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Radu Russu

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Articole semnate de acelasi autor in Revista Romana de Pediatrie:

DILEME ETICE IN SARCINA CU MALFORMATII FETALE

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DILEME ETICE IN SARCINA CU MALFORMATII FETALE

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REZUMAT

Malformaţiile congenitale de cord, cu o incidenţă de 6-8/1.000 de nou-născuţi, reprezintă aproximativ 30% dintre cazurile de mortalitate infantilă determinate de anomalii congenitale. Dintre acestea, o mare parte necesită intervenţie chirurgicală corectoare imediat în perioada neonatală. Malformaţiile rinichilor şi tractului urinar au o incidenţă de aproximativ 1%. Dezvoltarea tehnicilor de ecografie fetală a permis diagnosticarea prenatală a multor malformaţii, unele cu risc vital. Astfel, apar probleme deosebite de etică privind întreruperea sarcinii sau îndrumarea gravidei către un centru unde nou-născutul va putea fi operat în primele ore de viaţă.

Cuvinte cheie: decizii etice, nou-născut, malformaţii congenitale de cord, malformaţii renale, ecografie fetală

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ETHICAL DILEMMA IN THE PREGNANCY WITH FETAL MALFORMATIONS

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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ETHICAL DILEMMA IN THE PREGNANCY WITH FETAL MALFORMATIONS

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ABSTRACT

Congenital heart malformations, with an incidence of 6-8/1,000 births, represent about 30% of cases of infant mortality due to congenital abnormalities. Of these, most require immediate corrective surgery in the neonatal period. Kidney and urinary tract malformations have an incidence of approximately 1%. The development of ultrasound techniques allowed for prenatal diagnosis of many fetal malformations, some of them lifethreatening. Thus, important ethical problems occur, concerning abortion or guidance of the pregnant woman to a center where the newborn will be operated in the first hours of life.

Keywords: ethical decisions, newborn, congenital heart defects, kidney malformations, fetal ultrasound

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NECROZA TUBULARA ACUTA PRIN ACTIUNEA NEFROTOXICA MEDICAMENTOASA – CAUZA RARA DE SINDROM NEFROTIC LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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NECROZA TUBULARA ACUTA PRIN ACTIUNEA NEFROTOXICA MEDICAMENTOASA – CAUZA RARA DE SINDROM NEFROTIC LA COPIL

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REZUMAT

Sunt prezentate două cazuri de sindrom nefrotic (SN) indus de medicamente cu nefrotoxicitate la nivel tubular, cu evoluţie diferită în contextul maladiilor incriminate etiologic.

Fetiţă în vârstă de 5 luni internată cu SN (dovedit clinic şi biologic) şi insuficienţă renală acută, după o spitalizare în alt servici pentru bronhopneumonie. Fetiţa a fost tratată cu ceftriaxonă şi gentamicină 12 zile. Suspiciunea de SN congenital a fost înlăturată de evidenţierea necrozei tubulare renale în fază de recuperare (biopsie renală). Evoluţia a fost favorabilă în 7 zile sub dializă peritoneală.

Adolescentă de 16 ani cu boală Basedow tratată de 3 ani cu carbimazol. S-a prezentat cu sindrom nefrotic care nu a fost influenţat de corticoterapie. Examenul histopatologic a evidenţiat necroză tubulară toxică, fibroză interstiţială, absenţa leziunilor glomerulare. A fost sistat tratamentul nefrotoxic, s-a practicat tiroidectomie după care edemele s-au redus, dar funcţia renală a continuat să se deprecieze, în condiţiile terapiei nefrotoxice administrată timp de 3 ani.

Concluzii. Necroza tubulară renală exprimată clinic şi biologic prin sindrom nefrotic, însoţit de insuficienţă renală este o situaţie rară la copil; gentamicina şi carbimazolul pot fi incriminate etiologic. Suferinţa renală poate fi ameliorată sau nu prin înlăturarea medicamentului cauzal. Eşecul terapeutic s-a corelat cu durata agresiunii medicamentoase şi evoluţia unor comorbidităţi.

