Trastornos respiratorios del sueño en Pediatría. Estado de la cuestión / Sleep respiratory disorders in Pediatrics. State of the question

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Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria / Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy

Objetivo: Evaluar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el síndrome de apnea-hipopnea durante el sueño (SAHS) en la infancia mediante poligrafía respiratoria (PR). Material y métodos: Estudio prospectivo en niños menores de 14 años remitidos con la sospecha clínica de SAHS. A todos ellos se les realizó una historia clínica, examen físico general y otorrinolaringológico, así como PR previa a la adenoamigdalectomía y 6 meses después. Se excluyeron los síndromes cráneo-faciales, las alteraciones neuromusculares y la enfermedad concomitante grave. Resultados: Se estudiaron 150 casos (67,3% varones), con una edad media de 3,74±1,80 años y un percentil de IMC de 41,70±31,75, diagnosticados de SAHS, cuando el número total de eventos respiratorios, apneas más hipopneas, dividido por el tiempo total del estudio (IER) era mayor de 4,6, mediante PR previa a la cirugía. El IER medio fue de 15,18±11,11; del total, 58,7% (88) presentaba un SAHS grave (IER>10). Después de 6 meses tras la cirugía, mejoraron todos los parámetros clínicos y poligráficos. Persistió enfermedad (IER>4,6) en 21 pacientes (14%). Ninguno de ellos presentó IER>10 tras la cirugía. El IER preoperatorio se relacionó significativamente con la persistencia de enfermedad (p=0,042). Conclusiones: La PR es útil para monitorizar la eficacia del tratamiento quirúrgico mediante adenoamigdalectomía en el SAHS infantil (AU)

Objetive: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). Material and methods: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. Results: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=0.042). Conclusions: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS (AU)

[Evaluation of the efficacy of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome in children using respiratory polygraphy]. / Eficacia de la adenoamigdalectomía en el síndrome de apneas-hipopneas durante el sueño valorada mediante poligrafía respiratoria.

OBJECTIVE: To evaluate the effectiveness of adenotonsillectomy for the treatment of obstructive sleep apnea hypopnea syndrome (OSAHS) in children by respiratory polygraphy (RP). MATERIAL AND METHODS: Prospective study was conducted on children referred with clinical suspicion of OSAHS. A clinical history was taken and a general physical and ENT examination was performed on all patients. RP was performed before adenotonsillectomy and six months afterwards. Patients with craniofacial syndromes, neuromuscular disorders, and severe concomitant disease were excluded. RESULTS: We studied 150 children (67. 8% male), with a mean age of 3.74±1.80 years and a BMI of 41.70±31.75. A diagnosis of OSAHS was made if the total number of respiratory events, apneas and hypopneas, divided by the total study time (RDI) was > 4.6, using RP before undergoing adenotonsillectomy. The mean respiratory disturbance index (RDI) was 15.18±11.11, with 58.7% (88) of with severe OSAHS (RDI>10). There was a significant improvement in all clinical and polygraphic variables six months after adenotonsillectomy. The residual OSAHS was 14%. The preoperative RDI was significantly associated with persistent disease (P=.042). CONCLUSIONS: Respiratory polygraphy is useful for monitoring the efficacy of surgical treatment by adenotonsillectomy in children with OSAHS.

Síndrome de compresión del plexo lumbosacro durante el embarazo / Lumbosacral plexus compression syndrome during pregnancy

Las lesiones del plexo lumbosacro durante el embarazo y el parto son muy poco frecuentes y se han relacionado fundamentalmente con primigestas jóvenes con fetos de gran tamaño. Se suelen presentar en el puerperio inmediato, después de partos prolongados, o bien en partos instrumentales. La forma de aparición más común es como parestesias en miembros inferiores, pérdida de fuerza e incluso como síndrome de pie caído. Presentamos el caso de una paciente con una gestación a término, que acude al servicio de urgencias por síntomas sugestivos de compresión medular a nivel del plexo lumbosacro. Debido al riesgo de isquemia nerviosa se decide la finalización del parto mediante cesárea, que cursó sin incidencias. Tras la cesárea, la paciente empieza a recuperar la función sensitiva y motora con una resolución completa al alta (AU)

