Pericardial effusion in childhood nephrotic syndrome.

BACKGROUND: Nephrotic syndrome (NS) is one of the most common renal diseases in children, which is defined as idiopathic NS and secondary NS. Current data on adult showed that pericardial effusion was related only to SLE, but not to non-SLE nephrotic patients. Until now there were no studies about children. OBJECTIVE: To compare the frequency and clinical manifestations of pericardial effusion in childhood NS with SLE and non-SLE patients. MATERIAL AND METHOD: Consecutive cases of NS at Queen Sirikit National Institute of Child Health (QSNICH) from June 2004 to May 2005 were prospectively studied. Information concerning the following: gender, age, clinical manifestations, laboratory investigation and echocardiogram in each patient were obtained. RESULTS: A total of 37 cases were included, 13 with SLE and 24 with idiopathic cause. Pericardial effusion was found without any symptoms and signs of pericardial disease in both groups; 9 cases (69.2%) of SLE and 2 cases (8.3%) of non-SLE patients. Statistically significant differences were demonstrated between two groups (p = 0.001). CONCLUSION: Pericardial effusion in childhood NS was more frequent in SLE than non-SLE nephrotic patients statistically significant. This result was different from previous study in adult which revealed no pericardial effusion in non-SLE group.

Natural aortic valve complications of ventricular septal defect: a prospective cohort study.

OBJECTIVE: To study the incidence and onset of aortic valve prolapse (AVP) and aortic regurgitation (AR) in the ventricular septal defect (VSD). STUDY DESIGN: A prospective cohort study POPULATION: The less than one-year-old children with diagnosis of isolated VSD were studied from October 2000 to September 2006 at Queen Sirikit National Institute of Child Health. Clinical follow-up and echocardiographic studies were scheduled every 2-3 months in the first year of age and then every 6 months to evaluate the size, location, flow across VSD, aortic valve morphology and aortic regurgitation. RESULTS: Three hundred and twenty-one cases of VSD were followed up. One was excluded due to associated hypoplastic RV An overall of 2,644 echocardiograms were performed. The percentage of perimembranous, subpulmonic, muscular inlet and multiple types were 70.3%, 19.4%, 5.6%, 3.1% and 1.6%, respectively. Size of the VSD was diagnosed to be small, moderate, and large VSD in 62.5%, 15.9% and 21.6% respectively. At the end of the study, the incidence of AVP in subpulmonic VSD was 87.1% compared to 16.4% in perimembranous VSD, with a relative risk of 5.30 and the incidence of AR in subpulmonic VSD was 37.1% compared to 5.3% in perimembranous VSD, with a relative risk of 6.95. From the survival analysis, the patient with subpulmonic VSD developed AVP at 46%, 77%, 90% and 94% compare to 8%, 13%, 20% and 23% of perimembranous VSD at 12, 24, 36 and 48 months of age respectively (p < 0.001). The patient with subpulmonic VSD developed AR at 8%, 17%, 35% and 38% compare to 2%, 4%, 5% and 7% of perimembranous VSD at 12, 24, 36 and 48 months of age respectively (p < 0.001). At the end of the study, ninety-six cases (30%) underwent cardiac operation with the indication of heart failure or the occurrence of AR. Sixty one cases (19.1%), including two cases of subpulmonic type had spontaneous closure of VSD. Seven cases (2.2%) had lost to follow up and five cases (1.6%) died during the follow up period. CONCLUSION: The incidence of AVP and AR are high in subpulmonic VSD being much higher than perimembranous VSD with a relative risk of 5.30 and 6.95 respectively. These complications are significantly from infancy period and are an indication for early cardiac surgery.

Effect of cisapride on corrected QT interval in neonates.

OBJECTIVE: To evaluate the effect of cisapride on corrected QT (QTc) interval in neonates at the Queen Sirikit National Institute of Child Health. METHOD: A prospective study was performed to see the effects of cisapride on QTc interval in 20 neonates between 1st July 2001 and 31st January 2002. QTc interval was determined just before, 48 hours, 7 days and 15 days after the start of treatment with cisapride. QTc interval was calculated by averaging QT/square root(RR) values obtained from 5 consecutive beats in lead II of the EKG. Baseline electrolyte and calcium levels were drawn on all infants before treatment of cisapride. Drug dose ranged from 0.1-0.2 mg/kg every 6 to 8 hours. RESULTS: Twenty infants were enrolled in the survey but complete data was obtained on 18 infants only. QTc interval of > 0.45 seconds was not found in any neonate. There was no significant difference of QTc interval before and 48 hours, 7 days and 15 days after cisapride administration (p = 0.861). There were also no statistically significant effects of age at starting cisapride, weight, gestational age and dose on QTc interval (p = 0.581, 0.65, 0.8, and 0.497). There were no adverse effects such as diarrhea or jaundice during the study. CONCLUSION: Term and preterm infants using cisapride at the doses of 0.4-0.8 mg/kg/day did not develop QTc prolongation, arrhythmias or adverse effects. In the absence of risk factors, cisapride may be safe for use in neonates.

Subacute infective endocarditis caused by Corynebacterium diphtheriae: a case report.

The authors report an 11-year-old boy with septicemia and subacute infective endocarditis due to toxigenic-Corynebacterium diphtheriae. The patient had underlying congenital heart disease and incomplete immunization. He presented with fever, epistaxis and congestive heart failure. He received high-dose penicillin therapy and diphtheria antitoxin with clinical improvement. While he was receiving a high dose of penicillin for 1 month he developed a generalized tonic clonic seizure. A computerized tomogram revealed intracerebral and ventricular hemorrhage. Craniotomy with blood clot removal and ventriculostomy drainage were done. He died 2 days later from brain death and cardiovascular failure.

Aortic valve prolapse in subpulmonic ventricular septal defect.

BACKGROUND: Ventricular septal defect (VSD) is the most common congenital heart disease worldwide. Subpulmonic type VSD is an interesting subtype due to the aortic valve complications rate, which can change the prognosis of the VSD. Higher prevalence rates have been reported with this subtype in Eastern countries but there has been no report from Thailand so far. OBJECTIVE: 1. To determine the prevalence of subpulmonic VSD. 2. To determine the prevalence and demographic data of aortic valve prolapse (AVP) and aortic regurgitation (AR) in subpulmonic VSD. METHOD: A retrospective study of 1,977 patients with isolated VSD, diagnosed from January 1995 to June 2002 at the Cardiology Unit, Queen Sirikit National Institute of Child Health was reviewed to differentiate types of VSD. Color flow doppler echocardiogram was performed in all cases to confirm the diagnosis and differentiate the types of VSD. Patients with subpulmonic VSD were studied to find out the presence of the aortic valve prolapse and aortic regurgitation. Those who had subpulmonic VSD were called for reevaluation of aortic valve complications, from January 2000 to June 2002. MAIN OUTCOME MEASURE: Subpulmonic VSD, aortic valve prolapse (AVP) and aortic regurgitation (AR). RESULTS: Subpulmonic VSD was diagnosed in 312 cases (17.5%). At the mean age of 3.47 yr, AVP was found in 101 cases (32.4%) and AR was found in 54 cases (17.3%) at the first echocardiogram. Subsequent echocardiography follow-up showed that the overall number of AVP cases was 153 (49%) and AR was 84 (26.9%) at the mean age of 5.5 and 6.3 year respectively. CONCLUSION: The prevalence of subpulmonic VSD was high among Thai children. Aortic valve complication is common in this group and can occur from early infancy. The present findings support the progressive increase in this complication with age.