Revista de pediatrie, obstetrica si ginecologie. Pediatria最新文献

This study was prepared on the basis of the recent data published in the specialized literature, as well as on the personal experience of the authors, and is considered as a necessary updating in the field of heart rhythm disturbances which occur in the child. A review is presented of sinoatrial blocks, of atrioventricular conduction disturbances, and of intraventricular conduction abnormalities (branch blocks). A modern classification is used in the discussion of sinoatrial, and of atrioventricular blocks, with the three distinctive degrees (first degree block, second degree block--with type I and type II variants, and the third degree block). The authors have attempted, in their effort to present the data concerning each of the entities, to include a series of anatomical and electrophysiological notions, some of which represent modern acquisitions obtained by endocavitary electrocardiographic exploration, and which are considered to be essential for a good understanding of the material. An important place is given--for each of the entities discussed--to the etiological study, as well as to clinical semiology, and electrocardiography, to problems related to the positive and differential diagnosis, and to therapeutical means, as well as to evolution and prognosis. The study is concluded by a presentation of intraventricular conduction disturbances (branch blocks) which are evaluated in their distinct variants: the monofascicular block (single bundle block), the bi- and trifascicular bundle blocks, major or minor blocks, and functional rate-dependent blocks. In these cases also the authors have analysed etiologic aspects, the clinical picture, and the electrocardiographic aspects, as well as therapeutical, evolutive and prognostic features for each of the different forms.

A comparison was made between the results of an analysis of humoral immunological changes in 64 cases of inflammatory diseases of the connective tissue of children (32 cases of ACJ, 5 cases of systemic lupus erythematosus, 2 cases of polymyositis, and 25 cases of systemic vasculitis), and data reported in recent literature, the authors conclude as follows:--changes of the immunological parameters that were tested support the hypothesis of a humoral immunopathogenic mechanism in systemic lupus erythematosus, in some of the manifestations of ACJ, and in systemic vasculitis;--of particular value for the immunological diagnosis of ACJ is the detection of FR in the patients' serum (and especially of FR from the IgG and the IgA class), as well as changes of immunological parameters of the articular fluid (the presence of FR, of immune complexes, a reduction of the titer intra-articular complement, the presence of ragocytes);--demonstration of humoral immunological changes (polyclonal hypergammaglobulinemia, the presence in the serum of circulating immune complexes, and of cryoglobulins, the low titer of serum complement in active stages, the presence of antinuclear antibodies, and especially of antinative DNA, the presence of LE cells in peripheral blood, and of a varied range of autoantibodies) is mandatory for the diagnosis of systemic lupus erythematosus;--in the present stage of our knowledge humoral immunologic changes are not an absolutely certified criterion for the diagnosis of polymyositis, and of some cases of systemic vasculitis (Henoch-Schoenlein purpura).

Acute dehydration of diarrhoea of the breast-fed child is a type of hypovolemic shock which, by its severity and frequency is one of the major emergencies of pediatrics. The liver, as the site of many metabolic processes is mainly affected in the frame of the multiple-tissue involvement which is characteristic for this condition. The authors carried out a study of several enzymes (total LDH and the thermally-labile fraction, gluthamatdehydrogenase, gammaglutamyltranspeptidase, acid and alkaline phosphatase) in 27 breast-fed children. Determination of the enzymes was done on hospitalization, and 10 days later. The study showed that all the enzymes that were evaluated had moderate increases in 40.7-71% of all cases. The increases were significant (p less than 0.001). After 10 days the enzyme titers showed a tendency to become normal again, and slightly higher values were found in only 15-12% of all cases. Minimal hepatopathy can be considered, associated to the clinico-biological evolution of this severe conditions of the breast-fed child pathology.

The authors approach a notion of great present day interest--namely risk factors determining infantile morbidity and mortality. They review the methods for study and identification of risk factors and analyse the relative frequency and importance depending on the maternal-infantile biosystem and exogenous, environmental factors, showing the strategy of the control (reduction) of infantile mortality based upon the identification and knowledge of risk factors. The study is of practical value allowing pediatricians at all levels of the maternal-infantile network to perfect medical surveillance of the population at risk and to plan differentiated individual care for infants and children whose health status exposes them especially to risk.

The epidemiological study was organized in schools in urban and rural areas. The study is readily reproducible and can be carried out longitudinally in the course of several years. Blood pressure was determined in children ranging in age from 7 to 14 years, and included 1838 children from urban areas--954 boys and 884 girls, and 1622 from rural areas--838 boys and 784 girls, per total 3460 children. Recording was done in the classroom in a quiet, friendly atmosphere, eliminating all psychical factors that might influence pressure, and was never taken before or after physical education. The pressure gage was applied on the right arm the cuff being adjusted to a child's arm. Pressure was determined thrice by two doctors independently, according to the Korotkov method, phase IV representing diastolic pressure. The data were processed statistically calculating the mean and standard deviation per determinations, per age, and finally calculating the proportions (individual values in the range of initial variations that correspond to percentages of 5, 25, 50, 75, 90, 95) of the total population analyzed. The tables give the results of systolic and diastolic pressure values in children in urban and in rural areas, as well as percentile curves of the systolic and diastolic pressure per sex. On the basis of the results children were considered to be candidates to high blood pressure whose systolic and/or diastolic tension in terms of age and sex was situated at percentage 95 or higher.

The present paper reports on 26 children with intersexuality states, belonging to the following pathologic forms: 1. female pseudohermaphroditism--11 cases, including a) type I congenital corticoadrenal hyperplasia (8 cases) and type III (1 case); b) iatrogenic form (1 case), and c) corticoadrenal virilizing adenoma (1 case); 2. male pseudohermaphroditism--6 cases, and 3. gonadal dysgenesis of female phenotype--9 cases of which a) Turner syndrome (6 cases); b) gonadal dysgenesis 45 XO/46 XX (2 cases) and c) Swyer syndrome (1 case). The authors emphasize the prenatal conditioned character (chromosomal or metabolic genetic diseases, congenital diseases) in the majority of the cases; they discuss the diagnostic criteria, therapeutical possibilities and prophylaxis as well as their efficiency which depends upon the moment the diagnosis is established.