Cuvinte cheie: necroză tubulară, sindrom nefrotic, insuficienţă renală acută

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DRUG INDUCED ACUTE TUBULAR NECROSIS – RARE CASE OF NEPHROTIC SYNDROME

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 4, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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DRUG INDUCED ACUTE TUBULAR NECROSIS – RARE CASE OF NEPHROTIC SYNDROME

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ABSTRACT

We presented two cases of nephrotic syndrome (NS) drug-induced with tubular nephrotoxicity, with different evolution in the context of etiologic diseases.

First is 5-month-old girl admitted with NS (clinically and biological proven) and acute renal failure after another hospitalization for pneumonia. The girl was treated with ceftriaxone and gentamicin 12 days. Congenital NS suspicion was eliminated by renal biopsy who revealed renal tubular necrosis highlighting recovery phase. The development was favorable in 7 days of peritoneal dialysis.

The second case was 16 years old adolescents treated 3 years with carbimazol for Basedow disease. Was presented with nephrotic syndrome not influenced by corticosteroids. Histopathology revealed toxic tubular necrosis, interstitial fibrosis, absence of glomerular injury. Nephrotoxic treatment was stopped, and, after thyroidectomy, edema were reduced, but kidney function continued to depreciate, while nephrotoxic therapy given for 3 years.

Conclusions. Renal tubular necrosis clinical and laboratory expressed by nephrotic syndrome, accompanied by renal insufficiency is a rare occurrence in children; gentamicin and carbimazol can be criminalized. The suffering or impairment may be improved by removing the causative drug. Treatment failure was associated with duration of drug aggression and evolution of comorbidities.

Keywords: acute tubular necrosis, nephrotic syndrome, acute renal failure

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INGESTIA CONCOMITENTA DE ETILENGLICOL SI ETANOL: O CAPCANA DE DIAGNOSTIC?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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INGESTIA CONCOMITENTA DE ETILENGLICOL SI ETANOL: O CAPCANA DE DIAGNOSTIC?

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REZUMAT

Etilenglicolul este unul dintre cei mai toxici alcooli, fiind consumat accidental sau voluntar, ca substituent al etanolului sau în scop suicid. Ingestia de etilenglicol determină, prin metaboliţii săi toxici, acidoză metabolică severă, cu creşterea hiatusului anionic şi osmotic, conducând la un tablou clinic ce asociază deprimarea sistemului nervos central, afectare cardiovasculară şi insuficienţă renală. Prezentăm cazul unui pacient în vârstă de 16 ani internat pentru semne clinice şi biologice de intoxicaţie cu etilenglicol apărute după ingestia simultană de antigel şi alcool. Pacientul a prezentat acidoză metabolică doar la debut, rapid corectată de o doză de bicarbonat de sodiu; investigaţiile ulterioare nu au relevat acidoză, chiar dacă în evoluţie a apărut insuficienţa renală acută ce a necesitat hemodializă. Datorită absenţei anamnezei pozitive şi a acidozei metabolice persistente, diagnosticul de intoxicaţie cu etilenglicol a fost întârziat până la confirmarea prin testul toxicologic seric. Concluzii: ingestia concomitentă de etanol poate masca simptomele intoxicaţiei cu etilenglicol; absenţa acidozei metabolice persistente nu exclude diagnosticul.

Cuvinte cheie: etilenglicol, acidoză metabolică, insuficienţă renală acută, hemodializă, intoxicaţie

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CONCOMITANT INGESTION OF ETHYLENE GLYCOL AND ETHANOL: A DIAGNOSIS TRAP?

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Revista Romana de PEDIATRIE | Volumul LXIV, Nr. 3, An 2015
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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CONCOMITANT INGESTION OF ETHYLENE GLYCOL AND ETHANOL: A DIAGNOSIS TRAP?

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ABSTRACT

Ethylene glycol is one of the most toxic alcohols; it may be accidentally or intentionally consumed as a substitute for ethanol or related to suicidal attempts. Ingestion of ethylene glycol causes a severe metabolic acidosis with increased anion and osmotic gap due to its toxic metabolites, leading to a clinical picture of central nervous system depression, cardiovascular and renal impairment. A 16-year-old boy was admitted with clinical and biological signs of ethylene glycol poisoning after simultaneous ingestion of antifreeze and ethanol. The patient had mild anion gap metabolic acidosis only at the debut, rapidly corrected with one dose of sodium bicarbonate; further evaluation did not reveal acidosis, even if the subsequent evolution included acute renal failure requiring hemodialysis. Due to the absence of a positive history and of a persistent metabolic acidosis, the diagnosis of ethylene glycol poisoning was delayed until it was confirmed by serum toxicological test. Conclusions: concomitant ingestion of ethanol may mask the symptoms of ethylene glycol poisoning; the absence of persistent metabolic acidosis does not rule out the diagnosis.

