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Early treatment by thyroid hormone in congenital hypothyroidism (CH) prevents for mental retardation, but the autonomic condition could well remain impaired. The aim of this study was to get insights about the cardiovascular regulation of CH children by analysing their heart rate variability (HRV) data. RR-interval data of 34 early treated CH children, 24 to 48 months of age, were collected at rest in a clinical environment. In all these cases, CH resulted from an abnormal development of thyroid gland. Data from 29 age matched-controls were also collected in a scholar environment. Short time series were then analysed in time and frequency domains. Detrended fluctuation analysis (DFA) was also applied to obtain the scaling exponent α(1). We found that the HRV obtained from children with CH is diminished as suggested by statistical differences (p<0.05) in the following parameters: RMSDD, pNN20, total power, LF and HF. However, no significant differences were found in the LF/HF ratio, the central frequencies of the LF and HF bands, as well as in α(1). Given that the significant differences were basically reflected in static parameters rather than in the frequency distribution or scale-invariant behaviour of the studied data, we consider that the analysis points toward the effect of treatment on rising heart rate by the thyroid hormone, and not necessarily toward any residual autonomic dysfunction, as the dominant underlying cause of the diminished HRV exhibited by CH children.

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Thyroid hormones play a major role in the maturation process of the brain. Currently, congenital hypothyroidism is detected by mass screening. The impact of this early hormonal deficiency on the organization of the sleep pattern is not known. In this study, the polysomnographic features in children diagnosed with congenital hypothyroidism were analyzed. Children were detected by mass population screening and the hormonal replacement therapy starts immediately. Children's age ranged between 1.5 and 18 months of age. The duration of hormonal treatment before sleep recordings varied between 8 days and 17 months. Children were polysomnographically recorded in the morning, for at least 2h, obtaining more than one sleep cycle. Results showed a high prevalence of females (5/1) in the group studied. A high proportion of infants (43%) displayed central apnea in different degrees (mild, moderate and severe) as well as hypopnea (83%), mainly in subjects around 4 and 8 months of age. The proportion of infants displaying central apnea decreases as age increases. In addition, indeterminate (light) sleep increase and quiet (slow wave) sleep decrease significantly regardless of age and treatment. The percentage of REM sleep correlated positively with the age of the child at the beginning of the treatment, and negatively with their age at the time of the study. These data indicate that congenital hypothyroidism facilitates the presence of central sleep apnea. The decrease of these respiratory alterations correlates with the increase of the hormonal replacement therapy. It seems that sleep respiratory alterations in congenital hypothyroidism are linked to brain maturation processes in which thyroid hormones play a major role.

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The analysis of heart rate fluctuations, or heart rate variability (HRV), may be applied to explore children's neurodevelopment. However, previous studies have reported poor reliability (repeatability) of HRV measures in children at rest and during light exercise. Whether the reliability can be improved by controlling variables such as physical activity, breathing rate and tidal volume, or by selecting non-conventional techniques for analysing the data remains as an open question. We evaluated the short-term repeatability of RR-interval data from medicated children with congenital hypothyroidism (CH). The alpha(1) exponents, obtained by detrended fluctuation analysis (DFA), from the data of 21 children collected at two different sessions were compared. Elapsed days between sessions were 59 +/- 33, and data were obtained during 10 min, trying to restrict the children's activity while being seated. We found statistical agreement between the means of alpha(1) exponents for each session (p = 0.94) and no bias with a low-coefficient variation (9.1%); an intraclass correlation coefficient ri = 0.48 ([0.14 0.72], 95% confidence interval) was also estimated. These findings, which were compared with results obtained by conventional time and frequency techniques, indicate the existence of agreement between the alpha(1) exponents obtained at each session, thereby providing support concerning the repeatability of HRV data as analysed by DFA in children with congenital hypothyroidism. Of particular interest was also the agreement found by using the central frequency of the high-frequency band and the parameter pNN20, both showing better or similar ri than alpha(1) (0.77 [0.57 0.89] and 0.51 [0.17 0.74], respectively), yet considerably better repeatability than other conventional time and frequency parameters.

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OBJECTIVE: We sought to describe if neurological damage, in terms of brain lesions, syndrome and syndrome severity led to abnormalities in the brain-stem auditory evoked potentials (BAEPs) in order to provide a profile of children that could be used as an indicator of subsequent neurological sequelae. We analyzed the BAEPs from a group of children having prior evidence of neurological damage and determined the presence of neurological sequelae when the subjects were 3 years old. METHODS: Brain-stem auditory evoked potentials (BAEPs) were carried out in a group of 154 children with perinatal neurological damage. The children were classified with neurofunctional (clinical and EEG alterations) or organic and neurofunctional brain disease (clinical, EEG and image alteration) and were all followed from the first month of life and serially for 3 years. We used principal component analysis (PCA), clustered analysis and linear correlation to determine association between BAEPs, risk factors and future sequelae. RESULTS: Latencies of BAEPs decreased significantly with age, and the time of conduction was modified by the presence of neurological damage. All statistical analyses suggested positive and significant associations between risk factors (trophism and condition at birth), and the latencies of waves I, III and V as well as with IPL III-V (interpeak latency) and I-V. PCA showed that IPL I-III was also positively associated with condition at birth, severity of the neurological syndrome and encephalopathy. In addition, we found that the presence and type of sequela reflected changes in the latencies of the waves, as well as IPLs, primarily those of IPL I-III. CONCLUSIONS: Our results suggest that statistical methods are often needed to analyze neurological damage. The relation between BAEPs, risk factors and neurological sequelae allowed us to obtain a profile of children, which can be then used as an aid in the prognosis of children having a risk of developing neurological sequelae.

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Se presentan 14 anos de experiencia de la Unidad de Oncologia del Hospital General de Mexico de la Secretaria de Salubridad y Asistencia, en el tratamiento con histerectomia mas linfadenectomia pelvica del cancer cervicouterino recurrente a radiacion, destacandose que la operacion ocupo el 14 por ciento entre los casos explorados quirurgicamente por esta entidad y el 22 por ciento de los sometidos a cirugia radical por el mismo proceso.Se senala que unicamente el 30 por ciento de las pacientes tenian lesiones invasoras tempranas al establecerse en el servicio el diagnostico de cancer, y se hace notar que el 50 por ciento de los casos curso con morbilidad postoperatoria, siendo las complicaciones urinarias las de mas dificil solucion. Se hace un estudio de los factores que influyeron en la mortabilidad operatoria, y se muestra que el 42 por ciento de los casos evoluciono de 1 a 10 anos sin evidencia de actividad tumoral.Se concluye que la histerectomia con linfadenectomia pelvica constituye una alternativa util en el tratamiento del cancer cervicouterino recurrente a radiacion, a condicion de efectuarla en casos muy seleccionados de recurrencias tumolares centrales y con poca fibrosis consecutiva a la radioterapia

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Se estudio el tiempo de sangria de Ivy modificado en 110 pacientes pediatricos. Los valores normales mostraram igual: 5'45" y 1 DS: 60", siendo el rango del 95% de confidencia de 3'45" a 7'45". No se demostro diferencias del tiempo de sangria en las distintas edades pediatricas.La diferencia maxima entre 2 tiempos de sangria del duplicado es 1'30". Se comenta sobre las diferentes tecnicas del tiempo de sangria, siendo la usada en este estudio la mas reproducible y sensible por su mayor nivel de standarizacion. Los valores normales del recuento de palquetas x mm3, con el metodo de fase contrastados mostraron igual: 275.000 y 1 DS 60.000 siendo el rango del 95% de confidencia 150.000 a 400.000

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