Predictors of Unfavourable Outcomes in Children and Adolescents Submitted to Surgical Mitral Valvuloplasty Secondary to Chronic Rheumatic Heart Disease / Preditores de Desfecho Desfavorável em Crianças e Adolescentes Submetidos à Valvoplastia Mitral Cirúrgica Secundária a Cardiopatia Reumática Crônica

Abstract Background: Mitral valve repair in paediatric patients with chronic rheumatic heart disease is superior to valve replacement and has been used with good results. Objective: To identify predictors of unfavourable outcomes in children and adolescents submitted to surgical mitral valvuloplasty secondary to rheumatic heart disease. Methods: Retrospective study of 54 patients under the age of 16 operated at a tertiary paediatric hospital between March 2011 and January 2017. The predictors of risk for unfavourable outcomes were: age, ejection fraction, degree of mitral insufficiency, degree of pulmonary hypertension, presence of tricuspid insufficiency, left chamber dilation, preoperative functional classification, duration of cardiopulmonary bypass, duration of anoxia, presence of atrial fibrillation, and duration of vasoactive drug use. The outcomes evaluated were: death, congestive heart failure, reoperation, residual mitral regurgitation, residual mitral stenosis, stroke, bleeding and valve replacement. For all analyzes a value of p < 0.05 was established as significant. Results: Of the patients evaluated, 29 (53.7%) were female, with an average of 10.5 ± 3.2 years. The functional classification of 13 patients (25%) was 4. There was no death in the sample studied. The average duration of extracorporeal circulation was 62.7±17.8 min, and anoxia 50 ± 15.7 min. The duration of use of vasoactive drug in the immediate postoperative period has an average of 1 day (interquartile interval 1-2 days). The logistic regression model was used to evaluate the predictive variables for each unfavourable outcome. The duration of use of vasoactive drug was the only independent predictor for the outcomes studied (p = 0.007). Residual mitral insufficiency was associated with reoperation (p = 0.044), whereas tricuspid insufficiency (p = 0.012) and pulmonary hypertension (p = 0.012) were associated with the presence of unfavourable outcomes. Conclusion: The duration of vasoactive drug use is an independent predictor for unfavourable outcomes in the immediate and late postoperative period, while residual mitral regurgitation was associated with reoperation, and both tricuspid regurgitation and pulmonary hypertension were associated with unfavourable outcomes.

Resumo Fundamento: A plastia da valva mitral, em pacientes pediátricos com cardiopatia reumática crônica, é superior à troca valvar e vem sendo utilizada com bons resultados. Objetivo: Identificar variáveis preditoras de desfecho desfavorável em crianças e adolescentes submetidos à valvoplastia mitral cirúrgica secundária à cardiopatia reumática. Métodos: Estudo retrospectivo em 54 pacientes menores de 16 anos, operados em um hospital pediátrico terciário entre março de 2011 e janeiro de 2017. As variáveis preditoras de risco para desfecho desfavorável foram: idade, fração de ejeção, grau de insuficiência mitral, grau de hipertensão pulmonar, presença de insuficiência tricúspide, dilatação de câmaras esquerdas, classe funcional no pré-operatório, tempo de circulação extracorpórea, tempo de anóxia, presença de fibrilação atrial e tempo de uso de droga vasoativa. Os desfechos avaliados foram: morte, insuficiência cardíaca congestiva, reoperação, insuficiência mitral residual, estenose mitral residual, acidente vascular cerebral, sangramento e troca valvar. Para todas as análises foi estabelecido valor de p < 0,05 como significante. Resultados: Dos pacientes avaliados, 29 (53,7%) eram do sexo feminino, com média de idade de 10,5 ± 3,2 anos. A classe funcional de 13 pacientes (25%) foi 4. Não houve morte na amostra estudada. O tempo médio de circulação extracorpórea foi de 62,7 ± 17,8 minutos e de anóxia 50 ± 15,7 minutos. O tempo de uso de droga vasoativa no pós-operatório imediato teve mediana de 1 dia (intervalo interquartil 1-2 dias). O modelo de regressão logística foi utilizado para avaliar as variáveis preditoras para o desfecho desfavorável. O tempo de uso de droga vasoativa foi o único preditor independente para os desfechos estudados (p = 0,007). A insuficiência mitral residual foi associada à reoperação (p = 0,044), enquanto a insuficiência tricúspide (p = 0,012) e a hipertensão pulmonar (p = 0,012) se associaram à presença de desfechos desfavoráveis. Conclusão: O tempo de uso de droga vasoativa é um preditor independente para desfechos desfavoráveis no pós-operatório imediato e tardio, enquanto insuficiência mitral residual se associou à reoperação e tanto a insuficiência tricúspide quanto a hipertensão pulmonar foram associadas a desfechos desfavoráveis.

