Crise vaso-occlusive drépanocytaire sévère: aspects cliniques, étiologiques et thérapeutiques au CHU Sylvanus Olympio de Lomé / Clinical, aetiological and therapeutic features of severe sickle cell related vaso-occlusive crisis at the Sylvanus Olympio University Hospital, Lomé

Introduction: la crise vaso-occlusive (CVO) est la plus fréquente manifestation de la drépanocytose et la première cause d´hospitalisation des enfants atteints. L´objectif de cette étude est de décrire les aspects cliniques des CVO sévères, de déterminer les étiologies des syndromes infectieux qui les accompagnent et de décrire leur prise en charge. Méthodes: il s'agit d'une étude transversale descriptive portant sur 137 drépanocytaires majeurs hospitalisés pour CVO sévères du 1er janvier 2009 au 31 décembre 2011 dans le service de pédiatrie du CHU Sylvanus Olympio. Résultats: les drépanocytaires homozygotes SS étaient les plus nombreux (n=98; 71,5%), suivis des doubles hétérozygotes SC (n=28; 20,5). Le délai moyen de consultation était de 4,7 ± 4,4 jours. Le traitement avant l´admission comportait des antibiotiques (28,5%). Les CVO étaient surtout ostéo-articulaires (70,8%). Dans 98,5% des cas, une infection bactérienne associée a été confirmée (48,9%) ou présumée (49,6%). Les principales étiologies étaient le syndrome thoracique aigu (26,3%), l´ostéomyélite aiguë (10,9%), l´infection urinaire (6,6%), la septicémie (3,6%). Un germe a été isolé chez 14,6% des patients, Escherichia coli (30%) étaient en tête suivi de Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), le Streptocoque D (5%), l´Enterobacter (5%) et l´Acinetobacter (5%). Le taux de mortalité était de 2,2%. La durée moyenne d´hospitalisation était de 11,4 ± 8,8 jours. Conclusion: les CVO drépanocytaires sévères sont en majorité associées aux infections bactériennes en milieu tropical. Une antibiothérapie adaptée et précoce constitue le moyen thérapeutique indispensable pour prévenir ou traiter ces patients.

Introduction: vaso-occlusive crisis (VOC) is the most common manifestation of sickle cell disease and the leading cause of hospitalization among affected children. The purpose of this study is to describe the clinical features of severe VOCs, to determine the etiologies of infectious syndromes that accompany them and to describe their management. Methods: we conducted a descriptive cross-sectional study of 137 adult patients with sickle cell disease hospitalised for severe VOC in the Paediatric Department of the Sylvanus Olympio University Hospital from 1 January 2009 to 31 December 2011. Results: the majority of patients (n=98; 71.5%) had homozygous sickle cell (SS), followed by double heterozygous SC disease (n=28; 20.5). The median of consultation time was 4.7 ± 4.4 days. Treatment before admission was based on antibiotics (28.5%). VOCs were mainly osteoarticular (70.8%). In 98.5% of cases, an associated bacterial infection was confirmed (48.9%) or suspected (49.6%). The main etiologies included acute chest syndrome (26.3%), acute osteomyelitis (10.9%), urinary tract infection (6.6%) and septicaemia (3.6%). One germ was isolated from 14.6% of patients: Escherichia coli (30%), followed by Klebsiella pneumoniae (25%), Staphylococcus aureus (15%), Salmonella typhi (10%), Streptococcus pneumoniae (5%), Streptococcus D (5%), Enterobacter (5%) and Acinetobacter (5%). Mortality rate was 2.2%. The average length of stay in hospital was 11.4 ± 8.8 days. Conclusion: severe sickle cell related vaso-occlusive crisis is mainly associated with bacterial infections in tropical environments. Appropriate and early antibiotic therapy is the essential therapeutic means to prevent or treat these patients.

