RESUMEN
BACKGROUND: Central diabetes insipidus (CDI) is a heterogeneous disease caused by arginine vasopressin deficiency; its management implies a profound understanding of the pathophysiology and the clinical spectrum. The aim of the study was to describe the clinical characteristics that indicate organicity in children and adolescents with central diabetes insipidus treated at the Department of Endocrinology from The Child Health's Institute during 2001 to 2013. METHODS: Cross-sectional, retrospective study. 79 cases of patients diagnosed with CDI (51 males and 28 females) from 1 month to 16 years of age were reviewed. For the descriptive analysis, measures of central tendency and dispersion were used; groups of organic and idiopathic CDI were compared using χ2-test and t-test. A p-value<0.05 was considered significant. RESULTS: The average age of patients was 8.1±4.2 years. Organic causes were intracranial tumors, 44 (55.7%), Langerhans cell histiocytosis (LCH), 11 (13.9%) and cerebral malformations in 7 (8.9%) patients, while the idiopathic group was 14 (17.7%) patients. Regarding clinical characteristics suggestive of organicity, headache (p=0.02) and visual disturbances (p=0.01) were found statistically significant. The anterior pituitary hormonal abnormalities were documented in 34 (52.3%) organic CDI patients. Furthermore, we did not find a significant difference in the average daily dose of desmopressin between patients with permanent vs. transitory CDI (0.81±0.65 vs. 0.59±0.62; p=0.363). CONCLUSIONS: The main clinical features suggestive of organicity in pediatric patients with central diabetes insipidus were headache and visual disturbances; furthermore, anterior pituitary hormonal abnormalities suggest an underlying organic etiology.
Asunto(s)
Neoplasias Encefálicas/complicaciones , Cerebro/patología , Diabetes Insípida/etiología , Histiocitosis de Células de Langerhans/complicaciones , Adolescente , Neoplasias Encefálicas/patología , Cerebro/anomalías , Niño , Preescolar , Estudios Transversales , Diabetes Insípida/patología , Femenino , Estudios de Seguimiento , Histiocitosis de Células de Langerhans/patología , Humanos , Lactante , Recién Nacido , Masculino , Perú , Hormonas Adenohipofisarias/deficiencia , Pronóstico , Estudios Retrospectivos , Factores de TiempoRESUMEN
Se llevó a cabo un estudio clínico para valorar la oxigenación y eliminación de bióxido de carbono, con un soporte no valvular, con función espiratoria, diseñado para el sistema Bain. Se tomó una muestra de 108 pacientes desde lactantes mayores a adultos, sometidos a cirugía electiva, la ventilación fue controlada manualmente. El flujo de gas fresco para los niños fue de 3.5 lts. y para los adultos fue de 70 ml/kg. Se tomaron determinaciones de gases en sangre arterial para determinar pH, PO2, EB, BA, CO2 y PaCO2, después de la intubación y 1 hora posterior a ventilación manual con FiO2 de 40%. Los resultados obtenidos fueron analizados mediante la "t" de Student y la X2 mostrando tendencia a la normocarbia