RESUMO
The objective of this study was to determine the main clinical, neurophysiological and angiographic findings in brain death (BD) in children seen at the Instituto Nacional de Pediatría, a third-level facility in Mexico City, between 1991 and 1996. The following variables were retrospectively analyzed: sex, age, etiology, associated morbidity, duration of stay in hospital, and the results of two of three confirmatory studies (electroencephalogram, evoked potentials, radioisotopic angiography). In all, 125 patients were studied 78 male, median age 2 years (range: 18 days to 17 years)[. The most frequent etiology was infection (34%); 57% of the children developed associated morbidity. In 111 of 122 patients electrocerebral silence was observed; 100 of 107 had brain stem and somatosensory evoked potentials affording conclusive evidence of BD; and 83 of 90 patients had a positive radioisotopic angiography indicating BD. In 76 patients all three confirmatory studies were performed: for 15 there was at least one false-negative test result. Our age cohort showed a predominance of children less than 2 years old. BD etiologies in developing countries differ from those reported in developed countries.
Assuntos
Morte Encefálica/diagnóstico , Angiografia Cintilográfica , Adolescente , Morte Encefálica/fisiopatologia , Criança , Pré-Escolar , Eletroencefalografia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Valor Preditivo dos Testes , Estudos RetrospectivosRESUMO
From March 1980 to December 1995, at the Department of Neurosurgery of the Instituto Nacional de Pediatría (INP), 23 patients were treated for orbital tumors. In this communication, the authors report on the clinical presentation, age, radiological findings, visual-evoked potentials, type of surgery, histological diagnosis, and results. Two kinds of surgical techniques were employed: craniotomy with orbital roof removal (NAFZIGER) and fronto-orbitotomy. Eleven patients had optic nerve gliomas, 3 had fibrous osseous dysplasia, 2 meningiomas, neurofibromas, Langerhans cells histiocytosis, and 1 case of Anaplastic astrocytoma, Teratoma, primitive Neuroectodermal tumor, germinoma with areas of choriocarcinoma. The results were evaluated for the quality of life in regard to the Karnofsky scale, tumor recurrence and postoperative visual-evoked potentials. It is important to note the very variable histological kinds of lesions found in this series that can be approached surgically with cranio orbitotomy with good results.
Assuntos
Astrocitoma/cirurgia , Neoplasias Orbitárias/cirurgia , Adolescente , Astrocitoma/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Germinoma/cirurgia , Humanos , Lactente , Recém-Nascido , Masculino , Neoplasias Meníngeas/cirurgia , Meningioma/cirurgia , Tumores Neuroectodérmicos/cirurgia , Neurofibroma/cirurgia , Órbita/cirurgia , Neoplasias Orbitárias/diagnóstico por imagem , Teratoma/cirurgia , Tomografia Computadorizada por Raios XRESUMO
A retrospective historical analysis of patients under 18 years of age with the histopathological diagnosis of infratentorial primitive neuroectodermal tumor (PNET) is presented. The survey embraced two different groups of children. Group 1 was defined as those patients treated from 1972 to 1984 with surgical resection plus neuraxis radiotherapy alone. Group 2 was made up of children treated from 1990 to 1996 with the same approach but with the addition of adjuvant chemotherapy: cisplatin (day 1) and etoposide (days 1-3) every 3 weeks for 6 months. Group 1 embraced 42 children with an age range of 1-16 years (mean 6 years, SD 4.4 years). In group 2 there were 34 children, their ages ranging from 1 to 18 years (mean 7.2, SD 4.6 years). The prevalence of stages T2M0 and T3M0 was similar in both groups, but in group 1 there were 4 patients (9.5%) whose spinal fluid was positive for tumor cells (M1), while in group 2 there were 7 children (20.5%) with positive spinal fluid. There was an unequivocal initial response to treatment in 86% of these children in group 1 and in 79% in group 2. The event-free survival (EFS) was 30% at 252 months in group 1, while for group 2 the EFS was 67.6% at 63 months (P 0.002). Mortality from tumor activity was noted in 26 patients (70%) in group 1, while in group 2 mortality attributable to tumor progression was documented in 11 children (32%). We conclude that the use of adjuvant chemotherapy in these patients improves survival without any significant morbidity.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Neoplasias Cerebelares/radioterapia , Neoplasias Cerebelares/cirurgia , Tumores Neuroectodérmicos Primitivos Periféricos/radioterapia , Tumores Neuroectodérmicos Primitivos Periféricos/cirurgia , Adolescente , Adulto , Antineoplásicos/administração & dosagem , Antineoplásicos/uso terapêutico , Antineoplásicos Fitogênicos/administração & dosagem , Antineoplásicos Fitogênicos/uso terapêutico , Neoplasias Cerebelares/patologia , Criança , Pré-Escolar , Cisplatino/administração & dosagem , Cisplatino/uso terapêutico , Terapia Combinada , Etoposídeo/efeitos adversos , Etoposídeo/uso terapêutico , Feminino , Humanos , Lactente , Masculino , Estadiamento de Neoplasias , Tumores Neuroectodérmicos Primitivos Periféricos/patologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do TratamentoRESUMO
Achondroplasia (ACh) is the most frequent bone dysplasia. The mode of inheritance is autosomal dominant. The incident of neurological complications ranges between 20% and 47%; frequently the symptoms are subtle but are due to such serious conditions as cervicomedullary compressive syndromes, syringomyelia or hydrocephalus; thus, the early identification of this disorder is very important. We made a prospective study of 39 patients (20 female, 19 male) with ACh; their ages ranged from 3 months to 17 years (mean 4 years and 6 months). All patients had hypotonia and psychomotor delay; 3 had recurrent apnea, 1 developed radicular syndrome and 1 had leg paresthesias. The CT scan was normal in 5, 20 had cortical atrophy and 18 communicating hydrocephalus; we identified foramen magnum abnormalities in 28 patients, and reduced craniocervical junction with cervicomedullary compression in 6. Myelography and myelotomography demonstrated spinal compression in 12 patients. The MRI showed cervicomedullary infarct in 1, syringomyelia in 2 and diastematomyelia in 1. The somatosensory evoked responses (SSER) were very useful in the early identification of brain stem and spinal abnormalities. We concluded that the neurological manifestations of pediatric patients with ACh are frequent and very important, demanding comprehensive clinical evaluation even in asymptomatic patients, especially those with severe hypotonia or SSER alterations.