Lumbosacral plexus injuries during pregnancy and labor are highly uncommon and have been related to young primiparous women and overweight fetuses. These injuries usually appear during the early puerperium, after a long labor, or after instrumental deliveries. The clinical features are paresthesia in the lower extremities, weakness and drop foot syndrome. We report the case of a woman with term pregnancy who presented to the emergency room with symptoms of lumbosacral plexus compression. Due to the risk of nerve ischemia, a cesarean section was carried out with no adverse events. Immediately after delivery, the patient began to recover sensitivity and mobility, with complete resolution at discharge (AU)

Endometriosis abdominal. A propósito de 2 casos / Abdominal endometriosis. Report of two cases

La endometriosis abdominal es una entidad poco frecuente que suele plantear problemas diagnósticos. La presencia de una masa abdominal cíclicamente dolorosa en una mujer premenopáusica con antecedentes de cirugía abdominal previa por causa obstétrica o ginecológica es altamente sospechosa. El diagnóstico diferencial generalmente se realiza mediante las complicaciones posquirúrgicas más habituales, como hernias, granulomas de suturas, abscesos o incluso hematomas en los músculos rectos. El diagnóstico por imagen suele ser poco específico, por lo que se llega al diagnóstico final a través del análisis anatomopatológico de la pieza tras su escisión quirúrgica. A continuación se presentan 2 casos de endometriosis abdominal: uno es el caso de una mujer con antecedente de cesárea 3 años antes y el otro es el caso con de una mujer antecedente de extirpación de teratoma ovárico maduro 4 años antes (AU)

Abdominal endometriosis is a rare entity, which usually hampers diagnosis. The presence of a cyclically painful abdominal mass in women with a previous history of abdominal surgery for obstetric or gynecological causes is highly suggestive. The differential diagnosis should be made with the most common postsurgical complications such as abdominal hernia, suture granuloma, abscesses, and rectus muscle hematomas. Imaging diagnosis has low specificity, and the final diagnosis is reached by histopathological study of the surgical specimen. We report two cases of abdominal endometriosis; the first patient had a history of cesarean section 3 years previously and the second had a history of mature ovarian teratoma extirpated 4 years previously (AU)

Factores moleculares pronósticos relacionados con el control del ciclo celular en el cáncer de mama. Situación actual / Molecular prognostic factors related to cell cycle in breast cancer. Current situation

El cáncer de mama es una de las enfermedades malignas más frecuentes en las mujeres. Su incidencia se ha ido incrementando cada año hasta considerarse un problema sanitario de características epidémicas. Alrededor de un 15% de las mujeres desarrolla cáncer de mama a lo largo de su vida. En los últimos años se ha realizado una gran cantidad de trabajos sobre los factores de riesgo y pronósticos de esta enfermedad. En esta revisión de la bibliografía científica, se presenta el estado actual de los factores pronósticos relacionados con la regulación del ciclo celular en el cáncer de mama (AU)

Breast cancer is one of the most common malignancies among women. The incidence of this disease has been increasing yearly and it could now be considered an epidemic disease. Approximately 15% of women will develop this kind cancer during their lifetime. In the last few years, multiple studies have been carried out on the risk and prognostic factors of breast cancer. We provide a review of the scientific literature on the current situation of molecular prognostic factors for breast cancer related to cell cycle control (AU)

[The growth plate in chronic renal insufficiency]. / La placa de crecimiento en la insuficiencia renal crónica.

