Transcranial Doppler changes in children with sickle cell disease on transfusion therapy

Transcranial Doppler (TCD) is an effective method for screening patients with sickle cell disease (SCD) at risk for first stroke. Its usefulness in monitoring children with SCD receiving transfusions has not been established. The authors studied 17 children with SCD evaluated with TCDs and magnetic resonance angiograms (MRAs) while receiving transfusion therapy. Patients with normalized TCDs had normal MRAs that remained normal on transfusions. Patients with persistently abnormal TCDs had abnormal MRAs. In these children, TCD velocities decreased but rarely reverted to normal. Patients with low TCD velocities (<70 cm/s) had corresponding vasculopathy on MRA. Low velocities may be a risk factor for stroke and should be followed. Overall, there was good correlation between TCD velocity changes and MRA analysis.     

经颅多普勒超声在危重患儿脑功能监测中的应用

脑功能监测是危重患儿监测的重要内容之一,其目的除了解患儿脑功能状态及受损程度外,对于判断疾病治疗效果和预后也有重要作用。常用监测方法包括Glasgow评分、颅内压、脑电图、脑血流和影像学监测等。经颅多普勒超声(TCD)可以穿透颅骨较薄的区域,直接获取颅底Willis环大动脉的血流动力学参数,反映脑血管的功能状态。因TCD技术具有操作简便,对患儿无损伤、无放射性,床边可行等优点,已逐渐成为儿科监护病房脑功能监测的常用方法之一。1超声窗及所探测的血管颅骨上某些区域能通过超声束并能探及血管的部位称为“超声窗”[1]。(1)颞窗:位于…     

Transcranial Doppler assessment of cerebral blood flow velocity in term newborns

Using the transcranial Doppler technique to assess postnatal changes in cerebral blood flow velocity, we studied the anterior cerebral artery, middle cerebral artery, and internal carotid artery of 31 healthy, term newborn infants. Normative values for the 1st, 3rd, and 5th days of life were determined. Cerebral blood flow velocity values in all three arteries examined correlated well with each other and we observed a statistically significant increase only in middle cerebral artery blood flow velocity between the 1st and 3rd, and 1st and 5th postnatal days. Thus, if we assume that flow velocities in various cerebral arteries undergo similar change, only one representative artery need be examined. The middle cerebral artery appears to be the vessel of choice. This choice simplifies the recording procedure, particularly in repeated examinations.     

Behavior and self-perception in children with a surgically corrected congenital heart disease

OBJECTIVE: We sought to combine parental and child reports in order to describe the behavior, self-perception, and emotional profile of children with a surgically corrected congenital heart disease (CHD). METHODS: Forty-three children with a surgically corrected CHD were selected and compared to an age- and sex-matched healthy group. The parents of the CHD children completed a behavior rating scale, the Child Behavior Checklist. Children 8 years and older (n = 23) completed a self-report questionnaire concerning perceived competence, their anxiety level, and feelings of depression. RESULTS: Compared to parents of healthy children, those of CHD children report significantly lower school results (p < .01), more school problems in general (p < .01), and a higher percentage of their children repeated a school year (p < .01). They also reported more social (p < .01) and attention problems (p < .01) and more aggressive behavior (p < .05). On self-perception and state anxiety questionnaires, no significant differences were found between the patient group and the healthy group. On a depression scale, however, children with a surgically corrected CHD reported more depressive feelings than healthy controls (p < .01). CONCLUSION: Parents of children with CHD rate their child's school competence to be weaker than healthy peers, they report more attention and social problems and more aggressive behavior. Children themselves did not report differences on perceived competence or anxiety but they do indicate more depressive symptoms than healthy peers.     