Assuntos
Acondroplasia/diagnóstico , Doenças do Sistema Nervoso/diagnóstico , Exame Neurológico , Adolescente , Encéfalo/patologia , Criança , Pré-Escolar , Potenciais Somatossensoriais Evocados/fisiologia , Feminino , Humanos , Hidrocefalia/diagnóstico , Lactente , Imageamento por Ressonância Magnética , Masculino , Hipotonia Muscular/diagnóstico , Estudos Prospectivos , Transtornos Psicomotores/diagnóstico , Canal Medular/patologia , Medula Espinal/patologia , Compressão da Medula Espinal/diagnósticoRESUMO
Cysticercosis is the most frequent parasitic disease of the central nervous system in the world and is endemic in such developing countries as Mexico. There is insufficient information about neurocysticercosis in children. The purpose of this study was to collect information on the main social factors associated with neurocysticercosis, the clinical picture, diagnosis and treatment, and the final outcome in 122 Mexican children. The ages of the patients ranged from 14 months to 17 years, with a mean of 8 years; 51 male (41.8%) and 71 female (51.8%) patients were seen; half of these patients (61) lived in well-urbanized areas; the parents of 77 families (57.3%) had only an elementary school grade average, and 46 (37.7%) lived in close proximity to animals. The most common features were seizures, intracranial hypertension and learning disabilities. The diagnosis of neurocysticercosis was supported by computed tomography or magnetic resonance imaging studies and cerebrospinal fluid analysis. The treatment was varied, with anti-convulsives, steroids, and albendazole, and only 8 patients underwent ventriculo-peritoneal shunts for hydrocephalus. The follow-up ranged from 6 months to 5 years; 90 patients became asymptomatic; 6 developed refractory epilepsy; 14, learning disabilities; and 10, a chronic type of the disease with repeated episodes of intracranial hypertension; 2 died because of chronic arachnoiditis.
Assuntos
Encefalopatias/psicologia , Cisticercose/psicologia , Fatores Socioeconômicos , Adolescente , Encefalopatias/diagnóstico , Encefalopatias/terapia , Criança , Pré-Escolar , Terapia Combinada , Cisticercose/diagnóstico , Cisticercose/terapia , Escolaridade , Feminino , Seguimentos , Humanos , Renda , Lactente , Masculino , Meio Social , Resultado do Tratamento , População UrbanaRESUMO
Five hundred and seventy primary central nervous system (CNS) tumors from the Department of Pathology at the National Institute of Pediatrics in Mexico City, collected from 1970 to 1989, were histologically reclassified in order to find out their relative incidence as well as their outstanding features. With this, we could establish a frame of reference for our local population, contributing to the epidemiological analysis of these entities. All the tumors were examined independently by two pathologists (C.R. and M.R.), using the classification of Rorke et al. Histological type, patient age and sex, and tumor location were analyzed. CNS tumors were the secondmost frequently encountered solid tumors, after lymphomas, and were increasing in incidence at a rate of 2.2 annually. Children in the age group 0-9 years were most often affected, and there was a predominance of male patients. Astrocytoma and medulloblastoma were the most common tumor types. The infratentorial region was the most frequent tumor location in the 2- to 9-year age group. By contrast, in the under 2-year-olds a supratentorial location was more frequent, and the incidence of germ cell tumors was proportionally high. In general, some histological types seemed to be associated with particular age groups. Although we found primitive neuroectodermal tumors to be the fifth most common at all ages (except for medulloblastoma), many other authors do not report a similar finding.