ABSTRACT
No disponible
Subject(s)
Humans , Child , Hospitals, University/organization & administration , Neurology/trends , Hospital Units/organization & administration , Specialization/trends , Health Services Research/trendsABSTRACT
Hypertension is common following renal transplantation, affecting up to 80% of transplant recipients. It is generally accepted that hypertension is associated with poor graft survival and reduced life expectancy, contributing to increased cardiovascular risk factors and mortality rates. The aim of the study was to compare the blood pressure (BP) control in kidney transplant patients through the use of ambulatory BP monitoring (ABMP) versus office BP measurements (oBP). A multicenter, cross-sectional, observational study was conducted in 30 nephrology/kidney transplant units. Eligible patients included hypertensive cadaveric kidney transplant recipients aged <70 years, with a functioning kidney for at least 1 year and with an estimated glomerular filtration ≥30 mL/min/1.73 m(2) and a serum creatinine < 2.5 mg/dL. Recorded data included demographic characteristics, oBP, and ABPM and labroatory investigations. The 868 patients showed a mean recipient age of was 53.2 ± 11.6 years and mean follow-up after transplantation, 5.5 ± 2.8 years. Mean systolic and diastolic oBP were 140.2 ± 18 and 80.4 ± 10 mm Hg, respectively. Seventy-six percent of patients had oBP higher than or equal to 130/80 mm Hg. Mean 24 hour ABPM were 131.5 ± 14 and 77.4 ± 8.7 mm Hg for systolic and diastolic BP, respectively. Using the ABPM, we observed that 36.5% of subjects were controlled (mean 24-hour BP < 130/85 mm Hg). The two methods (oBP and ABPM) showed significant agreement. After ABPM, 65% of patients diagnosed as true controlled hypertension were considered to have white-coat RH. In clinical practice ABPM may help for better adjustment of drugs for adequate BP control.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Blood Pressure , Hypertension/diagnosis , Kidney Transplantation/adverse effects , Adult , Aged , Antihypertensive Agents/therapeutic use , Biomarkers/blood , Blood Pressure/drug effects , Creatinine/blood , Cross-Sectional Studies , Glomerular Filtration Rate , Humans , Hypertension/drug therapy , Hypertension/etiology , Hypertension/physiopathology , Middle Aged , Office Visits , Predictive Value of Tests , Spain , Time Factors , White Coat Hypertension/diagnosis , White Coat Hypertension/etiology , White Coat Hypertension/physiopathologySubject(s)
Acute Kidney Injury/etiology , Calcium Oxalate/metabolism , Hyperoxaluria/etiology , Short Bowel Syndrome/complications , Aged , Bile Duct Neoplasms/surgery , Bile Ducts, Intrahepatic , Biliary Fistula/etiology , Calcium Oxalate/pharmacokinetics , Cardiac Output, High/etiology , Cholangiocarcinoma/surgery , Crystallization , Dietary Fats/pharmacokinetics , Drainage/adverse effects , Humans , Intestinal Absorption , Ischemia/etiology , Liver/blood supply , Male , Postoperative Complications , Proteinuria/etiology , Short Bowel Syndrome/metabolism , Surgical Wound Infection/etiology , Surgical Wound Infection/surgeryABSTRACT
In 2007 there were important scientific contributions in the field of kidney transplant and specifically in chronic transplant nephropathy (interstitial fibrosis and tubular atrophy). A new nomenclature and classification of chronic kidney disease was probably the most important contribution in this entity. Use of the C4d stain has allowed the concepts of glomerulopathy to be updated and to reveal the frequency of this entity and its impact in kidney transplant. Finally, two experimental studies provide new perspectives on the treatment of chronic kidney disease such as the use of statins or the use of pyridoxamine to block glycation end products.
