Pediatría
| Au: Burton BK. ----- Ti: Inborn errors of metabolism in infancy: a guide to diagnosis. ----- So: Pediatrics. 102(6):E69, 1998 Dec. ----- Ab: Recent advances in the diagnosis and treatment of inborn errors of metabolism have improved substantially the prognosis for many of these conditions. This makes it essential that the practicing pediatrician be familiar with the clinical presentation of these disorders. A practical clinical approach to the recognition of inborn errors of metabolism in the young infant is presented in this review. Indications for specific laboratory studies are discussed. Guidelines are provided for the stabilization and emergency treatment of critically ill infants. This approach will identify those infants who will benefit from additional evaluation and specific treatment. Many of the inborn errors of metabolism, including urea cycle defects, organic acidemias, and certain disorders of amino acid metabolism, present in the young infant with symptoms of an acute or chronic metabolic encephalopathy. Typical symptoms include lethargy, poor feeding, apnea or tachypnea, and recurrent vomiting. Metabolic acidosis and/or hyperammonemia are observed in many of these conditions, but there are notable exceptions, including nonketotic hyperglycinemia and molybdenum co-factor deficiency. Therefore, appropriate laboratory testing for metabolic disorders should be performed in any infant who exhibits these findings. Although sepsis may be the initial consideration in a neonate with these symptoms, inborn errors of metabolism should always be in the differential diagnosis, particularly in a full-term infant with no specific risk factors. Hypoglycemia may be the predominant finding in a number of inborn errors of metabolism, including glycogen storage disorders, defects in coneogenesis, and fatty acid oxidation defects. The latter disorders, among the most common encountered, exhibit marked clinical variability and also may present as a sudden death, a Reye's-like episode, or a cardiomyopathy. Jaundice or other evidence of hepatic dysfunction is the mode of presentation of another important group of inborn errors of metabolism including galactosemia, hereditary tyrosinemia, neonatal hemochromatosis, and a number of other conditions. A subset of lysosomal storage disorders may present very early with coarse facial features, organomegaly, or even hydrops fetalis. Specific patterns of dysmorphic features and congenital anomalies characterize yet another group of inherited metabolic disorders, such as Zellweger syndrome and the Smith-Lemli-Opitz syndrome. Each of these symptom complexes, and the appropriate evaluation of the affected infants, is discussed in more detail in this review (Au). |
| Au: Luo ZC; Albertsson-Wikland K; Karlberg J. ----- Ti: Length and body mass index at birth and target height influences on patterns of postnatal growth in children born small for gestational age. ----- So: Pediatrics. 102(6):E72, 1998 Dec. ----- Ab: OBJECTIVE: Previous growth studies on children born small for gestational age (SGA) indicate that birth length, weight, and target height are important predictors for postnatal catch-up growth in SGA. Their influences on different phases of catch-up growth are still not described. The aim of this study was to clarify the influences of target height, length, and nutritional status at birth on different phases of postnatal catch-up growth (infancy, childhood, puberty) in SGA and the long-term consequences. METHODS: Data were obtained from a longitudinal population-based growth study on Swedish children (N = 2815). Primary outcome measurements include heights, the changes in height standard deviation scores (SDS) during various phases of growth and relative risk for adult shortness. RESULTS: The difference in final height in children born SGA was attributable to their difference in target height and the magnitude of catch-up growth during the first 6 months of life, rather than the difference in length or body mass index (BMI) at birth. Length at birth showed negative influence on catch-up growth during infancy (0 to 2 years of age), but no significant influence thereafter. The BMI or weight for length SDS at birth showed no significant influence on catch-up growth during any growth phase. Target height showed positive influence on catch-up growth from the onset of childhood. Neither target height nor length and BMI at birth showed any significant influence on catch-up growth during puberty. The magnitude of catch-up growth during infancy, especially the first 6 months of