Variantes de la normalidad del crecimiento infantil versus fallo de medro

Introducción: El fallo de medro es la incapacidad de un niño menor de 3 años de conseguir un desarrollo y crecimiento óptimo. A menudo es confundido con las variantes normales del crecimiento y desarrollo infantil. Objetivo: Examinar las variantes normales del crecimiento infantil y diferenciarlas del verdadero fallo de medro. Métodos: Se localizaron y seleccionaron estudios relevantes en las bases electrónicas Medline, Biblioteca Virtual de Salud, Google Académico, SciELO y en libros digitales. Para la búsqueda se emplearon los vocablos: fallo de medro, variantes de la normalidad del crecimiento y desarrollo infantil. Se hallaron 89 artículos publicados entre 2005-2020 sobre temáticas afines, se escogieron 41 que conformaron la muestra. Análisis y síntesis de la información: Se actualizaron diferentes aspectos del fallo de medro: definición, clasificación, criterios diagnósticos, factores de riesgo, causas potenciales, evaluación diagnóstica y conducta. Se examinaron las características clínicas de las variantes de la normalidad del crecimiento y desarrollo infantil que permiten diferenciarlas del fallo de medro. Conclusiones: El retardo constitucional del crecimiento y desarrollo, la talla baja familiar, la talla baja idiopática, la prematuridad, el crecimiento intrauterino retardado, la delgadez y el catch-down, constituyen variantes normales del crecimiento infantil que se diagnostican erróneamente como fallo de medro y genera medicalización injustificada, gastos innecesarios en análisis complementarios y angustia familiar. Diferenciar estas entidades del fallo de medro permitiría enfocar las acciones de salud hacia objetivos más concretos y ofrecer a cada niño un tratamiento individualizado de acuerdo a su condición real de salud.

Introduction: Failure to thrive is the inability of a child under 3 years of age to achieve optimal development and growth. It is often confused with the normal variants of child growth and development. Objective: To examine the normal variants of infant growth and differentiate them from true failure to thrive. Methods: Relevant studies were located and selected in the electronic databases Medline, Virtual Health Library, Google Scholar, SciELO and in digital books. For the search, the words used were: failure to thrive, variants of the normality of growth and child development. 89 articles published between 2005-2020 on related topics were found; 41 were chosen and made up the sample. Analysis and synthesis of information: Different aspects of failure to thrive were updated: definition, classification, diagnostic criteria, risk factors, potential causes, diagnostic evaluation and behavior. The clinical characteristics of the variants of the normality of child growth and development that allow them to be differentiated from the failure of growth were examined. Conclusions: Constitutional growth and development retardation, family short stature, idiopathic short stature, prematurity, delayed intrauterine growth, thinness and catch-down were normal variants of infant growth that are erroneously diagnosed as failure to thrive and generate unjustified medicalization, unnecessary expenses in complementary tests and family anguish. Differentiating these entities from the failure to thrive would allow health actions to focus on more specific objectives and offer each child an individualized treatment according to their real health condition.

Variations in the Origin of Inferior Phrenic Arteries and Their Relationship to Celiac Axis Variations on CT Angiography

OBJECTIVE: Knowing the origin of the inferior phrenic artery (IPA) is important prior to surgical interventions and interventional radiological procedures related to IPA. We aimed to identify variations in the origin of IPA and to investigate the relationship between the origin of IPA and celiac axis variations using computed tomography angiography (CTA). MATERIALS AND METHODS: The CTA images of 1000 patients (737 male and 263 female, the mean age 60, range 18–94 years) were reviewed in an analysis of IPA and celiac axis variations. The origin of IPA was divided into two groups, those originating as a common trunk and those originating independently without a truncus. The relationship between the origin of IPA and celiac axis variation was analyzed using Pearson's chi-square test. RESULTS: Both IPAs originated from a common trunk in 295 (29.5%) patients. From which the majority of the common trunk originated from the aorta. Contrastingly, the inferior phrenic arteries originated from different origins in 705 (70.5%) patients. The majority of the right inferior phrenic artery (RIPA) and the left inferior phrenic artery (LIPA) originated independently from the celiac axis. Variation in the celiac axis were detected in 110 (11%) patients. The origin of IPA was found to be significantly different in the presence of celiac axis variation. CONCLUSION: The majority of IPA originated from the aorta in patients with a common IPA trunk, while the majority of RIPA and LIPA originating from the celiac axis in patients without a common IPA trunk. Thus, the origin of IPA may widely differ in the presence of celiac axis variation.

