Acardius acephalus. Descripción de un caso / Acardius acephalus. A case report

Comunicamos un caso de embarazo gemelar (monocorial biamniótico) con malformación de uno de los fetos del tipo acardius acephalus. El otro gemelo presentó complicaciones de tipo infeccioso, hematológico y neurológico asociadas. Este cuadro forma parte del amplio espectro clínico del síndrome de transfusión feto-fetal (STFF), exclusivo de embarazos monozigotos en los que los sistemas vasculares fetales están conectados, dependiendo la gravedad del tipo de anastomosis y del momento de producción de éstas. El corazón del gemelo "donante" bombea su volemia y la del arcadio, sufriendo sobrecarga y posible insuficiencia cardíaca. El gemelo receptor puede presentar alteraciones graves e incluso letales, como la ausencia de corazón y/o cabeza. En algunos casos puede existir una anomalía previa de uno de los gemelos (arteria umbilical única, alteración cromosómica). El diagnóstico precoz es esencial para plantear la actitud terapéutica, que irá dirigida al gemelo normal (AU)

[Effects of competitive physical exercise on neuroendocrine response and interleukin-6 liberation in children]. / Repercusión del ejercicio físico competitivo en la respuesta neuroendocrina y liberación de interleuquina-6 en niños.

OBJECTIVE: The purpose of this study was to evaluate the effects of physical activity on the secretion of cortisol, melatonin and interleukin-6 (IL-6) in children. PATIENTS AND METHODS: A controlled prospective study was carried out. Based on anthropometrical measurements and physical examination, which excluded those with an organic pathology or that were further than one standard deviation from the 50th percentile, 74 male children aged 6 or 7 years were included in this study. Forty-one children from a public school (PS) and 33 children from a soccer sport school (SS) were selected and asked to perform three different physical activities. A score was made to evaluate their performance and both before and after physical activity salivary samples were obtained to measure cortisol, melatonin and IL-6 concentrations. RESULTS: The children in the SS group had a better global physical performance score than those from the PS. There were no statistically significant differences in biochemical parameters between the two groups before and after exercise. There was a rise in the cortisol, melatonin and IL-6 levels after physical activity in both groups. The increment in melatonin levels after exercise was significantly higher in the SS group. There was a strong positive correlation between the rise of cortisol and IL-6 levels after exercise. CONCLUSIONS: In our study, controlled physical competitive activity in children 6 or 7 years of age showed no negative repercussion on cortisol secretion or in the liberation of IL-6.

[Inadequate secretion of atrial natriuretic peptide in children with acute brain injury]. / Secreción inadecuada de péptido natriurético auricular en niños con daño cerebral agudo.

OBJECTIVE: Fluid and electrolyte disturbances are frequent after acute brain damage. Atrial natriuretic peptide (ANP), which can also be found in brain tissue, could be a hormone implicated in such disorders (cerebral salt wasting syndrome). PATIENTS AND METHODS: Plasma ANP levels were analyzed in 50 children with acute neurological deterioration (secondary to traumatic, infectious, convulsive tumor or vascular disorders) evaluated according to the modified Glasgow Coma Scale (GCS). Hemodynamic stability was determined by standard monitoring. ANP, renin and aldosterone levels were determined by RIA and the results compared with a control group of healthy children. RESULTS: There was an increase in ANP levels in children with brain injury in comparison to the control group (p < 0.001), but not in children under one year of age. Renin and aldosterone were also significantly increased in this group of patients, with no difference in ANP, renin or aldosterone level found in function of their GCS score. All patients were hemodynamically stable and no correlation between hemodynamic and hormone variables was seen. Mechanical ventilation did not influence the hormone levels. CONCLUSIONS: There is an important increase in ANP levels in patients with acute neurological pathologies, but it was not related to the hemodynamic condition and its importance has yet to be established. One of its possible consequences is a secondary hypotonic/hypovolemic condition, a potentially dangerous event for the patient with intracranial hypertension that needs immediate treatment. Differentiation of this syndrome from inappropriate vasopressin secretion could be very important in children with acute brain injury.