life, is most critical in decreasing risk at adult shortness. We confirmed that the SGA group had a sevenfold greater risk for adult shortness than the non-SGA group (relative risk = 7.31; 95% confidence interval: 3.96-13.52). However, approximately 40% of children who were below -2 in height SDS at 2 years of age remained short at final height in both SGA and non-SGA groups. The mean height SDS of children born SGA increased by 1.65 from birth to final height, but the length deficit in centimeters at birth (-5.4 cm) persisted into adulthood (-5.9 cm). CONCLUSIONS: BMI at birth is not related to postnatal catch-up growth in infants born SGA, but birth length and target height are important. The genetic influence on catch-up growth appears to start from the onset of childhood. Being born short or becoming short during the first 2 years of life is similar in terms of risk for adult short stature (Au). |
| Au: Arditi M; Mason EO Jr; Bradley JS; Tan TQ; Barson WJ; Schutze GE; Wald ER; Givner LB; Kim KS; Yogev R; Kaplan SL. ----- Ti: Three-year multicenter surveillance of pneumococcal meningitis in children: clinical characteristics, and outcome related to penicillin susceptibility and dexamethasone use. ----- So: Pediatrics. 102(5):1087-97, 1998 Nov. ----- Ab: OBJECTIVES: To evaluate the antibiotic susceptibility of Streptococcus pneumoniae isolates obtained from the blood and cerebrospinal fluid of children with meningitis. To describe and compare the clinical and microbiological characteristics, treatment, and outcome of children with meningitis caused by S pneumoniae based on antimicrobial susceptibility of isolates and the administration of dexamethasone. DESIGN AND PATIENTS: Children with pneumococcal meningitis were identified from among a group of patients with systemic infections caused by S pneumoniae who were enrolled prospectively in the United States Pediatric Multicenter Pneumococcal Surveillance Study at eight children's hospitals in the United States. From September 1, 1993 to August 31, 1996, 180 children with 181 episodes of pneumococcal meningitis were identified and data were collected by retrospective chart review. OUTCOME: Clinical and laboratory characteristics were assessed. All pneumococcal isolates were serotyped and antibiotic susceptibilities for penicillin and ceftriaxone were determined. Clinical presentation, hospital course, and outcome parameters at discharge were compared between children infected with penicillin-susceptible isolates and those with nonsusceptible isolates and for children who did and did not receive dexamethasone. RESULTS: Fourteen (7.7%) of 180 children died; none of the fatalities were because of a documented failure of treatment caused by a resistant strain. Only 1 child, who had mastoiditis and a lymphangioma, experienced a bacteriologic failure with a penicillin-resistant (minimum inhibitory concentration = 2 microgram/mL) organism. Of the 166 surviving children, 41 (25%) developed neurologic sequelae (motor deficits) and 48 (32%) of 151 children had unilateral (n = 26) or bilateral (n = 22) moderate to severe hearing loss at discharge. Overall, 12.7% and 6.6% of the pneumococcal isolates were intermediate and resistant to penicillin and 4.4% and 2.8% were intermediate and resistant to ceftriaxone, respectively. Clinical presentation, cerebrospinal fluid indices on admission, and hospital course, morbidity, and mortality rates were similar for patients infected with penicillin- or ceftriaxone-susceptible versus nonsusceptible organisms. However, the relatively small numbers of nonsusceptible isolates and the inclusion of vancomycin in the treatment regimen for the majority of the patients limit the power of this study to detect significant differences in outcome between patients infected with susceptible and nonsusceptible isolates. Nonetheless, our results show that the nonsusceptible organisms do not seem to be intrinsically more virulent. Forty children (22%) received dexamethasone (>/=8 doses) initiated before or within 1 hour after the first dose of antibiotics. The incidence of any moderate or severe hearing loss was significantly higher in the dexamethasone group (46%) compared with children not receiving any dexamethasone (23%). The incidence of any neurologic deficits, including hearing loss, also was significantly higher in the dexamethasone group (55% vs 33%). However, children in the dexamethasone group more frequently required intubation and mechanical ventilation and had lower initial concentration of glucose in the cerebrospinal fluid than children who did not receive any dexamethasone. When we controlled for the confounding factor, severity of illness (intubation), the incidence of any deafness and of any neurologic sequelae, including deafness, were no longer significantly different between children who did or did not receive dexamethasone. CONCLUSIONS: Children with pneumococcal meningitis caused by penicillin- or ceftriaxone-nonsusceptible organisms and those infected by susceptible strains had similar clinical presentation and outcome. The use of dexamethasone was not associated with a beneficial effect in this retrospective and nonrandomized study. (ABSTRACT TRUNCATED) (Au). |
