CONGENITAL HEART MALFORMATIONS IN NEWBORN BABIES WITH LOW BIRTH WEIGHT.

UNLABELLED: Congenital heart malformations represent a public health problem, holding a significant percentage of the total of heart diseases. Beside the elevated frequency of the malformations, we also notice their occurrence in newborn babies with low birth weight, increasing, thus, the risk of complications and late therapeutic approach. The goal of the study was to highlight the general and particular aspects of cardiovascular malformations epidemiology in newborn babies with low weight at birth, the correlation of the malformations with implied genetic and environmental factors, assessing the complications and their procedures on the therapeutic management. MATERIAL AND METHODS: Our study was performed on a group of 271 patients, hospitalized in the Department of Pediatric Cardiology of "Sf. Maria" Emergency Clinical Hospital for Children of Iasi, during January 2011-December 2013. The patients were assessed based on anamnesis, clinical, biological and imagistic exam. RESULTS: The study lot was divided according to the type of the structural defect: 95% of the patients were diagnosed with non-cyanogenic congenital heart malformations and 5% with cyanogenic congenital heart malformations. Regarding the patient's origin background, we notice an elevated frequency of the rural environment (71%). The incidence of the malformations was high in premature low birth weight (48%), followed by premature very low birth weight (22%). In evolution, congenital heart malformations often get more complicated heart failure, arterial hypertension and respiratory infections being most often met. Mortality was maximum in the first year of life, a third of the cases being associated with chromosomal malformations. CONCLUSIONS: Congenital heart malformations in newborn patients with low weight at birth represented an elevated percentage of 44.13% of the total of the cases hospitalized for cardiovascular diseases from the Department of Pediatric Cardiology of Iasi. Many cases were associated with other congenital malformations or different complications, being necessary an interdisciplinary collaboration to adequately monitor the anatom5ical and functional parameters and to ensure a somatic and mental development as normal as possible.

CLINICAL AND PARACLINICAL ASPECTS OF EBSTEIN'S ANOMALY--SEVERE FORM IN NEWBORNS.

Ebstein's anomaly is a rare heart malformation, with a broad spectrum of anatomic abnormalities, leading to different clinical, electrocardiographic, echocardiographic changes and a reserved prognosis. We have described a case of an infant diagnosed with Ebstein's anomaly--a severe form.

Infectious endocarditis with five localisations--case reports.

Infectious endocarditis is defined as an infection of the endocardial surface area of the heart which can include one or more cardiac valves, mural endocardium or a septal defect. We present the case of a patient, aged 8, hospitalized in Hemato-Oncology Department with pontine glioma, who was also diagnosed with infectious endocarditis in five locations.

A case of turner syndrome associated with severe coarctation of the aorta.

Turner Syndrome (TS) is a chromosomal abnormality due to the complete or partial lack of chromosome X, with clinical polymorphic elements: small size, hypogonadism, various visceral abnormalities. About half of the cases may suffer from congenital heart abnormalities. We describe hereunder a case of TS diagnosed with coarctation of the aorta due to high blood pressure detected by accident.

Obesity--a risk factor for cardiovascular diseases.

UNLABELLED: Infantile and juvenile obesity is a medical, social and cultural problem, which reaches epidemic proportions worldwide. In Romania, according to the World Health Organization, one out of four Romanians is obese. As far as infantile obesity is concerned, Romania ranks third in Europe. Infantile obesity has a major impact on all body systems and is associated with risk factors for cardiovascular diseases and accelerated atherosclerotic processes, including hypertension, atherogenic dyslipidemia, atherosclerosis, metabolic syndrome and functional and structural cardiac changes. AIMS: To study the cardiovascular complications of the obesity at children and adolescents. MATERIAL AND METHODS: Our study was conducted on a group of 188 obese and overweight patients that were hospitalized in the Pediatric Cardiology Department, the "Sfânta Maria" Children's Hospital of Iasi between 1 January 2006 and 1 January 2011. The patients' evaluation was based on: anamnesis, clinical criteria and paraclinical criteria. RESULTS: The distribution of cases by age group was the following: 51% of patients were aged 7-13 years, 42% were teenagers and only 6% of patients were aged between 2-6 years. As far as the patients' origin is concerned, we noted that 58% of them lived in urban areas. In the study group, 21% of the subjects had borderline hypertension, while 16% of them suffered from definite hypertension. The echocardiogram that was performed on all the patients included in the study revealed hypertrophic cardiomyopathy in 12% of the patients. CONCLUSIONS: Child obesity has a major impact on all the big body systems and it is known to contribute to significant increases in the mortality and morbidity rates.

Particularities in diagnosis and treatment for infectious endocarditis in children.

