RESUMO
Asthma morbidity and mortality has increased. One of the possible causes is the excessive use of beta agonists. The aim of this study is to compare the effects of six week treatment with beclomethasone alone (Ibec) or the combination of beclomethasone-salmeterol (Ibe + Isal) on serum potassium (K), CPK-MB and ECG in children suffering asthma. It was a prospective, randomised, open cross-over trial. Patients received either Ib2 (2 puff/12 hr, 100 micrograms per puff) or Ibe + Isal (B 2 puff/12 hr, 100 micrograms per puff and S 2 puff/12 hr, 25 micrograms per puff) with dose meter inhaler by 6 weeks, with a four-week wash-out period between the treatments. K, CPK-MB and ECG were assessed at baseline, and after each treatment period. There were 9 girls and 20 boys, aged 11 +/- 2.18 (mean +/- SD) years, baseline K was 4.57 +/- 0.43 mEq/l, after B K 4.38 +/- 0.39 IU and after BS K 4.38 +/- 0.40. The CPK-MB level were baseline 14.75 +/- 4.5, after B 20.10 +/- 6.9 and after BS 21 +/- 8.05 (p < 0.05). Baseline QTc was 0.416 +/- 0.02 msec, after B 0.425 +/- 0.027, and after BS 0.415 +/- 0.029. We conclude that the treatment of children with asthma with 400 micrograms per day of Ibec or concomitantly with 100 micrograms of Isal for 6 weeks does not alter the serum K+ or the QTc. However, the CPK-MB has a significant increment with both treatments but without clinical and/or ECG changes. We can't affirm that Ibec or Ibec plus Isal have a cardiotoxic side-effect by the only presence of high levels of CPK-MB. We agree that it is necessary a close follow up of these apparently asymptomatic patients not induce important cardiovascular changes although CPK-MB was increased.
Assuntos
Agonistas Adrenérgicos beta/efeitos adversos , Albuterol/análogos & derivados , Albuterol/efeitos adversos , Antiasmáticos/efeitos adversos , Asma/tratamento farmacológico , Beclometasona/efeitos adversos , Creatina Quinase/sangue , Eletrocardiografia/efeitos dos fármacos , Coração/efeitos dos fármacos , Isoenzimas/sangue , Potássio/sangue , Adolescente , Agonistas Adrenérgicos beta/administração & dosagem , Agonistas Adrenérgicos beta/uso terapêutico , Albuterol/administração & dosagem , Albuterol/uso terapêutico , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/sangue , Asma/fisiopatologia , Beclometasona/administração & dosagem , Beclometasona/uso terapêutico , Criança , Creatina Quinase Forma MB , Estudos Cross-Over , Quimioterapia Combinada , Feminino , Humanos , Masculino , Estudos Prospectivos , Xinafoato de SalmeterolRESUMO
Critical pulmonary stenosis of the newborn is an emergency and the balloon dilatation can represent its definitive treatment. This procedure has important technical aspects related with the age and weight of patients and to anatomical factors that contributes to the obstruction. We present the case of a 20 days old newborn with this problem, in whom the use of an arterio-venous loop through the ductus arteriosus allowed the passage of balloon catheters of gradually increasing diameter until a balloon/pulmonary annulus index of 1.4 was reached. This procedure can be performed safely in cases in whom the common technique is difficult to apply. The procedure allows a successful valvular dilatation.
Assuntos
Derivação Arteriovenosa Cirúrgica , Cateterismo/métodos , Estenose da Valva Pulmonar/terapia , Feminino , Humanos , Recém-Nascido , Estenose da Valva Pulmonar/diagnóstico por imagem , UltrassonografiaRESUMO
The records of 16 cases seen at Mexico Children's Hospital with a diagnosis of KD were reviewed. Mean age was three years; eight were infants, and males were dominant with a ratio of 4.3:1. Two cases occurred in sibling. Evidence of myocarditis was recognized in six, and 12 had coronary anomalies, including five with aneurysms. Two infants with severe coronary disease died, one suddenly with myocardial ischemia, and one with a ruptured aortic aneurysm. Another infant developed severe stenosis of the right coronary artery but remains asymptomatic. Two cases have persistent coronary ectasia and seven are asymptomatic with a normal echocardiogram. Predictors of coronary risk were correlated with clinical outcome. All six cases with 6 or more points had coronary anomalies, two developed giant aneurysms, two died and one has severe coronary stenosis. Of 10 cases with less than 6 points, four did not have coronary involvement, none developed giant aneurysms and none died nor developed severe coronary sequelae. Although KD has been sporadically reported in this country, the present series, the largest from a single institution, firmly establishes the presence of the disease in Mexico.