factors involved in establishment and maintenance of methylation marks including ZFP57, MBD3, DNMT1 and DNMT3L the molecular clue for the ICR1/ICR2 hypomethylation in our patients remained unclear. Furthermore, the reason for the development of the specific SRS phenotype is not obvious. In conclusion, our data reflect the broad range of epimutations in SRS and illustrate that an extensive molecular and clinical characterization of patients is necessary.
Assuntos
Centrômero/genética , Metilação de DNA , Impressão Genômica , Síndrome de Silver-Russell/genética , Adolescente , Centrômero/metabolismo , Cromossomos Humanos Par 11/genética , Feminino , Regulação da Expressão Gênica , Humanos , Lactente , Masculino , Especificidade de Órgãos , FenótipoRESUMO
PURPOSE: Scrotal ultrasound, color Doppler and spectral Doppler analysis of intratesticular arteries are the most common and important examinations in boys with scrotal pain. In the existing literature information concerning feasibility and reference values of color Doppler and spectral Doppler in small testes is inconsistent. MATERIALS AND METHODS: In the present study 102 boys from 2 days to 16 years old without present or anamnestic scrotal disease were examined in a standardized manner. Using linear scanners (9 - 14 mHz), testicular volumetry and spectral Doppler analysis of typical intratesticular arteries were performed and the paratesticular structures were examined. For analysis we grouped the testes by volume and compared the measured values V. max syst., V. max enddiast., and RI. RESULTS: In all test subjects a complete examination with spectral Doppler analysis of intratesticular arteries could be performed. With increasing testicular volume, there is a linear increase in blood flow velocities V. max syst. and V. enddiast. Irrespective of age and testicular volume, the RI of the intratesticular arteries is 0.54 ± 0.08. CONCLUSION: In contrast to published data, this study shows that color Doppler and spectral Doppler of testicular arteries can be regularly performed even in small testes of less than 1 ml. Reference values for blood flow velocities and RI were found and should improve the diagnostic value of testicular ultrasound examinations in children.
Assuntos
Interpretação de Imagem Assistida por Computador/métodos , Escroto/diagnóstico por imagem , Testículo/irrigação sanguínea , Testículo/diagnóstico por imagem , Ultrassonografia Doppler em Cores/métodos , Ultrassonografia Doppler Dupla/métodos , Adolescente , Artérias/diagnóstico por imagem , Criança , Pré-Escolar , Análise de Fourier , Humanos , Lactente , Recém-Nascido , Masculino , Tamanho do Órgão/fisiologia , Valores de Referência , Sensibilidade e EspecificidadeRESUMO
BACKGROUND: Recently in a report of a single center a method has been described to apply surfactant via a thin endotracheal catheter to very low birth weight infants spontaneously breathing with nasal continuous positive airway pressure. We now analyzed available multicenter data. PATIENTS AND METHODS: In a multicenter study investigating genetic risk factors, clinical and outcome data and data of antenatal and postnatal treatment of infants with a birth weight below 1,500 g were prospectively recorded. The measures of infants treated with the new method of surfactant application were compared to those of infants who received standard care. The analysis was restricted to infants with a gestational age below 31 weeks (n=1,541). RESULTS: 319 infants were treated with the new method and 1,222 with standard care. The need for mechanical ventilation during the first 72 h (29% vs. 53%, p<0.001), the rate of bronchopulmonary dysplasia defined as oxygen at 36 weeks of postmenstrual age (10.9 % vs. 17.5%, p=0.004) and the rate of death or bronchopulmonary dysplasia were significantly lower in the treatment group than in the standard care group. Surfactant, theophyllin, caffeine and doxapram were significantly more often and analgetics, catecholamines and dexamethasone were significantly less frequently used in the treatment group. CONCLUSIONS: A new method of surfactant application was associated with a lower prevalence of mechanical ventilation and better pulmonary outcome. A prospective controlled trial is required to determine whether this approach is superior to standard care.