Several alterations have been reported in the growth plate of young rats rendered uremic by subtotal nephrectomy, a widely used experimental model of growth failure secondary to renal insufficiency. In our lab's experience, uremia is associated with a markedly increased growth plate height which results from an elongation of the hypertrophic zone. These findings are not consistently observed in all studies, likely because of the different experimental conditions. Regardless of growth plate size, growth retardation induced by chronic renal failure is accompanied by an alteration of the dynamics of the growth plate with a decreased bone apposition rate at the metaphyseal end of growth cartilage and slower production and progression of chondrocytes from the resting zone up to the most distal hypertrophic zone adjacent to bone. These abnormal dynamics are associated with an irregular bone-cartilage interface and a disturbed process of chondrocyte maturation which becomes evident by a morphological criteria and by depressed expression of markers of chondrocyte maturation such as collagen X. The microscopic findings also suggest a disturbed process of capillary invasion, which precedes formation of new osseous tissue in the primary spongiosa, although the levels of vascular endothelial growth factor, as measured by immunohistochemistry, have been reported to be similar in the growth plate of uremic and control rats. The meaning of these findings in the pathogenesis of growth impairment secondary to chronic renal failure remains to be determined.

[Effect of growth hormone and calcitriol on the growth plate in uremic rats]. / Efecto de la hormona de crecimiento y del calcitriol sobre la placa de crecimiento de ratas urémicas.

This study analyzed the modifications induced by growth hormone (GH) and/or calcitriol treatments in the growth plate of growth retarded uremic rats. Four groups of 5/6 nephrectomized rats were studied: untreated (U), treated with GH (U + GH), treated with calcitriol (U + D), treated with GH and calcitriol (U + GH + D). Treatments were given intraperitoneally during the second week of renal failure. Uremic groups were compared with sham-operated rats fed ad libitum (C) or pair-fed with U (CP). In comparison with C and CP, histomorphometric analysis of tibial proximal ends of U group showed decreased bone formation, as estimated by osseous front advance (OFA), elongation of growth cartilage and its hypertrophic zone, and decreased size of most distal chondrocytes. The U + D group tended to normalize growth cartilage height, and that of its hypertrophic zone, as well as the size of chondrocytes. In U + GH group OFA improved and chondrocyte size became normal, but growth cartilage remained elongated. Similar results were found in the U + GH + D group. These findings indicate that, in chronic renal insufficiency, the beneficial effect of GH on growth is not associated with normalization of growth cartilage morphology and that calcitriol facilitates chondrocyte maturation. When given together the effect of GH prevails.

La placa de crecimiento en la insuficiencia renal crónica / The growth plate in chronic renal failure

Se han descrito diversas alteraciones en la placa de crecimiento de la tibia de ratas jóvenes urémicas por nefrectomía subtotal, un modelo experimental de hipocrecimiento secundario a fallo renal crónico ampliamente utilizado. En nuestra experiencia, la uremia severa se acompaña de un marcado aumento en la altura del cartílago de crecimiento consecutivo a un acusado incremento de la zona de condrocitos hipertróficos. Esta elongación del cartílago no se observa consistentemente en todos los estudios lo que puede depender de diferentes condiciones experimentales. Con independencia del tamaño del cartílago epifisario, el hipocrecimiento de la insuficiencia renal crónica se asocia a una alteración en la dinámica de la placa con disminución tanto del ritmo de aposición de hueso primario en el extremo metafisario del cartílago de crecimiento como de la producción y progresión de los condrocitos desde la zona germinal hasta la hipertrófica adyacente al hueso. Esta dinámica anormal se acompaña de una irregular interfase hueso-cartílago y de alteración del proceso de maduración de los condrocitos evidente tanto por criterios morfológicos como por disminución de marcadores de maduración condrocitaria, por ejemplo, colágeno X. Los hallazgos microscópicos indican también una perturbación del fenómeno fisiológico de invasión capilar y formación de nuevo tejido óseo en la espongiosa primaria, aunque los niveles del factor de crecimiento endotelial vascular, valorados por inmunohistoquímica, no han demostrado que estén modificados en la placa de crecimiento de ratas urémicas con respecto a los controles. El significado de estos hallazgos en relación con la patogenia del hipocrecimiento del fallo renal crónico está aún por aclarar (AU)

