[Idiopathic pulmonary hemosiderosis: case report] / Hemossiderose pulmonar idiopática: relato de caso.

OBJECTIVE: To alert pediatricians about the possibillity of childhood Idiopathic Pulmonary Hemosiderosis, in cases of anemia associated with chronic lung disease. METHODS: This article documents a case of Idiopathic Pulmonary Hemosiderosis in a 6 year-old child, with histopathological documentation, and reviews it against published literature. RESULTS: A 6 year-old child with history of anemia and lung disease characterized by wheezing, recurrent pneumonia and digital clubbing was admitted to the hospital for investigation, where he suffered sudden respiratory failure and hemoptysis.He was submitted to a lung biopsy which showed a histopathological diagnosis compatible with pulmonary hemosiderosis. Therapy with high doses of corticosteroids was initiated with a good early response. After two and a half months of therapy he had a new bleeding episode, culminating in death. CONCLUSIONS: Idiopathic Pulmonary Hemosiderosis should be included as a possible diagnosis of children with anemia and chronic lung disease. This case is a good example.

A simple method for Emax trend evaluation: in vitro and in vivo results.

The aim of this study is the evaluation of end systolic ventricular elastance trend (as a measure of heart contractility) by hemodynamic variables available in intensive care units or during heart surgery: heart rate, cardiac output, left atrial, mean and diastolic arterial pressure. Its basic assumption is the description of ejection as the interaction between variable left ventricular and arterial compliances (reciprocal of the corresponding elastances) connected in parallel. As pressure is the same in each compliance at systole beginning and ending, ventricular elastance can be estimated by assuming that energy variation is the same on both compliances. The algorithm has been tested on a numerical simulator of the circulatory system and on six sheep at basal conditions and during drug infusion. Correlation function in numerical simulation, between true and computed ventricular elastance (range 0.45 divided by 5 mm Hg-cm(-3)), yields 0.985. In vivo comparison between computed ventricular elastance trend and ventricular dp/dt trend yields a correlation function ranging between 0.87 and 0.99. The result of the algorithm cannot be assumed to be Emax value. However, it can be considered a contractility index as it closely follows any change in dp/dt. It can be computed by simple calculations and needs no variables other than those usually measured in intensive care . It allows the extrapolation of useful information for evaluating the trend in heart contractility and for setting up a control strategy for mechanical or pharmacological assistance during heart recovery.

Foreign body in the tracheobronchial tree.

A 20-year experience with the treatment of 74 patients (83.8% children) for foreign body aspiration is reviewed. The object of this review is to show the clinical manifestations, the radiological findings, the nature and distribution in the bronchial tree, and complications due to longstanding (months or years) foreign bodies in the bronchial tree. The most common foreign bodies found were peanuts (13.5%), corn (13.5%), and beans (13.5%). The most frequent clinical manifestation was choking (67.5%), and the most frequent radiological finding was atelectasis (41.8%). The most serious complication was bronchiectasis needing resection in six patients who had the foreign body retained for years in the bronchial tree. In conclusion, in spite of an obvious foreign body in the tracheobronchial tree many cases are not diagnosed, and a longstanding foreign body in the airway may be responsible for irreversible complications.

Technical standards for medical devices. Assisted circulation devices.

The steep rise in the clinical use of high technology biomedical devices and materials, involving multidisciplinary competencies, points out the problem of mutual standards defining, first of all, functional characteristic and tests able to characterise and qualify devices, materials and minimal safety requirements both for patients and operators. Standards defined by consent of the parties or by law are used to this aim. Fast technical development in specific sectors produces besides lack of rules, which must be quickly filled up. The aim of this paper is both the presentation of the approach to problems related to technical standards for biomedical devices and the presentation of the set up of a technical standard for mechanical heart assist devices.

Nutritional management and weight changes during hospitalization of Brazilian infants with diarrhoea: primary reliance on oral feeding or continuous nasogastric drip with locally made, modulated minced chicken formula.