Comas non traumatiques chez l'adulte à l'Unité de soins intensifs du Centre Hospitalier Universitaire Sylvanus Olympio: à propos de 484 cas / Non-traumatic comas with the adult in the intensise care unit of the Sylvanus Olympio Teaching Hospital: concerning 484 cases

Introduction : Le coma non traumatique est une urgence médicale, relativement fréquente dont les différents aspects restent encore obscurs dans les services de réanimation en Afrique. Objectif : Cette étude avait pour but de décrire les aspects épidémiologiques, étiologiques et pronostiques des comas non traumatiques (CNT). Méthodes : Il s'était agi d'une étude rétrospective descriptive menée au Centre Hospitalier Universitaire Sylvanus Olympio à l'Unité des Soins Intensifs (USI) de janvier 2018 à décembre 2019. Résultats : L'étude avait concerné 484 patients hospitalisés pour comas non traumatiques sur un total de 1835 patients. Les comas non traumatiques de l'adulte représentaient 26,4% des admissions à l'USI. L'âge moyen des patients était de 52,8 ans (extrêmes de 18 et 92 ans) avec une sex-ratio (H/F) de 0,94. Plus de la moitié des patients avait été référée de structures sanitaires périphériques (55,4%). L'hypertension artérielle (HTA) était l'antécédent le plus retrouvé dans 36,4% ; suivi du diabète et de l'infection au virus de l'immunodéficience acquise (VIH) dans 14,9% chacun. Le coma était de survenue brutale dans 77,7% des cas. Les étiologies des comas étaient dominées par les causes vasculaires dans 32,2% des cas, puis les causes infectieuses dans 27,3% des cas et les comas urémiques dans 14,1% des cas. Le pronostic était défavorable avec une mortalité de 68,6%. La première étiologie de décès concernait les causes vasculaires. Conclusion : L'amélioration du pronostic des comas non traumatiques passe nécessairement par une amélioration du plateau technique pour une meilleure prise en charge des patients

Introduction: The non-traumatic coma is a medical emergency relatively frequent which different aspects remain obscure in intensive care units in Africa. Goals: The aim of this study was therefore to describe the epidemiological, etiological and prognostic aspects of non-traumatic comas. Methodology: This was a retrospective descriptive study carried out at the Sylvanus Olympio Teaching Hospital in the Intensive Care Unit (USI) from January 2018 to December 2019. Results: The study involved 484 patients hospitalized for non-traumatic comas out of 1835 patients. Non-traumatic comas in adults were 26.4% of admissions in the Intensive Care Unit. The mean age of patients was 52.8 years of a sex ratio (M / F) of 0.94. More than half of patients (55.4%) were referred from peripheral care centers. Arterial hypertension was the most common antecedent found in 36.4%, followed by diabetes and the infection of human immunodeficiency virus (HIV) at 14.9% each. The coma was sudden aspect in 77.7% of the cases. Aetiologies of the comas were dominated by vascular causes in 32.2% of causes, then infectious in 27.3% of cases and uremic comas in 14.1% of cases. The prognosis was unfavorable with 68.6% mortality. The first etiology of death was related to vascular cases. Conclusion: The Improving of the prognosis of non-traumatic comas needs an improvement of modern medical technology for a better patient care.

Patología infecciosa del vestíbulo nasal / Infectious diseases of the nasal vestibule

El vestíbulo nasal corresponde a la primera porción de la fosa nasal, éste se encuentra delimitado lateralmente por los cartílagos alares y medialmente por el borde caudal del septum nasal y la columela. Las enfermedades infecciosas del vestíbulo nasal son patologías frecuentes en la práctica clínica; su diagnóstico se realiza en base a sospecha clínica y examen físico, requiriendo habitualmente solo manejo médico ambulatorio. Desde el punto de vista etiológico pueden ser virales, bacterianas y fúngicas. Las principales especies bacterianas involucradas corresponden a Staphylococcus coagulasa negativa, S. epidermidis, S. hominis y S. haemolyticus, difteroides spp y S. aureus. Su manejo es esencialmente médico con casos excepcionales requiriendo manejo quirúrgico. En la actualidad existe escasa información epidemiológica al respecto, lo que dificultad la clasificación de los dichos cuadros clínicos. Se realizó una revisión de la literatura sobre cuadros infecciosos que afectan el vestíbulo nasal para lograr sistematizar y clarificar las distintas patologías y sus tratamientos.

