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Se presentan 18 pacientes con lesiones de la glándula suprarrenal causadas por trauma penetrante 10 casos, o cerrado 8 casos. Se trata de un grupo de pacientes de alta gravedad, expresada por una incidencia de schock al ingreso del 66,6 por ciento, un índice de trauma, Trauma Score promedio de 11, un requerimiento transfusional promedio de 20 unidades, 4,3 lesiones asociadas por paciente, 50 por ciento de complicaciones y una mortalidad del 16,7 por ciento. Quince pacientes requerieron exploración quirúrgica y la suprarrenal lesionada pudo ser reparada en 7 de ellos. Se analizan las características de estas lesiones y su manejo

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OBJECTIVE: To examine the relationships among indicators of physical activity, physical fitness, and body composition with serum lipid and lipoprotein levels in young children. DESIGN: Cross-sectional and 1-year prospective cohort. SETTING: Studies of Child Activity and Nutrition (SCAN) program, Galveston, Tex. SUBJECTS: One hundred twenty-three 4- or 5-year-old black, Hispanic (of Mexican origin), and white children. MEASUREMENTS: Body composition, resting heart rate, and cardiovascular fitness variables and serum lipid and lipoprotein levels were measured at age 3 or 4 years (study year 1) and at age 4 or 5 years (study year 2), and day-long heart rate was measured and the Children's Activity Rating Scale was administered between study years 1 and 2. RESULTS: Year-1 waist/hip ratios were inversely correlated with total serum cholesterol (TSC) and low-density lipoprotein (LDL) levels. Mean activity level was inversely correlated with waist/hip ratios. On the basis of multiple regression analysis, the sum of seven skin-fold measurements, height, and gender explained 15.4% of the variation in triglyceride levels. The sum of seven skin-fold measurements was inversely correlated with the high-density lipoprotein (HDL) level. Resting heart rate, waist/hip ratio, and the slope of the exercise heart rate during fitness testing explained 19.5% of the variation in the concentration of an HDL subclass, HDL2. These children's levels of physical activity were associated with higher fitness levels. Year-1 waist/hip ratios and year-2 sum of seven skin-fold measurements were positively correlated with the LDL/HDL and TSC/HDL ratios. CONCLUSION: Higher levels of cardiovascular fitness and lower levels of fatness were associated with more favorable serum lipid and lipoprotein levels in these young children. Physical activity appeared to have an indirect association with serum lipid and lipoprotein values through its relationship with higher fitness levels and lower levels of fatness.

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The Type A behavior pattern (TABP) has been proposed as a risk factor for coronary heart disease (CHD). Several studies have indicated an association between Type A behavior and serum cholesterol levels. If the effects of TABP are mediated by conventional CHD risk factors, evidence for a causal relationship between TABP and CHD would be strengthened if associations were detected among the young. This paper addresses the following: (1) Do levels of serum lipids and lipoproteins among young children vary by ethnicity, gender, or TABP? (2) Can obtained differences be accounted for by possible confounding factors, such as SES or body composition? ANCOVA revealed no significant ethnic, gender, or TABP effects for total serum cholesterol or HDLc. Analyses of LDLc and triglycerides disclosed significant main effects for gender and for ethnicity. A Competition subscale by ethnicity interaction was the only effect to approach statistical significance for TABP. The strongest findings were a replication of differences in lipid and lipoprotein risk factors by ethnicity.

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Plasma norepinephrine and epinephrine levels were monitored to determine possible alterations of the sympathetic nervous system caused by hypertonic fluid administration. Iv infusion (3.5 ml/kg, 1 min) of 7.5% NaCl/6% Hespan transiently increased both plasma norepinephrine and epinephrine levels to 197 +/- 28% and 220 +/- 30% of control, respectively, at 1 min. These increases were no longer significant 5 or 15 min following infusion. A brief hypotension was also observed immediately following hypertonic fluid administration. Thus, prolonged sympathetic activation does not occur following hypertonic fluid infusion in normovolemic conscious rats.

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Plasma norepinephrine and epinephrine levels were monitored to determine possible alterations of the sympathetic nervous system caused by hypertonic fluid adeministration. Iv infusion (3.5 ml/Kg, 1 min) of 7.5% NaCl/6% Hespan transiently increased both plasma norepinephrine and epinehrine levels to 197 ñ 28% and 220 ñ 30% of control, respectively, at 1 min. These increases were no longer significant 5 or 15 min following infusion. A brief hypotension was also observed immediately following hypertonic fluid administration. This, prolonged sympathetic activation does not occur following hypertonic fluid infusion in normovolemic conscious rats

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The techniques of differential scanning calorimetry and electron microscopy were combined to locate collagens with different thermal stabilities in bovine dermis. When calfskin was heated at 1.25 degrees C/min, denatured cores developed in the fibrils at 65 degrees C, leaving native-banded sheaths. Coincident with the initiation of shrinkage and loss of molecular orientation at 68 degrees C, the sheaths of the fibrils began to be denatured at distributed sites along the fibrils. At 80 degrees C the collagen lost its organized fibrillar structure. When thermally labile crosslinks had been stabilized by reduction with borohydride, an endotherm lying above 66 degrees C was suppressed, with proportional lowering of the total enthalpy change, and a fibrous texture revealing a helical subfibrillar structure remained. The three populations of collagen are located in the same fibrils. One, located in the cores of the fibrils, is half denatured at 68 degrees C. Another, established by crosslinks, is competent to sustain the regular appearance of fibrils even after 56% of the collagen in them has been denatured. This population is located as sheaths at the peripheries of the collagen fibrils. A third, denaturing below 59 degrees C, is codistributed with one or both of the two others.

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Six girls, aged 5 to 15 years, presented with thyroid masses in otherwise nonpalpable thyroid glands and with normal serum thyroxine levels. Scintiscanning before and after TSH stimulation confirmed the presence of autonomous nodules in the four adolescents, of whom two had elevated T3 levels. Surgical exploration revealed adenomatous thyroid hyperplasia in three of the girls and papillary adenocarcinoma in the fourth. Scans in the other two girls revealed absence of the left lobe. One of them proved to have agenesis of the left lobe with enlargement of the right lobe because of lymphocytic thyroiditis. The other girl had an ectopic thyroid with chronic inflammation. A thorough diagnostic evaluation of single or multiple functioning thyroid masses in children and adolescents is essential in establishing the correct diagnosis. The possibility that carcinoma can occur in autonomous nodules as well as in hemiagenesis and ectopic thyroid tissue is discussed. An approach to the management of functioning thyroid masses in the pediatric age group is proposed.

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