| Au: Gerber MA; Tanz RR; Kabat W; Bell GL; Siddiqui Bp; Lerer TJ; Lepow ML; Kaplan EL; Shulman ST. ----- Ti: Potential mechanisms for failure to eradicate group A streptococci from the pharynx. ----- So: Pediatrics. 104(4 Pt 1):911-7, 1999 Oct. ----- Ab: OBJECTIVE: To investigate the relative efficacy of orally administered cefadroxil and penicillin V in the treatment of group A streptococcal (GABHS) pharyngitis and the mechanism(s) responsible for failure of antimicrobial therapy to eradicate GABHS from the pharynx. STUDY DESIGN: A prospective, randomized clinical trial was conducted in four pediatric offices in which 462 patients with acute pharyngitis and positive culture for GABHS were randomly assigned to receive cefadroxil (n = 232) or penicillin V (n = 230). RESULTS: Bacteriologic treatment success rates for patients in cefadroxil and penicillin groups were 94% and 86%, respectively. However, among patients classified clinically as likely to have bona fide GABHS pharyngitis, there was no difference in bacteriologic treatment success rates in cefadroxil and penicillin groups (95% and 94%, respectively). Among patients classified clinically as likely to be streptococcal carriers, bacteriologic treatment success rates in cefadroxil and penicillin groups were 92% and 73%, respectively. The presence of beta-lactamase and/or bacteriocin-producing pharyngeal flora had no consistent effect on bacteriologic eradication rates among patients in either penicillin or cefadroxil treatment groups or among patients classified as having either GABHS pharyngitis or streptococcal carriage. CONCLUSIONS: Neither beta-lactamase nor bacteriocin produced by normal pharyngeal flora are related to bacteriologic treatment failures in GABHS pharyngitis. Cefadroxil seems to be more effective than penicillin V in eradicating GABHS from patients classified as more likely to be streptococcal carriers. However, among patients we classified as more likely to have bona fide GABHS pharyngitis, the effectiveness of cefadroxil and penicillin V seems to be comparable (Au). |
| Au: Rane A. ----- Ti: Phenotyping of drug metabolism in infants and children: potentials and problems. ----- So: Pediatrics. 104(3 Pt 2):640-3, 1999 Sep. |
| Au: Connor JD. ----- Ti: A look at the future of pediatric therapeutics: an investigator's perspective of the new pediatric rule. ----- So: Pediatrics. 104(3 Pt 2):610-3, 1999 Sep. |
| Au: Nahata MC. ----- Ti: Lack of pediatric drug formulations. ----- So: Pediatrics. 104(3 Pt 2):607-9, 1999 Sep. ----- Ab: Many drugs frequently used in infants and young children are not available in suitable dosage forms. Liquid dosage forms must be prepared extemporaneously, while using appropriate excipients. However, it is critical to determine the stability of various drugs at clinically important concentrations and practical storage conditions. It is of concern that few funding agencies are willing to support research on the development of stable liquid dosage forms for pediatric patients. The need for such data will continue, because it is unlikely that all drugs approved for adults will also be labeled simultaneously for potential use in infants and children. Presentations and publications on stable drug formulations will offer the opportunities for pediatric patients to receive the desired drugs and doses most effectively and safely (Au). |
| Au: Choonara I. ----- Ti: Essential drugs for infants and children: European perspective. ----- So: Pediatrics. 104(3 Pt 2):606, 1999 Sep. |