The nasal vestibule corresponds to the first portion of the nasal passage, limited laterally by the lateral crus and medially by the caudal edge of the nasal septum and columella. Infectious diseases of the nasal vestibule are frequent in clinical practice, diagnosis is made based on clinical suspicion and physical examination, usually requiring only ambulatory medical management. In terms of etiology, they can be viral, bacterial and fungal. The main bacterial species involved correspond: Coagulase-negative Staphylococcus, S. epidermidis, S. hominis and S. haemolyticus, difteroides spp and S. aureus. Management is essentially medical and only exceptionally requires surgery. Currently, there is a lack of epidemiological information in this regard, which makes it difficult to classify these clinical conditions. A review of the literature on infectious conditions that affect the nasal vestibule was performed, to systematize and clarify the different pathologies and their management.

Clinical Study on Lesions Causing Cavernous Sinus Syndrome

Background: The naming of cavernous sinus was in the year1732 due to its resemblance to the corpus cavernosum. Thepresent study was conducted with the aim to determine theetiologies of cavernous sinus thrombosis.Materials and Methods: The present retrospective crosssectional study was performed in the Department of Medicine,SP Medical College, Bikaner, Rajasthan (India) andDepartment of Eye, Government District Hospital, Bikaner,Rajasthan (India). The type of management received was alsotaken into consideration. Patients with incomplete records werenot enrolled in the study. Subjects belonging to ASA grade 4,patients with significant co morbidities were excluded from thestudy. All the data thus obtained was arranged in a tabulatedform and analysed using SPSS software. Data was expressedin percentage.Results: The mean age of the subjects was 41.73+/- 3.56years. The most common cause was tumour followed bytrauma. Least number of cases was of diabetes (3.3%). Therewere 13.3% cases of inflammation. Surgery was attributed in10.7% cases. There were 6 and 6.7% cases of infection andaneurysm respectively.Conclusion: The most frequent cause of cavernous sinusthrombosis in our study was trauma.

Actualización en: El trastorno neuromuscular, un reto diagnóstico / Update on: Neuromuscular disorder, a diagnostic challenge

Los trastornos neuromusculares (TNM) son una causa frecuente de morbilidad pediátrica. Muchos de estos trastornos, generan a largo plazo una discapacidad progresiva en el niño/a, por lo cual, el diagnóstico oportuno es elemental. Como es común con otras afecciones médicas, el punto de partida del proceso diagnóstico es una detallada historia clínica y un examen físico completo. Este abordaje, esencialmente clínico, permite establecer un diagnóstico sindromático inicial y posteriormente orientarnos hacia cuadros específicos que nos permitan dirigir la solicitud de los estudios complementarios. El laboratorio neuromuscular comprende una serie de exámenes que complementan la identificación de estos cuadros y nos permiten el planteamiento de un diagnóstico diferencial entre fenotipos muy similares. Los objetivos de la investigación diagnóstica son los de ofrecer un consejo genético, definir un pronóstico futuro y establecer un plan de tratamiento actualizado, orientado a mantener la funcionalidad, prevenir las complicaciones y mejorar la calidad de vida de cada paciente. Este artículo tiene como finalidad, brindar herramientas de abordaje diagnóstico pediátrico, del niño/a que se presenta a la consulta médica, con síntomas sugestivos de un trastorno neuromuscular

Neuromuscular disorders (NMS) are a common cause of pediatric morbidity. Many of these disorders, in the long term, create a progressive disability in the child, so that timely diagnosis is essential. As is common with other medical conditions, the starting point of the diagnostic process is a complete and detailed medical history and physical examination. This approach, mainly clinical, makes it possible to establish an initial syndromic diagnosis and then to orient ourselves to specific charts and direct the request for complementary studies. The neuromuscular laboratory includes a series of tests that complement the identification of these charts and allow us to approach a differential diagnosis between common phenotypes. The objectives of the diagnostic investigation are to offer genetic counseling, to define a future prognosis and to establish an updated treatment plan, aimed at maintaining the functionality, preventing complications and improving the quality of life of each patient. This article aims to provide tools for a pediatric diagnostic approach of the child who presents to the medical consultation, with symptoms suggestive of a neuromuscular disorder