Basic Electrophysiology of the Electroencephalography

Although neuroimaging techniques and other diagnostic procedures has been developed, electroencephalography(EEG) is still very important for the evaluation of various brain diseases and functional studies of human brain. EEG is formed mainly by spatial and temporal summations of postsynaptic potentials generated from a large population of pyramidal cells that can be considered as a collection of oscillating dipoles. EEG shows continuous rhythmic oscillation depending on sleep-waking state. Alpha rhythms are generated in cortical areas acting as epicenters with local spread, although the precise cellular mechanism is still unknown. It's been known that neurons in the nucleus reticular thalami are the pacemakers of sleep spindle. Alterations in the circuit of the reticular nuclei-thalamocortical relay neuron-cortical neuron are responsible for generalized spike and wave complexes. At the intracellular level, large paroxysmal depolarizing shifts produce focal epileptic spikes. Slow waves of EEG appear to be related to thalamocortical and/or corticothalamic deafferentation. The interpretation of routine EEG requires a well training from a qualified EEG teacher and reading adequate amount of EEG under supervision. Frequent misinterpretations of routine EEG have been observed in both local clinics and general hospitals. The most common findings of normal routine EEG misinterpreted as abnormal are normal variants and artifacts of various sources. There are considerable variations of normal EEG rhythms and pseudoepileptiform discharges. Eyeball movements produce prominent or subtle EEG changes over the frontal regions that are sometimes hard to be differentiated from abnormal slow waves over that region. Systematic approach was described for a good interpretation of routine EEG.

Normal Variation of Right Gastric Artery Origin on Abdominal Angiogram

PURPOSE: To evaluate the normal variations in the origin of the right gastric artery (RGA), as seen on abdominal angiogram. MATERIALS AND METHODS: Four hundred and twenty-six patients underwent celiac and superior mesenteric arteriogram, and in 154, the origin of the RGA was identified (M:F=116:38 ; mean age, 56 years ; range, 6-84 years). Digital subtraction angiography were performed in 101 patients, and conventional angiography in 53 ; we thus evaluated the origin of the RGA, normal variation of the hepatic artery, and the relationship between them. RESULTS: The origin of the RGA was the proper hepatic artery (PHA) in 43% of cases (n=67), the left hepaticartery (LHA) in 41% (n=63), the common hepatic artery (CHA) in 9% (n=14), the right hepatic artery (RHA) in 4% (n=6),and the gastroduodenal artery (GDA) in 3% (n=4). of these 154 patients, 126 (82%) showed a normal hepatic artery branching pattern, with both hepatic arteries arising from the PHA ; in 18 patients (12%), the RHA arose from the superior mesenteric artery (SMA), and in 6 patients (4%), the LHA arose from the left gastric artery (LGA). In 4 patients (3%), other branching patterns of the hepatic artery were noted. In 16 of 18 patients (89%) whose RHA arose from the SMA, the RGA originated in the LHA ; in the other two, the RGA arose from the GDA and CHA, respectively. CONCLUSION: In 43% of cases, the main site from which the RGA originated was the PHA, and in 41%, the LHA, as seen on abdominal angiogram. Where the RHA arose from the SMA, its most frequent site of origin, seen in 89% of cases, was the LHA. The exact recognition of the origin of the RGA, as seen on abdominal angiogram, could lead to a reduction of transarterial chemoembolization-related gastric complications.

The Variants of Macular Choroidal Veins in ICG Angiography

The choroidal vascular structure in macula is anatomically different from that in other region. And choroidal venous drainage in macula represents various types. This study attempted to classify the choroidal venous drainage in macula and focused on the relationship between the choroidal venous drainage type and a disease involving macula, esp. age-related macular degeneration(ARMD). The authors performed indocyanine green(ICG) angiography in 115 eyes (93 patients) without macular disease and in 31 eyes (24 patients) with ARMD, which were presented with choroidal new vessels. The choroidal venous drainage in macula was classified as 4 types. They were superotemporal drainage, inferotemporal drainage, horizontal watershed, and irregular type. The most common type of choroidal venous drainage was horizontal watershed type which was showed in 55 eyes (48%) without macular diease and 15 eyes (48%) with ARMD. Any relationship between a type of choroidal venous, drainage and ARMD was not found.