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Dillenburg D.R.,Institute Cardiologia | Mostarda C.,University of Sao Paulo | Mostarda C.,Hospital Universitario Materno Infantil | Moraes-Silva I.C.,University of Sao Paulo | And 5 more authors.
Autonomic Neuroscience: Basic and Clinical | Year: 2013

Polyphenols consumption detected in red wine and grape juice may prevent or help in the treatment of hypertension. However, cardiovascular autonomic effects of polyphenols were poorly studied. Therefore, we evaluated the effects of resveratrol and grape juice treatments in hemodynamics, baroreflex sensitivity, heart rate (HR) and blood pressure (BP) variability and cardiac redox parameters. Male Wistar rats were divided in 3 groups (n= 7/each) and treated for 30. days: only L-NAME-treated (60. mg/kg/day by oral gavage), L-NAME. +. resveratrol (L-NAME. +. R) and L-NAME. +. grape juice (L-NAME. +. G). BP signal was directly recorded and pulse interval (PI) and systolic arterial pressure (SAP) variability were analyzed in time and frequency domains. Baroreflex sensitivity (BRS) was determined by the alpha index. Oxidized and reduced glutathione concentrations were determined in cardiac tissue. L-NAME increased BP with no differences among groups (mean BP: L-NAME = 124 ± 4, L-NAME + R = 126 ± 3 and L-NAME + G = 125 ± 4 mmHg). PI and SAP variability expressed by total variance were also similar among groups. However, normalized low frequency (LF) and high frequency (HF) components of PI variability were lower and higher, respectively, in both R and G-treated groups when compared to only L-NAME group. Interestingly, sympathetic modulation to the vessels (LF from SAP variability) and BRS were decreased and increased, respectively, only in L-NAME. +. R rats. Additionally, GSH/GSSG ratios were higher in L-NAME. +. R and L-NAME. +. G than in L-NAME group. Our results indicate that resveratrol and grape juice treatments can modulate autonomic function and promote cardiac redox benefits even when nitric oxide is decreased. Moreover, resveratrol influences not only cardiac but also vascular autonomic modulation. © 2013 Elsevier B.V.


Ayuso Velasco R.,Hospital Universitario Materno Infantil
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2011

The nonpalpable testis refers to the inability to make objective the teste through exploratory maneuvers. These patients have benefited from the laparoscopic approach that previously they could require even a laparotomy. Definitive treatment of nonpalpable testis depends on the laparoscopic findings, being in dispute their resolution in one or two stages. The aim of this study is to assess the incidence and the results after the application of laparoscopy for the treatment of nonpalpable testis in our department. All the cases of nonpalpable testis between 2000-2009 are selected. The age of intervention, laterality, operative findings, treatment performed and the size of the testes in cases operated in two stages are analized. Fifty-eight children are reviewed with a total of 60 testis. Thirty-one cases are left (53.4%), 25 are rights (43.1%) and 2 are bilateral (3.5%). In 32 children the testis is absent or atrophic, in 10 the Fowler-Stephens technique is developed, 8 gonads are next to the internal inguinal ring, 5 are in the inguinal canal and 2 is so high and so hipoplasic that orchiectomy is decided. Of those operated in 2 stages, 9 testes survive after the first time and 7 of them have a normal size 6 months after the second surgery. Laparoscopy is an effective method for diagnosis and treatment of non palpable testis, however, there is still no consensus, for certain locations, to descend the testicle in 1 or 2 stages and if the way is by laparoscopy or inguinotomy.


Ayuso Velasco R.,Hospital Universitario Materno Infantil
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2010

The paediatric surgeon should know the details of prenatal ultrasound diagnosis to participate in advising parents about the continuation of the pregnancy, and to plan the prenatal and postnatal treatment. Our objectives are: to determine the incidence of congenital anomalies detected with ultrasound in the 2nd trimester, the number of these diagnoses which is confirmed at birth and what is the usefulness of this test when advising parents. We reviewed the prenatal ultrasound in 2nd trimester reports made from January 2005 to July 2009. We note the ultrasound findings, the maternal and gestational age. The evolution of anomalies of the fetuses and the number of spontaneous and volunteers abortions are noted. Finally, the diagnoses are checked in the newborns. 10,256 ultrasonographies are made in this period. 209 stories of pregnant women (2%), which present fetal pathology amenable to general surgical treatment, are accessible for study. These include: 182 urologic disorders (85.44%), 13 digestive disorders (6.1%), 6 thoracic disorders (2.8%), 6 multiple malformations (2.8%), 4 maxillofacial disorders (1.88%) a sacrococcygeal teratoma (0.47%), an umbilical cord cyst (0.47%), 7 pregnancies are spontaneous abortion and 7 are terminated voluntarily. 183 stories of newborns are reviewed, we can confirm 48 uropathies (26.37%), 4 digestive malformations (30.77%), 4 thoracic disorders (66.66%), 2 maxillofacial disorders (50%) and 1 teratoma. Ultrasonography in the 2nd trimester detects almost 2% of specific fetal malformations. False positives are common in all diagnostic groups. The number of abortions and the terminations of pregnancy is low, most of them are polymalformated fetuses. We believe that ultrasonography in the 20th week have low value to counsel the termination of pregnancy, because only 7 of the 160 terminations indicated in our hospital during the study period, correspond to fetuses with pathology detected in the 2nd trimester. We recognize the usefulness of this test but, the false positive and favorable developments in a high percentage of fetuses, make us to be cautious to advise the continuation of pregnancy and the indication of treatment.