Identification of the difference in the pathogenesis in heart failure arising from different etiologies using a microarray dataset

OBJECTIVES: Clinically, patients with chronic heart failure arising from different etiologies receive the same treatment. However, the prognoses of these patients differ. The purpose of this study was to elucidate whether the pathogenesis of heart failure arising from different etiologies differs. METHODS: Heart failure-related dataset GSE1145 was obtained from the Gene Expression Omnibus database. Differentially expressed genes were identified using R. A protein-protein interaction network of the differentially expressed genes was constructed using Search Tool for the Retrieval of Interacting Genes. The modules in each network were analyzed by Molecular Complex Detection of Cytoscape. The Database for Annotation, Visualization and Integrated Discovery was used to obtain the functions of the modules. RESULTS: Samples contained in GSE1145 were myocardial tissues from patients with dilated cardiomyopathy, familial cardiomyopathy, hypertrophic cardiomyopathy, ischemic cardiomyopathy, and post-partum cardiomyopathy. The differentially expressed genes, modules, and functions of the modules associated with different etiologies varied. Abnormal formation of extracellular matrix was overlapping among five etiologies. The change in cytoskeleton organization was specifically detected in dilated cardiomyopathy. The activation of the Wnt receptor signaling pathway was limited to hypertrophic cardiomyopathy. The change in nucleosome and chromatin assembly was associated with only familial cardiomyopathy. Germ cell migration and disrupted cellular calcium ion homeostasis were solely detected in ischemic cardiomyopathy. The change in the metabolic process of glucose and triglyceride was detected in only post-partum cardiomyopathy. CONCLUSION: These results indicate that the pathogenesis of heart failure arising from different etiologies varies, which may provide molecular evidence supporting etiology-based treatment for heart failure patients.

Eritrosedimentación extremadamente elevada en una población de adultos en la ciudad de Buenos Aires / Extremely elevated erythrosedimentation in an adult population in the City of Buenos Aires

Resumen Introducción: Una velocidad de eritrosedimentación (VHS) extremadamente elevada, definida como mayor o igual a 100 mm/h, se ha asociado a condiciones graves subyacentes como enfermedades infecciosas, enfermedades del colágeno u oncológicas. Objetivo: Analizar un grupo de pacientes para determinar los diagnósticos de base y las características que se asocian con valores de VHS mayores a 100 mm/h en nuestro medio. Pacientes y Métodos: Estudio tipo observacional de corte transversal, con recolección retrospectiva de datos de pacientes adultos con al menos un valor de VHS mayor o igual a 100 mm/h, registrado en el laboratorio entre enero de 2002 y agosto de 2014 en el Hospital Italiano de Buenos Aires. Resultados: Durante el período evaluado se analizaron 879 pacientes mayores de 18 años. La mediana de los valores de VHS fue 111 mm/h (Rango intercuartil 105-120). La etiología prevalente de VHS elevada fueron las enfermedades infecciosas (41,6%), seguida de malignidad (21,6%) y de autoinmune/inflamatoria (12,9%). El diagnóstico individual más frecuente fue el de neumonía (11,4%), seguido por causa indeterminada (5,9%). Conclusión: En pacientes internados, la causa más frecuente de VHS ≥ 100 mm/h fue las enfermedades infecciosas, mientras que en pacientes ambulatorios la causa más frecuente fue la malignidad.

Background: An extremely elevated erythrosedimentation rate (ESR), defined as equal or higher than 100 mm/h, has been linked to serious underlying conditions, such as infections, connective tissue and oncologic disease. Aim: To analyze a group of patients in order to determine the underlying diagnosis and the characteristics associated with extremely elevated ESR in our environment. Methods: Cross-sectional study of adult patients, who presented with at least one ESR equal or higher than 100 mm/h at Hospital Italiano, in Buenos Aires (Buenos Aires, Argentina) between January 2002 and August 2014. Results: During the previously stated period of time, we analyzed the results of 879 patients. All patients were over 18 years of age. The median for the ESR results was 111 mm/h (interquartile range 105-120). The most prevalent etiology of an elevated ESR was infectious (41.64%), followed by malignancies (21.62%) and autoimmune / inflammatory diseases (12.97%). The most frequent individual diagnosis found was pneumonia (11.49%), followed by undetermined causes (5.92%). Conclusion: When comparing inpatient versus outpatient populations, the most frequent cause was infectious in the former group, while malignancies were the most frequent diagnosis in the latter.

