Serum melatonin concentration in the child with non-organic failure to thrive: comparison with other types of stress.

Human beings must adapt both to novel, unfavourable conditions and to circumstances of physical or psychological isolation. The initial response to stress depends fundamentally on the activation of the HPA axis. In regaining homeostatic equilibrium, melatonin plays a role due to its synchronising and anti-stress properties. To study the role of melatonin and the pineal gland in the organic and/or behavioural response to acute or chronic stress, 311 children were divided into two large groups: 1) Control Group - 121 healthy children classified, in turn, into 4 control subgroups, one for each pathology being studied; 2) Problem Groups, classified as traumatic stress (n=58), surgical stress (n=38), psychic stress (n=64) and febrile stress (n=30), according to pre-established clinical criteria. These groups were sub-classified according to the degree (low or high) and duration (acute or chronic) of the stress. This study used a case controlled, cross sectional design. Serum melatonin was measured by radioimmunoassay (RIA). In all the situations of acute stress, melatonin increased at a rate directly proportional to the severity and/or duration of the stress-causing stimulus. In contrast, in chronic stress, i.e. the Affective Deprivation Syndrome (or Psychological Dwarfism) with or without non-organic failure to thrive, resulted in the opposite response with a significant reduction of melatonin. In conclusion, in acute stress an increase in the bioavailability of melatonin could contribute to maintaining homeostatic balance. The lack of an appropriate response to acute stress could make some groups of patients (Affective deprivation syndrome with or without growth failure) predisposed to suffer depressive symptoms associated with a wide range of neurological, endocrinological or immunological consequences.

Spotted fever group Rickettsia in brown dog ticks Rhipicephalus sanguineus in southwestern Spain.

A total of 2,229 adults ticks (1,428 males and 801 females) belonging to the brown dog tick, Rhipicephalus sanguineus Latreille, 1806, collected from dogs in Seville province (Andalusia), distributed in 500 lots ranging from one to eight specimens per lot, were examined for the presence of rickettsiae by molecular techniques. Specific rickettsiae DNA were detected in 90 lots (18%) of ticks tested. Sequence analysis of amplicons revealed that R. sanguineus ticks were infected exclusively with Rickettsia massiliae (including the strain Bar-29). The results of this study extend the knowledge of the geographic distribution and prevalence of these spotted fever group (SFG) rickettsiae and indicate that at least two of them, with yet uncertain pathogenicity to humans, are present in brown dog ticks in south western Spain. Although Mediterranean spotted fever (MSF) is an endemic disease in Andalusia, Rickettsia conorii was not found, whereas R. massiliae, recently described as a pathogenic species, was highly prevalent in this area. Our data suggest that in Andalusia a number of MSF or MSF-like cases attributed to R. conorii could have been actually caused by other SFG rickettsia present in R. sanguineus, particularly, R. massiliae.

Neuroendocrine and circadian aspects (melatonin and beta-endorphin) of atopic dermatitis in the child.

Atopic dermatitis (AD) is a disease of increasing incidence among paediatric patients. Among the factors involved in its pathogenesis is the alteration of the immune response, and so the objective of this study was to evaluate the involvement of certain neuroendocrine factors with immune properties in the development of the disease. Fifty-five subjects were selected and divided into the following three groups: healthy subjects, those diagnosed with symptomatic AD and those with asymptomatic AD. Plasma levels of melatonin and beta-endorphins were measured by radioimmunoassay, in serum samples obtained at 9 am and 9 pm, with two samples being obtained from each of the patients and controls. In the phases of AD outbreaks, there is a reduction in the serum levels of both melatonin and beta-endorphin. In the case of melatonin, the difference is statistically significant only during the day, although nocturnal levels are greater for both hormones. In AD, a central neuroendocrine dysfunction may be a primary pathogenic event. Our hypothesis is that the physiological nocturnal peak of melatonin due to pineal gland production may mask the decline of melatonin of possibly extrapineal (immunological) origin during episodes of dermatitis outbreaks. Further studies are required, particularly of neurovegetative and hormonal aspects, to better define this process. Such a definition would also be of therapeutic interest.