Intestinal permeability to [51Cr]EDTA in children with Crohn's disease and celiac disease

[51Cr]EDTA was used as a probe molecule to assess intestinal permeability in 7 healthy control adults, 11 control children, 17 children with Crohn's disease, and 6 children with untreated celiac disease. After subjects fasted overnight, 75 kBq/kg (= 2 microCi/kg) 51Cr-labeled EDTA was given by mouth; 24-h urinary excretion of [51 Cr]EDTA was measured and expressed as a percentage of the total oral dose. Mean and SD were as follows: control adults 1.47 +/- 0.62, control children 1.59 +/- 0.55, and patients with Crohn's disease or celiac disease 5.35 +/- 1.94. The difference between control children and patients was statistically significant (p less than 0.001). These results show that intestinal permeability to [51Cr]EDTA is increased among children with active or inactive Crohn's disease affecting small bowel only or small bowel and colon, and with untreated celiac disease. The [51Cr]EDTA permeability test could facilitate the decision to perform more extensive investigations in children suspected of small bowel disease who have atypical or poor clinical and biological symptomatology.     

Doppler assessment of pulmonary artery pressure in neonates at risk of chronic lung disease

AIM—To evaluate the pulmonary artery pressure (PAP) change in very low birthweight (VLBW) infants at risk of chronic lung disease (CLD).
METHODS—The time to peak velocity:right ventricular ejection time (TPV:RVET) ratio calculated from the pulmonary artery Doppler waveform, which is inversely related to PAP, was used. The TPV:RVET ratio was corrected for different heart rate (TPV:RVET(c)). Seventy three VLBW infants studied on days 1, 2, 3, 7, 14, 21 and 28 were enrolled for the analysis.
RESULTS—Twenty two infants developed CLD with a characteristic chest radiograph at day 28. Fifty one did not, of whom 17 were oxygen dependent on account of apnoea rather than respiratory disease, and 34 were non-oxygen dependent. The TPV:RVET(c) ratio rose progressively in all three groups over the first three days of life, suggesting a fall in PAP. In the oxygen and non-oxygen dependent groups, the mean (SD) ratio rose to 0.53 (0.09) and 0.57 (0.09), respectively, on day 7, then remained relatively constant thereafter. The CLD group rose more slowly after day 3 and had a significantly lower mean ratio from day 7 onwards compared with the other two groups (day 7: P<0.001, days 14-28: P<0.0001), and fell significantly from 0.47 (0.11) on day 7 to 0.41 (0.07) on day 28 (P=0.01), suggesting a progressive rise in PAP. The mean (SD) ratios at day 28 of all infants were: CLD group 0.41 (0.07); oxygen dependent group 0.66 (0.15); and the non-oxygen group 0.67 (0.11). The CLD group had a significantly lower ratio than the oxygen dependent group and the non-oxygen group (P<0.0001). Using the TPV:RVET(c) ratio of <0.46, infants at risk of developing CLD could be predicted on day 7 (predictive value 82.8%, sensitivity 54.5%, specificity 94.1%).
CONCLUSION—The non-invasive assessment of PAP using the TPV:RVET(c) ratio may be useful in the longitudinal monitoring of PAP change in VLBW infants, and for prediction of chronic lung disease.

     

Hyperlipemia and hyperlipoproteinemia [HLP] screening among the children from premature myocardial infarction risk families.

Serum lipids and lipoproteins were investigated in the premature myocardial infarction (PMI) risk families before 45 years of age with the aid of screening for hyperlipemia and hyperlipoproteinemia (HLP): in the case of 174 persons from Csongrád County from the Departments of Internal Medicine I and II and of 42 patients (fathers) suffering from PMI and their 79 "high risk" children from Heves County. In the investigated three groups of "high risk" children the genetically determined antiatherogenic HDL-Ch level diminished in 34.8, 52.3, 40.5 per cent. Significant negative correlation was detected between the serum HDL-Ch and beta-lipoprotein; significant positive correlations were found between the HDL-Ch and the serum lipase activity; between the beta-lipoprotein and the phospholipid level; significant negative correlation was proved between the HDL-Ch and the phospholipid level in the group of PMI patients and their offsprings. The Ch/Tg, and the HDL-Ch ratios were significantly diminished in the PMI patients' group against the risk children' group, while the Ch/HDL-Ch rate was significantly elevated.     