Predictive Value of Cranial Ultrasound for Neurodevelopmental Outcomes of Very Preterm Infants with Brain Injury / 中华医学杂志(英文版)

<p><b>Background</b>Compared with full-term infants, very preterm infants are more vulnerable to injury and long-term disability and are at high risk of death. The predictive value of ultrasound and imaging on the neurodevelopment is one of the hot topics. This study aimed to investigate the relationship between cranial ultrasound (cUS) variables and neurodevelopmental outcomes of very preterm infants.</p><p><b>Methods</b>Totally 129 very preterm infants (gestational age ≤28 weeks) in neonatal intensive care unit of Hunan Children's Hospital between January 2012 and November 2014 were included in this retrospective study. Serial cUS (weekly before discharge and monthly after discharge) was performed on the infants until 6 months or older. Magnetic resonance imaging (MRI) was performed on the infants at approximately the term-equivalent age. The mental developmental index (MDI) and psychomotor developmental index (PDI) were followed up until the infants were 24 months or older. The relationship between brain injury and MDI/PDI scores was analyzed.</p><p><b>Results</b>The consistency rate between cUS and MRI was 88%. At the first cUS, germinal matrix hemorrhage (GMH) Grades 3 and 4, hospitalization duration, and weight are significantly correlated with MDI/PDI and prognosis (MDI: odds ratio [OR] = 8.415, 0.982, and 0.042, P = 0.016, 0.000, and 0.004; PDI: OR = 7.149, 0.978, and 0.012, P = 0.025, 0.000, and 0.000, respectively). At the last cUS, gestational age, extensive cystic periventricular leukomalacia (c-PVL), and moderate and severe hydrocephaly are significantly correlated with MDI (OR = 0.292, 60.220, and 170.375, P = 0.004, 0.003, and 0.000, respectively). Extensive c-PVL and moderate and severe hydrocephaly are significantly correlated with PDI (OR = 76.861 and 116.746, P = 0.003 and 0.000, respectively).</p><p><b>Conclusions</b>Very premature infants with GMH Grades 3 and 4, short hospitalization duration, and low weight have low survival rates and poorly developed brain nerves. Cerebral palsy can result from severe cerebral hemorrhage, moderate and severe hydrocephaly, and extensive c-PVL. The sustained, inhomogeneous echogenicity of white matter may suggest subtle brain injury.</p>

Sonographic Alteration of Basal Ganglia in Different Forms of Primary Focal Dystonia: A Cross-sectional Study / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Few studies have addressed whether abnormalities in the lenticular nucleus (LN) are characteristic transcranial sonography (TCS) echo features in patients with primary dystonia. This study aimed to explore alterations in the basal ganglia in different forms of primary focal dystonia.</p><p><b>METHODS</b>cross-sectional observational study was performed between December 2013 and December 2014 in 80 patients with different forms of primary focal dystonia and 55 neurologically normal control subjects. TCS was performed in patients and control subjects. Multiple comparisons of multiple rates were used to compare LN hyperechogenicity ratios between control and patient groups.</p><p><b>RESULTS</b>Thirteen individuals were excluded due to poor temporal bone windows, and two subjects were excluded due to disagreement in evaluation by sonologists. Totally, 70 patients (cervical dystonia, n = 30; blepharospasm, n = 30; oromandibular dystonia, n = 10) and 50 normal controls were included in the final analysis. LN hyperechogenicity was observed in 51% (36/70) of patients with primary focal dystonia, compared with 12% (6/50) of controls (P < 0.001). Substantia nigra hyperechogenicity did not differ between the two groups. LN hyperechogenicity was observed in 73% (22/30) of patients with cervical dystonia, a greater prevalence than in patients with blepharospasm (33%, 10/30, P = 0.002) and oromandibular dystonia (40%, 4/10, P = 0.126). LN hyperechogenicity was more frequently observed in patients with cervical dystonia compared with controls (73% vs. 12%, P < 0.001); however, no significant difference was detected in patients with blepharospasm (33% vs. 12%, P = 0.021) or oromandibular dystonia (40% vs. 12%, P = 0.088).</p><p><b>CONCLUSIONS</b>LN hyperechogenicity is more frequently observed in patients with primary focal dystonia than in controls. It does not appear to be a characteristic TCS echo feature in patients with blepharospasm or oromandibular dystonia.</p>

Prophylactic intravenous ketorolac for prevention of intraventricular hemorrhage in preterm infants ? 32 weeks and < 1500 grams: A double-blind, randomized, placebo-controlled trial