Longitudinal study of the simultaneous secretion of melatonin and leptin during normal puberty.

BACKGROUND/AIMS: Pubertal changes are a consequence of the activation of the hypothalamic-pituitary-gonadal axis due to an increase in the frequency and magnitude of pulses of gonadotropin-releasing hormone (GnRH), which may depend on the intrinsic properties of the neurons of the hypothalamic arcuatus nucleus, or on the influence of neurotransmitters and/or neuromodulators. We evaluated the serum concentrations of melatonin and leptin in healthy prepubertal and adolescent subjects of both sexes, to define their participation at the initial stages and during the progression of pubertal development. METHODS: 80 pediatric subjects (47 females and 33 males), aged 6-18 years, were divided into 2 groups, prepubertal (n = 25) and adolescent (n = 55), according to the absence or presence, respectively, of physical signs of pubertal development. The subjects were assessed on two occasions: at the time of their inclusion in the study, and 12-18 months later when the subject had advanced one pubertal stage according to the Tanner classification. Blood was obtained in fasting for clinical purposes and for the hormonal study. Melatonin and leptin were measured by radioimmunoanalysis. RESULTS: As described previously, melatonin decreases at the onset of puberty and during pubertal development. Both the absolute melatonin value and the decrease between evaluations tended to be greater in females; the variations were correlated with neither an increase in body weight nor with the degree of pubertal development. The concentration of leptin increased in both sexes with the progression of puberty, this value being 40% greater in women, and correlated with the indicators of an increase in body volume and fat accumulation. Although its concentration remained stable between evaluations for both sexes, among the males the association between leptin and pubertal development took place at the start of the process, while for the females we observed a significant overall association between pubertal stage and leptin concentration, this association being stronger at more advanced Tanner stages. Neither at the onset of puberty nor during its course did we observe any significant relation between melatonin concentration and any of the Tanner stages, whether for males or for females. Neither was there any correlation between the absolute values or rates of modification of melatonin and leptin. CONCLUSION: According to the evolutionary dynamics of their respective concentrations, both initially and during pubertal progress, melatonin and leptin do not interact in the initiation or progression of human pubertal development, and do not seem to play a key role in this process.

Traumatismo de glándula tiroides: consideraciones de interés práctico / Thyroid gland trauma: some practical considerations

Los traumatismos de la glándula tiroides constituyen una rara complicación en el contexto de una afectación cervical previa. Sin embargo, su diagnóstico debe ser tenido en cuenta, incluso después de traumatismos menores o en ausencia de síntomas clínicamente significativos, debido a la posibilidad no desdeñable de fracturas o hematomas ocultos, así como a la afectación de la función glandular tiroidea secuelar, con hipofunción o hiperfunción de ésta. El diagnóstico de los traumatismos de tiroides puede efectuarse, en caso de estabilidad hemodinámica y escasa sintomatología, mediante técnicas ultrasonográficas, pudiendo reservarse otros procedimientos diagnósticos (tomografía computarizada, fibroscopia, angiografía, etc.) para aquellos casos en los que el estado general del paciente o la propia ecografía cervical sugieran traumatismos extensos, afectación de la vía respiratoria o sangrado activo importante

Thyroid gland trauma constitutes a rare complication of a previous neck injury. However, this diagnosis should be kept in mind, even after minor injuries or in the absence of clinically significant symptomatology, due to the possibility of occult fractures or hematomas, as well as sequelae involving the thyroid gland such as hypothyroidism or hyperthyroidism. In hemodynamically stable patients with mild symptoms, the diagnosis of thyroid gland trauma can be made by ultrasound, reserving other diagnostic procedures (computed tomography, fiberoptic bronchoscopy, angiography, etc.) for those cases in which the general condition of the patient or the results of cervical ultrasound suggest the presence of major trauma, airway compromise or severe active bleeding

Síndrome de cardiopatía y asplenia (síndrome de Ivemark) asociado a mielomeningocele y malformación de ArnoldChiari / Ivemark syndrome associated with myelomeningocele and Chiari malformation

