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Angela Butnariu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

Dilated cardiomyopathies in children – evolutive aspects under Carvedilol treatments

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 4, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Dilated cardiomyopathies in children – evolutive aspects under Carvedilol treatments

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REZUMAT

In dilated cardiomyopathies, carvedilol can be a therapeutic resource, but experience with children is limited.

Objectives. The study of the clinical and paraclinical evolution of dilated cardiomyopathies in children, unresponsive to conventional treatment with angiotensin converting enzyme inhibitors, diuretics, digoxin, requiring the association of carvedilol; the study of the pharmacokinetics of carvedilol in children.

Materials and metods. 16 children with severe dilated cardiomyopathy and left ventricular ejection fraction ≤ 31% were clinically evaluated according to the ROSS / NYHA score and echocardiographical. The measurement of carvedilol in human plasma, high performance liquid chromatography associated with mass spectrometry the external standard method, was used for 7 patients.

Results. Of the 16 children with dilated cardiomyopathies treated with carvedilol as adjuvant medication to conventional therapy, 14 evolved towards clinical and echocardiographic improvement and two towards death. Clinically, the children tolerated carvedilol well, the NYHA score improved and the left ventricular ejection fraction increased from 31% to more than 40%. The study of the pharmacokinetics of carvedilol was performed for 7 subjects. It was demonstrated that the absorption rate does not change with the increase of the administered dose. The time to reach peak concentration is identical for all subjects. The mean half-time is 2.88 hours, being much shorter than in adults. The mean residence time of carvedilol in the body varies similarly, 4.28±1.52 hours.

Conclusions. At the pediatric age, dilated cardiomyopathies unresponsive to conventional treatment with angiotensin-converting enzyme inhibitors, diuretics and digoxin benefited from the association of betablocking medication – carvedilol, with the improvement of the NYHA/ROSS score and of the left ventricular ejection fraction. The study of the pharmacokinetics of carvedilol in children evidenced a mean half-time of 2.88 hours and a mean residence time in the body of 4.28±1.52 hours.

Key words: dilated cardiomyopathy, evolution, pharmacokinetics of carvedilol, child

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CARDIOMIOPATIA DILATATIVA LA COPIL – ASPECTE EVOLUTIVE SUB TRATAMENT CU CARVEDILOL

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Revista Romana de PEDIATRIE | Volumul LX, Nr. 4, An 2011
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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CARDIOMIOPATIA DILATATIVA LA COPIL – ASPECTE EVOLUTIVE SUB TRATAMENT CU CARVEDILOL

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REZUMAT

În cardiomiopatiile dilatative, carvedilolul poate reprezenta o resursă terapeutică, dar experienţa la copil este limitată.

Obiective. Studiul evoluţiei clinice şi ecocardiografice a cardiomiopatiilor dilatative ale copilului neresponsive la tratamentul convenţional cu inhibitori ai enzimei de conversie ai angiotensinei, diuretice, digoxin, care au necesitat asocierea carvedilolului; studiul farmacocineticii carvedilolului la copii.

Material şi metodă. 16 copii cu cardiomiopatie dilatativă severă şi fracţie de ejecţie a ventriculului stâng ≤ 31% au fost evaluaţi clinic prin scor ROSS / NYHA şi ecocardiografic. Măsurarea carvedilolului în plasma umană s-a efectuat la 7 subiecţi, utilizând cromatografia de lichide de înaltă performanţă, asociată cu spectrometria de masă, metoda standardului extern.

Rezultate. Dintre cei 16 copii cu cardiomiopatii dilatative trataţi cu carvedilol ca medicaţie adjuvantă terapiei convenţionale, 14 au evoluat spre ameliorare clinică şi ecocardiografi că şi doi spre deces. Clinic, copiii au tolerat bine carvedilolul, scorul NYHA s-a ameliorat, iar fracţia de ejecţie a ventriculului stâng a crescut de la sub 31%, la peste 40%. Studiul farmacocineticii carvedilolului a dovedit că viteza de absorbţie nu se modifică odată cu creşterea dozei administrate. Timpul de atingere a concentraţiei maxime a fost identic pentru toţi subiecţii. Timpul de înjumătăţire mediu a fost de 2,88 ore, mai mic decât la adulţi. Timpul mediu de rezidenţă al carvedilolului în organism a fost 4,28±1,52 ore.