Several alterations have been reported in the growth plate of young rats rendered uremic by subtotal nephrectomy, a widely used experimental model of growth failure secondary to renal insufficiency. In our lab’s experience, uremia is associated with a markedly increased growth plate height which results from an elongation of the hypertrophic zone. These findings are not consistently observed in all studies, likely because of the different experimental conditions. Regardless of growth plate size, growth retardation induced by chronic renal failure is accompanied by an alteration of the dynamics of the growth plate with a decreased bone apposition rate at the metaphyseal end of growth cartilage and slower production and progression of chondrocytes from the resting zone up to the most distal hypertrophyc zone adjacent to bone. These abnormal dynamics are associated with an irregular bone-cartilage interface and a disturbed process of chondrocyte maturation which becomes evident by a morphological criteria and by depressed expression of markers of chondrocyte maturation such as collagen X. The microscopic findings also suggest a disturbed process of capillary invasion, which precedes formation of new osseous tissue in the primary spongiosa, although the levels of vascular endothelial growth factor, as measured by immunohistochemistry, have been reported to be similar in the growth plate of uremic and control rats. The meaning of these findings in the pathogenesis of growth impairment secondary to chronic renal failure remains to be determined (AU)

Efecto de la hormona de crecimiento y del calcitriol sobre la placa de crecimiento de ratas urémicas / Effect of growth hormone and calcitriol in the growrh plate of uremic rats

Este estudio analizó la placa de crecimiento de ratas urémicas hipocrecidas tras administración de hormona de crecimiento (GH) y/o calcitriol. Se estudiaron cuatro grupos: sin tratamiento (U), tratadas con GH (U + GH), con calcitriol (U + D), con GH y calcitriol (U + GH + D), diariamente durante la segunda semana de IRC. Estos grupos se compararon con ratas control con dieta ad libitum (C) o pareada con U (CP). La histomorfometría de la tibia proximal reveló en U una menor formación de hueso estimada por el avance del frente óseo (AFO), alargamiento del cartílago de crecimiento y de su zona hipertrófica, y condrocitos terminales más pequeños, en comparación con los grupos C y CP. El grupo U + D tendió a normalizar la altura del cartílago de crecimiento, de la zona hipertrófica, y el tamaño de los condrocitos terminales. En el grupo U + GH mejoró el AFO y se normalizó el tamaño condrocitario, pero el cartílago de crecimiento y la zona hipertrófica permanecieron alargados. El grupo U + GH + D mostró hallazgos similares al U + GH. Estos hallazgos indican que en la IRC el tratamiento con GH no normaliza la morfología de la placa y que el calcitriol facilita la maduración del condrocito. Cuando se administran conjuntamente, el efecto de la GH prevalece (AU)

This study analyzed the modifications induced by growth hormone (GH) and/or calcitriol treatments in the growth plate of growth retarded uremic rats. Four groups of 5/6 nephrectomized rats were studied: untreated (U), treated with GH (U + GH), treated with calcitriol (U + D), treated with GH and calcitriol (U + GH + D). Treatments were given intraperitoneally during the second week of renal failure. Uremic groups were compared with sham-operated rats fed ad libitum (C) or pair-fed with U (CP). In comparison with C and CP, histomorphometric analysis of tibial proximal ends of U group showed decreased bone formation, as estimated by osseous front advance (OFA), elongation of growth cartilage and its hypertrophic zone, and decreased size of most distal chondrocytes. The U + D group tended to normalize growth cartilage height, and that of its hypertrophic zone, as well as the size of chondrocytes. In U + GH group OFA improved and chondrocyte size became normal, but growth cartilage remained elongated. Similar results were found in the U + GH + D group. These findings indicate that, in chronic renal insufficiency, the benefitial effect of GH on growth is not associated with normalization of growth cartilage morphology and that calcitriol facilitates chondrocyte maturation. When given together the effect of GH prevails (AU)

Prepubertal rats are more resistant to ischemic renal injury and recover more rapidly than adult rats.