Assuntos
Recém-Nascido de Peso Extremamente Baixo ao Nascer , Recém-Nascido de muito Baixo Peso , Intubação Intratraqueal/instrumentação , Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Produtos Biológicos/administração & dosagem , Displasia Broncopulmonar/mortalidade , Displasia Broncopulmonar/prevenção & controle , Estudos de Coortes , Pressão Positiva Contínua nas Vias Aéreas , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Instilação de Medicamentos , Masculino , Oxigenoterapia , Fosfolipídeos/administração & dosagem , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Análise de SobrevidaRESUMO
Fibroblast growth factor receptor 3 (FGFR3) is a glycoprotein that belongs to the family of tyrosine kinase receptors. Specific mutations in the FGFR3 gene are associated with autosomal dominant human skeletal disorders such as hypochondroplasia, achondroplasia, and thanatophoric dysplasia. Hypochondroplasia (HCH), the mildest form of this group of short-limbed dwarfism disorders, results in approximately 60% of cases from a mutation in the intracellular FGFR3-tyrosine kinase domain. The remaining cases may either be caused by defects in other FGFR gene regions or other yet unidentified genes. We describe a novel HCH mutation, the first found outside the common mutation hot spot of this condition. This point mutation, an N328I exchange in the extracellular Ig domain III of the receptor, seems to be unique as it affects a putative N-glycosylation site that is conserved between different FGFRs and species. The amino acid exchange itself most probably has no impact on the three-dimensional structure of the receptor domain, suggesting that the phenotype is the result of altered receptor glycosylation and its pathophysiological consequences.
Assuntos
Osteocondrodisplasias/genética , Proteínas Tirosina Quinases , Receptores de Fatores de Crescimento de Fibroblastos/genética , Substituição de Aminoácidos , Animais , Sequência de Bases , Sítios de Ligação/genética , DNA/química , DNA/genética , Análise Mutacional de DNA , Feminino , Glicosilação , Humanos , Lactente , Camundongos , Camundongos Endogâmicos C57BL , Mutação , Osteocondrodisplasias/patologia , Mutação Puntual , Estrutura Terciária de Proteína , Receptor Tipo 3 de Fator de Crescimento de Fibroblastos , Receptores de Fatores de Crescimento de Fibroblastos/química , Receptores de Fatores de Crescimento de Fibroblastos/metabolismoRESUMO
The influence of intravenously administered L-carnitine on lipid- and nitrogen-metabolism was studied during total parenteral nutrition of piglets (mean weight 4077 g; n = 9). The infusion protocol was divided into three isocaloric and isonitrogenous 48-hr periods. Amino acids (3 g/kg day) were administered throughout all three periods: 140 cal/kg/day were given as nonprotein calories, consisting only of glucose during period 1; during periods 2 and 3, an amount of glucose calorically equivalent to 4 g fat/kg/day was substituted with a lipid emulsion, and L-carnitine (1.5 mg/kg/day) was added in period 3. Key parameters of fat- and nitrogen-metabolism were determined during the entire regime. Indirect calorimetry was performed and the respiratory quotient calculated during all three periods. The results demonstrate a more effective lipolysis and oxidation of fatty acids during L-carnitine supplementation. These changes produce an increased energy gain from exogenously administered fat and a distinct improvement in nitrogen balance.
Assuntos
Carnitina/administração & dosagem , Metabolismo dos Lipídeos , Nitrogênio/metabolismo , Nutrição Parenteral Total , Nutrição Parenteral , Aminoácidos/administração & dosagem , Animais , Calorimetria Indireta , Carnitina/sangue , Emulsões Gordurosas Intravenosas/administração & dosagem , Glucose/administração & dosagem , Lipídeos/sangue , Masculino , Oxirredução , Suínos , Porco MiniaturaRESUMO
A 9 1/2-year-old girl suffered from intermitting tremor and jitteriness of her left hand and oral muscles every 4 to 6 weeks with long lasting episodes. Clinically myoclonias and dystonic positioning of the left arm, hand and facial muscles were seen. No evidence of trauma, infection or inborn errors of metabolism was found. Successful therapy with carbamazepine was initiated while L-DOPA failed. An ictal 99m-Tc-HMPAO-SPECT showed severe asymmetry with focal hyperperfusion of the contralateral right thalamus and basal ganglia as well as of the bifrontal cortex, whereas no anatomical lesions were found by MRI. In contrast, an interictally performed 99m-Tc-HMPAO SPECT showed hypoperfusion of the right thalamus and normalisation of the frontal perfusion under medical treatment. These 99m-Tc-HMPAO-SPECT findings may provide new insights into the localisation and pathophysiological pathways of idiopathic childhood dystonia.
