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Background: The phenomenon of deformation of devices for closure of intracardiac defects in catheterization has been reported, but not of devices for closure of patent ductus arteriosus. Objective: to report a case of deformation of a relatively new type of device for closure of patent ductus arteriosus. Methods: report an adult with hypertensive patent ductus arteriosus and a positive balloon occlusion test will be presented, in whom the occlusion was attempted with an Occlutech®-PDA device. Results: Upon delivery, the device took the shape of a "horn" instead of a "champagne cork" (usual appearance), so it was extracted prior to it is release and the procedure was carried out with another device. Conclusion: To our knowledge, no deformation during the delivery transcatheter of the Occlutech®-PDA device has been published. Adverse events related to new technologies, as in our case, should be reported as soon as possible, since it can help manufacturers to improve their quality and provide greater safety to patients.

Introducción: Existen comunicados sobre el fenómeno de la deformación de dispositivos oclusores de defectos intracardíacos durante el cateterismo, pero no acerca de los dispositivos oclusores para el conducto arterioso persistente. Objetivo: comunicar un caso de deformación de un relativamente nuevo tipo de dispositivo oclusor de conducto arterioso persistente. Método: se presenta un paciente adulto con conducto arterioso persistente hipertensivo y prueba de oclusión con balón positiva, en quien se intentó ocluirle con un dispositivo Occlutech®-PDA. Resultado: al momento de la entrega, el dispositivo adoptó la "forma de claxon" en lugar de "corcho de champagne" (apariencia habitual), motivo por el que fue retirado previo a su liberación y el procedimiento fue llevado a cabo con otro dispositivo. Conclusión: hasta donde conocemos, no hay comunicados acerca de deformación del dispositivo Occlutech®-PDA durante su implante mediante cateterismo. Los eventos adversos relacionados a nuevas tecnologías, como el presentado en este caso, deben ser comunicados tan pronto como sea posible, ya que esto puede ayudar a los fabricantes a mejorar su calidad y proveer mayor seguridad a los pacientes.

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Maternal consumption of polyphenol-rich foods has been associated with fetal ductus arteriosus constriction (DAC), but safety of chocolate exposure in fetal life has not been studied. This experimental study tested the hypothesis that maternal cocoa consumption in late pregnancy causes fetal DAC, with possible associated antioxidant effects. Pregnant Wistar rats, at the 21st gestational day, received by orogastric tube cocoa (720 mg/Kg) for 12 h, indomethacin (10 mg/Kg), for 8 h, or only water, before cesaren section. Immediately after withdrawal, every thorax was obtained and tissues were fixed and stained for histological analysis. The ratio of the narrowest part of the pulmonary artery to the fetal ductus inner diameter and increased ductal inner wall thickness characterized ductal constriction. Substances reactive to thiobarbituric acid were quantified. Statistical analysis used ANOVA and Tukey test. Cocoa (n = 33) and indomethacin (n = 7) reduced fetal internal ductus diameter when compared to control (water, n = 25) (p < 0.001) and cocoa alone increased ductus wall thickness (p < 0.001), but no change was noted in enzymes activity. This pharmacological study shows supporting evidences that there is a cause and effect relationship between maternal consumption of cocoa and fetal ductus arteriosus constriction. Habitual widespread use of chocolate during gestation could account for undetected ductus constriction and its potentially severe consequences, such as perinatal pulmonary hypertension, cardiac failure and even death. For this reason, dietary guidance in late pregnancy to avoid high chocolate intake, to prevent fetal ductal constriction, may represent the main translational aspect of this study.

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Phototherapy in neonates for treatment of pathological jaundice is an effective therapeutic tool that is widely used in neonatal units. Over the past years, a greater concern has emerged about the effects on the immune and inflammatory system and its potential genotoxic and side effects, especially the late ones, possibly associated with childhood diseases, showing that this treatment is not as harmless as previously believed. Numerous studies assessing these possible adverse effects of phototherapy on neonates have been published over the past years. Through this review, we seek to analyze what we know about the side effects of phototherapy in the neonatal period. The main causes of jaundice, phototherapy techniques, acute and late side effects, and effects on the immune and inflammatory system were reviewed. It was concluded that phototherapy is not a treatment free of side effects and further studies need to be conducted to elucidate its harmful effects on neonates.