[Tobacco consumption among school children and its relation to the environment]. / Consumo de tabaco entre escolares de E.G.B. y su relación con el entorno.

OBJECTIVE: The aim of our study was to know the prevalence of tobacco consumption and the influence of the immediate environment in schoolchildren. PATIENTS AND METHODS: Participants were a random sample of 1,195 sixth and eighth grade schoolchildren from our rural area (N = 14,537) with a mean age of 12.7 +/- 1.27 years. Data were collected from a confidential and anonymous survey about tobacco consumption. RESULTS: We found that 18.6% of children are currently smokers and 22% of them smoke daily. Forty-four percent of schoolchildren had tried tobacco occasionally. The mean age to start tobacco consumption was 11 years old. Regarding family environment, 56% of the fathers consumed tobacco daily in contrast to 22% of mothers. Logistic-regression analyses showed an independent association between smoking habits, alcohol and coffee consumption and smoking (habit in the best friend). CONCLUSIONS: A great number of schoolchildren had consumed tobacco occasionally. Group of friends had an important influence in the smoking habit, unlike the family environment. Moreover, tobacco consumption showed an independent association with bad habits like drinking alcohol and coffee.

[Effects of physical exercise on the cardiorespiratory system in children]. / Repercusión cardiorrespiratoria del ejercicio físico en niños.

OBJECTIVE: Our aim was to perform a prospective study to evaluate the effects of competitive sports on the cardiorespiratory system and physical performance in children. PATIENTS AND METHODS: Male children aged 6 and 7 years were selected from a public school (PS) and from a soccer sports school (SS). They underwent anthropometrical measurement. Those boys who were further than one standard deviation from the 50th percentile were excluded from the study. A total of 74 boys were selected with 41 being from the PS and 33 from the SS. Three different physical competitive activities were performed by the children. Hemodynamic measurements [heart rate (HR), systolic, mean and diastolic blood pressure (SBP, MBP and DBP)] and respiratory measurements [respiratory rate (RR), arterial oxygen saturation (SatO2), peak expiratory flow (PEF), forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and the FEV1/FVC relationship] were taken before and after the physical activity. RESULTS: Overall we found a significantly higher physical performance in the SS group (p < 0.001). The HR before and after exercise was significantly lower in the SS group. The comparison between constants before and after physical activity in each group showed a significant increase in HR, SBP, MBP and DBP in the PS group, but there was no difference between the SBP before and after physical activity in the SS group. The SS group had a significantly lower RR and better SatO2 in the basal measurement. The relationship between constants before and after physical activity showed a rise in the PEF in the PS group and a decrease in the SatO2 in the SS group. CONCLUSIONS: We recommend controlled physical competitive activity in children because of its benefits on cardiorespiratory function and the absence of adverse effects.

[Alcohol consumption and environmental influence among school children]. / Consumo de alcohol e influencia del entorno entre escolares de E.G.B.

OBJECTIVE: The objective of this study was to know the attitude towards alcohol and its consumption among schoolchildren. We also studied the influence of the immediate environment. PATIENTS AND METHODS: Participants were a random sample of sixth and eight grade schoolchildren during the 1995 school year from our rural area (n = 14,537). Data were collected from a confidential and anonymous survey about attitude and alcohol consumption. RESULTS: We found that 63% of children had tried alcohol occasionally. Forty-seven percent of them drank on a regular basis. Furthermore, 8% of this group consumed beer daily. Among frequent drinkers, 20.4% had gotten drunk at some time and this was more frequent among boys (p < 0.01) and older students. Forty percent of children did not think alcohol was a drug. Regarding family environment, 37% of fathers consumed alcohol daily in contrast to 4% of mothers. Logistic-regression analyses showed an independent association between alcohol consumption and smoking habits. CONCLUSIONS: A great number of schoolchildren and consumed alcohol occasionally. Boys and older students had gotten drunk more frequently than girls. Moreover, they believe that alcohol is not a drug and cannot perceive it as a harmful substance.

