To asses the possible role of prostaglandins in the fetoplacental circulation during delivery PGE and PGF2-alfa plasma levels were measured in the umbilical vessels of term newborns. The levels of ...PGF2-alfa in blood from the umbilical vein are significantly higher and more variable than in the umbilical artery; 83.38 +/- 78.05 pg/ml versus 43.28 +/- 5.32 pg/ml. PGE levels are also higher in the vein 114.73 +/- 25.16 pg/ml than in the artery 83.63 +/- 9.22 pg/ml. There was a statistically significant negative correlation between the arterial pH and PGE in the umbilical vein these results support the idea that the plasmatic umbilical prostaglandins are synthetized by the placenta the variability in the values obtained in venous umbilical blood may reflect the different times of ligation of the umbilical cord. A decrease in fetal pH may be the stimulus for the prostaglandin synthesis by the placenta.
The most frequent cause of toxic shock in our area is meningococcal sepsis. It is currently assumed that endotoxin produce by this bacteria, a lipopolysaccharide with toxic properties, is able to ...trigger shock and DIC by stimulating both arachidonic acid pathways, among other actions. Previous studies in our laboratory demonstrated significant differences (p +/- 0.001) in the amounts of endotoxins released in vitro by strains from patients and healthy carriers and statistically related criteria of severity with mortality in 256 patients in our center over the last 10 years. In the present study we attempted to establish whether plasma levels of endotoxin were correlated with the severity of the disease. We studied 32 patients with meningococcal sepsis, dividing the subjects into two groups: those in whom six or more criteria of severity were present, and those in whom less than six criteria were found. Blood levels of endotoxin were determined upon admission and after the administration of antibiotics (penicillin and chloramphenicol) using the limulus test with a chromogenic substrate (Coatest, Endotoxin, Kabivitrum, Sweden). Levels of endotoxins were significantly higher in patients with more than six criteria of severity both upon admission (0.6 +/- 0.03) ng/ml) and 4 h. afterward (0.74 +/- 0.006 ng/ml) in comparison to children in whom the clinical picture was less serious (0.27 +/- 0.18 ng/ml and 0.27 +/- 0.18 ng/ml and 0.27 +/- 0.16 ng/ml7 t = 5.8 y t = 5.6 respectively. Endotoxin levels were highest in patients presenting shock, disseminated intravascular coagulation in the hypocoagulability phase and more than 8 criteria.
Meningococcal sepsis with cardiovascular manifestations is one of the leading causes of pediatric intensive care admission (14.85%) in our area. We carried out a two phase study over period of 10 ...years from 1979 to 1988, involving a retrospective analysis of clinical and analytical manifestations in order to determine a prognostic score of the severity of meningococcal infections in our area. A total of 86 cases were studies over a two year period. After establishing the prognostic score, we applied a previously assayed therapeutic protocol, based on the number of criteria of severity, in 170 children selected as having the same criteria. The factors of seriousness considered were: Appearance of the first symptoms less than 12 h. previously, appearance of petechia less than 6 h. previously, hyperthermia, shock at admission, absence of meningitis, fulminating course of purpura and convulsions, leukopenia less than or equal to 5,000 mm3, prothrombin activity less than or equal to 45%, platelets less than or equal to 75,000 mm3, fibrinogen less than or equal to 250 mgrs% and FPD greater than 40 micrograms/ml (p less than or equal to 0.01 (CHI SQUARE. In the first phase of study, overall mortality was associated with the presence of three criteria, and was highest when more than seven criteria were present. The results indicate that mortality from meningococcal sepsis is linked to fulminating deterioration of hemodynamics and DIC.