Hinojosa Mena-Bernal J.,Hospital Universitario Materno Infantil
Pediatria Integral | Year: 2011

Anomalies in the size and shape of the skull are the commonest reason for consultation to a Paediatric Neurosurgical Unit from Primare Care Paediatricians. Initial evaluation and differential diagnosis are essential to decide the type of treatment, necessity to follow up and prognosis of these patients. Early and sharp diagnosis will lead to an effective conservative management in children with cranial deformities secondary to external molding (positional plagiocephaly) and to the recognition of patients affected by a true craniosynostosis that will require a prompt surgical correction and strict follow up to avoid the incidence of intracranial hypertension and other functional abnormalities. The most frequent differential diagnosis in front of a cranial deformity is positional plagiocephaly, but there are at least three other common conditions that could be misleading for a primary care paediatrician regarding its management: metopic synostosis (and all the spectrum), the dolicocephalic head shape of preterm infants and the differential diagnosis between positional plagiocephaly (due to external molding) versus synostotic plagiocephaly, may it be anterior (coronal synostosis) or posterior (lambdoid synostosis). Positional plagiocephaly has an excellent response to posturing and physiotherapy in the first five months of life. After this period, cranial orthesis (helmets) help to correct more severe fl attening. Early recognition of these deformities from parents and caregivers would avoid excessive frequentation to referring units and the necessity for cranial orthesis. On the other hand, early diagnosis of craniosynostosis will render the best results after referral and precocious treatment. Any patient with the slightest suspicion of craniosynostosis should be sent as soon as possible to a referring Paediatric Neurosurgical department with experience in the treatment of these children.


Amat V.S.,Hospital Universitario Materno Infantil
Cirugía pediátrica : organo oficial de la Sociedad Española de Cirugía Pediátrica | Year: 2011

The object is to present our experience with the small left colon syndrome (SLCS) and to investigate the usefulness of the anorrectal manometry in the study of these patients. This was a retrospective review of the clinical histories of 10 patients treated in our Hospital for SLCS. The following variables are valued: sex, mother precedents, type of childbirth, gestational age, birth weight, clinical presentation (low colonic obstruction), delayed meconium passage, contrast enema with gastrografin, anorrectal manometry and treatment (Nursing, days of digestive rest, time of parenteral nutrition). During the study period, 10 patient were identified (5 are men). SLCS is reported in 2 sets of twins; in one set both twins are affected and in the other set 1 twin is affected. Maternal diabetes was identified in 6 patients. The mean gestational age was 36.6 + 2.11 weeks, and the weight 3001 +/- 689.72 g. 2 patient presented anomalies associated: fetopatía diabetic, hemivértebras D11-L2. All 10 infants presented abdominal distention and vomiting at 48.73 +/- 45.39 hours of life. Only 2 presented meconium passage in the first 24 hours. The contrast enema with gastrografin performed show typical findings of this syndrome in all cases. The anorrectal manometry carries out in 8 patients and demonstrates presence of the recto-anal inhibitory reflex (RAIR) in 5 and absence in 3. In these 3 patients with no RAIR, the study was repeated weekly until the presence being observed (normally between 2a and 3a week of life). In 1 newborn was necessary colostomy; the suction rectal biopsy showed immaturity of ganglionars cells and the manometric control previously at the close of the colostomy (9 months) showed presence of the RAIR. Conservative treatment (nursing and digestive rest) was successful in all cases with a mean of duration the 6.40 +/- 5.10 days. 6 patient needed parenteral nutrition during 7.30 +/- 8.49 days. The mean of discharge was 17.78 +/- 13.28 days. The clinical development was favourable in all the cases. The contrast enema with gastrografin is diagnostic and therapeutic and together with the nursing, has allowed solve the distal intestinal obstruction in 9 cases (90%). In the newborns with absence of RIAR, the anomanometric controls have allowed to know the moment of the maturation of the anorectal function.

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