UNLABELLED: Infectious endocarditis (IE) represents a rare pathology in children, but with lethal potential. The goal of the therapy is fast and total eradication of the infection. AIMS: To study particularities in diagnosis and treatment for infectious endocarditis in children. MATERIAL AND METHODS: Children with infectious endocarditis hospitalized between January 2007 - February 2012 in the Cardiology Department of the ,,Sfânta Maria" Children Emergency Hospital of lasi have been included in the study. RESULTS: The patients are aged between 23 days and 16 years, the average age being 4 years old. At approximately 88% of the patients (14 cases), the endocardial damage appeared in the pre-existent valvular lesions, specially mitral and aortal. As associated congenital malformations, the patients prevailingly presented ventricular septal defect, mitral valve prolapse, arterial canal persistence, aortic stenosis, coarctation of the aorta. Blood cultures were collected and the most frequent identified etiological agents were: Staphylococcus coagulase-positive, Streptococcus mitis, Staphylococcus speciae coagulase-negative, Staphylococcus haemolyticus, Streptococcus bovis, Escherichia coli, for which the antibiogram showed sensitivity for beta-lactam, cephalosporins, glycopeptides, trimethoprim-sulfamethoxazole, rifampicin, quinolone, lincosamides, oxazolidinones, and thus specific treatment was set up according to the antibiogram. CONCLUSIONS: The infectious endocarditis is a serious disease that affects young age too, leading towards exitus in some cases. Diagnostic imaging and early blood cultures are of relevance in order to intervene promptly. The treatment must be targeted and applied as fast as possible.

Giant uterine leiomyoma.

Uterine leiomyomas represent the most common benign tumors of the female reproductive tract. Giant uterine leiomyomas are very rare neoplasms and represents a great diagnosis and therapeutic challenge. This article illustrates a case of a 45-year old woman presented to our surgery department with a 10-month history of progressive increasing abdominal size, back pain, vague abdominal pressure sensations, weight loss, constipation and urinary frequency. Physical examination, laboratory evaluation, transabdominal ultrasound and computed tomography scanning suggested a giant abdominopelvic mass. Abdominal supracervical hysterectomy with bilateral salpingo-oophorectomy was performed. Histologically, the specimen was a 18.1 Kg uterine leiomyoma measuring 33/28/22 cm. The patient's postoperative course was uneventful and she was discharged from the hospital on the sixth postoperative day.

Primary hydatid cyst with an unusual location--a case report.

Human cystic echinococcosis, a zoonotic infection caused by Echinococcus granulosus, is still a largely extended public health problem in endemic regions (China, Middle East, Mediterranean region, South America, Russian Federation, etc.). Primary echinococcosis may develop in almost any organ (liver, lung, kidney, spleen, mediastinum, heart, brain, bones, pancreas, breast, ovaries, etc.). The liver and the lungs are the most frequently involved organs. Primary hydatid disease of the soft tissue is extremely rare, even in endemic areas. The paper will be focused on analyzing this rare disease. A 46-years old woman who came to our Department of Surgery with a 7/8 cm painless, round, palpable mass in the subcutaneous tissue of the proximal anteromedial side of the right thigh. Based on clinical and laboratory findings and imaging techniques we suspected a hydatid cyst. Conservative surgery associated with antihelminthic substances intraoperative and Albendazole postoperative was performed. After an uneventful recovery the patient was discharged 7 days after operation. No local or systemic recurrences were detected during 1 year follow up.

Bacteriological aspects implicated in abdominal surgical emergencies.

UNLABELLED: The purpose of the present study was to establish the microbial etiology of abdominal surgical emergencies as well as the relationship between the bacterial etiology and the virulence factors produced by the respective isolated strains. 110 bacterial strains were isolated from 100 randomized clinical cases, operated during 2009-2010 in the First Surgical Clinic of the University Hospital of Bucharest. The clinical cases (sex ratio 52 M/48F aged between 22-85 years old) were classified into three risk groups, as related to their severity. The isolated strains were characterized by cultural, microscopic and biochemical methods. After identification, the bacterial strains were investigated for their virulence potential (adherence to abiotic surface and production of soluble virulence factors). RESULTS: The specimens were collected from different clinical pathologies: diffuse acute peritonitis, biliary duct infections, severe acute pancreatitis followed by septic processes etc. The 110 bacterial (72 aerobic and 38 anaerobic) strains were isolated only in 70 out of 100 cases. Out of these 70 cases, in 45 already submitted to pre-operatory empiric broad spectrum antibiotic therapy, there were isolated 74 strains, whereas in 25 cases without any treatment, there were isolated 36 strains. The etiology was either mono-specific or multi-specific (aerobic-anaerobic associations, especially in old persons). Out of the 30 negative culture cases, 16 were already submitted to pre-operatory parenteral empiric antibiotic therapy at the moment of specimen collection. The aerobic etiology was dominated by Enterobacteriaceae. The most frequent anaerobic species belonged to Clostridium, Peptococcus and Bacteroides genera. It is to be mentioned that the isolation of Bifidobacterium and Veillonella spp. in 11 (10%) severe cases of the studied abdominal surgical emergencies is pleading for the fact that in certain conditions, bacteria belonging usually to commensal gut flora can turn to pathogenic becoming responsive for life-threatening cases. All aerobic and anaerobic strains exhibited some of the following virulence factors: mucinase, esculinase, pore-forming toxins (lecithinase), proteolytic enzymes, adherence ability (slime factor). The presence of these virulence factors (VF) could explain the severity of the clinical aspects. CONCLUSIONS: The bacterial etiology of the abdominal surgical emergencies exhibited a very large spectrum, the highest number of strains being of endogenous origin (Enterobacteriaceae and anaerobic strains). It was demonstrated that the isolated strains produced (cell associated and soluble) VF proving in this way their role as important virulence sources in the hospital environment and explaining the large diversity and severity of the clinical abdominal pathology. The results of the present study are also pleading for periodical readjustments of the pre-operatory empiric antibiotic therapy.