Clinical characteristics of 88 cases of acute pancreatitis in children of different age / 中华消化杂志

Objective To investigate the clinical features of acute pancreatitis (AP) in children of differem age.Methods From January 2010 to December 2015,pediatric inpatients with AP were searched by pediatric inpatient medical records retrieval system.According to age,patients were divided into three groups:infant and toddler group (age 0 years to three years),preschool group (age ＞three years to six years) and school-aged group (age ＞ six years to 16 years).The clinical features,etiology and laboratory findings of differem age groups were retrospectively analyzed.One-way analysis of variation or rank sum test was performed for measurement data analysis.Chi-square test or Fisher exact probability test was used for the count data analysis.Results A total of 88 pediatric patients (male 38,female 50) were enrolled,and the mean age was (8.8±4.4) years.Infant and toddler group,preschool group and schoobaged group were 16,14,58 cases,respectively.The average days of hospitalization of infant and toddler group,preschool group and school-aged group were (8.4±1.9),(9.4±2.6) and (7.5± 2.5) days,respectively,and the difference was statistically significant (F=3.649,P=0.030).About 93.2％ (82/88) pediatric patients had abdominal pain.The incidence rate of epigastric distention of school-aged group (34.5％,20/58) was higher than those of infant and toddler group (2/16) and preschool-aged group (1/14).The rate of nausea/vomiting of infant and toddler group was significantly higher than those of preschool group and school-aged group (12/16,4/14 and 46.6 ％ (27/58),respectively),and the differences were both statistically significant (x2 =6.250 and 6.805,both P＜0.05).Biliary pancreatitis was the main etiology of infant and toddler group and preschool group,and the incidence was 6/16 and 6/14,respectively.Whereas,there was a variety of etiologies in school-aged group.There were 20 cases (22.7％) of severe AP.The severe cases were more in the infant and toddler group and preschool group (7/16 and 6/14,respectively),and less in school-aged group (12.1％,7/58).There was no statistically significant difference among the three age groups in blood amylase level,lipase level,white blood cells count,blood glucose level,blood calcium level and blood urea nitrogen (all P＞0.05).The percentage of obese children of school-aged group was significantly higher than those of infant and toddler group and preschool group (31.0％,18/58;1/16 and 1/14,respectively),and the difference was statistically significant (x2 =6.689,P=0.035).In addition,the level of serum total cholesterol of school aged group was higher than that of infant and toddler group and preschool group ((5.1±0.9),(3.9±0.6) and (4.8±0.8) mmol/L,respectively),and the difference was statistically significant (F =13.855,P＜ 0.01).The positive rates of abdominal ultrasound of infant and toddler group,preschool group and school-aged group were 5/16,4/14 and 21.1％ (12/57),respectively,and there was no statistically significant difference (x2 =0.889,P 0.706).The positive rates of magnetic resonance cholangiopancreatography (MRCP) of infant and toddler group and school-aged group were 4/4 and 5/6,respectively,and which were both higher than those of pancreases computed tomography (CT) examination (4/14 and 51.2％,22/43) and those of abdominal ultrasound (5/16 and 21.1％,12/57),and the differences were significant (x2 =6.655 and 15.207,both P＜0.05).Conclusions Obese children is more in school-aged children with AP.Children of this age should pay more attention to life style.Nausea or vomiting symptom is more obvious in the infant and toddler children with AP and the condition is more severe.If children of this age with unexplainable vomiting,AP should be considered.Biliary factors are more common in the infant and toddler children with AP.When children are suspected with abnormal structure of pancreatic and biliary ductal system,MRCP should be conducted.