Subject(s)
Kidney Transplantation , Kidney Tubules/pathology , Nephritis, Interstitial/etiology , Postoperative Complications/etiology , Transplants , Animals , Atorvastatin , Atrophy , Biopsy , Chronic Disease , Complement C4b/analysis , Heptanoic Acids/therapeutic use , Humans , Kidney Tubules/chemistry , Kidney Tubules/physiopathology , Nephritis, Interstitial/diagnosis , Nephritis, Interstitial/pathology , Nephritis, Interstitial/physiopathology , Nephritis, Interstitial/prevention & control , Peptide Fragments/analysis , Postoperative Complications/diagnosis , Postoperative Complications/pathology , Postoperative Complications/physiopathology , Postoperative Complications/prevention & control , Pyridoxamine/therapeutic use , Pyrroles/therapeutic use , Rats , Risk Factors , Terminology as TopicSubject(s)
Brain Diseases/diagnosis , Calcinosis/diagnosis , Psychomotor Disorders/diagnosis , Female , Humans , Infant, Newborn , SyndromeABSTRACT
No disponible
Subject(s)
Female , Infant, Newborn , Humans , Neurodegenerative Diseases/genetics , Diagnosis, Differential , Calcinosis/etiology , Pterins/analysis , Mutation/genetics , Brain Diseases/congenitalABSTRACT
Palatal tremor (PT) is a rhythmic movement of the soft palate that often causes an ear click. PT can be symptomatic (SPT) or essential (EPT). The symptomatic form usually occurs in adults and the essential form mainly occurs in children. Several different treatments for EPT in children appear in the literature with variable reported efficacy. This report details four paediatric patients with EPT (three males, one female; mean age 6y 4mo [SD 6mo]; age at onset 6-7y) treated with piracetam (2-oxo-1-pyrrolidine acetamide). Piracetam was used to treat EPT because of its antimyoclonic properties. All children showed a good response to doses of 100 to 300mg/kg/day. EPT relapsed on withdrawal of piracetam and remitted on reintroduction. Piracetam's effect on EPT was sustained. It is concluded that piracetam is an effective drug for the treatment of EPT in children.
Subject(s)
Essential Tremor/drug therapy , Neuroprotective Agents/therapeutic use , Palate, Soft , Piracetam/therapeutic use , Child , Female , Humans , Male , Treatment OutcomeABSTRACT
No disponible
Subject(s)
Female , Child, Preschool , Humans , Sweating, Gustatory/diagnosis , Obstetrical Forceps/adverse effectsABSTRACT
Las cardiopatías congénitas cianógenas (CCC) son el factor predisponerte más importante en la aparición del absceso cerebral en la infancia. El diagnóstico del absceso cerebral en fase inicial es difícil pues se confunde a menudo con otros procesos neurológicos tales como tumores cerebrales, infartos o hemorragias, como sucedió en nuestro caso. La TC Craneal con contraste es el examen de elección para el diagnóstico precoz en cualquier niño con CCC que presente sintomatología neurológica. La RM con espectroscopia puede ser de gran ayuda en casos dudosos. El diagnóstico y tratamiento precoces disminuyen claramente la mortalidad y morbilidad de esta patología, permite iniciar tratamiento lo más pronto posible, hecho que se correlaciona con un mejor pronóstico. Presentamos el caso de un niño con una CCC y clínica neurológica de instauración aguda y recurrente, secundaria a un absceso cerebral y cuyo diagnóstico ofreció serias dudas en las fases iniciales (AU)
Subject(s)
Male , Child , Humans , Heart Defects, Congenital/complications , Brain Abscess/etiology , Diagnosis, Differential , Asthenia/etiology , Tomography , Endocarditis , Penicillins/therapeutic use , Gentamicins/therapeutic use , Dexamethasone/therapeutic use , Fundus Oculi , Paresis/etiology , Headache/etiology , Vomiting/etiology , Brain Abscess/diagnosisABSTRACT
BACKGROUND: Because of improved obstetric and neonatal care, there is growing interest in the later outcome of very low birth weight newborns. OBJECTIVES: The aim of this study was to evaluate the survival rate of very low birth weight newborns and to identify disabilities at the age of 2 years. MATERIAL AND METHODS: An observational, follow-up study was performed of neonates with a birth weight of under 1,500 grams born between 1998 and 1999. The follow-up program included pediatric, maturative, neurological, psychological, ophthalmological, and audiological evaluation. Neurosensorial disabilities were classified as mild, moderate, or severe. RESULTS: One hundred thirty-six very low birth weight newborns were admitted. The survival rate was 77.9 % and 83.9 % completed the follow-up to the age of 2 years. The neurosensorial disability rate was 20.2 %; disability was severe in 9 %, moderate in 1.1 %, and mild in 10.1 %. In patients lost to follow-up, birth weight was higher, gestational age was older, and sonographic findings were more frequently normal. CONCLUSION: Survival in very low birth weight newborns has increased with improved neonatal care. The presence of sequelae was similar to that found in other follow-up studies. A substantial number of patients were lost to follow up, which influenced the disability rates.
