Insuficiencia renal aguda en niños con síndrome nefrótico / Acute renal failure in children with nephrotic syndrome

Introducción: La insuficiencia renal aguda (IRA) es una complicación poco frecuente en pacientes con recaída de un síndrome nefrótico (SN), y su presentación puede agravar seriamente el manejo y pronóstico de ellos. Su etiopatogenia, en la mayoría de los casos, no está aclarada, pudiendo ser un destino común de varias noxas renales en el contexto de un paciente nefrótico. Objetivo: Evaluar, en forma retrospectiva, nuestra experiencia con niños nefróticos que han presentado IRA. Resultados: Se describen cuatro pacientes en edad escolar con esta complicación del SN. Tres de ellos requirieron reemplazo renal agudo y 2 desarrollaron crisis hipertensiva. En 2 casos biopsiados se encontró evidencia de necrosis tubular aguda, además de su patología de base. Tres pacientes recuperaron función renal en rango normal. Conclusión: El SN complicado por IRA suele agregar bastante complejidad en el manejo de estos niños, especialmente por presentar usualmente requerimientos dialíticos y de manejo de hipertensión arterial severa. La información disponible, así como las evidencias histopatológicas, orientan su causalidad hacia una complicación isquémica por una recaída de SN.

[Progressive respiratory insufficiency secondary to pulmonary fibrosis in childhood. Report of one case]. / Insuficiencia respiratoria progresiva secundaria a fibrosis pulmonar en una escolar: Caso clínico.

Interstitial lung diseases are uncommon in children, and can be idiopathic or secondary to known causes, sharing common pathological findings. We report a girl with progressive respiratory insufficiency secondary to interstitial pneumonia and pulmonary fibrosis, with risk factors such as bronchopulmonary dysplasia and respiratory infections (respiratory syncytial virus and suspected Mycoplasma pneumoniae), that may have had an additive effect. Nasal bi-level Positive Airway Pressure was used in the last period of her disease. She died due to global respiratory failure at the age of 14 years.

Insuficiencia respiratoria progresiva secundaria a fibrosis pulmonar en una escolar: Caso clínico / Pulmonary fibrosis in childhood: Report of one case

Interstitial lung diseases are uncommon in children, and can be idiopathic or secondary to known causes, sharing common pathological findings. We report a girl with progressive respiratory insufficiency secondary to interstitial pneumonia and pulmonary fibrosis, with risk factors such as bronchopulmonary dysplasia and respiratory infections (respiratory syncytial virus and suspected Mycoplasma pneumoniae), that may have had an additive effect. Nasal bi-level Positive Airway Pressure was used in the last period of her disease. She died due to global respiratory failure at the age of 14 years.

[Perspective of heart transplantation in advanced congenital cardiopathy: report of a case]. / La perspectiva del trasplante cardiaco en la cardiopatía congénita avanzada: a propósito de un caso.

Heart transplantation is an infrequent treatment modality in advanced congenital cardiopathy. We present the case of a 17-years old youngster coursing with a dilated Fallot's tetralogy, in terminal stage, who was subjected to an orthotopic heart transplantation. We present the most relevant data on his management during the 53 months after the surgery and discuss the long-term perspectives, which are comparable to those expected in transplanted patients due to other cardiac disorders.

[Biatrial re-synchronization in the treatment of paroxysmal atrial fibrillation. 3- and 4-chamber pacemaker]. / Resincronización biatrial en el tratamiento de la fibrilación atrial paroxística. Marcapaso tres y cuatro cámaras.

The reason for multisite pacing is to correct atrial and ventricular electrical and mechanical asynchrony found in paroxysmal atrial fibrillation (PAF) and dilated cardiomyopathy. We report the first two cases in Mexico treated with biatrial pacing for PAF. The first was treated with a three chamber pacemaker and the other with a four chamber pacemaker. The first patient was a young man with uncontrolled ventricular rate in whom the atrioventricular conduction was modified with radiofrequency energy to control ventricular rate during atrial fibrillation. The second patient was a woman with corrected transposition of the great arteries, left ventricular ejection fraction (LVEF) of 30% and complete heart block. The pacing modalities were DDD for the first patient and DDDR for the second, both with sleep rate and auto mode switching. The atria were paced in right appendage and the left through the coronary sinus. PAF episodes were, found only in the first patient but were decreased in number and duration. The LVEF and functional class improved in the patient with biatrial and ventricular resynchronization. We conclude that biatrial pacing is effective in PAF.