Co relation of patterns and etiologies with visual ac uity in cystoid macular edema / 国际眼科杂志(Guoji Yanke Zazhi)

Abstract?AIM: To determine the relation between each of the optical coherence tomography ( OCT) patterns, etiologies and visual acuity in patients with cystoid macular edema ( CME) .?METHODS:Fifty-seven eyes with CME from 52 patients were included in our study. The data of this cross sectional study was collected rfom p atient s wtih CME assessed by OCT, who also underwent fun dus photography and visual acuity test the same day. The best corrected visual acuity ( BCVA ) was assessed by using E chart a nd converted in logarithm of the minimum angle of resolution( logMAR ) . Thevisual acuity varied from 2.3 logMAR to 0 logMAR w ith a mean of 1.11±0.57. The etiology was determined from medical history and the fundus ph otograph of the patient. Four O CT grades established according to ratio between the vertical size of largest cyst and the maximum macular thickness (<30 %,≥30% <60%,≥60% <90%and≥90%) were considered. The correlation was established by calculating the Pearson's correlatio n coefficient “r” and the statistical significance was considered when P value was inferior to 0.05.?RESULTS: OCT grade I V was the most associated with very severe visual loss with the greatest mean VA of 1.96± 0.23 logMAR and the correlation between OCT grades and visual acuity was strongly statistically significant ( r =0.729, P <0.001 ). The central retinal vein occlusion ( CRVO) was the most underlying disease associated with worsev ision, with the gre atest mean VA of 2 logMAR and the correlation was statistically significant ( r=0.375, P=0.004).Another associated OCT pattern, the disruption of bot h inner segment/outer segment ( IS/OS) and external limiting membrane ( ELM) , was inversely associated with severe visual loss ( high mean VA=1.11 ±0.57 logMAR, with statistically significant correlation, r=-0.346, P=0.008 ) . The presence of both vitreoretinal traction components and outer retinal layers disruption were significantly associated with OCT grade IV ( r=0.390, P=0.003) and CRVO (r=0.362, P=0.006).?CONCLUSION:In this study, the OCT fourth grade and CRVO seem to be more significantly associated with the worse vision in patients with CME.

Analysis on the etiology of seizures in a cohort of 975 children admitted to a pediatric emergency department / 中国小儿急救医学

Objective To document the etiologies of seizures in children admitted to the pediatric observation unit of an inen r city hospital in Chian .Me thods A ot tal of 975 children ( aged 1 month to 18 years old) admitted to the pediatric observation unit of Guangzhou Women adn Children′s Medical Center between October,2013 and October,2014 with seizures were evaluated restrospectively.Results A total of 975 patients were included in this study.The causes of seizures were febrile seizures ( 588 cases,60.3%) , epilepsy( 163 cases, 16.7%) , and benign inaf ntile convulsions associated with mild gasrt oenteritis ( 111 cases,11.4%) .The main causes of seizures for children less than one year old were febrile seizures ( 75 cases,34.1%) and epilepsy(75 cases,34.1%),following by the intracranial infection(22 cases,10.0%). Febrile seizures also predominated the causes of seizures among children between one and six years old(487 cases, 70.3%),whereas benign infantile convulsions associated with mild gastroenteritis accounting for 14.0%(97 cases) of all causes.Meanwhile, the leading causes of seizures for children of six years or older were febrile seizures(26 cases,41.9%) and epilepsy(20 cases,32.3%).Conclusion Febrile seizures is the leading cause of seizures among children.Contrast to previous studies,the proportions of epilepsy and benign infantile convulsions associated with mild gastroenteritis are increasing,while the proportion of intracranial infection is reducing.Rapid assessment and accurately identifying the etiology play an important role in the management of seizures.