Subject(s)
Infant, Very Low Birth Weight , Nervous System Diseases/mortality , Child, Preschool , Female , Follow-Up Studies , Humans , Infant , Infant, Newborn , Male , Survival RateABSTRACT
Antecedentes: Existe un interés creciente en el seguimiento de los recién nacidos de muy bajo peso al nacimiento con la mejoría de la asistencia obstétrica y neonatal. Objetivos: Evaluar las cifras de supervivencia de los recién nacidos de muy bajo peso, junto con la proporción y los tipos de secuelas que se observan a los 2 años de edad. Material y métodos Estudio observacional de seguimiento de los recién nacidos de menos de 1.500 g nacidos entre los años 1998-1999. Se evalúan los datos obtenidos en el programa de seguimiento compuesto por visitas a pediatría, maduración, neurología, psicología y oftalmología; y la realización de potenciales evocados visuales y auditivos. Las secuelas obtenidas se clasifican en leves, moderadas o graves. Resultados: Ingresan un total de 136 recién nacidos de muy bajo peso. La supervivencia es del 77,9 por ciento. Completaron el seguimiento hasta los 2 años un 83,9 por ciento de los supervivientes. La aparición de secuelas se observa en el 20,2 por ciento de los niños, de las cuales el 9 por ciento son graves, el 1,1 por ciento moderadas y el 10,1 por ciento leves. Los pacientes perdidos en el seguimiento presentan mayor peso al nacimiento, mayor edad gestacional y mayor normalidad ecográfica que los pacientes seguidos. Conclusión: Se obtiene un incremento en la supervivencia de los recién nacidos de muy bajo peso con la mejoría de los cuidados neonatales. La presencia de secuelas es similar a la obtenida en otros estudios de seguimiento. Se considera relevante la muestra de pacientes perdidos y su influencia en los porcentajes de secuelas obtenidas (AU)
Subject(s)
Child, Preschool , Male , Infant, Newborn , Infant , Female , Humans , Infant, Very Low Birth Weight , Survival Rate , Nervous System Diseases , Follow-Up StudiesABSTRACT
Introducción: El tratamiento en la fase aguda de las convulsiones es una urgencia neurológica y requiere un tratamiento agresivo para yugular la crisis y evitar la aparición del estado de mal convulsivo. La comercialización del valproato sódico inyectable abre nuevas expectativas y amplía las posibilidades terapéuticas. Objetivos: Analizar los resultados del empleo del valproato sódico inyectable entre abril de 1997 y octubre de 2001 en nuestro hospital. Métodos: Revisión retrospectiva hasta febrero de 1999 y prospectiva a partir de esta fecha a través de un protocolo de estudio. Se administró por vía endovenosa a dosis de 20 mg/Kg de entrada y si la respuesta era satisfactoria se continuó a 1-2 mg/kg/h en infusión continua. Se analizaron la siguientes variables: edad y sexo, causa de la convulsión o del estado de mal convulsivo, antecedentes personales, motivo de su utilización y respuesta terapéutica, niveles del fármaco, efectos adversos objetivados, conducta adoptada tras su administración y evolución clínica. Resultados: Se ha utilizado el valproato sódico en 60 pacientes con edades comprendidas entre 1 día y 17 años (media de 3 años). El 52,6 por ciento eran del sexo masculino y el 47,4 por ciento menores de dos años. Las causas que motivaron con mayor frecuencia el uso del valproato sódico fueron el comienzo o descompensación de epilepsia (46,7 por ciento), infección del sistema nervioso central (15 por ciento) y encefalopatía hipóxico-isquémica (10 por ciento). El valproato sódico permitió controlar el estado de mal convulsivo en el 56,3 por ciento de casos y las convulsiones en el 54,8 por ciento de casos (con reducción del número de crisis en un 30,9 por ciento) con buena tolerabilidad y escasos efectos secundarios. Conclusiones: La respuesta clínica y tolerabilidad del valproato sódico inyectable en la población pediátrica estudiada es satisfactoria. En base a los datos de la literatura y a nuestra experiencia consideramos que este fármaco debería incluirse en el protocolo de tratamiento de las convulsiones y estado de mal convulsivo en los casos en que fracase el diazepam endovenoso (AU)