@#<p style="text-align: justify;">Intraventricular hemorrhage (IVH) remains an important cause of morbidity and mortality in Very Low Birth Weight (VLBW) infants. Since 2004, Indomethacin, which is effective in preventing IVH, has been removed from the Philippine market. Ketorolac is a nonselective cyclooxygenase inhibitor which is structurally-related and of equal potency to Indomethacin.<br /><strong>OBJECTIVE:</strong> This study aims to determine if prophylactic ketorolac compared to placebo will decrease IVH and its associated morbidities among preterm neonates.<br /><strong>METHODS:</strong> We conducted a double-blind, randomized, placebo-controlled trial among neonates born in a tertiary government university hospital. Newborns with gestational age ?32 weeks and birth weight <strong>RESULTS:</strong> A total of 134 infants were included in this study. There was no difference in the proportion of infants who developed IVH between the ketorolac and placebo groups (46% vs. 45%). The mean serum creatinine levels were significantly higher in the ketorolac group (1.15 ± 0.69 vs 0.79 ±0.38; p=0.002). The rates of death, sepsis, necrotizing enterocolitis, bleeding, platelet counts of <50,000/mm3, mean urine output and the lengths of hospital stay were similar in the two groups.<br /><strong>CONCLUSION:</strong> Prophylactic intravenous ketorolac was ineffective in preventing IVH among preterm infants. Ketorolac cannot be recommended for the prevention of IVH.</p>

Perinatal ischemic stroke: a five-year retrospective study in a level-III maternity / Acidente vascular cerebral isquêmico perinatal: estudo retrospectivo de 5 anos em maternidade nível III

Objective To study the incidence, clinical presentation, risk factors, imaging diagnosis, and clinical outcome of perinatal stroke. Methods Data was retrospectively collected from full-term newborns admitted to the neonatal unit of a level III maternity in Lisbon with cerebral stroke, from January 2007 to December 2011. Results There were 11 cases of stroke: nine were arterial ischemic stroke and two were cerebral venous sinus thrombosis. We estimated an incidence of arterial ischemic stroke of 1.6/5,000 births and of cerebral venous sinus thrombosis of 7.2/100,000 births. There were two cases of recurrent stroke. Eight patients presented with symptoms while the remaining three were asymptomatic and incidentally diagnosed. The most frequently registered symptoms (8/11) were seizures; in that, generalized clonic (3/8) and focal clonic (5/8). Strokes were more commonly left-sided (9/11), and the most affected artery was the left middle cerebral artery (8/11). Transfontanelle ultrasound was positive in most of the patients (10/11), and stroke was confirmed by cerebral magnetic resonance in all patients. Electroencephalographic recordings were carried out in five patients and were abnormal in three (focal abnormalities n=2, burst-suppression pattern n=1). Eight patients had previously identified risk factors for neonatal stroke which included obstetric and neonatal causes. Ten patients were followed up at outpatients setting; four patients developed motor deficits and one presented with epilepsy. Conclusions Although a modest and heterogeneous sample, this study emphasizes the need for a high level of suspicion when it comes to neonatal stroke, primarily in the presence of risk factors. The prevalence of neurological sequelae in our series supports the need of long-term follow-up and early intervention strategies. .

Objetivo Estudar incidência, apresentação clínica, fatores de risco, resultado de exames de imagem e desfecho clínico do acidente vascular cerebral perinatal. Métodos Análise retrospectiva dos prontuários de recém-nascidos a termo internados com o diagnóstico de acidente vascular cerebral perinatal no Serviço de Neonatologia, de uma maternidade nível III, em Lisboa, de janeiro de 2007 a dezembro de 2011. Resultados Houve 11 casos de acidente vascular cerebral: nove isquêmicos arteriais e duas tromboses dos seios venosos. As incidências foram estimadas: para acidente vascular cerebral isquêmico arterial de 1,6/5.000 nascimentos; para trombose dos seios venosos de 7,2/100.000 nascimentos. Houve dois casos de recorrência. Oito doentes foram sintomáticos e três assintomáticos, com diagnóstico incidental. As convulsões foram o sintoma mais frequente (8/11): clônicas generalizadas (3/8) e clônicas focais (5/8). O território vascular esquerdo foi o mais afetado (9/11), particularmente a artéria cerebral média esquerda (8/11). A ecografia transfontanelar foi positiva na maioria dos doentes (10/11), sendo o diagnóstico confirmado por ressonância magnética cerebral em todos. Dos cinco doentes que realizam eletroencefalograma, três apresentaram alterações (alterações focais n=2 e padrão de surto-supressão n=1). Oito doentes apresentaram fatores de risco para acidente vascular cerebral neonatal, incluindo causas obstétricas e neonatais. Dez doentes foram acompanhados em ambulatório, dos quais quatro apresentaram défice motores e um apresentou epilepsia. Conclusão Apesar de uma amostra limitada e heterogênea, este estudo reforça a necessidade de um elevado nível de suspeita para acidente vascular cerebral perinatal, particularmente na presença de fatores de risco. A prevalência de sequelas neurológicas em nossa série reforça a necessidade de seguimento a longo prazo e de estratégias de intervenção precoces. .