Assuntos
Encéfalo/diagnóstico por imagem , Carbamazepina/uso terapêutico , Circulação Cerebrovascular , Distonia/diagnóstico por imagem , Compostos Radiofarmacêuticos , Tecnécio Tc 99m Exametazima , Anticonvulsivantes/uso terapêutico , Encéfalo/irrigação sanguínea , Encéfalo/patologia , Criança , Distonia/tratamento farmacológico , Distonia/patologia , Distonia/fisiopatologia , Feminino , Seguimentos , Lateralidade Funcional , Humanos , Levodopa/uso terapêutico , Imageamento por Ressonância Magnética , Fluxo Sanguíneo Regional , Tomografia Computadorizada de Emissão de Fóton ÚnicoRESUMO
The mortality rate from congenital diaphragmatic hernia is not much better than it was 25 years ago. Most children, who are more than 24 hours of age at operation, survive. On the first day of life postoperative mortality is about 47%. Pediatric surgical problems are stabilization of the diaphragm and abdominal decompression. Some risk patients may be brought out of the fatal zone by high frequency ventilatory support and pharmacologic reversal of the fetal circulation. The most important causes of death are pulmonary hypoplasia with abnormal pulmonary vascular reactivity and persistent fetal circulation, iatrogenic pneumothorax, interstitial emphysema, mediastinal shifting with subsequent pulmonary hypertension and right to left shunting, and associated cardiac malformations.
Assuntos
Hérnia Diafragmática/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Circulação Extracorpórea , Feminino , Hemodinâmica , Hérnias Diafragmáticas Congênitas , Humanos , Recém-Nascido , Complicações Intraoperatórias/prevenção & controle , Masculino , Complicações Pós-Operatórias/mortalidade , Cuidados Pré-Operatórios/métodos , Prognóstico , Respiração ArtificialRESUMO
Retinopathy of prematurity (ROP) is one of the three leading causes of legal blindness in childhood in developed countries. Adequate screening is one of the most important steps towards successful treatment. During the last decades, international and national guidelines for ROP screening have been continually updated. These guidelines correspond to progress in neonatal care and to a better understanding of the relationship between different neonatal parameters and the risk of developing ROP. The present article surveys ROP classification, the current national and international guidelines and new aspects of ROP screening.
Assuntos
Técnicas de Diagnóstico Oftalmológico/normas , Programas de Rastreamento/métodos , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Retinopatia da Prematuridade/diagnóstico , Criança , Humanos , Recém-NascidoRESUMO
To determine the frequency and the impact of parvovirus B19 (B19V) infection and its influence on the course of haematological and/or oncological diseases in paediatric patients, consecutive serum and bone marrow samples from 110 were analyzed for markers of acute, past and persistent B19V-infection using qPCR, ELISA and WesternLine. Twenty-seven out of 110 (24.5%) children suffered from non-malignant diseases (anaemia, pancytopenia, autoimmune disorders); 68/110 (61.8%) patients had developed leukaemia, malignant lymphoma or solid malignant tumours; 15/110 patients (13.6%) presented with other symptoms. At admission, B19V-specific IgM and IgG indicating acute or previous B19V-infection were observed in 5 (4.5%) and 48 patients (43.6%), respectively. B19V-DNA (10(3) -10(9) geq/mL) was detectable in serum and/or bone marrow of 22 patients (20.0%). These suffered from leukaemia (5), non-Hodgkin lymphoma (2), solid tumours (6), autoimmune (4) and haematological (4) disease and fever (1). During clinical observation four further leukaemia patients developed viraemia and persistent B19V-infection was observed in 13/22 DNA-positive patients. Treatment of B19V-DNA-positive cancer patients was associated with more supportive therapy involving erythrocyte and thrombocyte transfusion and/or antibiotic therapy. Acute B19V-infection has been frequently observed in paediatric patients with haematological and/or oncological disease. In patients with non-malignant diseases anaemia or autoimmune disorders were diagnosed in association with B19V-infection. Furthermore, a significant number of cancer patients displayed markers for acute, recent or persistent B19V-infection. This association may be strengthened by frequent treatment with blood products combined with therapeutic immune suppression. In B19V-infected cancer patients supportive therapy was more complex.