Investigation of the influence of different physico-chemical parameters upon the susceptibility of planktonic and adherent Escherichia coli cells to beta-lactams and quinolones.

The purpose of this study was to evaluate the influence of different physico-chemical parameters on Escherichia coli susceptibility to ceftriaxone (CRO), cefotaxime (CTX), imipenem (IMP), and nalidixic acid (as marker for resistance by impermeability). The influence of chemical composition of culture medium was evaluated by the comparative assessment of inhibition growth diameters on different solid media: Mueller Hinton Medium (MH), Plate Count Agar Medium (PCA), MacConkey Medium (MC) and Eosin Methylen Blue Medium (EMB). In order to evaluate the differences in antibiotic susceptibility between the biofilm embedded and planktonic cells, an original, simple experimental model was used, by including the bacterial cells in an agar layer, mimicking the biofilm matrix. Our results demonstrated that the inhibition diameter zone was much larger on PCA, EMB and MC than on MH, considered as general standard medium for the antibiosusceptibility testings (CLSI). When bacterial cells were included in the agar matrix, the growth inhibition diameters obtained for different beta-lactams proved to be different of planktonic cells, i.e.: for CTX, a narrow inhibition diameter was obtained, demonstrating the low efficiency of this antibiotic in the treatment of biofilm associated infections, whereas the CRO proved the same efficiency against planktonic as well as to agar embedded bacteria. The different susceptibility results obtained for the cells embedded in the agar matrix by an adapted disk diffusion method are pleading for the necessity to assess new adapted standard methods and specific parameters in the purpose to determine the antibiotic resistance of bacterial cells isolated from biofilm associated infections.

[Myocardial infarction in children. Case report]. / Infarctul miocardic la copil. Caz clinic.

Myocardial infarction is a rare condition in children. We present the case of a 14-year-old girl with known cardiac abnormalities admitted to our pediatric cardiology department with cough, cyanosis, low level of consciousness, and difficult breathing. Two days after her admission, she developed severe thoracic pain associated with tachycardia and agitation. The electrocardiogram revealed myocardial ischemia and then myocardial infarction with a rapid onset of cardiac arrest not responding to resuscitation techniques. Postmortem examination confirmed the diagnosis.

[Arrhythmic cardiomyopathy. Case report]. / Cardiomiopatia aritmica. Prezentare de caz.

An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.

Adaptation following intestinal resection: mechanisms and signals.

The intestine has an inherent ability to adapt morphologically and functionally in response to internal and external environmental changes. The functional adaptations encompass modifications of the brush border membrane fluidity and permeability, as well as up- or down-regulation of carrier-mediated transport. Intestinal adaptation improves the nutritional status following the loss of a major portion of the small intestine, following chronic ingestion of ethanol, following sublethal doses of abdominal irradiation, in diabetes, in pregnancy and lactation, with ageing, and with fasting and malnutrition. Following intestinal resection, morphological and functional changes occur depending upon the extent of the intestine removed, the site studied, and the lipid content of the diet. Therefore, intestinal adaptation has important implications in the survival potential and welfare of the host. An understanding of the mechanisms of, and signals for, intestinal adaptation in the experimental setting forms the basis for the use of management strategies in humans with the short-bowel syndrome.

[The ecological accident on the Siret River. A possible cyanide intoxication of children]. / Accidentul ecologic de pe râul Siret. Un episod de intoxicatie cu cianuri la copii.