Main etiologies for patients presented to ER with chest pain or chest pain equivalent / 中国综合临床

Objective To identify the main etiologies of emergency room (ER) patients with chest pain or equivalent syndrome.Methods This was a prospective and cross-sectinal survey of ER patinets with chest pain or equivalent syndrome in 17 medical centre in Beijing,China from July to August 2009.Data was collected by structured interviews and medical record reviews.The mean follow up period was 30 days.Results A total of 5666 patients were enrolled in the study (2663 males and 3303 females) and the mean age was 58.1 ± 18.4years.Their final diagnoses were:coronary heart disease 1506 ( 27.4％ ),acute heart failure 149 ( 2.6％ ),pericarditis 4 ( 0.1％ ),pulmonary embolism 11 ( 0.2％ ),aortic dissection 8 ( 0.1％ ),acute cerebrovascular disease 431 ( 7.6％ ) and non-cardic chest pain 2538 ( 44.9％ ).Thirty-seven cased died and 275 cases hospitalized again 30 days later,4.9％ patients with cornary heart disease had symptoms at their presentation.Conclusion Special vigilance and thorough coronary artery evaluation are needed for all patients with chest discomfort or respiratory distress in the ER,even for patients without chest pain.

Preeclampsia: nuevas etiologías

La preeclampsia afecta entre el 5 y 7% de todas las mujeres embarazadas y sigue siendo una causa importante de mortalidad y morbilidad maternal y perinatal, es particularmente devastadora en los países en desarrollo. La etiología de la preeclampsia es desconocida. En la actualidad, cuatro hipótesis son objeto de investigación exhaustiva: (1) Disfunción de la perfusión placentaria con aumento de factores angiogénicos y bioquímicos, (2) Alteraciones metabólicas relacionadas con el incremento de las adipoquinas, (3) Inadecuada adaptación inmune y (4) Factores genéticos relacionados con la expresión de genes implicados en esta patología.

Preeclampsia affects between 5% and 7% of all pregnancies and remains a major cause of maternal and perinatal mortality and morbidity, and it is particularly devastating in developing countries. The etiology of preeclampsia is unknown. At present, 4 hypotheses are the subject of extensive investigation, as follows: (1) Dysfunction of placental perfusion with increased angiogenic and biochemical factors, (2) Metabolic disorders related to the increase in adipokinas, (3) Inadequate immune adaptation and (4) Genetic factors related to the expression of genes involved in this pathology.

Etiologies and Clinical Characteristics of Cervical Lymphadenopathy in Children / 소아알레르기및호흡기학회지

PURPOSE:This study was performed to investigate clinical characteristics and the etiology of cervical lymphadenopathy in children. METHODS:A clinical review of 240 cases of children under the age of 18 who were admitted with cervical lymphadenopathy from January 2002 to December 2007. RESULTS:Cervical lymphadenopathy was diagnosed as follows:clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4 %), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%). Abscess was presented as an acute lesion (94.1%) with less than 2 weeks of fever (69.4 %) and tuberculous lymphadenitis was presented as a chronic lesion (62.5%) without fever (90 %). Malignant disease (100%) and necrotizing lymphadenitis (62.5%) were found in chronic lesion of older children with systemic symptoms (40% and 37.5%, respectively). Leukopenia (57.9%) with various duration of fever occured in case of necrotizing lymphadenitis. CONCLUSION:Clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4%), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%) were found in cervical lymphadenopathy. Although cervical lymphadenopathy was commonly caused by a benign infectious process, a more serious disease was not rare, which may have different clinical characteristics including age, duration of fever and disease, previous or accompanying symptoms, or white cell counts. Meticulous combination of clinical characteristics, history, physical examination and workup as well as follow-up may be the most important for the proper approach on cervical lymphadenopathy in children.