Subject(s)
Adolescent , Female , Child, Preschool , Infant , Male , Child , Humans , Infant, Newborn , Seizures/drug therapy , Valproic Acid/administration & dosage , Status Epilepticus/drug therapy , Clinical Protocols , Seizures/etiology , Injections , Valproic Acid/adverse effects , Valproic Acid , Metabolism, Inborn Errors/complicationsABSTRACT
INTRODUCTION: Acute disseminated encephalomyelitis (ADEM) is a postinfectious encephalitis that is usually preceded by an infectious disease or vaccination. The clinical presentation has a wide spectrum and complementary exams are none specific, except magnetic resonance imaging (MRI) findings showing multifocal white-matter lesions similar to those seen en multiple sclerosis. PATIENTS AND METHODS: We report 10 children with the diagnosis of ADEM. We describe the clinical course and response to treatment. RESULTS: The prodroms were fever in all cases except one. The most common neurological symptoms were consciousness impairment, headache and seizures. The cerebrospinal fluid examination was abnormal in 9 patients with positive serologic test to enterovirus in one of them. MRI showed hyperintense multifocal subcortical white-matter lesions on T2-mediated images. Treatment with steroids was given to 5 patients, steroids and immunoglobulins to one patient and symptomatic treatment to the rest. From the last group one patient relapsed and then received corticosteroid treatment. The follow up revealed a complete recovery in 6/7 patients that received steroids. Three patients have sequelae and of these, 2 received only symptomatic treatment. CONCLUSIONS: The diagnosis of ADEM is based on clinical and radiologic features, once other entities have been excluded. At the moment of suspicious of ADEM a brain-spinal chord MRI should be done, seeing that TAC brings not much information at the beginning. The treatment with steroids seems to be the most effective and the prognosis good, specially in cases that respond rapidly to it.
Subject(s)
Encephalomyelitis, Acute Disseminated/diagnosis , Child , Child, Preschool , Encephalomyelitis, Acute Disseminated/therapy , Female , Humans , Infant , Male , Retrospective StudiesABSTRACT
INTRODUCTION: Seizures during the neonatal period are the characteristic clinical expression of dysfunction of the nervous system. Not all the seizures seen during the neonatal period are due to epilepsy which only occurs in 10%. DEVELOPMENT: The aetiology of neonatal seizures is very varied and is mainly due to different types of aggression to the brain during this early stage of life. Epileptic syndromes are very rare during the neonatal period. In general the prognosis is very bad as occurs in infantile epileptic encephalopathy of early onset or myoclonic encephalopathy of early onset. However, the International League Against Epilepsy (ILAE) has identified and recognized some idiopathic epileptic syndromes of the neonatal period with a somewhat better prognosis. Two major groups have been established including the benign neonatal epilepsies (benign idiopathic neonatal epilepsies and benign familial neonatal seizures) and the group of status epilepticus (severe idiopathic status epilepticus). CONCLUSION: We analyze the different types of epilepsy of the newborn, form of onset, current knowledge of molecular biology, treatment and prognosis.
