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Biomedical subjects

A G Dimitriu

Publications and source records attributed to A G Dimitriu.

At least 19 recordsLinked to original sources
PubMedDate not supplied

Etiological, clinical and pathomorphological aspects of acute respiratory distress syndrome in children.

Acute respiratory distress syndrome (ARDS) is the result of severe injuries of different etiologies of the capillary system in patients with previously healthy lungs, resulting in noncardiogenic pulmonary edema. The authors studied 42 infants in whom the histopathologic aspects were suggestive for ARDS. The etiologic factors of this syndrome were: severe gastroenteritis with hypovolemic or endotoxic shock (13 cases), sepsis (9 cases), fulminans purpura (2 cases), severe neurological disorders (13 cases), pulmonary infections (5 cases). In such conditions, if the infant presents hyperpnea followed by generalised cyanosis, refractory to oxygen therapy, and if there are clinical and radiologic signs of acute pulmonary edema, the diagnosis of ARDS must be considered and a complete intensive care therapy is compulsory in order to alleviate the severe prognosis of this syndrome.

Acute Disease↗
PubMedDate not supplied

Value of intravenous ATP in the diagnosis and treatment of tachyarrhythmias in children.

Actual researches show that adenosine and its forerunner, ATP, can realise a nodal block in intravenous (i.v.) administration. This effect, even if transient, is of particular usefulness in the therapy of paroxysmal supraventricular tachycardia (PST) in children and adults. 1 mg/kg ATP was administered i.v. to 51 children (aged 3 months to 15 years) admitted to the Intensive Care Unit for severe regular paroxysmal tachyarrhythmias with clinical and ECG symptoms. In 31 cases, the P wave was absent on ECG. In 6 of 31 cases in whom wide QRS complexes were found (over 0.10 sec), a WPW syndrome (4 cases) or bundle branch block (2 cases) was associated. Rapidly i.v. administration monitored electrocardioscopically was followed by ending of PST in 43 children, including those with wide QRS complexes. The highest effectiveness was in junctional tachycardia by re-entering mechanism. The drug was well tolerated, had no side effects or hemodynamic disturbances and this is very important, because in 12 infants already existed symptoms of congestive cardiac failure at their admission. The use of i.v. digoxin with/without propranolol was necessary in 8 cases, in which the repeated ATP administration was ineffective. We consider that i.v. ATP administration in regular tachyarrhythmias in children is very useful for the proper diagnosis of the types with wide QRS complexes and/or when the P wave did not appear on the ECG, and also for the treatment, because ATP has a high effectiveness and an excellent tolerance.

Adenosine Triphosphate↗
PubMedDate not supplied

[White-coat arterial hypertension in children and adolescents].

Although intensively discussed and finally accepted in the last years "white coat phenomenon" (WCF) still raises the question of the benefit of diagnosing it in pediatric patients as its possible link with the subsequent essential hypertension is not clear yet. This study included 1068 schoolchildren (aged 10 to 16 years) submitted to a screening program for detecting the in time variations of blood pressure (BP). When the study was started WCP was present in 60 children (5.6%) and when it ended its frequency raised to 8.73%. In 14 of 60 children (23.3%) WCP progressed to borderline or confirmed essential hypertension, incidence higher that that of similar forms of essential hypertension occurring in patients with normal BP levels (20 of 955 = 2.05%). With time, the frequency of borderline and confirmed essential hypertension has also increased: 5.11% at the first determination to 7.85% at last one. The high frequency of WCF and associated with the high frequency of its progression to essential hypertension support the idea that WCP has a predictive value for the development of essential hypertension. An early diagnosis and the prevention of other risk factors may lower the frequency of essential hypertension in adults.

Adolescent↗
PubMedDate not supplied

[The morphofunctional characteristics of cardiac involvement in arterial hypertension in children].

UNLABELLED: The aim of the study was to investigate the main morphofunctional aspects of the cardiac involvement in systemic hypertension in child. METHODS: 48 children with aged ranging between 2 months-18 years, diagnosed with systemic hypertension (SH), were followed up more than 1 year (with treatment) and investigated by clinical examination and noninvasive methods. The etiology of SH was: * secondary SH (40 cases): acute (8) and chronic nephropathy (20), 13 cases being dialysed; coarctation of aorta (10) and pheochromocytoma (2 cases) and * essential SH (8 cases): "borderline" type and also confirmed. RESULTS: The echocardiographic findings had a superior sensibility to ECG and chest X-ray findings, concerning cardiac involvement in SH, especially in the secondary forms, with high values of systolic and/or diastolic blood pressure and with a long period of evolution: hypertrophy of the left ventricle (LV) (31 cases = 65%) with septal predominance (10); * alteration of diastolic function of LV (11), but with normal systolic function of LV (all the cases). These changes have not been observed in acute nephropathy or they were unsignificant in essential SH. Repeated echocardiography after minimum 6 months proved a varied regression of hypertrophy of LV and improved diastolic function of LV in children who received antihypertensive therapy, including spironolactone and/or angiotensin converting enzyme inhibitors. CONCLUSION: Because such cardiac involvement are important and of greater risk factor for the hypertensive patients, the early diagnosis by echocardiography, the follow up of the evolution and the diminish of cardiac disorders by the treatment mentioned above, may improve the prognosis of the disease.

Adolescent↗
PubMedDate not supplied

[Risk factors in child and adolescent with systemic hypertension].