Presence of Fragmented QRS Complexes in Patients with Obstructive Sleep Apnea Syndrome / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Obstructive sleep apnea syndrome (OSAS) is a disease with increasing prevalence, which is mainly characterized by increased cardiopulmonary mortality and morbidity. It is well-known that OSAS patients have increased prevalence of cardiovascular diseases including coronary heart disease, heart failure, and arrhythmias. The aim of this study was to evaluate the presence of prolonged and fragmented QRS complexes, which have previously been associated with cardiovascular mortality, in OSAS patients.</p><p><b>METHODS</b>Our study included 51 patients (mean age 41.6 ± 10.1 years) who were recently diagnosed with OSAS (apnea-hypopnea index [AHI] ≥5 events/h) and never received therapy. The control group consisted of 34 volunteers (mean age 43.1 ± 11.6 years) in whom OSAS was excluded (AHI <5 events/h). The longest QRS complexes was measured in the 12-lead electrocardiogram (ECG) and the presence of fragmentation in QRS complexes was investigated.</p><p><b>RESULTS</b>Fragmented QRS frequency was significantly higher in patients with OSAS (n = 31 [61%] vs. n = 12 [35%], P = 0.021). QRS and QTc durations were also significantly longer in OSAS patients than controls (99.8 ± 13.9 ms vs. 84.7 ± 14.3 ms, P < 0.001; 411.4 ± 26.9 ms vs. 390.1 ± 32.2 ms, P = 0.001, respectively). Analysis of the patient and controls groups combined revealed a weak-moderate correlation between AHI and QRS duration (r = 0.292, P = 0.070). OSAS group had no correlation between AHI and QRS duration (r = -0.231, P = 0.203).</p><p><b>CONCLUSIONS</b>In our study fragmented QRS frequency and QRS duration were found to increase in OSAS patients. Both parameters are related with increased cardiovascular mortality. Considering the prognostic importance of ECG parameters, it may be reasonable to recommend more detailed evaluation of OSAS patients with fragmented or prolonged QRS complexes with respect to presence of cardiovascular diseases.</p>

Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus among Very-Low-Birth-Weight Infants in Korea

Here, we aimed to evaluate the incidence and mortality of intraventricular hemorrhage (IVH) and post-hemorrhagic hydrocephalus (PHH) among very-low-birth-weight (VLBW) infants in Korea and assess the associated factors of PHH. This cohort study used prospectively collected data from the Korean Neonatal Network (KNN). Among 2,386 VLBW infants in the KNN database born between January 2013 and June 2014, 63 infants who died without brain ultrasonography results were excluded. Maternal demographics and neonatal clinical characteristics were assessed. The overall incidence of IVH in all the VLBW infants was 42.2% (987 of 2,323), while those of IVH grade 1, 2, 3, and 4 were 25.1%, 7.0%, 4.8%, and 5.5%, respectively. The incidence and severity of IVH showed a negatively correlating trend with gestational age and birth weight. PHH developed in 0%, 3.5%, 36.1%, and 63.8% of the surviving infants with IVH grades 1, 2, 3, and 4, respectively. Overall, in the VLBW infants, the IVH-associated mortality rate was 1.0% (24/2,323). Only IVH grade severity was proven to be an associated with PHH development in infants with IVH grades 3-4. This is the first Korean national report of IVH and PHH incidences in VLBW infants. Further risk factor analyses or quality improvement studies to reduce IVH are warranted.

Relationship between serum S100B protein level and brain damage in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study changes of serum S100B protein level in preterm infants with brain damage and its role.</p><p><b>METHODS</b>Forty-seven preterm infants were classified into 3 groups based on the results of brain ultrasound and MRI: brain white matter damage (WMD; n=13), brain but not white matter damage (non-WMD; n=14) and control (no brain damage; n=20). Blood samples were collected within 24 hrs, 72 hrs and 7 days after birth. S100B protein level was measured using ELISA.</p><p><b>RESULTS</b>Serum levels of S100B in the WMD and non-WMD groups were significantly higher than in the control group within 24 hours, 72 hours and 7 days after birth (P<0.05). More increased serum S100B levels were observed in the WMD group compared with the non-WMD group (P<0.05).</p><p><b>CONCLUSIONS</b>Serum S100B protein level increases in preterm infants with brain damage within 7 days after birth, suggesting that it may be used as an early sensitive marker for the diagnosis of brain damage, especially WMD.</p>