Color Doppler ultrasonography in the assessment of vesicoureteric reflux in children with bladder dysfunction

To determine whether color Doppler ultrasound (DUS) evaluation of ureteric jets could predict vesicoureteric reflux (VUR) in children with non-neuropathic and neuropathic bladder/sphincter dysfunction, 129 children were evaluated to identify the vesicoureteric orifice and measure the distance from the orifice to the midline of the dorsal bladder wall (MVU distance). The type of bladder dysfunction was determined by urodynamic studies. Forty-two children with no history of kidney or bladder disease were examined by DUS as a control group. MVU distances were compared between several groups of children with different urodynamic findings, and the significance was tested. Jets were visualized in 81% of children. MVU distances were significantly lower in children without VUR compared to those with VUR. No statistically significant differences were observed between children without VUR and those with VUR and more severe urodynamic disturbances like dysfunctional voiding. In children with neuropathic bladders, jets were visible in only 57% of refluxive units and the range of MVU distances was very wide (5–22 mm). If a cut-off point of 10 mm is used, in children without bladder dysfunction the sensitivity of MVU measurement in the diagnosis of VUR was 87.5% and the specificity 97%. However, in children with non-neuropathic and neuropathic bladder dysfunction, the sensitivity was only 55% and the specificity 79%. Color Doppler (DUS) and measurement of the MVU distance proved useful in predicting VUR only in children with normal bladder function. In children with neuropathic and non-neuropathic bladder dysfunction it can be used to visualize ureteric jets, but cannot replace radiographic or radionuclide voiding cystourethrography. Accepted: 21 March 2001     

Tissue Doppler echocardiographic assessment of cardiac function in children with bronchial asthma

BACKGROUND: The aim of the present study was to evaluate the role of tissue Doppler echocardiography in assessment of ventricular function in pediatric patients with bronchial asthma (BA). PATIENTS AND METHODS: Fifty-one pediatric patients with BA and 30 age- and sex-matched healthy subjects were studied. BA patients were divided into two groups: mild BA (n = 33) and moderate to severe BA (n = 18). All subjects were examined on conventional and tissue Doppler echocardiography, and 44 patients had pulmonary function tests on spirometry within 1 week of echocardiographic examination. RESULTS: Conventional echocardiographic parameters were all similar in mild asthmatic patients and control subjects. Tricuspid E velocity, E/A ratio and isovolumetric relaxation time (IVRT) in moderate and severe cases differed significantly from mild cases and control subjects. E', A', E'/A' ratio and IVRT of the lateral tricuspid annulus, and IVRT of the medial and lateral mitral annuli were different between mild cases and control subjects. E' velocity and IVRT of the lateral tricuspid annulus and IVRT of the medial and lateral mitral annuli were also different between mild cases and moderate to severe cases. Pulmonary function tests correlated well with E', E'/A' and IVRT of lateral tricuspid annulus. CONCLUSION: Patients with BA have subclinical right ventricular diastolic dysfunction even in the early stages. The severity of the functional impairment is parallel with the severity of the disease. Tissue Doppler echocardiography has a greater predictive value than conventional imaging, and is useful for evaluating ventricular function in patients with BA.     

Paediatric liver transplantation [corrected] in Melbourne: the first 50 patients

To report the outcomes of the first 50 paediatric patients who have undergone liver transplantation (LT) at the Victorian Liver Transplant Unit, a retrospective review of case records was carried out. From December 1988 to December 2000, 108 patients 18 years or younger were referred for LT; 50 of these underwent a total of 53 transplants. The most common indications were biliary atresia (32%), metabolic disease (26%), and acute hepatic necrosis (26%). The majority of deaths (6/7) occurred in the 1st week after LT. The actuarial survival at 1 year was 88% (95% CI 75% to 94%) and at 10 years 85% (95% CI 71% to 93%). Survival rates were highest for children aged 3 to 14 years (95%) and lowest in those weighing less than 8 kg at the time of LT (66%). All 43 survivors are attending age-appropriate activities including kindergarten, school, and employment. The survival of patients undergoing LT in this unit compares favourably with those recorded by the Australia and New Zealand Transplant Registry and is commensurate with that reported by larger paediatric transplant programs overseas.