Hereditary Hemolytic Anemia in Korea: a Retrospective Study from 1997 to 2006

BACKGROUND: The aim of this study was to investigate the prevalence, clinical and laboratory findings of hereditary hemolytic anemia (HHA) in Korea from 1997 to 2006 and to develop the appropriate diagnostic approach for HHA. METHODS: By the use of questionnaires, information on the clinical and laboratory findings ofHHA diagnosed from 1997 to 2006 in Korea was collected and analyzed retrospectively. A total of 431 cases were enrolled in this study from 46 departments of 35 hospitals. RESULTS: The overall frequency of HHA did not change through the 10-year period for pediatrics but did show an increasing tendency for internal medicine. The overall male to female sex ratio did not show sex predominance (1.17:1), but a significant male predominance with a ratio of 1.49:1 was seen for pediatrics while a significant female predominance with a ratio of 1:1.97 was seen forinternal medicine. Of the total cases, 74.2% (282/431) were diagnosed before the age of 15 years. The etiologies of HHA were classified as red cell membrane defects, hemoglobinopathies, red cell enzyme deficiencies and unknown causes. There were 382 cases (88.6%) of red cell membrane defects with 376 cases (87.2%) of hereditary spherocytosis and 6 cases (1.4%) of hereditary elliptocytosis, 20 cases (4.6%) of hemoglobinopathies with 18 cases (4.2%) of beta-thalassemia, a case (0.2%) of alpha-thalassemia and a case (0.2%) of Hemoglobin Madrid, 7 cases (1.6%) of red cell enzyme deficiencies with 5 cases (1.2%) of glucose-6- phosphate dehydrogenase (G-6-PD) deficiency, a case (0.2%) of pyruvate kinase (PK) deficiency and a case (0.2%) of enolase deficiency, and 22 cases (5.1%) of unknown causes. The most common chief complaint in pediatric patients was pallor and that in adult patients was jaundice. In the red cell membrane defect group of patients, the level of hemoglobin was significantly higher than in adult patients. The mean corpuscular volume, mean corpuscular hemoglobin, corrected reticulocyte count, total and indirect bilirubin level and lactate dehydrogenase levels in the hemoglobinopathy group of patients were significantly lower than the values in the red cell membrane defect group of patients. The mean concentration of G-6-PD was 0.8+/-0.7U/1012RBC in the G-6-PD deficient patients, PK was 1.7U/1010 RBC in the PK deficient patient, and the level of enolase was 0.04U/g of Hb in the enolase deficient patient. CONCLUSION: The most prevalent cause of HHA in Korea during 1997 to 2006 was hereditary spherocytosis, but HHA by other causes such as hemoglobinopathy and red cell enzyme deficiency gradually increased with the development of molecular diagnostic methods and increasing general interest. However, the etiologies of HHA need to be pursued further in 5.1% of the patients. An systematic standard diagnostic approach is needed in a nationwide prospective study for correct diagnoses and appropriate management of HHA.

Clinical analyses of etiopathogenisis,symptom and prognostic of spontaneous subarachnoid hemorrhage / 中国基层医药

Objective To explore clinical characteristics of spontaneous subarachnoid hemorrhage(SAM)pa- tients.Methods Etiopathogenisis and clinical manifestations of 167 SAIl patients of different ages and cause of 24 SAH patients' exacerbation and death were retrospectively analyzed.Results The aneurysm was the main etiologies of SAH.The youth and middle-ages SAH patients were caused by aneurysm.Hypertensive arteriosclerosis was the second etiologies of SAH which was mainly in middle-ages and old ages.SAH caused by Vascular malformation main- ly appeared in youth group.Headache and vomitus and meningeal irritation sign which mainly appeared in youth and middle-ages groups.Occiput pain and conscious disturbance was mainly the first symptoms of aggravation and death of SAH which happened in 14 days after hemorrhage and under 45 year ages.Conclusion Aneurysm and vascular malformations are the main causes of SAH of young patients.And hypertensive arteriosclerosis is the main cause of the old.The clinical manifestations of the old are not as typical as the young.Posterior cranial fossa hemorrhage is the main cause of SAH patients which are mostly under 45 year ages and mostly happen in 14 days after bleeding.

Etiologies of sensorineural hearing loss.

A retrospective study was done in 1,074 patients with sensorineural hearing loss (SNHL) as main symptoms who attended the Neuro-otology clinic, Department of Otolaryngology, Siriraj Hospital, from January 1983 to December 1987. The significant etiologies were determined in only 40% of the patients i.e sudden hearing loss (8.57%), Meniere’s disease (6.42%), syphilis (5.59%), congenital hearing loss (3.52%), inner ear trauma (3.45%), systemic diseases (2.98%), CPA tumours (2.88%), ototoxicity (1.68%), presbycusis (1.02%), viral infection (0.93%), bacterial infection (0.93%), miscellaneous (0.47%), intracranial tumours (0.19%),respectively.