A ultrassonografia transcraniana como método diagnóstico em neurologia. Parte I: Princípios e metodologia / Transcranial ultrasonography as a diagnostic method in neurology. Part I: Principles and methodology

A ultrassonografia transcraniana (USTC) é uma promissora técnica de neuroimagem para a investigação de distúrbios do movimento. O exame tem baixo custo, é inócuo, não é invasivo e pode ser realizado nos pacientes com movimentos involuntários sem sedação. As suas limitações incluem dependência de janela óssea adequada e de experiência e qualificação do examinador. Os valores de referência, no momento, só existem para pacientes da Europa, Estados Unidos da América e Ásia. A primeira parte do artigo apresenta alguns aspectos da técnica do exame; a segunda parte faz uma revisão da bibliografia disponível sobre a utilização da USTC em doenças neurológicas, particularmente na doença de Parkinson.

Transcranial sonography (TCS) is a promising neuroimaging technique for investigating movement disorders. The exam is inexpensive, harmless, non-invasive, and quick to perform in moving patients. Its limitations include its dependency on an adequate bone window and on qualified personnel. Reference values only exist for patients from Europe, North America and Asia. In the first part of this paper we present some technical aspects of the exam; the second part reviews the bibliography about TCS in neurological diseases, Parkinson's disease above all.

Aplasia cutis congénita tipo I: aporte de un caso / Aplasia cutis congenita: a case report

La Aplasia Cutis Congénita, es un grupo heterogéneo de alteraciones que consisten en la falta congénita localizada o extensa, de piel, que puede acompañarse de ausencia de estructuras subyacentes. Su apariencia clínica es variable y su origen es multifactorial. Presentamos el caso de un recién nacido con Aplasia Cutis Congénita, sin antecedentes familiares de esta enfermedad ni historia de uso materno de drogas, en quien no se constataron hallazgos extracutáneos.

Congenital aplasia cutis, is a heterogeneous group of disorders that involve the congenital absence, localized or extensive, of the skin, which may be accompanied by the absence of underlying structures. Its clinical appareance is variable with a multifactorial origin. We report the case of a newborn with Congenital Aplasia Cutis with no family history of the disease or history of maternal drug abuse, in whom extracutaneous findings were not found.

Intraoperative ultrasound assistance in the resection of small, deep-seated, or ill-defined intracerebral lesions / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Intraoperative ultrasound (IOUS) has been increasingly used as a guiding tool during neurosurgical procedures. In this study, we aimed to evaluate the potential application of intraoperative ultrasound assisted surgery in the resection of small, deep-seated, or ill-defined lesions.</p><p><b>METHODS</b>Eighty-six consecutive patients with small, deep-seated, or ill-defined intracerebral lesions were studied prospectively. An improved intraoperative imaging technique and surgical setup were practiced during the surgery. IOUS was performed in three orthogonal imaging planes (horizontal, coronal and sagittal).</p><p><b>RESULTS</b>Histopathological diagnoses of these 86 cases included cavernomas, metastases, hemangioblastomas, gliomas, and radiation necrosis. Forty-seven of the 86 lesions (54.7%) were small and deep-seated, 34/86 (39.5%) were ill-defined, and 5/86 (5.8%) were small, deep-seated, and ill-defined. Sonograms in the horizontal plane were obtained in all 86 cases. Sonograms in the sagittal plane and in the coronal plane were obtained only in 52 cases and in 46 cases, respectively, due to technical limitation. In 13 cases, sonograms in all three orthogonal planes were available. All lesions were successfully identified and localized by IOUS. Total resection was performed in 67 lesions (77.9%) and partial resection was performed in 19 lesions (22.1%).</p><p><b>CONCLUSIONS</b>We propose IOUS to be performed in three orthogonal planes when surgery is planned for small, deep-seated, or ill-defined brain lesions. By applying this simple, improved technique, surgeons can perform resection of these lesions precisely.</p>

Avaliação do comprimento e área do corpo caloso fetal por meio da ultrassonografia tridimensional / Assessment of length and area of corpus callosum by three-dimensional ultrasonography