Assuntos
Neoplasias Hematológicas/virologia , Neoplasias/virologia , Infecções por Parvoviridae/sangue , Infecções por Parvoviridae/complicações , Parvovirus B19 Humano/isolamento & purificação , Adolescente , Anticorpos Antivirais/análise , Anticorpos Antivirais/sangue , Biomarcadores/análise , Biomarcadores/sangue , Medula Óssea/virologia , Distribuição de Qui-Quadrado , Criança , Pré-Escolar , Estudos de Coortes , DNA Viral , Feminino , Neoplasias Hematológicas/sangue , Humanos , Lactente , Masculino , Neoplasias/sangue , Transplante de Células-Tronco , Adulto JovemRESUMO
Human bocavirus (HBoV) was recently described as a new member of the Parvoviridae. In order to investigate the suggested association of HBoV with respiratory and gastric disease in infants and young children, sera of 357 paediatric patients hospitalized with infectious and non-infectious diseases were retrospectively analyzed for the presence of HBoV DNA and virus-specific antibodies using quantitative PCR and ELISA, respectively. HBoV seroprevalence was determined to range from 25% in infants younger than 1 year of age to 93% in children aged more than 3 years. Viral loads between 1 x 10(2) and 1.2 x 10(6) geq/mL were observed in 6.7% (20/297) of sera obtained preferentially from young children suffering from infectious diseases. HBoV genomes were furthermore detected in 5% (3/60) of sera collected from individuals with non-infectious illnesses. HBoV DNA was present most frequently in patients with respiratory disease (9.6%). Whereas only 5.2% of patients with upper respiratory tract disease were viraemic, HBoV DNA was found in 14.6% and 10.0% of patients with lower respiratory tract illness and pneumonia, respectively. Acute HBoV infections were also observed in 7.5% of patients with gastroenteritis and in one child with inflammatory bowel disease. None of 77 patients hospitalized for various other infectious diseases (e.g. rash, urinary tract infection, meningitis) displayed viraemia. In 60.9% and 47.8% of DNA-positive children, HBoV-specific IgM and IgG was observed, respectively. The present prospective study provides comprehensive data on the clinical association of acute HBoV infection with respiratory illness and on the seroprevalence of virus-specific antibodies in children.
Assuntos
Bocavirus Humano/isolamento & purificação , Infecções por Parvoviridae/epidemiologia , Infecções por Parvoviridae/patologia , Adolescente , Fatores Etários , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , DNA Viral/sangue , Ensaio de Imunoadsorção Enzimática/métodos , Feminino , Gastroenteropatias/epidemiologia , Gastroenteropatias/patologia , Gastroenteropatias/virologia , Hospitalização , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Lactente , Masculino , Infecções por Parvoviridae/virologia , Reação em Cadeia da Polimerase/métodos , Prevalência , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/patologia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Soro/imunologia , Soro/virologia , Carga Viral , Virologia/métodosRESUMO
BACKGROUND: The insertion/deletion polymorphism of the angiotensin-converting enzyme (ACE-ins/del) and the angiotensin II type 1 receptor 1166A/C polymorphism (ATR1166A/C) were reported to be associated with several unfavorable outcome parameters in preterm infants like bronchopulmonary dysplasia, persistent ductus arteriosus and impaired insulin sensitivity. OBJECTIVE: To confirm the above-mentioned associations in a large cohort of very-low-birthweight (VLBW) infants. METHOD: Clinical data of VLBW infants were prospectively recorded. The ACE-ins/del polymorphism and the ATR1166A/C polymorphism were determined by polymerase chain reaction in 1,209 and 1,168 infants, respectively. RESULTS: There was no significant association between ACE-ins/del or ATR1166A/C genotype and outcome parameters (death, intraventricular hemorrhage, sepsis, bronchopulmonary dysplasia, ventilation, supplemental oxygen at discharge, postnatal treatment with insulin, surgery for intestinal perforation/necrotizing enterocolitis/retinopathy of prematurity/persistent ductus arteriosus. CONCLUSION: Both known functional polymorphisms of the renin-angiotensin system do not seem to be associated with the outcome of VLBW infants.
Assuntos
Predisposição Genética para Doença/genética , Doenças do Prematuro/genética , Recém-Nascido de muito Baixo Peso/fisiologia , Polimorfismo de Nucleotídeo Único , Sistema Renina-Angiotensina/genética , Adulto , Estudos de Coortes , Feminino , Predisposição Genética para Doença/epidemiologia , Testes Genéticos , Humanos , Lactente , Recém-Nascido , Doenças do Prematuro/epidemiologia , Masculino , Gravidez , Resultado da Gravidez , Estudos ProspectivosRESUMO
Pregnant women who have an urogenital Chlamydia trachomatis infection may transmit the infection to their infants. Conjunctivitis and nasopharyngeal infection are the most frequent manifestations. Less frequently the infants may develop pneumonia. We report a case of a 5-week-old girl with poor feeding, staccato cough and clinical signs of pneumonia. Chest radiography revealed severe bronchopneumonia. Despite of intravenous therapy with ampicillin and gentamicin respiration deteriorated and oxygen supplementation became necessary. After additional treatment with oral erythromycin (50 mg/kg per day) had been started the clinical condition improved. Polymerase chain reaction with a nasopharyngeal specimen was found to be positive for Chlamydia trachomatis.