Bilateral clamping of renal pedicles during 60, 75 or 90 min was used to characterize the evolution of ischemic acute renal failure (ARF) in prepubertal rats. To verify the existence of age-conditioned differences in the evolution of ARF, adult rats were exposed to 40, 60 or 75 min of clamping. After 7 days, survival rate was significantly better in young than adult rats for identical times of clamping (89 vs. 35% for 60 min and 69 vs. 35% for 75 min). Young rats largely died within the first 24 h following ischemia while the risk of death extended until the 4th day after ischemia in adult rats. Peak values of serum urea nitrogen and creatinine were observed on the 1st and 3rd day after ischemia in young and adult rats, respectively. In young rats, these markers of renal function returned to normal on days 5 and 6 whereas they remained elevated at the end of the study in adult animals. Growth curves of young rats paralleled those of sham-operated animals from the 3rd day of clamping whereas adult rats did not even reach the initial weight at the end of the study. Analysis of kidneys obtained 7 days after clamping revealed more severe histopathological lesions in adult rats as well as a higher proliferative activity (10-40 times the value of sham-operated animals versus 2-4 times the control value in young rats). Our findings indicate that kidneys from young rats are more resistant to ischemia and recover more quickly from the ischemic insult. Therefore, the experimental model of ischemic ARF is clearly different in young and adult rats.

Growth plate cartilage formation and resorption are differentially depressed in growth retarded uremic rats.

To characterize the modifications of growth plate in individuals with growth impairment secondary to chronic renal failure, young rats were made uremic by subtotal nephrectomy (NX) and, after 14 d, their tibial growth plates were studied and compared with those of sham-operated rats fed ad libitum (SAL) or pair-fed with NX (SPF). NX rats were growth retarded and severely uremic. Growth plate height (mean +/- SD) was much greater (P<0.05) in NX (868.4+/-85.4 microm) than SAL (570.1+/-93.5 microm) and SPF (551.9+/-99.7 microm) rats as a result of a higher (P<0.05) hypertrophic zone (661.0+/-89.7 versus 362.8+/-71.6 and 353.0+/-93.9 microm, respectively). The increased size of the growth plate was associated with a greater number of chondrocytes and modifications in their structure, particularly in the hypertrophic zone adjacent to bone. In this zone, chondrocytes of NX animals were significantly (P<0.05) smaller (12080.4+/-1158.3 microm3) and shorter (34.1+/-2.5 microm) than those of SAL (16302.8+/-1483.4 microm3 and 37.8+/-2.0 microm) and SPF (14465.8+/-1521.0 microm3 and 36.3+/-1.8 microm). The interface between the growth plate cartilage and the metaphyseal bone appeared markedly irregular in NX rats. Kinetics of chondrocytes was also modified (P<0.05) in the NX rats, which had lower cell turnover per column per day (5.4+/-0.9), longer duration of hypertrophic phase (89.0+/-15.2 h), and reduced cellular advance velocity (7.4+/-2.2 microm/h) compared with SAL (8.0+/-1.6, 32.1+/-6.7 h, and 11.3+/-2.7 microm/h) and SPF (7.2+/-1.1, 34.8+/-5.1 h, and 10.1+/-2.5 microm/h). Cell proliferation was no different among the three groups. Because the growth plates of SPF and SAL rats were substantially not different, modifications observed in the NX rats cannot be attributed to the nutritional deficit associated with renal failure. These findings indicate that chronic renal failure depresses both the activity of the growth plate cartilage by altering chondrocyte hypertrophy and the replacement of cartilage by bone at the metaphyseal end. The two processes are differentially depressed since cartilage resorption is more severely lowered than cartilage enlargement and this leads to an accumulation of cartilage at the hypertrophic zone.

Morphometry of uremic rat growth plate.