Keywords: ethylene glycol, metabolic acidosis, acute renal failure, hemodialysis, poisoning

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A prognostic score in Rotavirus gastroenteritis in children

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 3, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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A prognostic score in Rotavirus gastroenteritis in children

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ABSTRACT

Diarrhea is a major health problem and a common cause of morbidity and mortality in children, Rotavirus being the most frequent cause of infectious diarrhea in infants and young children. Aim. Evaluation of patients diagnosted and treated at Arcadia Hospital with Rotavirus gastroenteritis associated on admission with leukocytosis with polynucleosis, and development of a prognostic score by analyzing the associated clinical and biological changes. Methods. Included in the study were 70 patients diagnosed with Rotavirus diarrheea in which several clinical and biological parameters were analyzed in view of determining the changes occurring in those associating leukocytosis with polynucleosis at onset. By statistical analysis the “profile” of the patient with Rotavirus diarrhea associated with leukocytosis with polynucleosis was outlined. Thus we formulated a porgnostic score classifying Rotavirus gastroenteritis into 3 forms: mild (score < 11), moderate (score = 12-20) and severe (score > 20). Clinical course in patients associating leukocytosis with polynucleosis was considered favorable within approximately 1½-3 days, corresponding to prognostic score 12-20. Conclusions. Leucocytosis with polynucleosis at onset in patients with Rotavirus gastroenteritis is not an indicator of bacterial infection, but a negative prognostic factor. This score is easy to calculate and use in clinical practice in patients with acute Rotavirus diarrheea and allows a rapid formulation of prognosis and estimation of disease progression.

Key words: diarrheea, Rotavirus, child, prognostic score

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UN SCOR PROGNOSTIC UTIL IN GASTROENTERITA ACUTA CU ROTAVIRUS LA COPIL

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Revista Romana de PEDIATRIE | Volumul LXII, Nr. 3, An 2013
ISSN 1454-0398  |  e-ISSN 2069-6175
ISSN-L 1454-0398
DOI: 10.37897/RJP

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UN SCOR PROGNOSTIC UTIL IN GASTROENTERITA ACUTA CU ROTAVIRUS LA COPIL

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REZUMAT

Diareea reprezintă o problemă majoră de sănătate şi o cauză comună de morbiditate şi mortalitate la copii, Rotavirusul reprezentând cea mai importantă cauză de diaree infecţioasă la sugar şi copilul mic. Obiectivul lucrării. Evaluarea pacienţilor diagnosticaţi şi spitalizaţi în Arcadia Hospital cu gastroenterită acută cu Rotavirus, care prezentau la internare leucocitoză cu polinucleoză şi elaborarea unui scor prognostic prin analiza modificărilor clinice şi biologice asociate. Material şi metodă. Am urmărit 70 de pacienţi diagnosticaţi cu diaree cu Rotavirus, la care am analizat mai mulţi parametri clinici şi biologici, urmărind modificările la cei care asociau leucocitoză cu polinucleoză la debut. Am conturat cu ajutorul analizei statistice „profilul” pacientului cu diaree cu Rotavirus care asociază leucocitoza cu polinucleoză. Am formulat astfel un scor prognostic care clasifică gastroenterita cu Rotavirus în 3 forme: uşoară (scor prognostic < 11), moderată (scor prognostic = 12-20) şi severă (scor > 20). Evoluţia la pacienţii care asociau leucocitoză cu polinucleoză a fost considerată favorabilă într-un interval de aproximativ 1½-3 zile, corespunzând scorului prognostic cuprins între 12-20. Concluzii. Leucocitoza cu polinucleoză la debut la pacienţii cu gastroenterită cu Rotavirus nu a reprezentat un indicator de infecţie bacteriană, ci un element de prognostic nefavorabil. Scorul prognostic propus este uşor de calculat şi de aplicat în practica medicală la pacienţii cu diaree acută cu Rotavirus şi permite formularea rapidă a prognosticului şi estimarea duratei de evoluţie a bolii.

Cuvinte cheie:  diaree, rotavirus, copil, scor prognostic

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