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Renal cell carcinoma (RCC) accounts for 2-3% of all malignant disease in adults. Hereditary RCC represents 5 to 8% of kidney tumors. Hereditary leiomyomatosis and renal cell carcinoma (HLRCC) represents an autosomal dominant syndrome that results from a germline mutation in fumarate hydratase gene (FH). HLRCC patients typically present with skin or uterine leiomyomas and renal neoplasms. HLRCC was recently recognized as a distinct renal tumor subtype by the WHO 2016 classification. Many morphological patterns such as papillary, solid, tubular, and cystic had been described as part of morphological aspects of HLRCC. In this study, we describe a case of a patient that had a history of persistence of ductus arteriosus (PDA) and cryptorchidism. In addition, the renal tumor showed a very unusual hystiocytoid morphological aspect. We confirmed the presence of a FH germline mutation both in the patient and his mother.

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OBJECTIVES: To test the hypothesis that intrauterine inflammation increases prostaglandin production and may be a risk factor for persistent ductus arteriosus after therapy with indomethacin, a nonselective cyclooxygenase inhibitor. STUDY DESIGN: Indomethacin therapy was started after confirming ductus arteriosus within 24 hours after birth in extremely low birth weight infants. After one cycle of therapy, infants with closed ductus were classified as responders, and those with patent ductus were classified as nonresponders. Multiple logistic regression analysis was used to determine important perinatal factors associated with persistent ductus arteriosus. Immunohistochemistry with cyclooxygenase antibodies and radioimmunoassay by 6-keto prostaglandin F(1α) kit were used to determine the relationship between intrauterine inflammation and ductal patency. RESULTS: Forty-one infants were responders, and 37 infants were nonresponders. Responders were frequently small for gestational age; nonresponders frequently had lower gestational age, respiratory distress syndrome, and intrauterine inflammation. By multiple logistic regression analysis, respiratory distress syndrome and intrauterine inflammation were more frequent in nonresponders. Cyclooxygenase-1 expression in the umbilical arteries and plasma 6-keto prostaglandin F(1α) levels were higher in nonresponders. CONCLUSIONS: Respiratory distress syndrome and intrauterine inflammation were independent risk factors for persistent ductus arteriosus after indomethacin therapy in extremely low-birth weight infants. Intrauterine inflammation may have a negative influence on ductus arteriosus closure via increased cyclooxygenase-1 activity.

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Se realizó un estudio prospectivo en el Hospital de Gineco-Obstetricia del Instituto Mexicano del Seguro Social en León, Guanajuato, con el objetivo de evaluar la asociación entre polihidramnios y 100 pacientes con cantidad de líquido amniótico normal (grupo testigo). El diagnóstico de polihidramnios se efectuó mediante ultrasonido con la técnica de medición única y el índice de líquido amniótico. Las pacientes con polihidramnios tuvieron en promedio una medición máxima de 9.3 centímetros y un índice de cuatro cudrantes de 27.0 centímetros. Se presentaron 24 casos de productos malformados en las pacientes con polihidramnios y ningún caso en las pacientes con líquido amniótico normal (P<0.01) las malformaciones más frecuentes fueron: atresia esofágica (25 por ciento), anenecefalia (21 por ciento) y persistencia del conducto arterioso (21 por ciento). Existieron seis casos de muertes perinatales en las pacientes con polihidramnios, cinco de las cuales tenían malformaciones, en tanto que en el grupo testigo no se presentaron pérdidas fetales (P<0.01). Estos hallazgos obligan a tratar de llegar a un diagnóstico precoz del polihidramnios y por consiguiente descartar la presencia de malformaciones congénitas asociadas, con la finalidad de ofrecer un mejor pronóstico y en su caso un tratamiento oportuno