| Au: Lesko SM; Mitchell AA. ----- Ti: The safety of acetaminophen and ibuprofen among children younger than two years old. ----- So: Pediatrics. 104(4):e39, 1999 Oct. ----- Ab: BACKGROUND: Recently ibuprofen has been introduced as a nonprescription analgesic/antipyretic for use in children. OBJECTIVE: To compare the incidence of serious adverse clinical events among children <2 years old given ibuprofen and acetaminophen to control fever. STUDY DESIGN: A practitioner-based, randomized clinical trial. A total of 27 065 febrile children were randomized to receive acetaminophen (12 mg/kg), ibuprofen (5 mg/kg), or ibuprofen (10 mg/kg). Rates of hospitalization for acute gastrointestinal bleeding, acute renal failure, anaphylaxis, Reye's syndrome, asthma, bronchiolitis, and vomiting/gastritis were compared by randomization group. RESULTS: The risk of hospitalization with any diagnosis in the 4 weeks after enrollment was 1.4% (95% confidence interval, 1. 3%-1.6%) and did not vary by antipyretic assignment. No children were hospitalized for acute renal failure, anaphylaxis, or Reye's syndrome. Three children were hospitalized with gastrointestinal bleeding; all 3 had been assigned to treatment with ibuprofen. The risk of hospitalization with gastrointestinal bleeding among children randomized to ibuprofen was 17 per 100 000 (95% confidence interval, 3.5-49 per 100 000) but was not significantly greater than the risk among children given acetaminophen. The risk of hospitalization with asthma, bronchiolitis, or vomiting/gastritis did not differ by antipyretic assignment. CONCLUSIONS: The risk of serious adverse clinical events among children <2 years old receiving short-term treatment with either acetaminophen or ibuprofen suspension was small and did not vary by choice of medication. These data do not provide any information on the safety of these medications when used for prolonged periods or when used together, regardless of duration (Au). |
| Au: Bronsky EA; Pearlman DS; Pobiner BF; Scott C; Wang Y; Stahl E. ----- Ti: Prevention of exercise-induced bronchospasm in pediatric asthma patients: A comparison of two salmeterol powder delivery devices. ----- So: Pediatrics. 104(3 Pt 1):501-6, 1999 Sep. ------ Ab: BACKGROUND: A powder formulation of salmeterol has been shown to prevent exercise-induced bronchospasm (EIB) in asthmatic children and adults; however, the delivery device (Diskhaler; Glaxo Wellcome Inc, Research Triangle Park, NC) must be reloaded after 4 doses. A new multidose powder inhaler (Diskus) provides 60 doses of salmeterol in a blister pack presentation with a dose counter. OBJECTIVE: To evaluate the safety and efficacy of 50-microg salmeterol powder via two different delivery systems (Diskhaler and Diskus) in preventing EIB in asthmatic children. STUDY DESIGN: A randomized, double-blind, double-dummy, single-dose, placebo-controlled, three-way crossover study was conducted in 24 children 4 to 11 years of age demonstrating EIB and mild to moderate asthma. Serial forced expiratory volume in 1 second (FEV(1)) was measured before and after treadmill exercise challenges conducted at 1, 6, and 12 hours after study drug administration. Adverse events were also assessed. RESULTS: During all exercise challenges, EIB-mediated reductions in FEV(1) were minimized or prevented in patients receiving single doses of salmeterol powder compared with placebo. Single doses of salmeterol powder delivered via either system were equally effective in preventing EIB. There were no drug-related adverse events, cardiovascular, or other clinically relevant safety concerns. CONCLUSIONS: Single doses of salmeterol powder delivered by either delivery system are safe and effective in preventing EIB for >/=12 hours in asthmatic children (Au). |
| Au: Celedon JC; Litonjua AA; Weiss ST; Gold DR. ----- Ti: Day care attendance in the first year of life and illnesses of the upper and lower respiratory tract in children with a familial history of atopy. ----- So: Pediatrics. 104(3 Pt 1): 495 - 500, 1999 Sep. ----- Ab: OBJECTIVE: To examine the relationship between day care attendance and illnesses of the upper and lower respiratory tract in the first year of life. STUDY DESIGN: Prospective birth cohort study. METHODS: Children (N = 498) who had at least 1 parent with a history of allergy or asthma were enrolled at birth and followed prospectively for the first year of life. A home visit at 2 to 3 months of age and bimonthly telephone questionnaires were used to obtain information on day care arrangements, home characteristics, respiratory symptoms, and physician-diagnosed illnesses of the upper and lower respiratory tract. RESULTS: Day care attendance in the first year of life was associated with two or more doctor-diagnosed ear infections (OR: 2.4; 95% CI: 1.7-3.6), three or more parental reports of runny or stuffed nose (OR: 3.2; 95% CI: 1.9-5.5), a doctor's diagnosis of sinusitis (OR: 2.2; 95% CI: 1.1-4.2), and doctor-diagnosed lower respiratory illnesses (croup, bronchitis, bronchiolitis, and pneumonia; OR: 1.6; 95% CI: 1.0-2.4). For children attending day care, exposure to pets in day care, the presence of a rug or carpet in the area where the child slept in day care, and a nonresidential setting for day care all were independent predictors of two or more doctor-diagnosed ear infections. CONCLUSIONS: The results suggest that day care increases the risk of illnesses of the upper and lower respiratory tract in the first year of life for children with a familial history of atopy. Specific environmental exposures within day care, such as the presence of pets or having a rug or carpet in the area where children sleep, may increase the risk of recurrent ear infections in the first year of life among children with familial history of atopy who attend day care (Au). |
| Au: Peng CT; Lin HC; Lin YJ; Tsai CH; Yeh TF. ----- Ti: Early dexamethasone therapy and blood cell count in preterm infants. ----- So: Pediatrics. 104(3 Pt 1):476-81, 1999 Sep. ----- Ab: OBJECTIVE: To assess the effects of early postnatal dexamethasone therapy on hematologic values in preterm infants. Materials and METHODS: We reviewed the hematologic data of 179 preterm infants who participated in a double-blind clinical trial of early postnatal dexamethasone therapy (<12 hours after birth) for the prevention of chronic lung disease. One group (86 infants) received saline and the other group (93 infants) received dexamethasone. Dexamethasone was given intravenously every 12 hours in tapering doses: 0.25 mg/kg on days 1 to 7, 0.12 mg/kg on days 8 to 14, 0.05 mg/kg on days 15 to 21, and 0.02 mg/kg on days 21 to 28. Blood samples were obtained on days 0, 3, 7, 10, 14, 21, and 28. None of the infants received prenatal steroid therapy. RESULTS: Multiple regression analysis revealed significant differences in the values versus time curves of the white blood cell, neutrophil, lymphocyte, basophil, and eosinophil counts between the two groups. The white blood cell count was significantly higher in the dexamethasone group on days 7 through 14, and this was associated with significantly higher numbers of segmented neutrophils and band forms and significantly lower numbers of lymphocytes and eosinophils. The hematocrit and platelet counts were similar in the two groups throughout most of the trial. Except for platelet count, steroid therapy did not alter the hematologic values for infants with bacteremia. CONCLUSION: Dexamethasone affects white blood cell, segmented neutrophil, lymphocyte, basophil, and eosinophil counts in neonates. This should be taken into consideration when evaluating preterm infants who are receiving dexamethasone.early dexamethasone therapy; neonatal blood count; preterm infant; respiratory distress syndrome (Au). |
| Au: Newman RD; Grupp-Phelan J; Shay DK; Davis RL. ----- Ti: Perinatal risk factors for infant hospitalization with viral gastroenteritis. ----- So: Pediatrics. 103(1):E3, 1999 Jan. ----- Ab: CONTEXT: A tetravalent vaccine against rotavirus, the most commonly identified etiologic agent of viral gastroenteritis (GE), has recently been licensed for use in the United States. OBJECTIVE: To evaluate whether specific groups of infants might be at sufficiently high risk to warrant a focused rotavirus vaccine policy, we investigated perinatal risk factors for hospitalization with viral GE and rotavirus in the first year of life. DESIGN: Population-based, case-control study. SETTING: Washington State linked birth certificate and hospital discharge abstracts from 1987 through 1995. PATIENTS: Infants, 1 through 11 months of age, hospitalized for viral GE (N = 1606) were patients in this study. Control subjects were 8084 nonhospitalized infants, frequency-matched to patients on year of birth. PRIMARY OUTCOME MEASURE: Maternal and infant characteristics associated with infant hospitalization for viral GE. RESULTS: We found a significant association between birth weight and the risk for hospitalization. Very low birth weight infants (<1500 g) were at the highest risk (odds ratio [OR] 2.6; 95% confidence interval [CI]: 1.6,4.1);, low birth weight infants (1500-2499 g), at intermediate risk (OR 1.6; 95% CI: 1.3,2.1); and large infants (>4000 g), at reduced risk (OR 0.8; 95% CI: 0.6,0.9). Other characteristics associated with GE hospitalization were male gender (OR 1.4; 95% CI: 1.3,1.6); maternal smoking (OR 1.2; 95% CI: 1.1,1. 