Relationship between hemodynamic changes and blood hormone concentrations after cardiac surgery in children with congenital heart disease.

OBJECTIVES: To evaluate changes in atrial natriuretic factor in relation to modifications in hemodynamic variables, and to evaluate hormones determining salt and water metabolism after heart surgery in children with congenital heart disease. DESIGN: Prospective study. SETTING: Medical-surgical pediatric intensive care unit (ICU) in a tertiary referral center. PATIENTS: Sixty-five infants and children admitted to the pediatric ICU with congenital heart disease who underwent cardiac surgery with extracorporeal circulation. The control group consisted of 48 children undergoing noncardiac surgical interventions, without a history of cardiac disease and with normal hemodynamic variables. MEASUREMENTS AND MAIN RESULTS: Patients with congenital heart disease were distributed into two groups, according to hemodynamic variables. Group 1 consisted of patients with normal pulmonary blood flow (pulmonary/systemic blood flow ratio of < 2, pulmonary arterial systolic pressure of < 35 mm Hg, pulmonary arterial systolic pressure/aortic systolic pressure ratio of < 0.35). Group 2 consisted of patients with relatively increased pulmonary blood flow (pulmonary/systemic blood flow ratio of > 2.5, pulmonary arterial systolic pressure of > 65 mm Hg, pulmonary arterial systolic pressure/aortic systolic pressure ratio of > 0.75). Blood samples were obtained 24 hrs before, and 24 and 48 hrs after surgery. Hormone determinations included plasma concentrations of atrial natriuretic factor, vasopressin, plasma renin activity, corticotropin, cortisol, and aldosterone. Hemodynamic measurements were recorded simultaneously with blood sampling. Twenty-four hours before surgery, plasma concentrations of atrial natriuretic factor were higher in congenital heart disease patients than in the control group (67.36 +/- 93.44 vs. 15.11 +/- 8.29 pmol/L) (p < .001). Plasma concentrations of atrial natriuretic factor were 57.12 +/- 82.20 and 74.63 +/- 101.03 pmol/L in groups 1 and 2, respectively. Before surgery, in group 2 patients, there was a significant correlation between mean right atrial pressure and atrial natriuretic factor (r2 = .64; p < .001), vasopressin (r2 = .55; p < .001), cortisol (r2 = .43; p < .01), corticotropin (r2 = .53; p < .01), and aldosterone (r2 = .57, p < .001). None of these correlations were observed in group 1. However, 24 hrs after surgery, we found a significant correlation between diastolic blood pressure and atrial natriuretic factor in group 1. Plasma concentrations of atrial natriuretic factor did not change significantly after surgery. After surgery, the correlation between mean right atrial pressure and the various hormone concentrations persisted at 24 hrs (p < .05), but not at 48 hrs. Twenty-four hours after surgery, patients with a central venous pressure of > 7 mm Hg showed higher concentrations of atrial natriuretic factor than those patients with central venous pressures of < 7 mm Hg (p < .05). However, there was a large overlap of atrial natriuretic factor values between the two groups. CONCLUSIONS: Patients with congenital heart disease have increased plasma concentrations of atrial natriuretic factor. During the early postoperative period, in patients with a more severe degree of congenital heart disease, the increase in central venous pressure correlated with higher plasma concentrations of atrial natriuretic factor. High pulmonary blood flow was associated with an increase in plasma renin activity and serum aldosterone, and an increased secretion of atrial natriuretic factor.

[Organochlorine compounds: blood levels in mothers, newborns, and infants, in maternal milk and formula. Study in the province of Huelva]. / Compuestos organoclorados: niveles sanguíneos en madres, recién nacidos y lactantes, en leche materna y de fórmula. Estudio en la provincia de Huelva.

