Reciente modificación de la Academia Americana de Pediatría del concepto episodio aparentemente letal (ALTE) por el actual evento breve resuelto inexplicado (BRUE). Comentarios a propósito de una experiencia de cinco años en monitorización cardiorrespiratoria domiciliaria / Episode apparently lethal (ALTE) concept has been recently modified by the American Academy of Pediatrics by the current brief resolved unexplained event (BRUE), in relation to acute events in infants. Comments concerning of an experience of five years in monitoring cardiorespiratory home

Los lactantes que consultan por un evento agudo de cambios en la respiración, color y respuestas forman un grupo heterogéneo con fisiopatología diversa. En el pasado se denominaban episodio aparentemente letal (ALTE). La Academia Americana de Pediatría (AAP) recomienda sustituir este término por el de episodio breve resuelto inexplicado (BRUE). Además, propone una aproximación diagnóstica. Objetivo: describir las características clínicas y la evolución de pacientes incluidos en un programa de monitorización cardiorrespiratoria en un hospital de segundo nivel. Valorar este estudio según la nueva guía de la AAP. Métodos: estudio descriptivo retrospectivo de todos pacientes con indicación de monitorización cardiorrespiratoria domiciliaria (CRD), centralizados en una consulta de Neumología Pediátrica, en un hospital de segundo nivel durante los últimos cinco años (2010-2014). Base de datos: Excel® 2010. Resultados: se monitorizaron siete pacientes (7/10 000 nacidos), todos varones. La indicación inicial de monitorización CRD fue: ALTE de repetición o grave (cinco casos), hipotonía neonatal grave (un caso) y el hermano de un paciente con síndrome de muerte súbita del lactante (SMSL) (un caso). Edad media de indicación de 59,8 días. Conclusiones: apoyamos la propuesta de la AAP para usar el término BRUE con o sin factores de riesgo y evitar el nombre de ALTE. Debido a la diversa presentación, causas, factores de riesgo y pronóstico de los lactantes que se presentan con un evento agudo, se debe individualizar su enfoque diagnóstico. La mayoría de los pacientes en los que está indicada monitorización CRD puede tener seguimiento en hospitales de segundo nivel. Los programas de seguimiento a largo plazo de niños con un ALTE-BRUE podrían contribuir a adaptar las acciones sanitarias a las necesidades de cada paciente, así como confirmar el diagnóstico médico (AU)

Infants who present with a history of an acute event (an unexpected change in breathing, appearance, or behavior) reported by their caregiver represent a heterogeneous group with diverse pathophysiology. In the past, these events were termed apparent life-threatening events (ALTE). The American Academy of Pediatrics (AAP) recommends the replacement of the term ALTE with a new term: brief resolved unexplained event (BRUE). It provides an approach to patient evaluation, and management recommendations. Objective: to describe the clinical characteristics and the evolution of patients enrolled in a CRD monitoring program in a second level hospital. We assess this work according to the new guide from the AAP. Methods: retrospective study of all patients with indication of monitoring CRD, enrolled in a secondary level hospital, in Pediatric Neumology consultation (2010-2014). Database: Excel 2010®. Results: seven patients were monitored (7/10,000 born), all males. The initial indication of monitoring CRD was: serious or recurrent ALTE (five cases), severe neonatal hypotonia (one case) and brother of sudden infant death (SID) (one case). The mean age of indication was 59.8 days. Conclusions: we support the AAP proposition to use the term BRUE with or without risk factors, avoiding the name ALTE. Because of the diverse presentations, causes, risk factors, and prognosis of infants presenting with acute events, evaluation and management should be individualized. Most of the patients in which monitoring CRD is indicated may have tracking in a second level hospital. Long-term follow-up programs of infants with a BRUE-ALTE could contribute to adapt the healthcare activities to the needs of each patient and confirm the medical diagnosis (AU)

Mapping of methionine-enkephalin-arg6-gly7-leu8 in the human diencephalon.

Using an immunohistochemical technique, we mapped the immunoreactive structures containing methionine-enkephalin-Arg6-Gly7-Leu8 (Met-8) (a marker for the pro-enkephalin system) in the human diencephalon. Compared with previous studies, we observed a more widespread distribution of Met-8 in the human diencephalon. Met-8-immunoreactive cell bodies and fibers exhibited a more widespread distribution in the hypothalamus than in the thalamus. We observed six populations of Met-8-immunoreactive cell bodies. These perikarya were observed in the paratenial thalamic nucleus, ventromedial and dorsomedial hypothalamic nuclei, lateral hypothalamic area, pallidohypothalamic nucleus and in the paraventricular hypothalamic nucleus (posterior part). In the thalamus, Met-8-immunoreactive fibers were primarily observed in the midline region, whereas in the hypothalamus, these fibers were widely distributed. In general, a moderate/low density of Met-8-immunoreactive fibers was observed in the diencephalic nuclei. A moderate density was observed in the paraventricular thalamic nucleus, reuniens thalamic nucleus, lateral and medial geniculate nuclei, dorsomedial hypothalamic nucleus, paraventricular hypothalamic nucleus (posterior part) and ventromedial hypothalamic nucleus. The present study is the first to demonstrate the presence of clusters of Met-8-immunoreactive cell bodies in the human thalamus and hypothalamus, the distribution of fibers containing neuropeptides in the hypothalamus and the presence of these fibers in several thalamic nuclei. This neuroanatomical study will serve to elucidate the physiological roles of Met-8 in future studies of the human diencephalon.