Subject(s)
Epilepsy, Benign Neonatal/etiology , Humans , Infant, NewbornABSTRACT
INTRODUCTION: Perinatal mortality has dropped markedly in recent years. However, there is still a considerable prevalence of neurological sequelas. Symptoms may present during the first months of life or later. Thus it is necessary to follow-up children with a clinical history of risk of neurological disorders. DEVELOPMENT: The various programmes for follow-up show slight variations in criteria of inclusion, calendar and methods of evaluation. We report the results of our follow-up of children at risk: long and short term sequelae in children of very low birth-weight and their correlation with neuroimaging findings. We review the use of some investigations (clinical examination, cranial ultrasound, CAT, magnetic resonance, EEG, visual and auditory evoked potentials and different biological, hemodynamic and nerve damage markers. CONCLUSIONS: It is necessary to: 1. Restrict the criteria for inclusion in hospital follow-up programmes; 2. Match a suitable investigative calendar to the pathology of the newborn baby; 3. Coordinate with the pediatricians of primary care areas and centres of early health care; 4. Use specific instruments for detection of mild sequelae at an earlier age; 5. Prolong follow-up at least until the age of 6-7 years old, and 6. To seek new biological markers to allow early detection of brain damage.
Subject(s)
Clinical Protocols , Developmental Disabilities/diagnosis , Infant, Low Birth Weight , Patient Selection , Biomarkers , Cerebrovascular Circulation , Child , Child, Preschool , Developmental Disabilities/etiology , Electroencephalography , Evoked Potentials , Follow-Up Studies , Humans , Infant, Newborn , Magnetic Resonance Imaging , Neurologic Examination , Program Evaluation , Risk Factors , Tomography, X-Ray Computed , Ultrasonography, Doppler, TranscranialABSTRACT
Introducción. La mortalidad perinatal ha disminuido de forma notable en los últimos años, si bien la prevalencia de secuelas neurológicas continúa siendo elevada. Los síntomas pueden presentarse en los primeros meses o en edades más tardías, de ahí la necesidad de un seguimiento de los niños con antecedentes de riesgo de patología neurológica. Desarrollo. Los distintos programas de seguimiento presentan ligeras variaciones en los criterios de inclusión, calendario y métodos de valoración. Presentamos algunos resultados de nuestra experiencia en el seguimiento de niños de riesgo: secuelas a corto y largo plazo en recién nacidos de muy bajo peso y correlación con los hallazgos en la neuroimagen. Se revisa la utilidad de algunas exploraciones (examen clínico, ecografía transfontanelar, TAC, resonancia magnética, EEG, potenciales evocados visuales y auditivos, y de distintos marcadores biológicos, hemodinámicos, del daño neuronal). Conclusiones. Es necesario: 1. Restringir los criterios de inclusión en el seguimiento hospitalario; 2. Adecuar las exploraciones y el calendario en función de la patología que haya presentado el neonato; 3. Coordinarse con los pediatras de áreas básicas y centros de atención precoz; 4. Utilizar instrumentos más específicos para detectar las secuelas leves a una edad más temprana; 5. Prolongar el seguimiento como mínimo hasta los 6-7 años de edad, y 6. Buscar nuevos marcadores que permitan identificar precozmente el daño cerebral (AU)
Subject(s)
Child , Child, Preschool , Infant, Newborn , Humans , Patient Selection , Clinical Protocols , Infant, Low Birth Weight , Risk Factors , Tomography, X-Ray Computed , Biomarkers , Ultrasonography, Doppler, Transcranial , Neurologic Examination , Developmental Disabilities , Cerebrovascular Circulation , Magnetic Resonance Imaging , Electroencephalography , Evoked Potentials , Follow-Up Studies , Program EvaluationABSTRACT
