RESUMO
Concentrations of serum digoxin were measured by the polarized immunofluorescence Abbot TDx11 method in 59 samples from 53 children under treatment with mean beta methyl digoxin doses of 8.9 +/- 2.0 micrograms.kg.day. The therapeutic range for serum digoxin concentration was estimated to be 0.9 to 2.25 ng/ml. Simultaneous Na, K and creatine serum concentrations were measured. In 36 samples mean serum digoxin level was 1.52 +/- 0.45 ng/ml -within therapeutic range- and in only one of these cases clinical evidence of toxicity was apparent. In 15 samples digoxin level was above the therapeutic range and 11 patients of this group (73%) showed clinical signs of toxicity, consisting in arrythmias (six cases: supraventricular in 5 patients, ventricular in one child) and gastrointestinal symptoms (eight patients). Six patients with digoxin levels over therapeutic range and signs of digitalis toxicity had coincidental acute renal failure, which in 4 cases was subclinical--in 2 of these late it was pre-renal- and, in spite of this, all were inadvertently given the usual dosage of beta methyl digoxin. Almost invariably there was clinical evidence of toxicity when digoxin serum levels were above 2.4 ng/ml, so established maximal therapeutic level at 2.25 ng/ml seems adequate. Signs of digitalis toxicity must be looked on systematically in children treated with such drugs. In the critically ill or in children with acute renal failure it is necessary to monitor serum digoxin concentration. Among the clinical signs of toxicity, gastrointestinal symptoms are more frequent in children. An oral dose from 7 to 10 micrograms.kg.day of beta methyl digoxin in recommended.
Assuntos
Doenças Cardiovasculares/tratamento farmacológico , Digoxina/sangue , Medigoxina/efeitos adversos , Injúria Renal Aguda/sangue , Injúria Renal Aguda/complicações , Fatores Etários , Doenças Cardiovasculares/induzido quimicamente , Doenças Cardiovasculares/diagnóstico , Criança , Pré-Escolar , Digoxina/efeitos adversos , Monitoramento de Medicamentos , Feminino , Imunofluorescência , Gastroenteropatias/induzido quimicamente , Humanos , Lactente , Recém-Nascido , Masculino , Medigoxina/farmacocinética , Medigoxina/uso terapêuticoRESUMO
An analysis of infant's deaths caused by heart diseases in Chile during year 1988, was performed through a critical review of 5,598 death's certificates and 4,419 infant death audits. The mortality rates due to congenital cardiac defects were 177 per 100,000 liveborn (LB) and varied between 31.5 and 293.0 for 100,000 LB along the country's 26 health districts. In 69% of death's certificates and 25% of death audits, diagnoses were nonspecific regarding to the type of cardiac malformation, in 15% of deaths diagnostic orientation was incorrect and in 32% a clinical suspicion of congenital heart disease was raised by the primary physician but patients did not reach specialized treatment. One half of deaths occurred at general regional non specialized hospitals and 28% at hospitals of higher complexity. Of these late, 10% occurred after corrective or palliative surgery and 7% in patients considered to be inoperable.
Assuntos
Doenças Cardiovasculares/mortalidade , Cardiopatias Congênitas/mortalidade , Mortalidade Infantil , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/etiologia , Chile/epidemiologia , Feminino , Cardiopatias Congênitas/epidemiologia , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
Se analiza la evolución postoperatoria alejada de la insuficiencia aórtica (I Ao) en 20 niños operados por una comunicación interventricular (CIV) complicada de I Ao. En todos se efectuó cierre de la CIV y plastía aórtica simultánea. La edad promedio de operación fue 7 años. La I Ao fue catalogada clínicamente y por aortográfia en acentuada (7 niños), moderada (11 niños) y leve 2 (niños). En todos los pacientes se efectuó aortografía preoparatoria. La CIV fue clasificada por ubicación en supracristal (sC): 12 niños e infracristal (iC): 8 niños; y por tamaño en grandes (11 niños) y pequeñas (9 niños). En 7 niños (35%) se efectuaron reoperaciones (6 segundas plastías más 2 resuturas de CIV y 2 reemplazos valvulares) en promedio 21 meses después de la primera operación. Después de la cirugía que incluye reoperaciones, 8 niños (40%) quedan sin I Ao; 6 niños disminuyen el grado de I Ao y 5 lo mantienen o agravan. De los pacientes que quedan sin I Ao; 6 (75%) eran portadores de CIV iC, lo que resulta estadísticamente significativo (p=0.04 x**2=4.06). Se concluye que la I Ao asociada a CIV se logra controlar mediante cirugía, pero ésta es curativa sólo en el 40% de los casos y paliativa en un 30%. La plastía aórtica es una buena alternativa frente al reemplazo aórtico primario. En nuestra casuística la I Ao de la CIV iC tiene mejor pronóstico que la asociada a CIV sC
Assuntos
Lactente , Pré-Escolar , Criança , Adolescente , Humanos , Masculino , Feminino , Comunicação Interventricular/cirurgia , Insuficiência da Valva Aórtica/complicações , Seguimentos , Complicações Pós-OperatóriasRESUMO
Se revisan las historias clinicas de 41 pacientes operados por malformaciones de la pared toracica en el Hospital Luis Calvo Mackenna: 24 con pectus excavatum, 14 con pectus carinatum y 3 con sindrome de Poland. Hay una clara mayor incidencia en el sexo masculino en las dos primeras patologias(18/24 y 11/14, respectivamente). La deformidad es evidente y por si sola motivo de consulta en el 38% de los pacientes; el resto presenta sintomatologia agregada. Dicha deformidad aparece precozmente en el 85% de los pacientes. El antecedente de familiar cercano con igual deformidad es significativo. La operacion no solo es cosmetica sino que realizada oportunamente previenen mayores deformidades y anomalias cardiopulmonares evidentes. La tecnica quirurgica utilizada es la de M.M de Ravitch y el resultado es altamente satisfactorio