The nutritional management of infants admitted with diarrhoea to the University Hospital of Botucatu includes a change from bolus feeding of a modulated minced-chicken formula to a continuous nasogastric drip (NGD) feeding, whenever the required calorie intake is not achieved or the diarrhoea does not subside. To evaluate this approach, the clinical course and weight changes of 63 children, aged 1-20 months, were reviewed; most (81 per cent) were below the third percentile for weight at admission and 76 per cent had a total duration of diarrhoea greater than or equal to 10 days. Associated infections, mainly systemic, were present at or after admission in 70 per cent of them. Twenty-five survivors needed nutritional support (NS), predominantly NGD, for a median duration of 30 per cent of their admission time, and were compared to 31 survivors managed without NS. Those who necessitated NS lost weight for a significantly longer median time (12 x 4 days, p less than 0.005), but their total weight loss was similar (5 x 4 per cent) as well as diarrhoea's duration (8 x 7 days). There was a tendency for a longer hospitalization (21 x 16 days 0.05 less than P less than 0.10) and a longer span to begin weight gain after diarrhoea's end for the group with NS (p less than 0.05), but subsequent growth quotient and daily weight gain during admission were similar for both groups. Both groups of survivors received similar amounts of energy, although the initial increase was delayed for those who needed the NGD.(ABSTRACT TRUNCATED AT 250 WORDS)

Doença de Chagas congênita: relato de um caso com boa evoluçäo / Congenital Chagas disease: report of a case with good course

É apresentado um caso de doença de Chagas Congênita em uma criança de termo com peso adequado ao nascimento. Os sintomas se iniciaram quando o paciente tinha 70 dias de vida e o diagnóstico foi feito pelo achado de Trypanosoma cruzi em esfregaços de sangue periférico pela microscopia direta. O paciente foi tratado com benzonidazol demonstrando boa evoluçäo clínica e laboratorial. Atualmente ele tem 3 anos e 8 meses de idade, sem sintomatologia

Pesquisa de eosinófilos no muco nasal e eosinofilia sangüínea em pacientes asmáticos e riníticos: valor diagnóstico na alergia de vias respiratórias / Research of eosinophils in the nasal mucous and blood eosinophilia in asmatic and rhinitic patients: diagnostic value in allergy of the respiratory tract

A pesquisa de eosinófilos no muco nasal e a eosinofilia sangüínea säo exames complementares freqüentemente utilizados na suspeita de pacientes alérgicos. Entretanto, segundo vários autores, ainda existem controvérsias sobre a sua real validade no diagnóstico de alergia. Estudamos 147 crianças divididas em 3 grupos: controle - 29 crianças (G1) provenientes do Ambulatório Geral e de Puericultura; asma - 75 crianças (G2) e asma com rinite - 43 crianças (G3) provenientes do Ambulatório de Pneumologia Infantil. A pesquisa de eosinófilos no muco nasal foi feita através de esfregaços fixados com Metanol 99% e corados pelos métodos de Shorr e Hansel e quantificados pelo critério de Shimizu. Na análise dos resultados observou-se: 1) Näo houve diferença no tempo decorrido entre o início dos sintomas até a consulta especializada no grupo G2 e G3. 2) o intervalo entre as crises foi maior em G2 que em G3. 3) G2 tem maior proporçäo de casos graves. 4) Näo foi constatada diferença entre os 3 grupos para glóbulos brancos. 5) A % de eosinófilos sangüíneos foi maior em G2 e G3 que näo diferiram entre si. 6) Em G1 näo se encontram eosinófilos no muco nasal e em G2 e G3 todos apresentaram eosinófilos com a mediana situada em ++ (critério Shimizu). Com estes resultados os autores acreditam que a pesquisa de eosinófilos em pacientes alérgicos é de grande validade, além de consistir em exame simples, econômico e exequível em qualquer serviço médico

Mal de Pott em lactantes de 11 meses de idade / Pott's disease in an infant of 11 months old

Apresenta-se um paciente do sexo masculino, de 11 meses e 6 dias, que apresentava adenopatia cervical, axilar e inguinal há 1 semana e diminuiçäo de atividade, palidez, vômitos pós-alimentares e dificuldade respiratória há 3 dias. Antecedentes familiares: baixa condiçäo sócio-econômica e mäe com Tbc, e tratamento irregular durante esta gestaçäo. O paciente nasceu com desnutriçäo intra-uterina, apresentava retardo de desenvolvimento deformidade torácica. Pelo exame clínico e radiológico tratava-se de paciente com tuberculose pulmonar e vertebral. Foi iniciado esquema tríplice, imobilizaçäo no leito e posteriormente colete de gesso. Após 5 meses de tratamento a criança passou a sentar sozinha e trocar passos e com 2 anos estava andando e correndo, apesar do quadro radiológico de coluna ficar inalterado