From a total of three-hundred and fifty-six children admitted into the Department of Pediatrics at the Hospital Clínico of the University of Granada during of period of two years, twenty cases that ...needed admittance in critical pediatrics care unit are revised. Organic etiology that provoked coma, time of appearance, intensity, evolution, complications and short term outcome are analysed. A comparison is made of the incidences and prognosis of this type of coma with that of other authors presenting therapeutic outline carried. Two large evolutive groups; one which consisted of nine patients which entered into coma immediately after injury. The second group includes those patients which had lucid period before entering into coma. Following conclusions have been withdrawn: Severity and duration of coma does not have a definite relationship with the existence of a mass-lesion. Presence of an associated--mass-lesion is a sign of grave prognosis. For a good therapeutic response the following approaches are necessary: Immediate assistance monitoring and periodic or systematic maintenance of extracranial variants diagnostic, and treatment of the primary causing factor.
A study was made of polynuclear leucocyte function: chemotaxis, NBT reduction and the influence of total plasma on chemotaxis, was investigated in a large group of asthmatic paediatric patients, both ...during and between asthmatic attacks. It has been proved that polynuclear function is different in the two types of asthma. During the asthmatic's crisis and in the intrinsic patients in intercrisis periods, there is a polynuclear neutrophil hyperreaction when the chemotaxis and the NBT reduction are raised. An inhibited chemotactic activity in the plasma of these patients is noted. This activity doesn't produce irreversible effects on the cells; it acts as a regulating mechanism on the chemotactic factors found in plasmatic fractions.
A study of urinary osmolarities and plasmatic level of arginine-vasopressin (AVP) 48 hours after birth in a group of 70 newborns (30 of which are normal and 40 of which have acute perinatal hypoxia), ...selected according to previously established criteria is carried out. An evolutionary study of urinary osmolarities of newborns with acute perinatal hypoxia, osmolar index and its relation to plasmatic levels of AVP during the first week of life is also considered. AVP 48 hours after birth was blatantly more elevated among those newborns who had shown acidosis at birth (p less than 0.001) which correlated significantly with urinary osmolarity, although it showed low figures (p less than 0.05). This same correlation (p less than 0.001 and p less than 0.05) appears with osmolar index and urinary osmolarity on successive days, but it is important to point out that vasopressin decreased to base values at the end of the first week of life while osmolarities in urine increased. Conclusions are: 1) AVP is higher after 48 hours of life among those newborns with acute perinatal hypoxia and decreases progressively during the first week of life, being comparable to values obtained from normally born children 48 hours after birth at the eight day of life. 2) Renal response to this hormone is slight during the first days of life.
Authors have studied pharmacokinetic parameters of theophylline in a sample of 21 children with bronchial asthma, through evolution of plasmatic concentrations, evaluated by RIA, in order to ...appreciate therapeutic response to it depending on the time-variation of such concentrations. They have determined that theophylline's kinetic obeys to a "depending dose" reaction represented by Michaelis-Menten equation. This induce them to refuse those therapeutic methods based on the establishment of maintaining doses depending on drug clearance, as minimal increases in posology can give spectacular decreases of drug clearance. They have also seen that great amplitude of individual variation for pharmacokinetics parameters of theophylline, in intra-patient studies is very short.
In clinical pediatric urology distinction between obstructive and non obstructive dilatation of the upper urinary tract represents a difficult task for which usual procedures, both radioisotopes and ...conventional radiologic methods, have not discriminatory value. The aim of this investigation in to suggest a method of study that contributes to establish, in children, true diagnosis in clinical situations of hydronephrosis and to study evolution of renal function in surgical patients. Suggested technique, known an isotopic diuretic urography (UID), consists in intravenous administration of a diuretic (Furosemide, 0.4 mg/kg body weight) thirty minutes after injection of a radiotracer (I-123 Hippuran and or Tc-99-DTPA) into the vascular space and recording and analysis of variations of activity in parenchyma and renal pelvis during, at least, the following 60 m. Method described has been used in a series of 24 patients suffering from uni or bilateral hydronephrosis, with ages ranging from 2 months to 12 years. Results obtained, have shown that UID is notably superior to actually existing non-invasive methods of study of obstructive uropathy.