AIM: The etiology of cerebrovascular disease in the paediatric population, remains unknown in up to 40% of the cases ("idiopathic"), but recent advances could improve this percentage. We devised a comprehensive study protocol for such investigation aimed at the identification of potentially modifiable risk factors for paediatric stroke. PATIENTS AND METHODS: From the 141 patients initially registered in our data base for stroke population (from January 1984 until December 1995), we invited all the patients with idiopathic cerebrovascular disease to complete the study protocol. New cases appeared from January 1996 until July 1999 were also included. RESULTS: A total of 68 cases were identified. We found an etiology in 38% and in 76% of the cases we found at least one risk factor for stroke. Mild hyperhomocysteinemia was the most frequent risk factor identified (36% of patients versus 5% of controls), one of them an infant with fatal haemorrhagic infarct with classic homocystinuria. 31% of the patients had thrombotic risk factors (protein S, protein C, antithrombine III deficiency, factor V Leiden, etc). 17.6% had unspecific febrile illness at the time of the cerebral infarction and 11.6% had minor head injuries before the stroke. CONCLUSIONS: The use of the protocol improves the identification of potentially modifiable risk factors for stroke in childhood and may serve as a practical guideline for clinicians. The stroke protocol is as important as management strategies for acute stroke or for recurrence prevention, currently under consideration in the adult population.
Subject(s)
Cerebrovascular Disorders/complications , Cerebrovascular Disorders/diagnosis , Adolescent , Cerebrovascular Disorders/epidemiology , Child , Child, Preschool , Clinical Protocols , Female , Humans , Infant , Infant, Newborn , Male , Risk FactorsABSTRACT
OBJETIVO: La etiología de la enfermedad cerebrovascular en la población pediátrica permanece sin aclarar hasta en un 40 por ciento de los casos. Recientes avances en el conocimiento de la etiopatogenia pueden mejorar este porcentaje. Pretendemos diseñar un protocolo de estudio estructurado con el objetivo de identificar los factores de riesgo de enfermedad cerebrovascular potencialmente modificables. PACIENTES Y MÉTODOS: En nuestra base de datos constaban 141 pacientes con enfermedad cerebrovascular (desde enero de 1984 hasta diciembre de 1995); se invitó a los pacientes con enfermedad cerebrovascular idiopática a completar el protocolo de investigación. También se incluyeron los nuevos casos que aparecieron desde enero de 1996 hasta julio de 1999. RESULTADOS: Se estudiaron en total 68 casos. Se realizó un diagnóstico en el 38 por ciento de los pacientes, y en el 76 por ciento de los casos se identificó algún factor de riesgo. El factor de riesgo vascular no estructural más frecuente fue la hiperhomocisteinemia (36 frente al 5 por ciento de los controles), entre ellos un lactante con infarto hemorrágico fatal que se diagnosticó de homocistinuria clásica. Un 31 por ciento de los pacientes tenían factores pretrombóticos (déficit de proteína S, C, antitrombina III, factor V de Leiden, etc.). El 17,6 por ciento padecía un proceso febril inespecífico en el momento del infarto y el 11,7 por ciento refería historia de traumatismo craneal menor previo al infarto. CONCLUSIÓN: La aplicación de un protocolo para el estudio de la enfermedad cerebrovascular mejoró el porcentaje de casos diagnosticados, así como la identificación de factores de riesgo de enfermedad cerebrovascular potencialmente modificables. El protocolo de investigación es tan importante como las estrategias de actuación en la fase aguda o la prevención de recurrencia, actualmente en estudio para la población adulta (AU)
