RESUMO
Background: Brain damage resulting from perinatal cerebral hypoxia-ischemia is a major cause of acute mortality and chronic neurological disability in infants and children. Statistics suggest an incidence of systemic asphyxia up to 20 per 1000 full- term neonates. Between 20 to 50 percent of asphyxiated newborns who exhibit hypoxicischemic encephalopathy die during the neonatal period. Among the available neuroimaging modalities, brain CT-scan is superior as a new technique with a low cost. It is a non-invasive technique which can provide information about the nature and extent of cerebral damage
Patients and Methods: This is a cross-sectional analytical study performed for evaluation of neonates with asphyxia who were admitted in the neonatal wards of Nemazee and Hafez Hospitals, Shiraz. Inclusion criteria were a gestational age of more than 37 weeks, appropriate weight for gestational age, severe peripartum asphyxia, abnormal neurological signs and absence of major congenital anomalies. Staging of clinical findings was according to the Sarnat staging of hypoxic-ischemic encephalopathy which divided the cases into three groups. Correlation of clinical findings with brain CT-scan was performed during the first two weeks of life and the data were analysed using chi-square and Fisher's exact tests
Results: Forty-five neonates with asphyxia were enrolled in this study. There was a statistically significant difference between the three stages of clinical findings and brain edema [p=0.02] and possibility of brain edema was more in the higher stages [stage one: 10 percent, stage two: 45 percent, stage three: 66.7 percent]. Intracranial hemorrhage [ICH] was present in 15 cases [33.3 percent]. The incidence of intracranial hemorrhage in stages 1, 2 and 3 were 20, 20 and 60 percent, respectively [p=0.027]. There were 9 cases [20 percent] with normal and 36 cases [80 percent] with abnormal CT -scan findings which correlated directly with higher clinical stages. Abnormal findings in CT-scan were found in 75, 75 and 93.3 percent of the neonates in stages 1, 2 and 3, respectively, with 30 percent specificity and 83 percent sensitivity
Conclusion: According to clinical findings, severity of damage in asphyxiated neonates and its complications such as brain edema, intracranial hemorrhage and convulsion are directly related to brain CT-scan findings. Therefore, in the absence of access to CT-scan, patients may be managed according to clinical findings
RESUMO
The aim of this study was to evaluate the role of fine needle aspiration cytology in the diagnosis of abdominal and retroperitoneal masses in children on this study. In 53 cases of childhood abdominal and retropertioneal massess within a 4 year period [1998-2001] preoperative finer needle aspiration was done under the guide of CT scan. 2 pathologists reviewed fine needle aspiration smears. In all of the cases the gold standard for diagnosis was the tissue specimen, which showed 37 malignant, 2 benign neoplastic and 12 nonneoplastic diseases. This study showed that the sensitivity and specificity of fine needle aspiration cytology for the diagnosis of malignancy and benignity [positive or negative for malignancy] is 97.2% and 81.2% respectively. It was 100% accurate for the diagnosis of cell type in neuroblastoma-ganglioneuroblastoma, hepatoblastoma and Wilm's tumor, 77% accurate for lymphoma and 57% for germ cell tumors. There was no complication in any of the cases after fine needle aspiration. So fine needle aspiration is a reliable and sensitive method for the preoperative diagnosis of malignant pediatric abdominal and retroperitoneal masses and we recommend doing FNA cytology as a routine method for the diagnosis of such cases