Cesko-Slovenska Pediatrie最新文献

The actually used examination algorithm of imaging methods was checked in 35 neonates examined in the course of two years (1991 and 1992) on account of suspected diseases of the urinary pathways. It involved sonographic examination of 28 children, voiding cystourethrography (34x) and intravenous urography (18x). Ascendent pyelography and irrigography were performed three times, one neonate was examined by computed tomography. The procedure used as a basic sonographic prenatal screening in 11 children, in 20 clinical suspicion of disease of the urinary pathways, and four neonates were examined on account of an anorectal malformation or abnormality of the external genitalis. The most frequent finding--in 18 children--was hydronephrosis. It was associated with signs of subrenal obstruction (8x), with ren duplex (5x) and with a megaureter (6x). The association of the sonographic finding of dilatation of the intrarenal urinary pathways with absent contrast filling during excretory urography was observed in a child with hydronephrosis and subrenal obstruction and in four children with a multicystic dysplastic kidney. In individual cases the authors detected a valve of the posterior urethra, a sigmoid-vesical fistula, agenesis of the penis and stenosis of the urethra. Eleven neonates had a normal findings of the urinary tract.

The authors examined the rate of cerebral blood flow in 60 mature neonates during the first 6 days of life. The infants had a negative perinatal and postnatal history, satisfactory post-partum adaptation and a normal objective finding. For assessment ultrasound was used-Aloka SD 680 with a coloured pulsed Doppler. The authors assessed velocity in the anterior cerebral artery and in the middle cerebral artery. The results were recorded in curves giving mean values +/- SD. The authors evaluated maximal systolic and diastolic velocity, the mean rate and the index of resistance. A more marked decline of the resistance index was recorded on the second day of life. The different velocities had a continuous rising trend. Results of other authors are discussed.

Long-term administration of neuroleptic drugs to 149 severely mentally retarded children led to a significantly higher number of somatic complications and respiratory morbidity, as compared with a control group (p < or = 5%). Precise differentiation of the influence of neuroleptics from other drugs, complications of the basic diagnosis of oligophrenia and others is not possible so far. Therefore it is essential to consider carefully the indication for administration of neuroleptics and to reduce thus their undesirable effects to a minimum.

The aim of this study is the analysis of long-term results of surgery for vascular airway compression. Out of those operated within last 14 years at our institution, thirty two have a longer than five years follow up, being now 9.1 +/- 3.0 years following surgery. All are in excellent clinical condition. One quarter of patients show occasional stridor and one third frequent respiratory infections. Eighty percent have some lung function abnormality, 72% features of central airways obstruction. Pulmonary perfusion scintigraphy demonstrated in 19% asymmetric pulmonary blood flow. Magnetic resonance imaging showed relationship between vessels and airways. Although long-term outcome of surgery for vascular airway compression is excellent, high percentage of pathologic lung functions is of concern and substantiates the need for close long-term follow-up.

The authors describe their initial experience, organization, and problems associated with the development of an EMCO centre. Its main activities are those of a neonatal ECMO centre (to a smaller extent paediatric ECMO and ECCO2R-LF PPV of adults) during the first 4 months of its existence. During the period the ECMO centre was contacted in 10 instances. The referring department indicated the ECMO centre correctly in six instances. However, at least in two instances too late and the patients died (during priming of the ECMO circuit or transport could not be implemented because of the critical condition). In two instances, however, the ECMO staff failed as it was unable to ensure a minimum of seven days of safe operation of ECMO and therefore ECMO was not provided. Based on this experience the authors present an organizational model of the ECMO unit which is formed ad hoc when needed and comprises specialists of various professions from the sphere of emergency medicine. The main purpose of the present paper is to inform referring departments on the indications, selection criteria, contraindications of ECMO in neonates and children and to ensure thus not only smooth communication between the ECMO centre and the referring department but in the first place early referral to the ECMO centre at a time when transport is not yet a problem.

Prenatal ultrasonic examination during the 28th week of gestation revealed a transient disorder of the cardiac rhythm in the foetus. Subsequently repeated echocardiographic examinations confirmed foetal hydrops which together with signs of EP gestosis of the mother was an indication to terminate pregnancy during the 29th week by Caesarean section. In the severely hydropic male foetus in the enlarged anterior wall of the right atrium an atypical vascular canal was found which was in the close vicinity of the sinoatrial node. The latter most probably caused intermittent intrauterine supraventricular tachycardia in a heart with a normal configuration in other respects.

Recently great attention is paid to hypotonia of the orofacial region because this disorder is a great handicap for mentally normal children. In the submitted paper the authors demonstrate treatment of a girl who suffered from hypotonia of the orofacial region with hypersalivation to the age of four years. After intensive therapy complete normalization of this developmental defect was achieved.