4); unmarried mother (OR 1.2; 95% CI: 1.1,1.4); Medicaid insurance (OR 1.4; 95% CI: 1.3,1.7); and maternal age <20 years (OR 1.2; 95% CI: 1.0,1.5). Infants born October through December were at decreased risk for hospitalization (OR 0.8; 95% CI: 0.7,0.9), as were infants born to Asian mothers (OR 0.5; 95% CI: 0.3,0.7), and infants born to mothers >34 years of age (OR 0.7; 95% CI: 0.6,0.9). Using these factors, the area under a receiver operating characteristic curve was 0.63. Therefore, to achieve a sensitivity of 90% in identifying high-risk infants, specificity would fall to 10%. Subanalyses of children admitted for viral GE during the peak of the Northwest rotavirus season (January to March) and children with confirmed rotavirus infection demonstrated similar risk factors and receiver operating characteristic curves. CONCLUSION: We conclude that a focused rotavirus vaccination policy using readily identifiable potential high-risk groups would be unlikely to prevent most infant hospitalizations associated with rotavirus infection. However, the safety of rotavirus vaccine in low birth weight and premature infants must be established, because these children appear to be at greater risk for hospitalization with viral GE and rotavirus (Au). |
| Au: Fox LM; Gerber MA; Penix L; Ricci A Jr; Hyams JS. ----- Ti: Intractable diarrhea from cytomegalovirus enterocolitis in an immunocompetent infant. ----- So: Pediatrics. 103(1):E10, 1999 Jan. ----- Ab: Infection with cytomegalovirus (CMV) in infants can be congenital or perinatal. Infected infants may be asymptomatic or present with pneumonia, rash, epatosplenomegaly, or encephalitis.1 In the presence of an immunodeficiency, severe and sometimes fatal disease may occur. To our knowledge, CMV has not been identified previously as a cause of intractable diarrhea of infancy. We report the case of a 5-week-old immunocompetent infant with intractable diarrhea attributable to CMV-induced enterocolitis. Recognition of this infection and initiation of ganciclovir therapy was associated with a rapid improvement and resolution of the diarrhea (Au). |
| Au: Costa LA; Kopreski MS; Demers LM; Chinchilli VM; Santen RJ; Harvey HA; Lipton A. ----- Ti: Effect of the potent aromatase inhibitor fadrozole hydrochloride (CGS 16949A) in postmenopausal women with breast carcinoma. ----- So: Cancer. 85(1):100-3, 1999 Jan 1. ----- Ab: BACKGROUND: Fadrozole hydrochloride (CGS 16949A) is a highly potent, nonsteroidal aromatase inhibitor that significantly lowers estrogen levels in postmenopausal women and can be effective therapy for patients with advanced hormone-dependent breast carcinoma. Circulating estradiol, estrone, and estrone sulfate are reduced to undetectable levels within weeks of the initiation of therapy. Before this study, it was not known whether this decrease in serum estrogen levels results in altered parameters associated with cardiovascular disease. The authors examined the levels of several critical blood parameters that are important to cardiovascular risk for heart disease and thromboembolic disorders in patients treated with fadrozole. METHODS: Cholesterol, triglyceride, low density lipoprotein (LDL), high density lipoprotein (HDL), very low density lipoprotein (VLDL), antithrombin III, protein C, protein S, and fibrinogen were serially measured in 21 postmenopausal women with advanced breast carcinoma treated with various doses of fadrozole (1.8 mg/day, n=3; 2.0 mg/day, n=13; 4.0 mg/day, n=5) over 3-24 months (mean, 15.8 months). A repeated measure analysis of variance was applied to each cardiovascular variable to assess changes in the response over time. Analyses were performed separately for each dose group and were also pooled over the dose groups. RESULTS: There was no statistically significant change over time in lipid parameters, namely, total cholesterol (P=0.57), triglyceride (P=0.27), LDL (P=0.99), HDL (P=0.30), and VLDL (P=0.43), over the 24 months of therapy. There were also no significant changes in coagulation factors, namely, antithrombin III (P=0.41), protein C (P=0.49), or protein S (P=0.31), over the 24 months. However, an increase in fibrinogen that occurred over time did reach statistical significance (P=0.011). CONCLUSIONS: With the exception of acute phase reactant fibrinogen, this study did not identify an increase in parameters associated with cardiovascular disease in women treated with fadrozole, a potent aromatase inhibitor (Au). |