Women in transition--menopause and body composition in different populations.

Human biology has provided valuable and applicable points of view to contribute towards human welfare, when it has analyzed changes in the transitional phases of the ontogenetic process. The purpose of this presentation coincides with WHO recommendations to study the modifications suffered by the female body during her stage of reproductive aging in different environments. We study and compared three different groups of women living in the cities of Madrid (Spain), Havana (Cuba) and in Tuxpan, a village in the State of Michoacán (Mexico). Three groups differed with respect to their socio-economic levels, food habits, social organization and culture. We used the same anthropometric techniques, recommended by the IBP, and same tools to assess the women's reproductive life, demography and socio-economic condition. All three groups coincidences regarding the remodelation of their thorax, so after 55 years of age their waist-hip ratio surpassed the cut point of 0.80, associated whit higher risk for chronic cardiovascular disorders. However, examined groups differed, for instance, the rural Mexican women altered their bone density earlier, five years before the urban samples. Next, Mexican women of younger ages maintained high levels of their body mass index above the cut point for overweight.

[Trichamber pacing in dilated myocardiopathy. TTDR pacing?]. / Estimulación tricameral en la miocardiopatía dilatada. Modo de estimulación TTDR?

This article describes the first case in Mexico city that received a three chamber pacing system. A 40 year-old man with dilated cardiomyopathy with variant cardiac rhythm and bradycardia. The three leads were introduced by right subclavian approaches. The right chamber leads were placed in atrial's appendage and in the right ventricular outflow tract and the last one was placed in the great cardiac vein. The two ventricular lead were connected a Y-connector to the ventricular channel of a standard bipolar DDDR pacemaker. The right ventricular lead was connected to the distal pole (anode) and the left ventricular lead to the proximal pole (cathode). Eight days later, the patient's clinical status improved, his functional class improved from IV to II and his left ventricular ejection fraction increased from 30% to 35% by conventional ventriculography. In this type of patients the improvement in cardiac output is this result an of increase in left ventricular filling, reduced mitral and tricuspid regurgitation a better synchronization of ventricular contraction. Multisite pacing has added a mayor complexity to contemporary pacing and a modification of the standard pacer-maker code should be considered to accommodate multisite pacing. The letter in the first and second position might be T (three) or F (four) according to number of pacing chamber and also the letter "t" may be suitable to designate trigger in the third position. We conclude that implant of three chamber pacing in patients with dilated cardiomyopathy is technically feasible. An improvement in the patient's condition may be obtained and a modification in standard pacemaker code is necessary.

[Anomalous connection of inferior vena cava to left atrium: infrequent entity that can be a diagnosis and surgical challenge]. / Conexión anómala de la vena cava inferior a la aurícula izquierda: entidad poco frecuente que puede plantear un reto diagnóstico y quirúrgico.

This is the diagnostic experiences as well as the surgical mode of treatment used in a 31 years old women suffering diversion of the inferior vena cava into the left atrium associated with atrial septal defect. The patient had been previously studied and operated thrice under conventional circumstances at different institutions in order to solve the septal defect. The hemodynamic solution had not been reached due to a missing pathological definition. The cineangiogram through the saphenous vein specified the left atrium form the inferior vena cava. Some considerations are made on the surgical methods used for the fourth operation, and in regard of the fact that the patient refused blood transfusion because of religious convictions (Jehova Witness).

Síndrome de bandas de constricción congénitas / Congenital constriction band syndrome

Se presentan 7 pacientes pediátricos con bandas de constricción congénitas,tratadas en un solo tiempo quirúrgico mediante la escisión del surco de constricción anular,junto con plastias en Z múltiples.En todos los casos se obtuvieron excelentes resultados estéticos y funcionales,sin complicaciones ni lesiones vásculo-nerviosas

Síndrome de bandas de constricción congénitas / Congenital constriction band syndrome

Se presentan 7 pacientes pediátricos con bandas de constricción congénitas,tratadas en un solo tiempo quirúrgico mediante la escisión del surco de constricción anular,junto con plastias en Z múltiples.En todos los casos se obtuvieron excelentes resultados estéticos y funcionales,sin complicaciones ni lesiones vásculo-nerviosas

Caries conditions among 2-5-year-old immigrant Latino children related to parents' oral health knowledge, opinions and practices.

