RESUMO
Aims: To describe a case of choroid plexus carcinoma which initial signs and symptoms were related to the upper respiratory tract, contrary to the classic symptomatology of this disease reported in the literature. Case description: A two years and eight months old boy was admitted due to acute respiratory failure. He was treated with antibiotics for suspected croup without success. After two weeks he presented neurological manifestations that led to investigation and diagnosis of choroid plexus carcinoma. Resection was contraindicated due to extension of the tumor and involvement of vital areas.Conclusions: The rapid evolution of choroid plexus carcinoma in this case points to the need for early suspicion of central nervous system disorders. This case may alert pediatricians to the need to consider the presence of a brain tumor causinginjury to the vagus nerve in cases of respiratory distress resistant to treatment.
Objetivos: Descrever um caso de carcinoma do plexo coroide no qual os sinais e sintomas iniciais foram relacionadas ao trato respiratório superior, ao contrário da sintomatologia clássica da doença reportada na literatura.Descrição do caso: Um menino de dois anos e oito meses de idade foi internado por insuficiência respiratória aguda.O paciente foi tratado com antibióticos para suspeita de crupe, sem sucesso, e após oito dias mostrou sintomatologia neurológica, que levou a uma investigação e ao diagnóstico de carcinoma do plexo coroide. A ressecção foi contra-indicadadevido à extensão do tumor e envolvimento de áreas vitais.Conclusões: A evolução rápida do carcinoma do plexo coroide neste caso mostra a necessidade da suspeita precoce de distúrbios do sistema nervoso central. Este caso pode alertar os pediatras para a necessidade de considerar a presença de um tumor cerebral levando a lesão do nervo vago em casos de dificuldade respiratória resistente ao tratamento.
Assuntos
Humanos , Masculino , Feminino , Criança , Manifestações Neurocomportamentais , Neoplasias Encefálicas , Neoplasias do Plexo Corióideo , Nervo VagoRESUMO
OBJECTIVE: To compare the safety and efficacy of an oral rehydration solution (ORS) containing 75 mmol/L of sodium and glucose each with the standard World Health Organization (WHO) ORS among Egyptian children with acute diarrhea. METHODS: One hundred ninety boys, aged 1 to 24 months, who were admitted to the hospital with acute diarrhea and signs of dehydration were randomly assigned to receive either standard ORS (311 mmol/L) or a reduced osmolarity ORS (245 mmol/L). Intake and output were measured every 3 hours. RESULTS: In the group treated with reduced osmolarity ORS, the mean stool output during the rehydration phase was 36% lower (95% confidence interval, 1%, 100%) than in those treated with WHO ORS. The relative risk of vomiting during the rehydration phase was significantly lower in children treated with reduced osmolarity ORS (relative risk, 2.4; 95% confidence interval, 1.2, 4.8). During the maintenance phase, stool output, mean intake of food and ORS, duration of diarrhea, and weight gain were similar in the treatment groups. The relative risk of treatment failure (need for unscheduled administration of intravenous fluids) was significantly increased in children receiving standard WHO ORS (relative risk, 7.9; 95% confidence interval, 1.1, 60.9). The mean serum sodium concentration at 24 hours was significantly lower in children receiving the reduced osmolarity ORS solution (134 +/- 6 mEq/L) than in children receiving the standard WHO ORS (138 +/- 7 mEq/L) (p < 0.001). The relative risk of the development or worsening of hyponatremia was not increased in children given the reduced osmolarity ORS, and urine output was similar in the treatment groups. CONCLUSION: The reduced osmolarity ORS has beneficial effects on the clinical course of acute diarrhea in children by reducing stool output, and the proportion of children with vomiting during the rehydration phase, and by reducing the need for supplemental intravenous therapy. These results provide support for the use of a reduced osmolarity ORS in children with acute noncholera diarrhea.
PIP: Between July 1993 and March 1994, clinical researchers in Egypt enrolled 190 male children aged 1-24 months with acute diarrhea at the Abu El Reeche Hospital in Cairo in a randomized double-blind clinical trial to evaluate the relative efficacy of a reduced osmolarity oral rehydration solution (ORS) containing 75 mmol/l of both sodium and glucose (total osmolarity, 245 vs. 311 mmol/l for the standard ORS recommended by the World Health Organization and UNICEF) for treating acute noncholera diarrhea. They measured intake and output every three hours. Over the entire course of the study, the mean stool output was significantly lower in the reduced osmolarity ORS group than the standard ORS group (4.3 vs. 5 g/kg/hour; p 0.05). During the rehydration phase, the mean stool output was 36% lower in the reduced osmolarity ORS group than in the standard ORS group (p 0.05). The proportion of children vomiting during rehydration was much lower in the reduced osmolarity ORS group than the standard ORS group (17% vs. 33%; relative risk [RR] = 2.4; p 0.01). During the maintenance phase, the two groups shared similar stool output, mean intake of food and ORS, duration of diarrhea, and weight gain. Treatment failure was significantly more common in the standard ORS group than the reduced osmolarity ORS group (8% vs. 1%; RR = 7.9; p 0.01). The mean serum sodium level at 24 hours were much lower in the reduced osmolarity ORS group (134 vs. 138 mEq/l; p 0.001) but remained within the normal range in both groups. Children in both groups developed hyponatremia or their hyponatremia worsened at the same rate. Urine output was about the same in both groups. These findings suggest that the reduced osmolarity ORS has advantages over the standard ORS as a treatment for acute noncholera diarrhea. This safe and effective rehydration treatment reduces stool output and vomiting during rehydration as well as reduces the need for supplemental intravenous therapy.
Assuntos
Diarreia Infantil/terapia , Hidratação/métodos , Glucose/análise , Soluções para Reidratação/química , Soluções para Reidratação/uso terapêutico , Sódio/análise , Doença Aguda , Método Duplo-Cego , Egito , Humanos , Lactente , Masculino , Concentração Osmolar , Risco , Resultado do Tratamento , Organização Mundial da SaúdeRESUMO
PIP: Child and juvenile prostitution in Brazil has reached such proportions that a parliamentary commission launched an inquiry. The Brazilian Center of Children and Adolescents (CBIA) estimated that there are about 500,000 such prostitutes in the country, a record in Latin America. This type of prostitution flourishes in poor urban areas and in the North and Central-East. Not only girls become prostitutes; in Rio de Janeiro, 4000 boys cater to tourists from the industrialized world. 79% of these youngsters say that they use condoms, but 42% are infected with HIV. In many cases their families tolerate their homosexual encounters because of the extra income received. In the interior of the state of Rio, girls aged 11-15 years are enticed to cities as domestics and end up in prostitution. In Niteroi there is a prostitution network specializing in 13-year-old girls. Although there are 30,000 prostitutes in the state of Rio, the distribution of condoms among them has caused negative reactions among conservatives and Catholics claiming that it would increase licentiousness. The Brazilian Center for the Defense of the Rights of Children and Adolescents countered that condoms help prevent the spread of diseases. In Para, Acre, and Rondonia, 13-, 14-, and 15-year-old girls sell their bodies in order to survive. In the maternity ward of Barbara Heliodora, Rio Branco, Acre, 31% of deliveries are to girls aged 10-16 years. In Sao Paulo and in the neighborhoods of Bras and Belem, girls as young as 10 years of age become prostitutes under the protection of corrupt police who exact sexual favors or a share of receipts. According to CBIA, 80% of sexual violence against children and adolescents occurs in the home, with fathers being the main aggressors. The prostitution of children and adolescents in Brazil is connected to the destruction of the family and is the result of misery and hunger.^ieng