Assuntos
Broncopneumonia/etiologia , Infecções por Chlamydia/complicações , Chlamydia trachomatis , Pneumonia Bacteriana/etiologia , Administração Oral , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Broncopneumonia/diagnóstico por imagem , Broncopneumonia/tratamento farmacológico , Broncopneumonia/terapia , Chlamydia trachomatis/isolamento & purificação , Eritromicina/administração & dosagem , Eritromicina/uso terapêutico , Feminino , Seguimentos , Humanos , Lactente , Nasofaringe/microbiologia , Oxigenoterapia , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/diagnóstico por imagem , Pneumonia Bacteriana/tratamento farmacológico , Pneumonia Bacteriana/terapia , Reação em Cadeia da Polimerase , Radiografia Torácica , Fatores de Tempo , Resultado do TratamentoRESUMO
We investigated the association between the interleukin 6 (IL-6)-174-genotype and unfavorable outcomes in preterm infants since it has been reported that the IL-6-174GG-genotype is associated with increased susceptibility to sepsis, and the IL-6-174CC-genotype is more common in preterm infants with severe intraventricular hemorrhage (IVH). We studied 1206 preterm infants with a birth weight below 1500 g. In contrast to previously published data, the frequency of IVH grade IV, periventricular leukomalacia, ventricular-peritoneal-shunting or death was not different between infants with different IL-6-genotypes: IL-6-174GG (n = 430) 8%, IL-6-174GC (n = 605) 9% and IL-6-174CC (n = 167) 12% (P = 0.2 for IL-6-174CC vs GG + GC). Furthermore, we were not able to confirm previously reported association between sepsis and the IL-6-174GG-genotype. Blood-culture-proven sepsis occurred in 19% of IL-6-174GG-carriers (n = 157), 26% of IL-6-174GC-carriers (n = 193) and 27% of infants carrying the IL-6-174CC-genotype (n = 67). We were not able to confirm previously reported associations between sepsis, cerebral injury and the IL-6-174-genotype in VLBW-infants.
Assuntos
Hemorragia Cerebral/genética , Recém-Nascido de muito Baixo Peso , Interleucina-6/genética , Regiões Promotoras Genéticas , Sepse/genética , Sangue/microbiologia , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/mortalidade , Feminino , Predisposição Genética para Doença , Genótipo , Humanos , Recém-Nascido , Recém-Nascido Prematuro , Leucomalácia Periventricular/genética , Leucomalácia Periventricular/mortalidade , Masculino , Sepse/diagnóstico , Sepse/mortalidade , Derivação VentriculoperitonealRESUMO
In 43 insuline dependent diabetics postprandial serum glucose concentrations as 24-hour glucose excretions have been determined. Their value for a long term metabolic information was compared to that of HbAIc concentrations. A correlation between postprandial serum glucose concentration of the partial correlations. Those excluded the influence of an interrelationship among the individual serum glucose concentrations, at the time of different presentations for metabolic control, on the serum glucose to HbAIc relationship. There was no correlation between the concentrations of HbAIc and the amount of glucose excreted into the urine. The study shows that single determinations of postprandial serum glucose concentrations, as the excretion of small amounts of glucose into the urine are of no use for a long term metabolic information in juvenile diabetics.
Assuntos
Glicemia/análise , Diabetes Mellitus Tipo 1/sangue , Adolescente , Adulto , Criança , Diabetes Mellitus Tipo 1/urina , Feminino , Glucose , Glicosúria , Hemoglobinas/análise , Humanos , Masculino , Matemática , Fatores de TempoRESUMO
In addition to the established treatment of neonatal respiratory distress syndrome by oxygen supplementation, artificial ventilation and thermoneutrality, substitution of surfactant offers a new therapeutic perspective. Up to now, either artificial mixtures of surface active components or surfactant extracts from minced animal lungs, lung lavage fluid, or human amniotic fluid have been used in controlled trials of prophylactic and rescue surfactant treatment. Meta-analysis of controlled prevention trials including about 2,400 preterm infants shows decreased mortality (21% in controls, 9.5% in infants treated with natural preparations, p less than 0.001; 17% in controls, 11% in infants treated with artificial preparations, p less than 0.001) and fewer complications of artificial ventilation (pneumothorax: 24 vs. 7.2% with natural preparations, p less than 0.001; 20 vs. 15% with artificial preparations, p less than 0.05). In rescue studies on more than 1,900 preterm infants, natural surfactant preparations decreased complications of artificial ventilation such as pulmonary interstitial emphysema and pneumothorax (32 vs. 13%, p less than 0.001). Although the immediate effect of artificial preparations is mild, the incidence of pneumothorax also could be reduced (30 vs. 19%, p less than 0.001). Mortality could be reduced by 1/3 with natural (31 vs. 20%, p less than 0.001) and with artificial preparations (23 vs. 16%, p less than 0.01). The incidence of bronchopulmonary dysplasia and intracerebral hemorrhage, however, did not drop significantly. Severe adverse side effects of this treatment seem to be rare. There are, however, potential hazards of surfactant substitution. Its use should be restricted to fully staffed and equipped neonatal intensive care units.
