Cardiovascular complications in a child with chronic renal failure.

This is the report of an 11-year-old boy with chronic renal disease and secondary hyperparathyroidism. The child had been on dialysis, calcitriol, calcium carbonate, and presented dyslipidemia and calcified thrombi in various vessels and organs in the course of his condition. Pathological examination showed ischemic cerebral necrosis, calcification in coronary arteries, and myocardial infarction.

Complicações cardiovasculares em criança com insuficiência renal crônica / Cardiovascular complications in a child with chronic renal failure

Relatamos o caso de uma criança de 11 anos, com doença renal crônica e hiperparatireoidismo secundário. Havia sido tratada com diálise, calcitriol, carbonato de cálcio e, na evolução, apresentou dislipidemia e trombos calcificados em vários vasos e órgãos. O exame anatomopatológico revelou necrose cerebral isquêmica, calcificação nas artérias coronárias e infarto do miocárdio.

We describe a case 11 year-old boy, in which a chronic renal disease and secondary hyperparathyroidism was treated by dyalisis, calcitriol, and calcium supplementation. He developed dyslipidemia, calcified lesions with thrombus formation in several organs and vessels. Necropsy findings showed ischemic cerebral necrosis, calcification in arteries including coronaries, and myocardial infarction.

[Pseudotumor cerebri secondary to dural sinus thrombosis: pediatric case report]. / Pseudotumor cerebral secundário a trombose venosa dural: relato de caso pediátrico.

Pseudotumor cerebri is a relatively common neurologic syndrome in adolescence. In most cases, etiology is idiopathic, but it may have serious complications, such as blindness, that are related to increased intracranial pressure. The aim of this article is to emphasize the differential diagnosis of pseudotumor cerebri, with special attention to treatable etiologies. We report a case of an 12 year-old adolescent who presented with diplopia and headache 9 days after right-sided otitis media and mastoiditis. Head computerized tomography was normal, but brain magnetic resonance imaging demonstrated thrombosis of ipsilateral transverse and sigmoid sinuses, which responded promptly to early anticoagulation. The conclusion is that magnetic resonance imaging is essential for patients with a clinical diagnosis of pseudotumor cerebri in order to exclude treatable causes, such as dural sinus thrombosis.

Pseudotumor cerebral secundário a trombose venosa dural: relato de caso pediátrico / Pseudotumor cerebri secondary to dural sinus thrombosis: pediatric case report

O pseudotumor cerebral é uma síndrome neurológica relativamente comum na adolescência. Na maioria dos casos, a etiologia é idiopática, mas pode haver complicações graves, como cegueira, relacionadas com a hipertensão intracraniana. O objetivo deste artigo é enfatizar o diagnóstico diferencial do pseudotumor cerebral, com atenção especial às etiologias tratáveis. Relatamos o caso de um adolescente de 12 anos que se apresentou com diplopia e cefaléia 9 dias após otite média e mastoidite à direita. A tomografia computadorizada do crânio foi normal, mas a ressonância magnética do encéfalo detectou trombose dos seios transverso e sigmóideo ipsilaterais, a qual respondeu à anticoagulação precoce. A conclusão é que a ressonância magnética do encéfalo é essencial nos pacientes com diagnóstico clínico de pseudotumor cerebral para exclusão de causas tratáveis, como a trombose venosa dural.

[Pheochromocytoma in childhood]. / Feocromocitoma em criança.

Pheochromocytoma is a neoplasia of chromaffin cells that is very rare in children. Its signs and symptoms result from the release of catecholamines. We report the case of a child with pheochromocytoma of difficult clinical management, confirmed on the anatomicopathological study, and cured after surgical resection.

Feocromocitoma em criança / Pheochromocytoma in childhood

Feocromocitoma é uma neoplasia de células cromafins que causa sintomas e sinais decorrentes da libertação de catecolminas e é muito rara em crianças. Relatamos um caso feocromocitoma em criança, com difícil manejo clínico, confirmado também pela anatomia-patológica e curado após a ressecção cirúrgica.