| Au: Rahman ZU; Frye DK; Smith TL; Asmar L; Theriault RL; Buzdar AU; Hortobagyi GN. ----- Ti: Results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with standard dose doxorubicin-containing chemotherapy: a reference. ----- So: Cancer. 85(1):104-11, 1999 Jan 1. ----- Ab: BACKGROUND: The authors report results and long term follow-up for 1581 patients with metastatic breast carcinoma treated with doxorubicin-containing combination chemotherapy at a single institution; this report is meant to serve as a reliable reference for single-arm studies of newer therapies in this patient population. METHODS: Prospectively collected data from 18 successive doxorubicin-containing protocols for the treatment of metastatic breast carcinoma were evaluated. RESULTS: The response rate was 65.0% (95% confidence interval [CI]: 62.5-67.3%), complete response (CR) rate was 16.6% (95% CI: 14.8-18.6%), and partial response (PR) rate was 48.5% (95% CI: 46.0-50.9%). Median progression free survival (PFS) was 11.5 months (95% CI: 10.9-12.3 months) and median overall survival (OS) was 21.3 months (95% CI: 20.3-22.7 months). Survival correlated with response to therapy; median PFS and OS were 22.4 and 41.8 months, respectively, … (AU) |
| Au: Gutierrez Bottino, Ma. del Carmen; Rubio Santoro, Ivonne M; Balbela Ballebela, Beatriz N; Lemes Araballo, Aida L. ----- Ti: Muerte inesperada del lactante / Unexpected infant death. ----- Fu: Arch. pediatr. Urug; 68(4):59-69 , 1997. tab. ----- Co: Presentado en: Congreso Uruguayo de Pediatria, 21, Montevideo, oct. 1997. ----- Re: La muerte de un lactante sano es un hecho desesperante e imprevisto para sus padres y su pediatra. Por su frecuencia y consecuencias trasciende el campo de la salud publica y es actualmente un problema sanitario no resuelto. Tiene connotaciones juridicas que deben contemplarse. En esta comunicacion se plantea la necesidad del abordaje multidisciplinario del tema con la creacion de un equipo de estudio nacional que contemple en su integracion el ambito pediatrico, anatomo patologico y medico legal y que permita formular politicas sanitarias validas (AU). |
| Au: Comite de Neumologia de la SUP; Comite de Infectologia de la SUP. ----- Ti: Pautas de neumonia / Guidelines on pneumonia. ----- Fu: Arch. pediatr. Urug; 68(4):53-7, 1997. |
| Au: Caggiani Malzone, Marina; Otero Bosque, Ana M; Cotic Salaberry, M. Graciela; Nairac Perdomo, Antonio. ----- Ti: Sindrome de anticuerpos antifosfolipidos primarios en el niño: presentacion de cinco casos clinicos / Antiphospholipid antibodies syndrome in childhood. ----- Fu: Arch. pediatr. Urug; 68(4):25-32, 1997. ilus, tab. ----- Re: El sindrome de anticuerpos antifosfolipidos (SAAF) primario y secundario se caracteriza por trombosis venosas y arteriales, trombocitopenia, aborto y muerte fetal recurrente entre otras manifestaciones menos frecuentes. Se presentan cinco casos de S¡ndrome antifosfolipidos (SAAF), primario en ni¤os con edades comprendidas entre 1 y 13 años; dos casos se manifestaron con signologia neurologica: infarto cerebral y accidente isquemico transitorio, dos casos como hipertension renovascular severa con encefalopatia hipertensiva y un caso como purpura trombocitopenico y flebotrombosis. Se analiza la forma de presentacion clinica, destacando aspectos relacionados con la patogenia, mecanismo de accion de los anticuerpos antifosfolipidos asi como las controversias acerca de la conducta terapeutica (AU). |
| Au: Giachetto Larraz, Gustavo A; Braga Novoa, Jorge Luis; Rossi Crivocapich, Martha; Mogdasy Seluja, M. Cristina; Azambuja, C. ----- Ti: Encefalitis por herpes simple tipo 1: necesidad de pautas de diagnostico y tratamiento / Herpes simplex virus type 1 encephalitis: need of guidelines for diagnosis and treatment. ----- Fu: Arch. pediatr. Urug; 68(4) :15-23, 1997. ilus, tab. ----- Re: La encefalitis por Herpes Simple tipo 1 es una enfermedad grave. Su pronostico depende del diagnostico y tratamiento precoz. Se analizan cuatro historias clinicas de niños con encefalitis herpetica diagnosticada por Reaccion en Cadena de la Polimerasa (PCR) en liquido cefalorraquideo (LCR) entre marzo de 1995 y marzo de 1997. Se trata de tres lactantes y un escolar. Todos presentaron manifestaciones clinicas similares al ingreso: fiebre, depresion neurosiquica (DNS) y convulsiones (parciales o generalizadas). El analisis citoquimico del LCR al ingreso fue normal en tres casos. Los hallazgos tomograficos en la evolucion fueron identicos: infarto fronto temporo parietal. En un solo caso se valoro el fondo de ojo al inicio. Tres pacientes tuvieron evolucion clinica similar: profundizacion de la DNS, convulsiones y signos locales. Todos quedaron con secuelas, que fueron mas graves en los pacientes en los que el tratamiento se instalo tardiamente. Con el objetivo de protocolizar las indicaciones de la busqueda viral por PCR y de mejorar el pronostico de estos pacientes se propone un algoritmo de diagnostico, estudio y tratamiento para esta enfermedad (AU). |