OBJECTIVES: To collect baseline data prior to initiating a community-based, oral health promotion program in an inner city Latino community in Washington DC, populated by Central American immigrants. METHODS: In 1995, an oral survey of a convenience sample of children 2-5 years of age (n = 142) and a survey of the knowledge, opinions and practices (KOP) of their parents (n = 121) were completed. Clinical data of children were matched with parent respondents of the KOP survey. Data were analyzed for statistical associations using univariate odds ratios, Fisher's exact tests, and multiple logistic regression. RESULTS: Only 53% of the children were caries free. Eighteen percent of all children were in need of immediate dental care and 26% were in need of early or non-urgent dental care. Only 7% of the parents knew the purpose of sealants and 52% knew the purpose of fluorides. Further, only 9% thought that brushing with toothpaste can prevent tooth decay The strongest predictors of dental caries in this population, after adjusting for child's age and mother's education, were recency of mother's residence in the United States and report of an uncooperative child when attempting toothbrushing. CONCLUSIONS: Regimens of caries prevention have been successful in reducing dental decay for a large segment of the US population, yet this disease remains prevalent especially among low socioeconomic groups. The oral health status of the children and the oral health KOP of the parents in this community are disturbingly deficient.

Alteraciones en la tensión arterial, niveles de colesterol y peso durante una convención de trabajo / Laterations of arterial tension, cholesterol levels and body weight during a working convention

Con el objetivo de conocer los factores de riesgo de enfermedad cardiovascular en una determinada muestra de población, intentando salvar factores distorsionantes como la edad, la desiguladad en las condiciones del hogar y la presión laboral entre otros, se realiza el presente estudio en el curso de la convención anual de ejecutivos de la empresa farmaceútica Merck, Sharp & Dohme de España, celebrada en 1991. De un universo de 200 asistentes, se seleccionaron 70 varones y 68 mujeres con edades entre 24 y 45 años, a quienes se les realizó una encuesta personal según el formulario (The coronary risk profile program). Las variables somáticas estudiadas fueron los pliegues cutáneos (tricipital, bicipital, escapular y suprailíaco) y el peso. Las variables fisiológicas medidas fueron la capacidad vital, la fuerza dinanométrica, la tensión arterial y el colesterol sérico total. Se utilizó el programa BMDP para el análisis factorial en componentes principales. No se encontró una clara asociación entre la hipercolesterolemia y la hipertensión arterial, aunque dicha asociación es mucho más patente en las mujeres. El sexo sigue siendo uno de los condicionantes básicos sobre el cual se puede realizar una estimación de la morbilidad. Los hombres presentan un acúmulo troncal de la grasa corporal. Las mujeres al parecer son menos receptivas a los factores...

Alteraciones en la tensión arterial, niveles de colesterol y peso durante una convención de trabajo / Laterations of arterial tension, cholesterol levels and body weight during a working convention

Con el objetivo de conocer los factores de riesgo de enfermedad cardiovascular en una determinada muestra de población, intentando salvar factores distorsionantes como la edad, la desiguladad en las condiciones del hogar y la presión laboral entre otros, se realiza el presente estudio en el curso de la convención anual de ejecutivos de la empresa farmaceútica Merck, Sharp & Dohme de España, celebrada en 1991. De un universo de 200 asistentes, se seleccionaron 70 varones y 68 mujeres con edades entre 24 y 45 años, a quienes se les realizó una encuesta personal según el formulario (The coronary risk profile program). Las variables somáticas estudiadas fueron los pliegues cutáneos (tricipital, bicipital, escapular y suprailíaco) y el peso. Las variables fisiológicas medidas fueron la capacidad vital, la fuerza dinanométrica, la tensión arterial y el colesterol sérico total. Se utilizó el programa BMDP para el análisis factorial en componentes principales. No se encontró una clara asociación entre la hipercolesterolemia y la hipertensión arterial, aunque dicha asociación es mucho más patente en las mujeres. El sexo sigue siendo uno de los condicionantes básicos sobre el cual se puede realizar una estimación de la morbilidad. Los hombres presentan un acúmulo troncal de la grasa corporal. Las mujeres al parecer son menos receptivas a los factores

Protection against lethal Venezuelan equine encephalitis (VEE) virus infection by cell-free supernatant obtained from immune spleen cells.