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OBJECTIVE: To examine the role of ductus arteriosus (DA) constriction and loss of luminal blood flow in producing permanent closure of the DA in human infants. METHODS: We studied 77 newborn infants (gestational age, 23 to 33 weeks) with asymptomatic patent ductus arteriosus (PDA), who had "complete clinical closure" (defined as the disappearance of all PDA signs) after treatment with indomethacin (three doses within 36 hours). All infants had an echocardiogram 24 to 36 hours after the last dose of indomethacin. They were then followed for the development of ductus reopening. RESULTS: Despite the absence of clinical signs, 18 (23%) of 77 infants still had some residual luminal blood flow according to their echocardiograms. The failure to obliterate luminal blood flow completely was directly related to the infant's postnatal age when treatment was begun and to the amount of fluid administered before treatment. Subsequently the DA reopened in 16 (21%) of 77 infants. As predicted, infants with residual luminal blood flow after indomethacin treatment had a higher rate of subsequent clinical reopening than did those with no luminal flow. In addition, immature infants had a significantly higher reopening rate than did more mature infants. The increased risk of reopening in immature infants was seen even when indomethacin caused complete obliteration of ductus luminal blood flow. CONCLUSION: The DA of immature infants is resistant to the constriction-induced ischemic damage that is necessary for subsequent permanent closure of the vessel.

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The effects on the neonate of severe maternal hypertension originating before the thirty-sixth week of gestation were determined by comparing data obtained on 28 preterm infants born of hypertensive mothers with data from 28 gestational age-matched controls. All hypertensive mothers had diastolic blood pressure greater than or equal to 110 mm Hg, proteinuria, and systemic symptoms of their disease; over half had thrombocytopenia and significant elevations of LDH and SGOT. All hypertensive mothers had been treated intravenously with magnesium sulfate, and 79% received other antihypertensive agents. When compared to control infants, the infants of hypertensive mothers had a significantly higher incidence of somatic growth retardation, microcephaly, thrombocytopenia, leukopenia, neutropenia, low Apgar scores, delayed adaptation, patent ductus arteriosus, hypotonia, and gastrointestinal hypomotility. Apgar scores, platelet count, WBC count, neutrophil count, and weight percentile correlated with the severity of maternal platelet and enzyme abnormalities. The occurrence of gastrointestinal hypomotility, hypotonia, and patent ductus arteriosus may be related to transplacental passage of maternally administered drugs.

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Daily weights and mean daily fluid volumes administered to 62 infants with birth weights of less than 2,000 gm, who required respiratory support for respiratory distress syndrome, were reviewed. In 31 infants signs of patent ductus arteriosus developed. In a comparison group of 31 infants, the mean daily fluid volume was 144 ml/kg/24 hours, and the mean body weight was 102% of expected, differing significantly from the 189 nl/kg/24 hours, and 114% of expected weight in those infants who developed PDA. Those infants who developed PDA had not differed significantly from the comparison group in either mean daily fluid volumes or expected weights prior to a period two days before clinical evidence of PDA. Seven infants developed PDA in association with increased fluid administration on more than one occasion during nursery stay. Diuresis after excessive fluid administration was associated with improvement in, or resolution of, signs of PDA in many infants. The results suggest that excessive fluid administration to premature infants with RDS may be one factor associated with the developed of PDA complicating RDS (PDA/RDS).

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Infants with athyrotic hypothyroidism usually manifest signs and symptoms of hypothyroidism prior to or during the period in the newborn nursery. These features are variable and include: prolonged gestation with large size at birth, large posterior fontanel, respiratory distress, hypothermia, peripheral cyanosis, hypoactivity, poor feeding, lag in onset of stooling, abdominal distension with vomiting, protracted icterus, and/or edema. Retrospective assessment of newborn nursery records of three infants from the Collaborative Perinatal Project who were subsequently found to have congenital hypothyroidism disclosed that they had six, eight, and nine, respectively, of these features while in the newborn nursery. Evaluation of newborn records on 12 other infants, often less complete, who were later found to have congenital hypothyroidism disclosed that each infant had from one to seven of these signs and symptoms, with an average of 3.2 per infant. Thus the most important period for clinical consideration of athyrotic hypothyroidism is in the newborn nursery to initiate early thyroid replacement therapy in affected infants.

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