OBJETIVO: determinar os valores de referência para o comprimento e a área do corpo caloso fetal entre a 20ª e 33ª semanas de gestação por meio da ultrassonografia tridimensional (US3D). MÉTODOS: foi realizado um estudo do tipo corte transversal com 70 gestantes normais entre a 20ª e 33ª semanas de gestação. Utilizou-se um aparelho da marca Accuvix XQ, equipado com transdutor convexo volumétrico (3 a 5 MHz). Para a obtenção do corpo caloso fetal, foi utilizado um plano transfrontal, com a sutura metópica como janela acústica. Para o cálculo do comprimento, utilizou-se a distância entre os pontos médios dos polos proximal e distal do corpo caloso. Para o cálculo da área, a delimitação manual da superfície externa do corpo caloso foi realizada. Para o comprimento e a área do corpo caloso, foram calculadas: as médias, as medianas, os desvios padrão e os valores máximo e mínimo. Para a correlação da área e do comprimento do corpo caloso com a idade gestacional e o diâmetro biparietal foram criados diagramas de dispersão, sendo a qualidade dos ajustes verificada pelo coeficiente de determinação (R²). Para a variabilidade intraobservador, utilizou-se o coeficiente de correlação intraclasse (CCI). RESULTADOS: a média do comprimento do corpo caloso variou de 21,7 mm (18,6 - 25,2 mm) a 38,7 mm (32,6 - 43,3 mm) entre a 20ªe 33ª semanas, respectivamente. A média da área do corpo caloso variou de 55,2 mm² (41,0 - 80,0 mm²) a 142,2 mm² (114,0 - 160,0 mm²) entre a 20ªe 33ª semanas, respectivamente. O comprimento e a área do corpo caloso foram fortemente correlacionados com a idade gestacional (R² = 0,7 e 0,7, respectivamente) e com o diâmetro biparietal (R² = 0,7 e 0,6, respectivamente). A variabilidade intraobservador foi adequada com CCI = 0,9 e 0,9 para o comprimento e área, respectivamente. CONCLUSÕES: valores de referência para o comprimento e área do corpo caloso fetal entre a 20ªe 33ª semanas foram determinados. A variabilidade intraobservador foi adequada.

PURPOSE: to establish reference values for the length and area of the fetal corpus callosum between the 20th and 33rd weeks of gestation using three-dimensional ultrasound (3DUS). METHODS: this cross-sectional study involved 70 normal pregnancies with gestational age between 20 and 33 weeks. An Accuvix XQ instrument with a convex volumetric transducer (3 to 5 MHz) was used. To assess the corpus callosum, a transfrontal plane was obtained using the metopic suture as an acoustic window. Length was obtained by measuring the distance between the proximal and distal extremities of the corpus callosum. Area was obtained by manual tracing of the external corpus callosum surface. The means, medians, standard deviations, and maximum and minimum values were calculated for the corpus callosum length and area. Scatter graphs were created to analyze the correlation between corpus callosum length and area and gestational age and biparietal diameter, the quality adjustments was verified according to the determination coefficient (R²). The intraclass correlation coefficient (ICC) was used to assess the intraobserver variability. RESULTS: mean corpus callosum length increased from 21.7 (18.6 - 25.2 mm) to 38.7 mm (32.6 - 43.3 mm) between 20 and 33 weeks of pregnancy, respectively. Mean corpus callosum area increased from 55.2 (41.0 - 80.0 mm²) to 142.2 mm² (114.0 - 160.0 mm²), between 20 to 33 weeks of pregnancy, respectively. There was a strong correlation between corpus callosum length and area and gestational age (R² = 0.7 and 0.7, respectively) and biparietal diameter (R² = 0.7 and 0.6, respectively). Intraobserver variability was appropriate, with an ICC of 0.9 and 0.9 for length and area, respectively. CONCLUSIONS: reference values for corpus callosum length and area were established for fetuses between 20 and 33 weeks gestation. Intraobserver variability was appropriate.

Relationship between the grading of periventricular echodensities and periventricular white matter cystic lesions in preterm infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To understand the relationship of the grading of periventricular echodensities (PVE) with the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.</p><p><b>METHODS</b>A retrospective, single-centre cohort study of 120 preterm infants with PVE diagnosed by ultrasonography between February 2005 and May 2008 was performed. The infants had a median gestational age of 32 weeks and a median birth weight of 2 230 g.</p><p><b>RESULTS</b>Fifty-two infants (43%) were diagnosed as having PVE I, 42 infants (35%) having PVE II, and 26 infants (22%) having PVE III. The grading of PVE was closely related to birth weight, but not with gestational age. The total morbidity of periventricular white matter cystic lesions was 24% (29/120). The morbidity of the cystic lesions in PVE III patients (65%) was significantly higher than that in PVE II patients (21%) (<0.01). The PVE III patients developed the cystic lesions earlier than the PVE II patients.</p><p><b>CONCLUSIONS</b>The grading of PVE is closely related to the morbidity and the occurrence time of periventricular white matter cystic lesions in preterm infants.</p>

Multicenter follow-up report of 147 premature infants with brain injuries from 6 hospitals in China / 中国当代儿科杂志