| Au: Giachetto Larraz, Gustavo A; Farcilli Ruiz, Rosana I; Fein Caplan, Lilian; Gambetta Gonzalez, Julio C; Pascale Mello, Andres; Tor Gonz lez, Elsa L; Vergara Couto, Adriana; Ferrari Castilla, Ana M; Tamosiunas Gorski, Gustavo A. ----- Ti: Bronquiolitis: que tratamiento se esta utilizando en los pacientes que ingresan al hospital? / Bronchiolitis: which treatment is used with patients admitted at hospital?. ----- Fu: Arch. pediatr. Urug; 68(4):5-13, 1997. ilus, graf. ----- Re: El tratamiento de la bronquiolitis se ha basado clasicamente en medidas de sosten: sintomaticas y fisiopatologicas. El uso de Beta 2 antagonistas (B2) es frecuente aunque controvertido. En el Centro Hospitalario Pereira Rossell (CHPR) se ha propuesto una pauta para su indicacion que no se cumple regularmente. En el marco de un estudio cuyo objetivo es racionalizar el uso de medicamentos, se planteo como primera etapa conocer que tratamiento se esta realizando en esta enfermedad. Se revisaron en forma retrospectiva las historias clinicas (HC) de todos los pacientes que ingresaron a la Clinica Pediatrica "A" entre junio y agosto de 1996. Se analizaron 87 HC que cumplian con los criterios diagnosticos de bronquiolitis. En el 18 por ciento el diagnostico realizado en sala fue otro. La edad promedio de los niños fue de 4 meses; 80 por ciento eran eutroficos. Todos recibieron tratamiento fisiopatologico. El 69 por ciento recibio B2, 80 por ciento en forma de aerosol. Casi en un 90 por ciento se desconoce el fundamento de esta indicacion. Recibieron antibioticos el 71 por ciento de los niños y corticoides el 22 por ciento. La severidad clinica fue similar en los niños tratados y no tratados con B2. El promedio de estadia fue de 4.6 dias, no existiendo diferencias entre ambos grupos. El 53 por ciento presento algun tipo de complicacion (37 por ciento sobreinfeccion y 16 por ciento atelectasia). No hubo diferencias en la frecuencia y tipo de complicaciones en ambos grupos. El 14 por ciento requirio traslado a CTI en algun momento de su evolucion y solo el 4 por ciento AVM por 48 a 72 horas. Ningun paciente fallecio durante la internacion. La utilizacion de B2 en los pacientes con bronquiolitis que ingresan a la Clinica Pediatrica "A" no sigue una pauta racional. Para contribuir a la racionalizacion de esta terapeutica se realizar un estudio prospectivo para valorar su eficacia (AU). |
| Au: Prego Petit, Javier; Sehabiague Rigau, Graciela R; De Leonardis Capello, Daniel. ----- Ti: Complicaciones graves de la varicela: Analisis de ingresos a la unidad de reanimacion del depto de Emergencia del Centro Hospitalario Pereira Rossell / Complications of varicella: analysis of admissions to Reanimation Unit of the Department of Emergency at the Centro Hospitalario Pereira Rossell. ----- Fu: Arch. pediatr. Urug; 68(1):19-26, 1997. tab. ----- Re: La varicela es una enfermedad frecuente de la infancia. Las complicaciones de su padecimiento obedecen al propio virus (varicela-zoster), sobreinfeccion bacteriana y a manifestaciones inmunologicas. En los ultimos años se ha observado incidencia de infecciones por germenes Gram positivos, en especial por estreptococo B-hemolitico del grupo A (EBHGA), el que puede determinar formas invasivas en el curso de la varicela. El objetivo del estudio fue: analizar las complicaciones de la varicela que ponen en riesgo la vida en la infancia y que por su entidad requirieron su internacion en la Unidad de Reanimacion y Estabilizacion (URE) del Departamento de Emergencia Pediatrica (DEP). Se revisaron 9 historias clinicas en un periodo de 3 años (1993-95), 6 de los cuales ocurrieron en el ultimo año de estudio, con predominio en los meses calidos. Todos los enfermos fueron inmunocompetentes, con una mediana de edad de 10 meses. Las complicaciones fueron: encefalitis (1), deshidratacion (1), neumonia (l); 6 pacientes presentaron complicaciones infecciosas potencialmente graves: fascitis necrotizante con sindrome de shock toxico (2), impetigo con sindrome de shock toxico (2), celulitis con shock septico (1), y shock septico (1). En 3 de estas se aislo EBHGA. El tratamiento requerido en las complicaciones bacterianas invasivas fue exigente (AVM, reposicion, inotropicos, debridamiento quirurgico en alguno de ellos), siendo derivados a UCI 3 pacientes. Un caso murio. Dos casos presentaron secuelas cosmetico funcionales. Actualmente se dispone de una vacuna eficaz para su prevencion (AU). |
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