Considerable effort has been directed at unraveling the mechanisms underlying protection and recovery in acute viral infections. Various factors, including antibody, interferon, lymphokines and certain lymphocyte and macrophage cell constituents, have been shown to play a role in host recovery. We have previously studied an adoptive transfer system in experimental VEE virus CNS infection in a mouse model, and shown that both T cells and B cells exert an influence in protecting the host from lethal CNS infection with this virus. Because of the complexity involved in the adoptive transfer of protection, we sought a simpler and more easily defined experimental approach to dissect the various factors responsible for protection in our model. We here report that immune cell-free supernatant, derived from mice immunized with vaccine against VEE virus, exerts as much protection as the whole cell transfer system against lethal VEE virus infection. Such cell-free supernatant allowed us to look more closely at individual host immune factors in their relationship to protection against infection. Studies herein reported demonstrate that the protection conferred by immune cell-free supernatants is not dependent on neutralizing antibody or interferon, but rather appears to be related to the presence of both interleukin-1 and -2 and the activation and potentiation of NK cell activity against VEE virus.

Central nervous system demyelination in Venezuelan equine encephalomyelitis infection.

Arboviruses are important pathogens for both animals and humans. Venezuelan equine encephalomyelitis virus (VEEV) is an arbovirus whose pathogenicity for grey matter structures has been previously studied. To our knowledge, the present study is the first to describe extensive inflammation and demyelination in spinal cord white matter of mice infected with VEEV. To probe a possible immunepathogenesis of white matter alterations in this infection, nude mice and heterozygous controls were similarly infected. Whereas controls still showed inflammatory demyelination, nude mice showed no white matter changes in the absence of a mononuclear inflammatory response. These results suggest that white matter changes in VEEV infection are dependent upon the host immune-response, rather than produced by primary viral cytolytic activity. Such findings are similar to those we and others obtained in a number of different viral infections and support the possibility that the host immune response may be the common denominator leading to myelin injury in a variety of viral diseases. The hypothesis of "by-stander killing" of myelin is discussed as a possible host-mediated mechanism of demyelination in viral infections.

Cambios en la reserva coronaria con el uso de dipiridamol oral y su correlacion angiografica. / Changes in coronary reserve with the use of oral dipyridamole and its angiographic correlation

Por metodo doble ciego se estudiaron 40 pacientes con insuficiencia coronaria, administrando a la mitad de ellos 75 mg de dipiridamol tres veces al dia y a la otra mitad placebo durante tres meses consecutivos. Los pacientes que recibieron dipiridamol mostraron un aumento en la tolerancia a la prueba de esfuerzo en la banda sinfin, asi como una recuperacion electrocardiografica mas rapida al suspender esta prueba. Durante un segundo periodo de tres meses se administro en estudio abierto, a treinta de estos cuarenta pacientes, 75 mg de dipiridamol tres veces al dia.Los pacientes que inicialmente habian recibido placebo, mostraron un notable incremento en la tolerancia a la prueba de esfuerzo y en el tiempo de recuperacion electrocardiografica. Los pacientes que recibieron dipiridamol, durante los dos periodos de estudio, tambien mejoraron en los parametros estudiados, pero en menor intensidad en este segundo periodo de tratamiento. El estudio angiografico coronario practicado en catorce pacientes revela que el dipiridamol ejerce un efecto terapeutico mas intenso en aquellos en que la funcion contractil ventricular esta mas comprometida

A new model of persistent viral infection with primary demyelination.

Theiler's encephalomyelitis virus (TMEV) in mice represents one of the few existing animal models of virus-induced demyelination and may provide further information about the human disease, Multiple Sclerosis. An inbred strain of mice (SJL/j) employed in the present ultrastructural study, develops a life-long neurologic illness characterized by profound spasticity after intracerebral inoculation of TMEV. Anesthetized animals were sacrificed sequentially by total body perfusion with gluteraldehyde from 7 days to 9 months after infection. An intense mononuclear inflammatory infiltrate appeared in the leptomeninges and white matter of spinal cord by 15 days and persisted for as long as one year. These infiltrates contained numerous plasma cells, and perivascular demyelination could be found in almost every 1 micron section. Vesiculation and stripping of myelin by mononuclear cell processes were seen as mechanisms of myelin break-down. However, virions were not found in cells in grey or white matter and the integrity of oligodendrocytes was maintained. At one year, active demyelination was still seen in areas containing naked and remyelinated axons. The relevance of these ultrastructural findings to postulated mechanisms of virus-induced demyelination will be discussed.