<p><b>OBJECTIVE</b>Sponsored by the Subspecialty Group of Neonatology of Pediatric Society, China Medical Association, more than 10 large-scale hospitals participated in the near two-year multicenter investigation for Brain Injuries in Premature Infants in China. The present study presents the follow-up results of 147 premature infants with brain injuries from 6 Third Class A Level hospitals.</p><p><b>METHODS</b>All premature infants with intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL) diagnosed in the early neonatal period in the 6 hospitals were followed-up between January 2005 and August 2006. Based on the synthetic results of physical development, examination of nervous system, intelligence tests and cranial ultrasound, the premature infants with brain injuries were classified as normal development, marginal development and retarded development.</p><p><b>RESULTS</b>One hundred and forty-seven premature infants with brain injuries from the 6 hospitals consisted of 141 cases of IVH and 36 cases of PVL (30 cases having IVH and PVL). Based on the synthetic follow-up results, 51.4% of premature infants with brain injuries were generally assessed as normal development, 38.4% as marginal development and 10.7% as retarded development. Among them, delayed growth in head circumference, height and weight was 13.4%; the occurrence frequency of cerebral paralysis (CP) was 7.1% in PVL grade I, 28.6% in PVL grade II and 100% in PVL grade III; 12.7% showed retarded development of intelligence; and 30% presented post-injurious changes on cranial sonography.</p><p><b>CONCLUSIONS</b>The data of the multicenter follow-up can basically reflect the short-term prognosis of premature infants with brain injuries in major big cities of China. About 10% of them have retarded physical, motor-and mental developments. The long-term regular follow-up study is expected for more premature infants with brain injuries, and behavioral sequelae of brain injuries which may occur in peri-school age and adolescence should be paid particularly close attention.</p>

Assessment of insular development in small for gestational age infants / 中国当代儿科杂志

<p><b>OBJECTIVE</b>To study the insular development of small for gestational age (SGA) infants.</p><p><b>METHODS</b>The insular area and circle were measured by cerebral ultrasonography in 92 SGA infants. The results were compared with those from 109 appropriate for gestational age (AGA) infants.</p><p><b>RESULTS</b>The insular area and circle were positively correlated with the birth weight and gestational age in SGA infants. The insular area in SGA infants with a gestational age of either >37 weeks (451 +/- 92 mm2 vs 516 +/- 116 mm2; p<0.01) or < or = 34 weeks (248 +/- 78 mm2 vs 314 +/- 80 mm2; p<0.01) was significantly less than that in the AGA infants. The insular circle in SGA infants with a gestational age of >37 weeks was also significantly less than that in the AGA infants (92 +/- 11 mm vs 97 +/- 11 mm; p<0.05).</p><p><b>CONCLUSIONS</b>The insular development of SGA infants seems to be immature. The insular development may be assessed based on the insular area and circle measured by cerebral ultrasonography.</p>

Perinatal arterial stroke due to unilateral cerebral infarction: case report

Perinatal arterial ischemic stroke is a significant cause of neurological deficit including cerebral palsy, mental retardation, delayed motor development, epilepsy and severe cognitive impairment. Arterial stroke is diagnosed primarily in term neonates. One such case of a term newborn with unilateral cerebral infarction which led to spastic hemiplegia is reported along with review of relevant literature

Ultrasonografía y predicción de parálisis cerebral en prematuros extremos / Ultrasound and prediction of cerebral palsy in extreme premature infants

Introducción: Los prematuros extremos (PE) tienen alto riesgo de morbilidad y secuelas neurológicas. La leucomalacia periventricular (LMPV) y hemorragia intraventricular (HIV) extensa son patologías típicas de la prematurez que se asocian al desarrollo de parálisis cerebral (PC) y fácilmente pesquisables por ultrasonografía cerebral (USC). El objetivo es predecir PC a los dos años de edad corregida en todos los PE dados de alta en base a la presencia e intensidad del daño cerebral diagnosticado por USC. Pacientes y métodos: Se constituyó un equipo neuropediátrico y se protocoliza un plan de seguimiento clínico, neurológico y ultrasonográfico para todos los PE dados de alta nacidos en los años 2001 al 2003. Los resultados de la USC se dividieron en: grupo A (USC normal), grupo B (con lesiones cerebrales favorables) y grupo C (lesiones desfavorables), y se registra el diagnóstico de PC a los dos años de edad corregida. Resultados: 247 niños fueron dados de alta pero sólo 171 (69,2 por ciento) completaron el seguimiento. En el grupo A hubo 3 de 78 niños que presentaron PC (3, 8 por ciento), no se registraron casos en los 45 niños del grupo B, y en el grupo C presentaron PC 15 de 48 niños (31,2 por ciento). En total se registraron 18 casos de PC (10, 5 por ciento), 13 de ellos de carácter invalidante (7,6 por ciento) y 10 casos fueron asociados a HIV. Al juntar los grupos de USC normal y favorable (A y B) y confrontarlos con el grupo de USC desfavorable (C) se observa que la USC para predecir PC tiene sensibilidad de 83,3 por ciento, especificidad de 78,4 por ciento, valor predictivo positivo 31,3 por ciento y negativo 97,6 por ciento. Conclusiones: La prevalencia de PC fue similar a otras publicaciones. La USC demostró utilidad en seleccionar pacientes de mayor riesgo neuromotor aunque no predice PC a largo plazo y no determina el manejo neuro-kinésico posterior. Dado lo trascendente del diagnóstico de PC resulta importante saber que 1 de 3 niños con USC desfav...