El síndrome de Ivemark es una entidad infrecuente que incluye malformaciones cardiacas complejas, anomalías del desarrollo de diversas vísceras abdominales -principalmente el bazo, siendo la más frecuente la asplenia- y alteración de la simetría visceral. El caso que presentamos asocia a lo anterior mielomeningocele y malformación de Arnold-Chiari, dos malformaciones del sistema nervioso central (SNC) no comunicadas hasta la fecha. Dado que la cronología ontogénica de estas anomalías coincide con el resto de alteraciones del síndrome, consideramos que podrían ser expresiones clínicas de éste aún no descritas (AU)

Síndrome de blefarofimosis, ptosis, epicanto inverso y telecanto de presentación familiar tipo II / Blepharophimosis syndrome type 2, involving ptosis, inverse epicanthus and telecanthus

El síndrome de blefarofimosis, ptosis palpebral, epicanto inverso y telecanto (también denominado con el acrónimo BPES) es una alteración infrecuente, de aparición esporádica, o, más habitualmente, familiar. Han sido descritas en la bibliografía dos formas clínicas de esta última: la tipo T, la más frecuente (en la que las mujeres afectadas suelen presentar infertilidad secundaria a alteraciones en los ovarios), y la tipo II, no asociada con anomalías gonadales. En el presente trabajo se describen dos casos del síndrome BPES, subtipo II, en sendos miembros de una misma familia; ambos casos presentan anomalías asociadas: nistagmo e hipotonía transitoria muscular. Se incide en la necesidad de un estudio precoz de las posibles anomalias asociadas, así como en la cirugía plástica reparadora del defecto palpebral, con el fin de evitar los problemas de visión y cervicales secundarios a un diagnóstico y tratamiento tardíos. (AU)

Emisión espontánea de líquido a través del cordón umbilical en el período neonatal / Spontaneous fluid discharge through the umbilical cord in the neonatal period

No disponible

[Intrauterine dwarfism and dysmorfic features. A case of Russel-Silver syndrome]. / Enanismo intrauterino y rasgos dismórficos: un caso de síndrome de Russel-Silver.

Russel-Silver syndrome is characterized by severe intrauterine growth retardation and is the most characteristic intrauterine dwarfism syndrome. In addition to short stature, low birth weight and reduced postnatal growth, this syndrome is characterized by features such a relative macrocephaly, a typical craniofacial appearance, asymmetry of the body and other abnormalities. Recent studies on developmental delay in these children have shown that most require special education. Attempts to explain the mechanism underlying this condition have been unsuccessful. Recent studies suggest a genetic cause, mainly uniparental disomy 7, although definitive data are lacking. We report a characteristic case of Russel-Silver syndrome: a newborn with fetal growth retardation, the craniofacial features described by Russel, relative macrocephaly, asymmetry of the body and very low weight increase.

Enanismo intrauterino y rasgos dismórficos: un caso de síndrome de Russel-Silver / Intrauterine dwarfism and dysmorfic features. A case of Russel-Silver syndrome

El síndrome de Russel-Silver es una entidad caracterizada por un retraso importante del crecimiento intrauterino, y es el más característico de los nanismos intrauterinos. Además de la baja talla y peso al nacimiento, este síndrome se caracteriza por una serie de hallazgos característicos como macrocefalia relativa, rasgos faciales característicos, asimetría corporal y otra serie de malformaciones. Los últimos estudios realizados sobre posibles alteraciones cognitivas en estos niños detectan que la mayoría de los pacientes requieren seguimiento y atención especial. Los intentos por explicar la etiología de esta entidad han fracasado, aunque los últimos estudios apuntan hacia un origen genético, sobre todo disomía uniparental del cromosoma 7, si bien aún no existen datos definitivos. Se presenta uno de los casos más característicos descritos de síndrome de Russel-Silver, en el que aparecen la gran mayoría de los hallazgos relacionados con este cuadro. Un recién nacido con retraso del crecimiento intrauterino, con las alteraciones faciales descritas por Russel, macrocefalia relativa, asimetría corporal y una curva de ganancia ponderal pobre (AU)

No disponible