Concluzii. La vârsta pediatrică, cardiomiopatiile dilatative neresponsive la tratament convenţional cu inhibitori ai enzimei de conversie ai angiotensinei, diuretice, digoxin au beneficiat de adiţionarea carvedilolului, cu ameliorarea scorului NYHA/ROSS şi a fracţiei de ejecţie a ventriculului stâng. Studiul farmacocineticii carvedilolului la copii a evidenţiat timpul de înjumătăţire mediu al carvedilolului de 2,88 ore şi timpul mediu de rezidenţă în organism de 4,28±1,52 ore.

Cuvinte cheie: cardiomiopatie dilatativă, evoluţie, farmacocinetica carvedilolului, copil

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Kikuchi-Fujimoto disease – diagnosis problems

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Kikuchi-Fujimoto disease – diagnosis problems

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ABSTRACT

Kikuchi disease is a rare, benign, self-limiting disease of unknown etiology, which should be included in the diagnostic algorithm of cervical adenopathy. The certainty diagnosis is histopathological, specific changes including paracortical lymph node necrosis, histiocytes with crescent shaped nuclei and many apoptotic bodies. The case of a 13-year-old patient diagnosed with Kikuchi disease, a disorder rarely described at pediatric age, is presented.

Key words: adenopathy, child, Kikuchi disease

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BOALA KIKUCHI-FUJIMOTO – PROBLEME DIAGNOSTICE

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Revista Romana de PEDIATRIE | Volumul LXI, Nr. 3, An 2012
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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BOALA KIKUCHI-FUJIMOTO – PROBLEME DIAGNOSTICE

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REZUMAT

Boala Kikuchi este o afecţiune rară, benignă şi autolimitată, de etiologie necunoscută, care ar trebui inclusă în algoritmul diagnostic al adenopatiei cervicale. Diagnosticul de certitudine este histopatologic, modificările specifice fiind necroza paracorticală ganglionară, histiocitele cu nuclei în formă de semilună şi numeroşii corpi apoptotici. Se prezintă cazul unui pacient de 13 ani cu diagnosticul de boală Kikuchi, afecţiune rar descrisă la vârsta pediatrică.

Cuvinte cheie: adenopatie, copil, boala Kikuchi

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EFICIENTA OXIGENOTERAPIEI PRIN IZOLETA LA SUGARUL CU INSUFICIENTA RESPIRATORIE ACUTA

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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EFICIENTA OXIGENOTERAPIEI PRIN IZOLETA LA SUGARUL CU INSUFICIENTA RESPIRATORIE ACUTA

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REZUMAT

Oxigenoterapia este principala metoda de tratament în insuficienţa respiratorie acută la copil. Metoda administrării oxigenoterapiei cu izoleta la sugar reprezintă o metodă frecvent folosită în practica pediatrică.

Obiective. Evaluarea eficacităţii oxigenoterapiei administrate cu izoleta la sugarul cu insuficienţă respiratorie acută de cauză pneumogenă prin compararea a două metode de măsurare a saturaţiei în oxigen a hemoglobinei: din sânge capilar arterializat şi prin pulsoximetrie.

Material şi metodă. Au fost luaţi în studiu 30 de sugari, cu insuficienţă respiratorie acută de cauză pneumogenă. S-a utilizat un scor clinic de apreciere a insuficienţei respiratorii acute, care evaluează frecvenţa respiratorie, bătaia aripioarelor nazale, tiraj, cianoza, senzoriu, înainte şi după oxigenoterapie. Din sângele capilar arterializat s-a mă- surat presiunea parţială a oxigenului şi saturaţia în oxigen a hemoglobinei şi s-a citit cu analizorul Automatic Blood Gas System. Concomitent s-a măsurat şi saturaţia în oxigen a hemoglobinei utilizând puls oximetrul. Măsurătorile au fost efectuate înaintea iniţierii terapiei cu oxigen şi după 30 de minute şi 60 de minute de la iniţierea oxigenoterapiei.

