Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with beclomethasone or beclomethasone-salmeterol.

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 micrograms per puff) or Ibe + Isal (B 2 puff/12 hr, 100 micrograms per puff and S 2 puff/12 hr, 25 micrograms per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 +/- 2.18 (mean +/- SD) years, baseline K was 4.57 +/- 0.43 mEq/l, after B K 4.38 +/- 0.39 IU and after BS K 4.38 +/- 0.40. The CPK-MB level were baseline 14.75 +/- 4.5, after B 20.10 +/- 6.9 and after BS 21 +/- 8.05 (p < 0.05). Baseline QTc was 0.416 +/- 0.02 msec, after B 0.425 +/- 0.027, and after BS 0.415 +/- 0.029. We conclude that the treatment of children with asthma with 400 micrograms per day of Ibec or concomitantly with 100 micrograms of Isal for 6 weeks does not alter the serum K+ or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased.

Serum potassium levels, CPK-MB and ECG in children suffering asthma treated with Blecomethasone or Blecomethasone-Salmeterol

Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 μ g per puff) or Ibe + Isal (B 2 puff/12 hr, 100 μg per puff and S 2 puff/12 hr, 25 μ g per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 ± 2.18 (mean ± SD) years, baseline K was 4.57 ± 0.43 mEq/l, after B K 4.38 ± 0.39 IU and after BS K 4.38 ± 0.40. The CPK-MB level were baseline 14.75 ± 4.5, after B 20.10 ± 6.9 and after BS 21 ± 8.05 (p < 0.05). Baseline QTc was 0.416 ± 0.02 msec, after B 0.425 ± 0.027, and after BS 0.415 ± 0.029. We conclude that the treatment of children with asthma with 400mg per day of Ibec or concomitantly with 100 μ g of Isal for 6 weeks does not alter the serum K + or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased (AU)

El componente inflamatorio crónico del asma ha justificado el manejo con antiinflamatorios de tipo esteroide inhalados solos o en combinación con 2 de acción prolongada para manejo habitual del asma moderada crónica persistente (AMCP). El objetivo fue comparar los efectos de beclometasona frente a salmeterol con beclometasona en IDM sobre el potasio sérico, el intervalo QTc y en los valores de las enzimas del músculo cardíaco CPK-MB en niños asmáticos sin crisis del servicio de alergia del Hospital Infantil de México Federico Gómez. Se hizo un ensayo clínico prospectivo, longitudinal, ciego, cruzado, comparativo de dos tratamientos. administrados de forma aleatoria en diferentes tiempos en un mismo grupo de 30 pacientes de 7 a 17 años con AMCP de acuerdo a la clasificación del GINA. A los pacientes seleccionados se les determinó potasio, CPK-MB y trazo de ECG antes y después de las 6 semanas de tratamiento (salmeterol 100 g/día con beclometasona 400 g/día (Sal-Beclo) y beclometasona (Beclo) sola a la misma dosis. El inicio del tratamiento fue de tipo aleatorio quedando 14 pacientes con Sal-Beclo y 16 con Beclo, con 1 semana de lavado después del primer tratamiento para continuar el grupo que inició con Sal-Beclo con Beclo y el de Beclo con Sal-Beclo.Resultados: hubo 9 niñas y 20 hombres con una media de 11 ñ 2,18 años. Con K basal de 4,57 ñ 0,43 mEq/l con Beclo de 4,38 ñ 0,39 y con Sal-Beclo de 4,38 ñ 0,40. La CPK-MB basal fue de 14,75 ñ 8,45 después con Beclo 20,10 ñ 6,9 y con Sal-Beclo 21 ñ 8,05. Los cambios en la CPK-MB basal frente a CPK-MB con Beclo y la CPK-MB basal con Sal-Beclo se obtuvieron valores significativos (p 0,05).Conclusión: la administración de 400 g al día de beclometasona sola o en combinación con 100 g/día de salmeterol en inhalador de dosis medida por 6 semanas en el tratamiento habitual de niños con ACMP no induce cambios cardiovasculares importantes a pesar de haberse visto una elevación significativa de la CPK-MB en niños sin crisis (AU)

[Critical pulmonary valve stenosis in neonates; treatment with balloon valvuloplasty using an arteriovenous loop and gradual dilatations]. / Estenosis pulmonar valvular crítica del recién nacido; valvuloplastía con globo efectuada usando un asa arterio-venosa y dilataciones secuenciales.

Critical pulmonary stenosis of the newborn is an emergency and the balloon dilatation can represent its definitive treatment. This procedure has important technical aspects related with the age and weight of patients and to anatomical factors that contributes to the obstruction. We present the case of a 20 days old newborn with this problem, in whom the use of an arterio-venous loop through the ductus arteriosus allowed the passage of balloon catheters of gradually increasing diameter until a balloon/pulmonary annulus index of 1.4 was reached. This procedure can be performed safely in cases in whom the common technique is difficult to apply. The procedure allows a successful valvular dilatation.

[Aortic hypoplasia in a case of single ventricle with normally related vessels]. / Hipoplasia aórtica en un caso de ventrículo único con vasos normalmente relacionados.

In cases with double inlet left ventricle when there exists a hypoplasia of one of the great arteries, the affected vessel arises from the accessory right ventricular chamber. This is due in general to the presence of a restrictive bulbo-ventricular foramen that results in hypoplasic vessel. The case we present in this paper has unusual anatomic morphology: the hypoplasic vessel (the aorta) arises from the main ventricular chamber. We analyse the electrocardiographic findings useful for the differential diagnosis from cases of isolated aortic coarctation of hypoplasia. We review also the intraventricular anatomic malformations that may cause the presence of a hypoplasic vessel. Even if, our patient died in the neonatal period, the adequate surgical procedure for this case is reviewed.

[Kawasaki disease in Mexican children]. / Enfermedad de Kawasaki en niños mexicanos.

The records of 16 cases seen at Mexico Children's Hospital with a diagnosis of KD were reviewed. Mean age was three years; eight were infants, and males were dominant with a ratio of 4.3:1. Two cases occurred in sibling. Evidence of myocarditis was recognized in six, and 12 had coronary anomalies, including five with aneurysms. Two infants with severe coronary disease died, one suddenly with myocardial ischemia, and one with a ruptured aortic aneurysm. Another infant developed severe stenosis of the right coronary artery but remains asymptomatic. Two cases have persistent coronary ectasia and seven are asymptomatic with a normal echocardiogram. Predictors of coronary risk were correlated with clinical outcome. All six cases with 6 or more points had coronary anomalies, two developed giant aneurysms, two died and one has severe coronary stenosis. Of 10 cases with less than 6 points, four did not have coronary involvement, none developed giant aneurysms and none died nor developed severe coronary sequelae. Although KD has been sporadically reported in this country, the present series, the largest from a single institution, firmly establishes the presence of the disease in Mexico.