Growth retardation is a common manifestation of chronic renal failure in children. To gain insight into the alterations of bone growth plate of chronic uremia, a morphometric study of tibia proximal growth plate was performed in 5/6 nephrectomized rats (NX, n = 4) and sham animals (SHAM, n = 4). Toluidine blue stained sagittal sections (5-6 microns) from ethanol-fixed and methylmethacrylate-embedded tibias were analyzed. Widths (X +/- SEM) of growth plate (GPW), proliferative (PZW) and hypertrophic zones (HZW) were calculated. Results were as follows: [table: see text] Growth plate modifications in uremia are rather due to alterations in the hypertrophic than proliferative zone. This is consistent with an abnormal metabolism of condrocytes as shown by a lower mean area of extracellular matrix (EMA) per cell in the hypertrophic zone of the NX rats (0.23 vs. 0.58 microns 2).

Oxytocin-immunoreactive nerve cells in the supraoptic nucleus of the hypothalamus after treatment with histamine.

Immunohistochemical, morphometric and statistical methods were used to study oxytocin immunoreactive elements in the supraoptic nucleus (SON) of the hypothalamus of 180 male rats. Untreated rats, rats that were given either an intraperitoneal (ip) or intracerebroventricular (icv) injection of histamine (HA) (n = 40 each group) and control animals that received ip or icv injections of saline were included in our study. Oxytocin immunoreactive neurons and oxytocin-labelled nerve tracts were found in the SON of untreated animals. Treatment with saline either intracerebroventricular or intraperitoneally did not modify the oxytocin immunoreaction described for untreated animals. I.c.v. treatment with HA increased the numbers of oxytocin labelled elements. On the contrary, oxytocin immunoreaction after intraperitoneal treatment with HA was similar to that described for control and untreated animals. The morphometric and statistical studies confirmed these findings. The importance and signification of these results are discussed in this paper.

Morphological and functional study of the GH-immunoreactive adenohypophyseal cells in ovariectomized rats.

In view of the existence of a different secretion pattern of growth hormone (GH) between male and female rats, the aim of the present study was to analyse the role played by ovarian steroid hormones in the modulation of such secretion. To do so, postpubertal female rats were ovariectomized and killed at 30 days after the operation. The basal serum levels of growth hormone together with cell area, cytoplasmic area and nuclear area of the hypophyseal somatotropic cells of normal and ovariectomized rats were compared. The results obtained show that ovariectomy induces a significant decrease (p less than 0.05) in the basal serum levels of GH, accompanied by an increase in cellular and cytoplasmic areas, with no significant differences in nuclear area. Ovariectomy was also accompanied by an increase in reaction intensity and the number of GH-immunoreactive cells (p less than 0.01). These findings point to the shift towards a masculine secretory and morphological pattern following ovariectomy and supports the hypothesis that ovarian steroids intervene in the establishment of a different pattern in females compared to males.

Contribution to knowledge of GABAergic innervation of the intermediate lobe of the hypophysis.

Regulation of the synthesis and release of peptides by the melanotropic cells of the intermediate lobe of the murine hypophysis is mainly brought about by innervation of the lobe by dopaminergic and GABAergic fibres. The present work reports on a study of the distribution of nerve fibres inside the gland by immunocytochemical identification of the GABA contained in the axons.

Morphological study of the rat pituitary follicle stimulating hormone cells after alternate day treatment with luteinizing hormone-releasing hormone (LHRH).

The action of the luteinizing hormone-releasing hormone (LHRH) on the hypophyseal gonadotrophins has either an activatory or inhibitory effect depending on the doses administered or on the treatment followed. Both factors can induce a different response in the two hormones. In this work, the effect after the administration of 8 doses (40 micrograms/day) of LHRH at intervals of 48 hours, on the serum levels of follicle stimulating hormone (FSH), as well as the numerical density, distribution, intensity of staining and morphometrical parameters of the cells which react against the anti-FSH serum, are assessed. It has been found that with the treatment an increase of FSH serum levels, without modification in the number of immunoreactive cells, but a clear increase in the lightly stained cells, is produced. The distribution of the reactive cells, uniform in normal animals, shows a large numerical density in the dorsal and posterior hypophyseal areas in the treated animals. No change was observed in the nuclear and cellular areas between the different groups.