Volumen 22, Número 2. Marzo-Abril 2001
Kawasaki's disease
Ten patients with Kawasaki's disease (KD) were studied; the mean age was five years with male sex predominance of 1.5:1.
An echocardiogram was performed in eight cases; three showed coronary alterations; two had bilateral aneurysms, the first one measured 7 mm in the right coronary and 4 mm in the left; another patient had bilateral aneurysms measuring 6 mm in the left coronary and 3 mm in the right one. The third case had a 4 mm left coronary aneurysm. Pericarditis occurred in three patients; mild pericardial effusion in one; two had myocarditis and congestive heart failure. A coronariography and perfusory gammagram were performed in the cases with echocardiographic coronary alterations.An echocardiographic follow-up was done in eight patients; the aneurysm persisted in all. Every patient was given aspirin and five of them received intravenous gammaglobulin. This disease predominates in Asiatic population, but several cases have been diagnosed in our country.
Key words: Kawasaki's disease, coronary aneurysm, echocardiogram, pericarditis, congestive heart failure.
Continous gastroesophageal PH in children for 24 hours. 200 cases study.
Objective. The experience of 24 hour pH monitoring in the diagnosis of gastroesophageal reflux in children is described.
Design. Retrospective, cross-sectional, observational and descriptive study.
Methods. A 24 hours pH monitoring using a Digitrapper Mk III (Synectics Medical System) with monocristal antimony probe was performed in 200 children with the clinical diagnosis of gastroesophageal reflux. On the basis of Boyle's classification the patients were divided into two groups: Group I with pathological gastroesophageal reflux and group II with physiological reflux. Fisher exact test was used to compare the categorical variables; Wallis test, Chi square with a degree of freedom, to continuous variables. All the tests were two-tailed with an alpha of 0.05.
Results. 91/200 (45%) children were in group I (pathological reflux) and 109 in group II (physiological reflux). The most common variables in group I were: reflux index, fraction time of pH below 4 (percentage) and longest reflux episode.
Discussion. 45% of the children had a pathological gastroesophageal reflux. The three variables of Boyle's classification found suggested that they are related with the mechanism of esophageal clearance. However, it will be necessary to perform simultaneous 24 hours pH monitoring and motility of the esophagus to establish it with certainty.
Key words: Intraesophagic pH, esophagogastric reflux, gastroesophageal-duodenal X ray series, clearance mechanism.
Vascular access in children
The establishment of a vascular access is one of the most important procedures in emergency departments. Vascular access in children can difficult, delayed and frustrating. The intraosseus infusion was used for the first time in 1922 and gradually replaced from 1950 to 1960 by the use of intravenous catheters; it reappeared in 1983. Intraosseus infusions permits a fast and complete delivery of fluids and medicines comparable to an intravenous cannula of equal caliber in a similar position. It is different from most venous structures, and it is noncollapsible. The ideal sites of intraosseus access are the proximal tibia and the distal femur. Is only indicated as an emergency procedure, when a peripheral venous access cannot be obtained after 90 seconds or three attempts in critically ill children. It is contraindicated in cellulitis, osteomielitis, fractures, osteopetrosis and imperfect osteogenesis.
Key words: Intraosseous access, bone marrow, tibia, femur, osteomielitis, osteogenesis.
Hiperamonemia in Epileptic children treaties with Valproic acid.
Introduction. Epilepsy is a public health problem, which affects mainly children. Valproic acid is an antiepileptic drug useful for partial and for generalized seizures. It has colateral toxic effects; the more frequent of which are gastritis, thrombocitopenia, hepatopathy and hyperamonemia.
Material and methods. This study was done at the Department of Neurology in the Instituto Nacional de Pediatría, between January 1994 and December 1996. The main clinical findings of hyperamonemia in epileptic children managed with valproic acid are analyzed.
Results. Sixteen patients, eight were female, with a median for age of five years. Eleven had a normal psicomotor development. Seven had symptomatic epilepsy and ten developed both partial and generalized seizures. Two were treated only with valproic acid, four were given two medications and ten received three or more drugs. The main clinical findings of hyperamonemia were: altered mental status, anorexia and vomiting, nausea, skin eruption and ataxia. Blood concentration of ammonia ranged between 101 and 538 ug/mL. Treatment included valproic acid withdrawal in 13 and reduction of valproic acid total dose in three; ten patients received lactulose, neomicyne and sodium benzoate and three required blood exchange. Ammonia blood concentration returned to normal in seven to ten days. In fourteen patients hyperamonemia was brought under control; three of them had a recurrency because of reuse of valproic acid and two patients were lost to follow-up.
Conclusions. Hyperamonemia is a severe secondary effect of valproic acid. Factors related to hyperamonemia in this series were: chronic use with high therapeutic doses; polipharmacy specially with phenobarbital; age under three years and supratherapeutic blood concentration of valproic acid.
Key words: Valproic acid, epilepsy, hyperamonemia, gastritis, thrombocitopenia, hepatopathy.
Life Cycle of Aedes aegypti and clinical manifestations
The vectors that transmit dengue are certain species of Aedes, is the aegypti the most common with a single life cycle: man-A. aegypti-man.
The life cycle includes several stages: eggs, four larval stages, pupa and adult. It is associated with the activities of man in view of characteristics of reproduction and feeding habits. The clinical picture of this entity for the diagnosis of hemorrhagic and feeding. As for the clinical square of this entity for the diagnosis of hemorrhagic dengue and síndromes of shock for dengue are basic observe the séquense of the clinical events and of laboratory with evaluation and taking demonstrates periodic.
· There are identified signs of alarma that make inminent the square to the cardinal fact.
· Persistent vomit.
· Abrupt fall of temperature, from hyperthermia to hypothermia, frequently associated by sweating, adynamia and lypothymy.
· Restlesness or drowsiness.
For therefore is of vital importance that the clinic identifies this type of pathology for the importance of the clinical square and possibility of death.
Key words: Clinical features, Aedes aegypti, egg, larval stadium, pupa.
Socioeconomic identification compared with the social study. Analysis in the National Institute of the Pediatrics
Objective. To verify the difference in results obtained by the application of a Social Study and by a Socioeconomic Interview.
Methods. Observational, comparative, retrospective and cross-sectional study, of 94 families done in the Instituto Nacional de Pediatría which included: a) A review of the Socioeconomic Interview with selection of hospitalized patients was done to make the Social Study. b) A review of social and/or clinical records. c) Verification of the information for both instruments. Results by standard deviation, median (minimun-maximum) or percentage are described. Each component was compared by Chi square, correlation analysis and agreement coefficient; a p < 0.05 was considered as significant.
Results. There was a good agreement with respect to father's employment, economic status, expenses for food and number of people by room. There was a poor correlation between type of house and public services. In relation to the general assigned classification, there was an absolute agreement of 0.69 and kappa of 0.46 was considered apoor relation.
Discussion. We conclude that the socioeconomic interview is in general a good instrument to explore the socioeconomic condition of the family; caution is recommended with respect to house characteristics and global classification.
Key words: Socioeconomic interview, Social study, house characteristics, agreement coeficient, correlation analysis.
Sexual Secondary Characteristic (Teenagers)
During puberty, appear somatic characteristics with the purpose of long distance identification of the individuals with pleny reproductive capacity and distinguish male from female, as part of filogenetic process to assure the specie reproduction.
These changes, known as secondary sexual characteristics, shows different intensity between one population and other, and those descripted for northeuropeans differs from the expressed in mexican population, particularly in indigens.
Key words: Puberty, secondary sexual characteristics, menarche.