A prospective study was made on 1068 pupils, aged between 10-15 years (group I). From this group 995 pupils were examined after four to seven years (group II). Their age was between 16-19 years. The study contained: anthropometric data, blood pressure (BP) and pulse measurements, and a standard record using the epidemiologic interview method. For each pupil we determined the following familial and personal antecedent of cardiovascular disease, especially arterial hypertension; alimentary habits (salt and hydro-carbonate excess); consumption of coffee and cigarettes; physical activity; tendency to sedentarism; school or family stress; and behaviour type. Data were worked out and interpreted, using epidemiologic and statistic methods in Epi Info 6 program. The prevalence of genetic factors (4% in group I and 4.3% in group II), consumption of salt (38% in group I and 35% in group II), obesity (1.5% in group and 1.4% in group II), sedentariness (4.8% in group I and 6.8% in group II), stress (9.8% in group I and 10.5% in group II), with behaviour type A (41% I group and 52% in group II) all presented almost equal values in the two groups regardless of age or BP level. The statistical study of the influence of the risk factors on BP values, using student's t test has demonstrated the contributory part of the genetic factor, the excess of sweets and stress. The deleterious effects of arterial hypertension risk factors, which can begin early in childhood demonstrate the necessity for responsible parties (family, school, doctors, etc.) to be aware of these risk factors and assist in their control.

Adolescent↗
PubMedDate not supplied

[Aspects of left ventricular function in children with chronic renal failure].

OBJECTIVE: To present the main morphological and functional cardiac modifications in children with chronic renal failure (CRF) and the effect of hemodialysis on systolic function of the left ventricle (LV). METHODS: 22 patients (5-19 years) with CRF of different degrees of severity. 16 of them were included in a hemodialysis (HD) program and they were followed-up for at least 1 year. The systolic and diastolic function of the LV were investigated by echocardiography (echo) 2D and Doppler. RESULTS: Although the clinical signs of cardiac suffering were rare, echo detected concentric hypertrophy (9 cases), dilated cardiomyopathy (4 cases), mitral and tricuspidian regurgitation and pulmonary hypertension (3 cases) and pericardial effusion (10 cases). Systolic function was normal in most of the cases, but the diastolic function (evaluated by E/A ratio, isovolumic relaxation and deceleration time) was modified in 10 cases. The HD session induced the improvement of the LV systolic function parameters and the decrease of right ventricle dimensions. CONCLUSIONS: Echocardiography has a higher sensitivity compared to ECG and chest X-ray in evaluation of the LV function, mainly in the cases without cardiac symptoms. An efficient chronic HD program and also a complex antihypertensive treatment contribute to the alleviation of the LV function. For the HD session, echo is useful in monitoring the systolic LV function.

Adolescent↗
PubMedDate not supplied

[The assessment of left ventricular function in cardiac and extracardiac disorders in children].

The left ventricle (LV) suffers during various cardiac and extracardiac diseases. After the description of the cardiac performance during human development, the authors present the assessment of the left ventricle function in some cardiac and also extracardiac disorders of the child. There are listed the changes in myocardial structure, systolic and diastolic function in hypertrophy and dilation of the LV determined by systemic diseases that affect the pediatric patients and can lead to severe cardiac failure.

Cardiomyopathy, Hypertrophic↗
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[Clinical and developmental aspects of cardiac involvement in infant of diabetic mother].

The authors evaluated the main clinical and evolutive aspects of heart involvement in the newborn of diabetic mother (IDM). We studied the files of 35 IDM in a 4 years period; they were investigated the first week of life and at 6-12 months (18 cases). Most of the patients were asymptomatic/signs of extracardiac suffering; 15 had a systolic murmur. ECG: left ventricle (LV) hypertrophy (8) and LV repolarization disturbances (19 cases). Chest X-ray: cardiomegaly (9 cases). Echocardiography: hypertrophic cardiomyopathy (HCM), especially septal (25 cases, 71%); LV diastolic dysfunction (19-35) and normal systolic function; pulmonary hypertension (3), other congenital heart diseases (8 cases). The control revealed the alleviation of the LV walls size and LV diastolic function. The high incidence of the cardiac manifestations in IDM and the risk of occurrence of some severe problems, require a complete cardiological exam from the first few days of life and a follow-up schedule until the normalization of the cardiac parameters.

Adult↗
PubMedDate not supplied

[Arrhythmic cardiomyopathy. Case report].

An 11 year-old boy was admitted with incessant sinus node reentrant tachycardia and secondary dilated arrhythmic cardiomyopathy, treated by radiofrequency ablation. Two years later he was admitted with incessant automatic atrial tachycardia and arrhythmic cardiomyopathy; a second catheter ablation procedure failed, but the third one, performed four month later, was successfully and resulted in a restoration of a normal sinus rhythm and a complete regression of arrhythmic cardiomyopathy.

Arrhythmias, Cardiac↗
PubMedDate not supplied

[Cardiac arrhythmia in amitriptyline poisoning in children].

UNLABELLED: Amitriptyline (Antideprin) determines severe intoxications, especially because of its cardiac side effects. METHOD: We studied 8 children (2-14 years old) admitted with signs of amitriptyline intoxication. RESULTS: The clinical picture revealed altered general status, generalized hypertonia, arterial hypotension up to collapse, mydriasis, coma and cardiac arrhythmia. ECG monitoring showed ventricular premature beats, isolated, couplets and triplets, ventricular tachycardia and torsade des points, severe ventricular repolarisation disturbances with diffuse subendocardial ischemia. The treatment consisted in: gastric lavage with activated charcoal, alkalinisation with sodium bicarbonate, antiarrhythmic drugs and sustained vital functions. All cases recovered in 4-6 days. CONCLUSION: The severity of amitriptyline intoxication requires continue clinical and ECG monitoring, for early detection of some life threatening cardiovascular events. Thus, the treatment will be started early and will alleviate the severe prognosis of this intoxication.

Adolescent↗