Immunohistochemical mapping of pro-opiomelanocortin- and pro-dynorphin-derived peptides in the alpaca (Lama pacos) diencephalon.

Using an indirect immunoperoxidase technique, we studied the distribution of cell bodies and fibres containing non-opioid peptides (adrenocorticotropin hormone (ACTH), alpha-melanocyte-stimulating hormone) and opioid peptides (beta-endorphin (1-27), alpha-neo-endorphin, leucine-enkephalin) in the alpaca diencephalon. No immunoreactive cell bodies containing ACTH were found. Perikarya containing the other four peptides were observed exclusively in the hypothalamus and their distribution was restricted. Perikarya containing alpha-melanocyte-stimulating hormone or alpha-neo-endorphin showed a more widespread distribution than those containing leucine-enkephalin or beta-endorphin (1-27). Cell bodies containing pro-opiomelanocortin-derived peptides were observed in the arcuate nucleus, anterior and lateral hypothalamic areas and in the ventromedial and supraoptic hypothalamic nuclei, whereas perikarya containing alpha-neo-endorphin (a pro-dynorphin-derived peptide) were found in the arcuate nucleus, dorsal and lateral hypothalamic areas, and in the paraventricular, ventromedial and supraoptic hypothalamic nuclei. Immunoreactive cell bodies containing leucine-enkephalin were found in the lateral hypothalamic area and in the paraventricular hypothalamic nucleus. Immunoreactive fibres expressing pro-opiomelanocortin-derived peptides were more numerous than those expressing pro-dynorphin-derived peptides. A close anatomical relationship was observed: in all the diencephalic nuclei in which beta-endorphin (1-27)-immunoreactive fibres were found, fibres containing alpha-melanocyte-stimulating hormone or alpha-neo-endorphin were also observed. Fibres containing beta-endorphin (1-27), alpha-melanocyte-stimulating hormone or alpha-neo-endorphin were widely distributed throughout the diencephalon, but fibres containing ACTH or leucine-enkephalin showed a moderate distribution. The distribution of the five peptides studied here is also compared with that reported previously in other mammalian species. The widespread distribution observed indicates that both the pro-dynorphin and the pro-opiomelanocortin systems are involved in multiple physiological actions (e.g., food intake, thermoregulation, neuroendocrine and reproductive mechanisms) in the alpaca diencephalon.

Myocardial perfusion magnetic resonance imaging for detecting coronary function anomalies in asymptomatic paediatric patients with a previous arterial switch operation for the transposition of great arteries.

BACKGROUND: The main cause of long-term morbidity and mortality after the arterial switch operation for transposition of great arteries is complication at the coronary arteries. Myocardial perfusion magnetic resonance imaging represents a relatively novel and appealing tool for detecting myocardial ischaemia but with little experience in paediatric patients. The purpose of this paper is to report a single centre experience with myocardial perfusion magnetic resonance imaging for detecting ischaemia after the arterial switch operation for transposition of great arteries. METHODS: Twenty-eight patients aged 13-16 years with an arterial switch operation for transposition of great arteries were included in the study. Coronary pattern, operative and postoperative complications, and long-term follow-up events were reviewed. Patient functional evaluation included clinical examination, electrocardiogram and echocardiogram. Every patient underwent magnetic resonance imaging perfusion scanning at rest and under adenosine-induced stress. RESULTS: All patients were symptom free with no ischaemic signs on the electrocardiogram. All magnetic resonance imaging examinations were generally well tolerated with minor adenosine secondary effects in 36% of the patients. Two stress myocardial perfusion magnetic resonance studies were excluded from analysis for technical reasons. No perfusion stress defects were detected at the remaining 26. Myocardial delayed enhancement was performed in all 28 patients. In five subjects, a subendocardial late enhancement consistent with patch tissue for septal defect closure at the time of repair was indentified. CONCLUSION: Magnetic resonance imaging evaluation of myocardial perfusion and viability is feasible in paediatric patients long after arterial switch operation. No signs of myocardial ischaemia or necrosis were documented in this young asymptomatic population. Further studies including coronary angiography correlation are needed to validate magnetic resonance imaging results.