Rezultate. Comparativ cu valorile bazale, înregistrate înaintea iniţierii oxigenoterapiei, s-a înregistrat ameliorarea semnificativă statistic a scorului clinic atât la 30 de minute cât şi la 60 de minute după instituirea terapiei cu oxigen (p < 0,001). Ameliorarea a fost mai amplă la 60 de minute. Presiunea parţială a oxigenului a avut un trend ascendent semnificativ statistic atât la determinarea la 30 de minute cât şi la 60 de minute (p < 0,001). Pentru ambele metode de măsurare ale SaO2 au fost înregistrate creşteri semnificative statistic (p < 0,001) ale acestei variabile după 30 respectiv 60 de minute.

Concluzii. Oxigenoterapia administrată cu izoleta ameliorează insuficienţa respiratorie acută evaluată prin scor clinic. Administrarea oxigenoterapiei cu izoleta la sugar creşte semnificativ valorile presiunii parţiale a oxigenului şi a saturaţiei în oxigen a hemoglobinei măsurată din sânge capilar, precum şi valorile saturaţiei în oxigen a he moglobinei determinate cu pulsoximetrul atât la 30 de minute, cât şi la 60 de minute. Creşterile celor trei parametri sunt mai ample la 60 de minute. Există o concordanţă semnificativă statistic între valorile saturaţiei în oxigen a hemoglobinei determinată din sânge capilar şi prin pulsoximetrie în toate determinările.

Cuvinte cheie: presiunea parţială a oxigenului, parametri Astrup, saturaţia în oxigen a hemoglobinei, pulsoximetria

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EFFICIENCY OF OXYGEN THERAPY BY HEAD BOX FOR ACUTE RESPIRATORY FAILURE IN INFANTS

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 4, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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Promoting Global Health

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EFFICIENCY OF OXYGEN THERAPY BY HEAD BOX FOR ACUTE RESPIRATORY FAILURE IN INFANTS

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ABSTRACT

Oxygen therapy is the main treatment method for acute respiratory failure in children. The method consisting in the administration of oxygen therapy by head box to infants is frequently used in pediatric practice.

Objectives. To evaluate the efficiency of oxygen therapy administered by head box to infants suffering from pneumogenic acute respiratory failure by comparing two methods for measuring hemoglobin oxygen saturation: in arterialized capillary blood and by pulse oximetry.

Material and method. 30 infants suffering from pneumogenic acute respiratory failure were studied. We used a clinical appraisal score for acute respiratory failure, which appraises respiratory rate, nasal flaring, recession, cyanosis, sensorial, before and after oxygen therapy. In arterialized capillary blood we measured partial pressure of oxygen and hemoglobin oxygen saturation, and we used an Automatic Blood Gas System analyzer. We also measured hemoglobin oxygen saturation using a pulse oximeter. Determinations were made before the initiation of oxygen therapy, and 30 minutes and 60 minutes after the initiation of oxygen therapy.

Results. As compared to the baseline values, determined before the initiation of oxygen therapy, we recorded a statistically significant improvement in the clinical score both after 30 minutes and 60 minutes from the initiation of oxygen therapy (p<0.001). The improvement was greater after 60 minutes. The increase in the partial pressure of oxygen was statistically significant both at the 30 minute and 60 minute determination (p<0.001). Both methods of SaO2 measurement recorded statistically significant increases (p<0.001) in this variable after 30 and 60 minutes, respectively.

Conclusions. Oxygen therapy administered by head box improves acute respiratory failure appraised by clinical score. The administration of oxygen therapy by head box to infants significantly increases the values of partial pressure of oxygen and hemoglobin oxygen saturation measured in capillary blood, as well as the values of hemoglobin oxygen saturation determined by pulse oximeter both after 30 minutes and after 60 minutes. The increases in the three parameters are larger after 60 minutes. There is statistically significant concordance between the values of hemoglobin oxygen saturation determined in capillary blood and by pulse oximetry at all determinations.

Key words: partial pressure of oxygen, Astrup parameters, hemoglobin oxygen saturation, pulse oximetry

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