We have studied the presence of organochlorine compounds (OCC), DDT, HCB, HCH and isomers alpha, beta and gamma or lindane, hepta-chloro-epoxide (HE) and polychlorobiphenyl compounds (PCB), in 50 mothers and their newborn babies. The samples studied included the umbilical cord blood, blood from the mothers during the delivery, blood from the baby at one and three months of age, and the milk fed to the babies at these periods (breast n = 30; bottle n = 20). The objectives of the study were: 1) To detect the levels of OCC in the different samples. 2) To discover the difference in levels between breast and bottle fed babies. 3) To quantify the variations of the levels in the different samples. 4) To check whether the acceptable daily intake (ADI) established for these OCC is exceeded among these babies. The analyses were done in the National Institute of Toxicology in Seville, by using the following methods, gas chromatography, electron capture detector and mass spectrometry. The statistical analysis was based on the Kruskal-Wallis, Shapiro-Wilks, Levene, Pooled and Separate tests. We have found significant levels of OCC in the samples analyzed. The PCBs are the compounds in our study which have the highest levels, indeed being one of the highest levels documented to date. We verify the decline in OCC of agricultural origin in relation to previous reports in our country, as has also been reflected in the international literature in recent years. The levels of OCC in breast fed babies are significantly higher than those in bottle fed babies.

[Organochlorine compounds: correlation between maternal and infantile blood levels, maternal milk and maternal-infantile parameters. Study in the province of Huelva]. / Compuestos organoclorados: relación de niveles sanguíneos en madres y recién nacidos y en leche materna con parámetros maternos y de lactantes. Estudio en la provincia de Huelva.

In our study of the levels of organochlorine compounds (OCC), several factors were taken into account. In the mother, age, diet, place of residency, profession, the number of previous breast-fed children and alcohol and tobacco intake. We then studied the effect of the OCC passed through the placenta. Here, we checked the length of gestation, the birth weight, the cephalic perimeter measurement, the possible neurological alterations such as hypotonie and hyporreflexie and the possible clinical repercussions of the OCC. The OCC studied were, DDT, hexachlorobenzene (HCB), hexachlorocyclohexanes (HCH) and isomers alpha, beta and gamma or lindane, dieldrin, heptachloro epoxide (HE) and polychlorobiphenyl compounds (PCB). The samples studies included, blood for the mother and umbilical cord during the delivery, blood from the babies at the ages of one and three months, and the mother's milk (n = 30) and formula milk (n = 20) one and three months after birth. The analytical study was made at the National Institute o Toxicology in Seville with the following methods, gas chromatography, electron capture detector and mass spectrometry. The statistical analysis was based on the Kruskal-Wallis, Shapiro Wilks, Levene, Pooled and Separate tests. We have found that older mothers and those who consumed more fatty meat and blue fish had statistically significant higher levels of OCC. There were also differences depending on the place of residency. The newborn babies with a greater birth-weight and cephalic perimeter measurements also had higher levels of OCC. In these babies, we also found clinical symptoms such as hypotonie and hyporreflexie.

[Hanhart syndrome (aglossia-adactylia syndrome). Report of 2 cases]. / Síndrome de Hanhart (Síndrome de aglosia-adactilia). A propósito de dos casos.

We discuss two cases of Hanhart syndrome, diagnosed at 3 days and 4 months respectively. Minimal diagnostic criteria (micrognathia and peromelia) are reported, and various etiologic hypothesis are discussed. This syndrome includes others as: aglossia-adactylia, hypoglossia-hypodactylia, oro-acral, oro-mandibular-limb-hipogenesis, ankyloglosia superior, glossopalatine ankylosis, peromelia and micrognathia. Emphasize the impossibility of prevention; the patients may die because of food aspiration, both parents an children being subsidiary of psychological support. The possibilities of logopedical treatment and prothesis of peromelic limb must be evaluated.