THE PURPOSE: Of our study is to assess the gravity of cyanide intoxication of children, in the ecological accident in January 2001. MATERIAL AND METHODS: We included in our study 127 children aged between 2 months and 17 years. They were hospitalized in January and February 2001, in the "Sf. Maria" Children's Hospital. Case analysis was based on data of the emergency unit and units where the children were sent after primary care. We evaluated the patients from clinical and paraclinical point of view and we took samples of biological products in order to confirm the diagnosis. RESULTS: Age distribution was 0-1 year (4%), 1-3 years (7.8%), 3-6 years (9.4%), 6-12 years (33.8%), and 12-18 years (42.5%). The lapse of time between the ingestion of contaminated fish and symptomatology was variable. Measures were taken: removal from toxic contact, hospitalization, antidote administration, and treatment of complications. DISCUSSIONS: Although literature data shows that this intoxication appears after the age of three, we found that mother ingestion of contaminated fish, determined intoxication in nursings. Symptoms appeared at 3-12 hours after fish ingestion from the contaminated river and it was suggestive for the diagnosis. First aid measurements were necessary in specialized emergency unit and antidote administration sometimes only in clinical suspicion of intoxication. Correlation between clinical findings and toxic concentrations in urine samples confirm the diagnosis. CONCLUSIONS: Our study tries to highlight those ecological accidents with cyanides present important consequences on people and animal's health. The therapeutic intervention must be fast in order to stop blood distribution of the toxic.

[The morphofunctional characteristics of cardiac involvement in arterial hypertension in children]. / Particularitati morfo-functionale ale afectarii cardiace în hipertensiunea arteriala la copil.

UNLABELLED: The aim of the study was to investigate the main morphofunctional aspects of the cardiac involvement in systemic hypertension in child. METHODS: 48 children with aged ranging between 2 months-18 years, diagnosed with systemic hypertension (SH), were followed up more than 1 year (with treatment) and investigated by clinical examination and noninvasive methods. The etiology of SH was: * secondary SH (40 cases): acute (8) and chronic nephropathy (20), 13 cases being dialysed; coarctation of aorta (10) and pheochromocytoma (2 cases) and * essential SH (8 cases): "borderline" type and also confirmed. RESULTS: The echocardiographic findings had a superior sensibility to ECG and chest X-ray findings, concerning cardiac involvement in SH, especially in the secondary forms, with high values of systolic and/or diastolic blood pressure and with a long period of evolution: hypertrophy of the left ventricle (LV) (31 cases = 65%) with septal predominance (10); * alteration of diastolic function of LV (11), but with normal systolic function of LV (all the cases). These changes have not been observed in acute nephropathy or they were unsignificant in essential SH. Repeated echocardiography after minimum 6 months proved a varied regression of hypertrophy of LV and improved diastolic function of LV in children who received antihypertensive therapy, including spironolactone and/or angiotensin converting enzyme inhibitors. CONCLUSION: Because such cardiac involvement are important and of greater risk factor for the hypertensive patients, the early diagnosis by echocardiography, the follow up of the evolution and the diminish of cardiac disorders by the treatment mentioned above, may improve the prognosis of the disease.

Clinical and evolutive aspects in ventricular preexcitation syndromes in child.

Ventricular preexcitation syndromes (VPS) are very important between cardiac rhythm disturbances in childhood, because their presence can change the clinical and ECG picture and thus the treatment can be very difficult. The authors studied 58 cases of VPS in children (2 weeks-15 years old) admitted in a period of 3 years. The surface ECG showed VPS aspects: in 30% of cases we noticed WPW syndrome type B and the rest presented VPS with Mahaim pathways and Lown-Ganong-Levine syndrome. 4 cases were familial and 1 child a hidden WPW syndrome. In 65% of cases the cardiac symptoms put the diagnosis and 1/3 of cases were discovered by common ECG. The most important cardiac sign of the children with WPW syndrome was the paroxysmal supraventricular tachycardia, 4 cases presenting wide QRS complex. Others types of VPS were without clinical symptoms. The intravenous administration of digoxin + propranolol was the therapy of choice for paroxysmal supraventricular tachycardia in infants and children until 2-3 years old, and propranolol and chinidine after this age. The children older than 2-3 years and/or those with ineffective preventive for recurrent treatment received dysopiramide and specially amiodarone with satisfactory results; it was not necessary the surgical ablation of the aberrant pathway. Ventricular preexcitation syndromes and wrong treatment can induce severe ventricular arrhythmia, so all the tachyarrhythmias with unknown etiology and especially those with wide QRS complex must be investigated very carefully, using and Holter test and the endocavitary electrophysiology, for a correct medical and/or surgical treatment.

[Kurt Goldstein: from aphasia to linguistics]. / Kurt Goldstein: de l'aphasie à la linguistique.

The authors try to take into account Kurt Goldstein's contribution on the subject of aphasia. They introduce the significance of the phenomenological approach of the language leading them toward the structuralist theme.