Patologías placentarias y lesiones de la sustancia blanca cerebral detectadas por ultrasonografía en recién nacidos prematuros de muy bajo peso dentro de las 72 hs de vida / Placental pathologies and cerebral white matter injuries detected by ultrasonography in very low birth weight infant within the 72 hours of life

Las lesiones de la sustancia blanca cerebral como la leucomalacia periventricular (LPV), el infarto hemorrágicoperiventricular (IHP), la ventriculomegalia (VMG) y las ecodensidades periventriculares (EDPV) son la causa más frecuente de alteraciones en el neurodesarrollo y de parálisis cerebral (PC) en recién nacidos prematuros menores a 1.500 g de peso al nacer. La patogénesis de estas lesiones es compleja y multifactorial: hipoxia, isquemia, infección, citoquinas y radicales libres están implicados en la misma. Las formas severas de las lesiones de la sustancia blanca cerebral (LSBC) pueden ser detectadas por ultrasonografía cerebral. Los factores de riesgo que precipitan la injuria cerebral pueden tener un origen antenatal, periparto o postnatal. Múltiples estudios relacionan la patología placentaria con las lesiones de la sustancia blanca cerebral, por lo tanto el estudio ecográfico cerebral y anatomopatológico de la placenta durante la primer semana de vida del recién nacido, orientará al origen prenatal de las mismas. La presencia de lesiones del SNC no se deben solamente a la infección ovular inespecífica, sino que además existirían otros factores adicionales, ya sea placentarios o fetales. La sumatoria de los mismos jugaría un rol fundamental en la génesis de estas severas lesiones del cerebro en desarrollo, por lo tanto evaluaremos en forma amplia las patologías placentarias macro y microscópicamente. Objetivo: Describir en nuestra población de recién nacidos pretérminos (RNPT) la presencia y tipo de lesiones anatomopatológicas (infecciosas, vasculares, inmunológicas, etc.), y simultáneamente describir las lesiones de la sustancia blanca cerebral detectadas por ultrasonografía dentro de las 72 horas de vida. Material y métodos. Diseño: Observacional, descriptivo y prospectivo. Población: Se incluyeron todos los RNPT de ≤32 semanas de edad gestacional y peso de nacimiento entre 500 g y 1.500 gramos nacidos en el Hospital Materno Infantil Ramón Sardá de la Ciudad Autónoma de Buenos Aires entre el 01/04/03 y el 08/05/04 (15 meses). Se excluyeron los recién nacidos que presentaron anomalías del desarrollo del sistema nervioso central al nacimiento, con infecciones intrauterinas específicas y los fallecidos en sala de partos. Métodos: A todos los RNPT se les realizó una ecografía cerebral con un transductor sectorial de 7,5 Mhz dentro de las 72 hs de vida...

Alterações morfológicas e funcionais em pacientes com transtorno obsessivo-compulsivo: avaliação por métodos de imagem / Morphological and functional alterations in patients with obsessive-compulsive disorder: evaluation by imaging techniques

A etiopatogenia do transtorno obsessivo-compulsivo é pouco compreendida. Inúmeras evidências indiretas, tais como alterações eletroencefalográficas, neuropsicológicas, bem como presença de sintomas desta doença em pacientes com lesões neurológicas adquiridas, são sugestivas de anormalidades em regiões encefálicas específicas. Com o advento de novas técnicas de imagem, nas últimas décadas, tem sido possível pesquisar a existência de alterações anatômicas e funcionais em diversas estruturas do SNC. A maioria dos estudos na literatura aponta para um provável acometimento de córtex frontal, núcleos da base, vias córtico-estriatais e estruturas límbicas. O significado das anormalidades em cada uma destas regiões, assim como as possíveis interações entre elas, ainda não são bem compreendidas.