[Seasonal incidence of congenital hip dislocation. A risk factor]. / Incidencia estacional en la luxación congénita de cadera. Un factor de riesgo.

The congenital dislocation of the hip stational variation frequency is a known anecdotical data in various screening, but its etiology is unknown. Several authors had reported an increase of CDH during fall or winter time. The theory that they support for this finding is the wear use in some countries for the newborn, inducing extension and approximation of the limbs, which could justify the hip dislocation. Another etiological factors proposed by some authors is the climatical influence in mothers hormonal secretion. We have studied 33,000 alive newborns with a CDH frequency about 9.78 per thousand. The new fact that we report is an increase of CDH cases during springtime, without parallel increase in births. The hypothesis we support is: stational variations of CDH is not caused by mechanical factors instead there are another unknown agents. Nevertheless we advocate the springtime as a "risk factor" in our region.

[Brain death in the child. Review of 12 cases]. / Muerte cerebral en el niño. Revisión de 12 casos.

Twelve brain death diagnosed children have been retrospectively surveyed. Their age ranged between seven months and thirteen years (mean = 5.7 years old). Etiology was as follows: eight of cranial trauma, two of ground-trapped asphyxia, one of hypernatremic dehydration ans one of subglottic laryngitis. When a brain death diagnosis was suggested, neurodiagnosis complementary tests were carried out eight cases presented an isoelectric EEG since the first recording and their evoked potentials did no reflect any response. Among the eight children to whom brain angiogammography was made, five presented no flow in the first study. Brain circulation signs were detected in two other children, disappearing subsequently. When the EEG was isoelectric, positive responses were never obtained from the brainstem. However, flow was detected in two cases. We suggest that, in doubtful cases, absence of brain radioisotopic activity is the most specific way to assess brain death in children.

[Neonatal varicella: indications for the use of varicella-zoster specific immunoglobulin]. / Varicela neonatal: indicaciones para el uso de inmunoglobulina específica varicela-zoster.

Case reports from January-1986 through December-1988 of neonates born to women who develop varicella and neonates with household postnatal exposure are presented. Mother developed varicella in three cases (15 days before delivery, at delivery, 10 days after delivery), the last case was infected by direct exposure from his brothers. Only neonates with household contacts developed varicella. In every case varicella-zoster immunoglobulin a doses of 0.2 mg/kg/day from the three days was administered. Adding aciclovir intravenous a daily doses of 15 mg/kg/8h for seven days in neonates who developed varicella. Are propose considered a high risk group the neonates with postnatal exposure.

[Study of oxygenation and ventilation in critically ill children by non-invasive methods]. / Estudio de la oxigenación y ventilación por métodos no invasivos en niños críticamente enfermos.

Oxygenation and ventilation were studied by invasive and non-invasive methods in 31 critically ill children; the average age was 27.1 +/- 12.6 months (range from 1 to 144 months). All the patients were receiving mechanical ventilation and had arterial catheters. We correlated PtcO2, PtcCO2 and StcO2 with their respective arterial values, when FiO2 was 1.0, 0.6 and 0.4. There was a good correlation (p less than 0.001) in the three values of FiO2, but it was especially significant in 0.4 (r = 0.904 for PaO2 and PtcO2, r = 0.905 for PaCO2 and PtcCO2 and r = 1 for SaO2 and StcO2). We conclude that StcO2 is the most reliable transcutaneous parameter to evaluate oxygenation state in critically ill patients.

[Experimental study on the process of repair-healing of the flexor system in the growing chick]. / Estudio experimental del proceso reparación-cicatrización del aparato flexor del pollo en crecimiento.

In the present work, in view of the concern for tendinous injuries in children hand flexor apparatus, tendinous healing and its functional and morphological recuperation were studied after section and surgical restoration of the leg flexor apparatus of chicken at different growth stages. We conclude that best results are obtained when the rehabilitation begins ten days after surgery.