Assuntos
Surfactantes Pulmonares/administração & dosagem , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Terapia Combinada , Seguimentos , Humanos , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Taxa de SobrevidaRESUMO
A bilateral recurrent tension pneumothorax in an 18-year-old patient with cystic fibrosis was treated by fibrin glue pleurodesis. Within the observation period of 20 months no relapse has occurred.
Assuntos
Fibrose Cística/complicações , Pneumotórax/terapia , Adesivos , Adolescente , Drenagem , Feminino , Fibrina/uso terapêutico , Humanos , Pneumotórax/etiologiaRESUMO
We report on three patients suffering from cystic fibrosis (CF) who developed gastrointestinal symptoms of Crohn's disease (CD). Two patients developed enteroenteric or enterocutaneous fistulas. The diagnosis of CD is based on typical endoscopic, radiologic, and histological features of epithelioid granulomas in two children.
Assuntos
Doença de Crohn/complicações , Fibrose Cística/complicações , Adolescente , Doença de Crohn/diagnóstico , Fibrose Cística/diagnóstico , Diagnóstico Diferencial , Feminino , Humanos , Lactente , MasculinoRESUMO
Fifteen preterm infants suffering from respiratory distress syndrome were randomly allocated to receive either high-dose (200 mg/kg) or low-dose (100 mg/kg) surfactant treatment. Retreatments were done with the low dose. Blood pressure, blood gases and cerebral blood flow velocities were determined before and after 24 bolus instillations. With the high dose mean blood pressure and mean cerebral blood flow velocity dropped significantly. With the low dose only mean cerebral blood flow velocity decreased; the course was unrelated to blood pressure or PCO2 fluctuations. The mechanisms leading to the observed circulatory changes after surfactant instillation remain unclear.
Assuntos
Pressão Sanguínea/efeitos dos fármacos , Circulação Cerebrovascular/efeitos dos fármacos , Surfactantes Pulmonares/administração & dosagem , Surfactantes Pulmonares/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Velocidade do Fluxo Sanguíneo/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Humanos , Recém-Nascido , Masculino , Surfactantes Pulmonares/uso terapêuticoRESUMO
34 infants with intracerebral haemorrhage (intraventricular haemorrhage 26; subdural haemorrhage 2; epidural haemorrhage 2; subarachnoidal haemorrhage 4) were investigated by pulsed Doppler-sonography. Absolute flow velocities were measured in the anterior cerebral arteries in infants with intracranial haemorrhage and compared with the flow velocities of a healthy control group of identical gestational age, actual age and weight. All flow velocities were significantly reduced in premature and full-term infants with intracranial haemorrhage, whereas the pulsatility-index was significantly increased. 10 infants with severe intracranial haemorrhage developed a shunt-depending posthaemorrhagic hydrocephalus. These children showed a significant reduction of all flow velocities in the anterior cerebral arteries in comparison to the healthy control group. The diastolic forward flow was more reduced than the maximal systolic velocity resulting in a significant increase of the pulsatility index. In rapidly progressive hydrocephalus, often no diastolic flow or even a retrograde diastolic flow could be found. After shunt-implantation normalisation of the flow velocities could be observed. Reduced flow velocities could be observed. Reduced flow velocities in the anterior cerebral arteries in infants with subdural, epidural and subarachnoidal haemorrhage were associated with a bad outcome: 1 infant died, 1 infant developed severe leucomalacia, and 1 infant showed atrophy of one cerebral hemisphere. Normal flow velocities in the intracranial arteries in subdural, epidural and subarachnoidal were associated with a favourable prognosis. Absent or even retrograde diastolic flow indicates a dramatic decrease of cerebral perfusion. The longer the pathologic flow patterns were demonstrable the worse was prognosis.