Tratamento conservador da síndrome de Gradenigo / Conservative treatment of Gradenigo's syndrome

A síndrome de Gradenigo, uma complicaçäo rara de otite média, é caracterizada por otorréia purulenta, paralisia de nervo abducente e dor na área de inervaçäo do nervo trigêmeo. Sua ocorrência está relacionada ao acometimento do ápice da parte petrosa do osso temporal e estruturas vizinhas a essa área. Os autores relatam no artigo o caso de um paciente de 7 anos de idade com esta síndrome e o sucesso na adoçäo da conduta conservadora com antibioticoterapia sem mastoidectomia

Cardite reumática tratada com altas doses de metilprednisolona venosa (pulsoterapia): resultados em 70 crianças durante 12 anos / Rheumatic carditis treated with high doses of pulsetherapy methylprednisolone: results in 70 children over 12 years

Purpose - To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. Methods - Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After rulling out infections and stronglyoidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1,2 and 3, comprising of 40, 18 and 12 children, respectively. Results - Eighteen children in Group 1 (45 per cent) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25 per cent), 3 in 9 (23 per cent) and 4 in 21 (52 per cent). In Group 2, 14 cases (77 per cent) were in their 1st attack: 2 series were used in 7 (39 per cent), 4 in 9 (50 per cent) and 5 in 2 (11 per cent). The echocardiogram showed a flail mitral valve in 12 (66 per cent) of these patients (1 death occurred after mitral valvoplasty). In Group 3,6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41 per cent). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. Conclusion - There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.

Pulsoterapia (altas doses de metil-prednisolona venosa) em crianças com cardite reumática. Estudo prospectivo de 40 episódios / Pulse Therapy (High Dosis of Intravenous Methyl-Prednisolone) in Children with Rheumatic Carditis. Prospective Study of 40 Episodes

PURPOSE--To use corticosteroids in a shorter period to treat rheumatic carditis, keeping the patient in the hospital; and verify the time interval of normalization of rheumatic activity tests with this method. METHODS--In 36 patients (40 episodes) intravenous methyl-prednisolone (1g/day) was administered. The number of series ranged from two to four, according to severity of the disease. The ages ranged from 6 to 17 years old, all of them fulfilled the criteria of Jones for diagnosis of rheumatic fever. They were submitted to treatment to eradicate the streptococcus, worms, PPD and dental focus extraction, before use of corticosteroids. RESULTS--In all patients the signals and symptoms of heart failure improved. In six cases occurred complications during pulse therapy that were easily controlled with clinical measures. Two series of methylprednisolone were used in 10 children, three in nine and four in 21 episodes. Eight patients were sent to valve replacement. The interval of time that laboratory tests of rheumatic activity became negative was 41.2 +/- 13.3 days. CONCLUSION--Using this IV corticotherapy it was possible decrease the amount of days of this medication, keeping the patient in the hospital. In this way we eliminate the problem of interruption of the treatment. There was not significative difference between oral and IV corticotherapy in order to the laboratory tests become negative.

Doença de inclusão citomegálica: contribuição ao estudo clínico e patológico / Cytomegalic inclusion disease: contribution to the clinical and pathological study

Foi feito um estudo retrospectivo de trinta casos de doença de inclusão citomegálica, dentre 83, diagnosticados microscopicamente pelo serviço de anatomia patológica do Hospital Universitário Antonio Pedro, no período de 1970 a 1989. O diagnóstico foi confirmado pela presença da célula de inclusão típica em vários órgãos. A seleção dos pacientes foi feita pela disponibilidade dos prontuários clínicos. Seis crianças eram recém-nascidas, 21 tinham menos de seis meses, e três mais de seis meses. Sete eram prematuros. Os achados clínicos mais freqüentes foram distúrbios respiratórios (60%), hepatomegalia (60%), diarréia protraída (53%), desnutrição (peso abaixo do percentil 2,5 - 46%), esplenomegalia (30%) e insuficência cardíaca congestiva (16,6%). Exantema petequial ocorreu em apenas dois recém-nascidos. Somente quatro crianças foram investigadas laborarorialmente para a doença. Concluiu-se que a forma clássica descrita em recém-nascidos não foi comum e que a doença de inclusão citomegálica deve ser considerada no diagnóstico diferencial daqueles lactentes que apresentem pneumonite associada à diarreia protraída ou a colestase.