ABSTRACT
CLINICAL CASE: A 45-year-old male referred with a scotoma in the left eye of 2 months' evolution. A peripapillary tumor was found, with a basal diameter of 7 mm and thickness 3.4 mm. It was diagnosed as a circumscribed choroidal hemangioma. It was decided to treat the patient using photodynamic therapy. After 4 sessions and 17 months follow-up, the patient remained asymptomatic and visual acuity was stable. There was evidence of subretinal fibrosis and no subretinal fluid was found. DISCUSSION: Photodynamic therapy is a good option for the treatment of circumscribed choroidal hemangioma given the minimal damage is causes to the adjacent retina.
Subject(s)
Choroid Neoplasms/drug therapy , Hemangioma/drug therapy , Photochemotherapy , Humans , Male , Middle AgedABSTRACT
OBJECTIVES: The selection of patients for balloon aortic valvuloplasty is a vital clinical challenge in neonatal aortic stenosis. The present study was designed to establish possible predicting factors for poor results after balloon therapy. PATIENTS AND METHODS: 2D echocardiographic, Doppler color and clinical variables (grade of cardiac failure, aortic "anulus", mitral anulus, left ventricular diameter, ascending aorta, instantaneous Doppler gradient, and grade of aortic regurgitation) were analyzed in 32 neonates submitted to balloon dilation at 22 +/- 18 days of life. The evaluations were conducted during three periods in respect to balloon therapy (A: before; B: immediately after, and C: mid-term follow-up). The outcome in both, B and C periods was defined as favorable (all survivors with Doppler gradient < or = 70 mmHg and no other intervention on the valve) and unfavorable (death, first stage of univentricularization, valvular replacement or survivors with Doppler gradient > 70 mmHg). Mean values between subgroups were compared by Wilcoxon test; unconditional logistic regression was used to analyze the impact of cardiac failure and anatomic variables (continuous, categorized or Z) on the outcome. RESULTS: The Doppler gradient decreased from 70 +/- 28 to 34 +/- 14 mmHg after the valvuloplasty, and no changes were detected in the follow-up period (36 +/- 8 mmHg). An immediate favorable result was obtained in 72% of the patients; its consisted of 50% in period C. Nine neonates had an immediate unfavorable outcome (6 deaths and 3 with Norwood operation). In the follow-up, three patients had valvular replacement, one patient Doppler gradient > 70 mmHg and one patient with left ventricular endomyocardial abnormalities died. The severe cardiac failure (odds ratio: 33; CL 2.4-443; p = 0.008) and all categorized anatomic variables (aortic "anulus" < or = 6 mm; mitral anulus < or = 9 mm; ascending aorta < or = 8 mm; left ventricular diameter < or = 13 mm) were related with the immediate poor outcome. At 7.6 years, survival and freedom with no valvular replacement nor reintervention probability rates were 83% and 67%, respectively. CONCLUSIONS: 2D echo Doppler provides essential information about the anatomic and functional lesions coexisting with severe or critical aortic stenosis in neonates. Patients with left heart hypoplasia and severe heart failure should not be candidates for balloon valvuloplasty. The degree of residual aortic regurgitation and endomyocardial abnormalities of the left ventricle play an important role in the mid-term follow-up.
Subject(s)
Aortic Valve Stenosis/therapy , Catheterization , Aortic Valve Stenosis/congenital , Aortic Valve Stenosis/diagnostic imaging , Echocardiography , Female , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Treatment OutcomeSubject(s)
Cardiac Tamponade/etiology , Pericarditis/etiology , Pneumonia, Mycoplasma/complications , Child , Female , HumansABSTRACT
Two newborns with abdominal perforation during peritoneal dialysis are presented. The first probably before dialysis and the second iatrogenic. Both needed surgical intervention. Incidence in children in comparation with adults is discussed. Severe clinic complications of both patients that needed complete parenteral nutrition, mechanic ventilation and treatment of Candida sepsis are comented. Both survived without sequels in spite of severe complications.
