Artritis reumática juvenil idiopática: características y criterios diagnósticos / Idiopathic juvenile rheumatic arthritis: characteristics y diagnostic criteria

RESUMEN La artritis idiopática juvenil es la enfermedad reumática crónica más común en la infancia y es de causa desconocida. La artritis idiopática juvenil abarca varios subgrupos diferentes y se presenta predominantemente con artritis periférica. Se han descrito siete tipos de artritis idiopática juvenil que se distinguen por sus signos y síntomas, la cantidad de articulaciones afectadas, los resultados de las pruebas de laboratorio y los antecedentes familiares. El objetivo de este trabajo es revisar las principales características de la enfermedad y los criterios para el diagnóstico de la enfermedad reumática crónica más común en la infancia.

ABSTRACT Juvenile idiopathic arthritis is the most common chronic rheumatic disease in childhood and is of unknown etiology. Juvenile idiopathic arthritis encompasses several different subgroups and presents predominantly with peripheral arthritis. Seven types of juvenile idiopathic arthritis have been described, distinguished by their signs and symptoms, the number of joints affected, laboratory test results, and family history. The objective of this work is to review the main characteristics of the disease, the diagnosis criteria for the most common chronic rheumatic disease in childhood.

Quando a criança nasce doente: a subjetividade do infante e as relações familiares / When the child is born sick: the subjectivity of the infant and the family relationship / Cuando el niño nace enfermo: la subjetividad infantil y las relaciones familiares

A presença de patologia orgânica grave na criança permite investigar uma das modalidades pelas quais a constituição subjetiva sofre seus efeitos. Nesses casos, a condição psíquica, longe de ser consequência direta da patologia orgânica, configura um complexo jogo identificatório imaginário da relação que o campo social (em especial os cuidadores) estabelece com a criança. Muitas vezes, os pais de crianças que nascem com doenças graves não conseguem ver um futuro para elas e passam a tratá-las como impotentes: como sem o poder de realizar o desejo parental. Esse fato pode resultar num desinvestimento de libido parental sobre essas crianças e em prejuízos para a sua constituição subjetiva. Este trabalho faz uma elucidação teórica sobre a incidência de uma doença grave na infância. Para melhor compreensão, foi usado um caso clínico como exemplo

The presence of severe organic disease in children allows for investigation into one of the ways in which the subjective constitution suffers its effects. In such cases, the psychic condition, far from being a direct consequence of organic pathology, represents an identification of imaginary interplay very complex of the relationship that the social field (especially caregivers) establishes with the child. Often, parents of children born with serious diseases cannot see a future for them and begin to treat them as impotent, as someone without the power to realize parental desires. This fact can result in a divestment of parental libido on these children and in damages to hers subjective constitution. This paper makes a theoretical elucidation on the incidence of serious illness in childhood. For a better understanding was used a clinical case as example

La presencia de patología orgánica grave en los niños permite investigar una de las formas en que la constitución subjetiva sufre sus efectos. En estos casos, la condición psíquica, lejos de ser una consecuencia directa de la patología orgánica, configura un complejo juego identificador imaginario de la relación que el campo social (especialmente los cuidadores) establece con el niño. A menudo, los padres de los niños nacidos con enfermedades graves no pueden ver un futuro para ellos y empiezan a tratarlos como impotentes: como sin el poder para llevar a cabo el deseo parental. Esto puede dar lugar a la desinversión de la libido parental sobre estos niños y a daños a su constitución subjetiva. En este trabajo se hace una aclaración teórica sobre la incidencia de una enfermedad grave en la infancia. Para una mejor comprensión se utilizó como ejemplo un caso clínico

Clinical Evaluation of Stroke in Infants and Children

PURPOSE: The causes of stroke in children are varied and morbidity by stroke is significant, it needs further investigations to identify the underlying causes. Despite significant morbidity in childhood, only a few studies have been reported. So we reviewed retrospectively clinical records, diagnosed stroke in neuroradiologic study and analyzed sex, age, cause, clinical features, mortality, lesion of brain injury and residual deficits. METHODS: From January 1994 to July 1997, 67 patients diagnosed with stroke in neuroradiologic study were studied retrospectively. We described age, sex distribution, underlying causes, clinical features, mortality, lesion of brain injury and residual deficits. RESULTS: There were 50 cases(74.6%) of ischemic stroke and 14 cases(20.9%) of hemorrhagic stroke. The most common cause was moyamoya disease in ischemic stroke and hemato- oncologic disease in hemorrhagic stroke. The presenting features were seizure, 30 cases(44.8%) ; motor deficit, 27 cases(40.3%) ; mental change, 15 cases(22.4%) ; and headache, 11 cases(16.4%). Forty-five cases(67.1%) involved carotid system and 13 cases(19.5%) involved vertebrobasilar system. The mortality rate was 19.4% and the rate of residual deficit was 63.0%. CONCLUSION: Cerebrovascular disease in childhood is not an uncommon occurrence in Korea considering these results. As a consequence of medical progress, early mortality rate has decreased, but the rate of residual deficits tended to increase. So further studies on childhood stroke are required for early diagnosis and treatment which are important in decreasing mortality and morbidity.