OBJECTIVE: Detect of cardiac alterations in children with AIDS and compare their evolution with the administration of only one anti-retroviral and the recent cases who received drugs in combination. METHODS: We prospectively studied 47 children in 3 groups: group 1, 20 cases treated only with zidovudine; group 2, 10 patients treated initially with zidovudine and later with a combination of drugs and in group 3, 17 patients, who receiced two or three since the beginning. In all patients it was done chest X-ray, EKG and echocardiography every 6 months and after death complete pathological study. RESULTS: Among the 45 patients cases 26 (57%) were index cases. Malnutrition, diarrhea tachycardia, signs of congestive heart failure, pericardial effusion, abnormal ventricular repolarization and arrhythmias were more frequent in group 1. Echocardiographic abnormalities were present in 10 (50%) children of group 1. They were less frequent in the others two groups. In regard to the outcome in group 1, two patients had worsening of sings of cardiomyopaty and 4 died. Cardiac dysfunction in all cases of group 2 and 3 improved with the medication. CONCLUSION:- The children who received combination and their cardiac alterations had more favorable outcome than those who received only one drug.

PURPOSE: To report the result of patients treated with IV methylprednisolone divided into three groups and compare their follow-up during the last 12 years. METHODS: Seventy children with active rheumatic carditis (76 episodes) in heart failure Class III and IV (NYHA) were studied. The diagnosis was based on modified Jones' criteria. After ruling out infections and strongyloidiasis, treatment with IV methylprednisolone bolus was started three times a week until the laboratory tests became negative. Patients were divided into 3 groups, according to the time of hospital admittance: Groups 1, 2 and 3, comprising of 40, 18 and 12 children, respectively. RESULTS: Eighteen children in Group 1 (45%) were in their 1st attack: 2 series of pulsetherapy were used in 10 (25%), 3 in 9 (23%) and 4 in 21 (52%). In Group 2, 14 cases (77%) were in their 1st attack: 2 series were used in 7 (39%), 4 in 9 (50%) and 5 in 2 (11%). The echocardiogram showed a flail mitral valve in 12 (66%) of these patients (1 death occurred after mitral valvoplasty). In Group 3, 6 patients needed 5 or more series of pulsetherapy and a flail mitral valve was present in 5 (41%). One child underwent mitral valve replacement while still in the active phase, after 8 series of pulsetherapy, and another died. The number of patients who needed 5 or more series was significantly higher in Group 3. CONCLUSION: There were variations in the presentation and evolution of the cases during these 12 year. The established pulsetherapy protocol continues to be useful to treat severe cases.

OBJETIVO: Avaliar a gravidade das complicações cardíacas na asfixia neonatal, sua evolução e correlacioná-las com o grau e duração do processo hipóxico. MÉTODOS: Foram estudados 90 bebês nos últimos 7 anos com grau de Apgar <6 no 5°min de vida. Pelo protocolo, após o exame físico e os cuidados intensivos, eram submetidos a dosagem do pH arterial, CPK-MB, DHL, glicemia, além da realização de radiografia de tórax, eletrocardiograma (ECG), ecocardiograma, seriados e repetidos a cada semana. Aqueles que faleceram eram levados à necropsia. RESULTADOS: Dos 90, 73 (81%) eram prematuros, 30 (41%) eram apropriados para a idade gestacional (AIG) e 43 (59%) eram pequenos(PIG). Em 21 (23%) casos havia pH arterial <7,2. Os quadros clínicos mais observados foram: pneumonia em 28 (31%), anemia 24 (26%) e icterícia moderada 12 (5%), entre outros. Ao exame físico observaram-se: sopro sistólico em 46 (50%), ictus propulsivo 18 (20%) e ICC em 8 (9%). No ECG, os sinais mais freqüentes foram alterações de repolarização (ST e T) em 44 (49%). No ecocardiograma, observou-se persistência do canal arterial (PCA) em 20 (22%), regurgitação tricúspide em 6 (7%), hipertensão pulmonar em 6 (8%), hipocontratilidade de VE e dilatação de VD em 4 (5%). Dos 23 óbitos, 14 foram estudados e as alterações mais freqüentes foram necrose de fibras em 8 (68%) casos e em 4 (29%) congestão, vacuolização e perda de estriação. CONCLUSÃO: A maioria teve evolução favorável mesmo naqueles que tiveram acidemia importante. Muitas alterações de ECG e ecocardiograma se normalizaram. Daqueles que evoluíram para o óbito, as lesões mais graves ocorreram nos que sofreram, por mais tempo, processo anóxico.

PURPOSE: To evaluate the severity of cardiac complications of neonatal asphyxia in relation to the length and degree of hipoxia. METHODS: Ninety babies with an Apgar score <6 were examined in the intensive care unit at our institution during seven years. Arterial blood for measuring pH, glucose, LDH and MB fraction of CK, together with serial electrocardiogram (ECG), echocardiogram and chest X rays was obtained. The fatal cases were studied with macro and microscopic examination. RESULTS: From a total of 90 cases, 73 were premature: 30 (41%) appropriate for gestation age (AGA) and 43 (59%) small for gestation age (SGA). Twenty one (23%) cases had arterial pH <7.2. The most common clinical conditions were: pneumonia 28 (31%), anemia 24 (26%) and jaundice 12 (13%). The main cardiological findings were: systolic murmur in 46 (50%), signs of heart hypertrophy in 18 (20%) and heart failure in 8 (9%). On ECG the main findings were ST and T abnormalities. The echocardiogram showed a patent ductus arteriosus (PDA) in 20 (22%), tricuspid regurgitation in 6 (7%), pulmonary hypertension in 6 (7%), dyskinesia and ventricular dilatation in 4 (5%). Necropsy was performed in 23 cases and macro and microscopy obtained in 14; the most frequent findings were: myocite necrosis in 8 (54%), congestion, vacuolization and loss of striae in 4 (29%). CONCLUSION: In the majority of cases, patients had a benign course, even those presenting with severe acidemia. Many abnormal EKGs and echocardiograms became normal after a few weeks. Among those who had a fatal outcome, the severity of histological lesions was observed in babies who had suffered asphyxia for more prolonged periods.

A autorização de internação hospitalar (AIH), unidade de observação do Sistema de Informações Hospitalares do SUS (SIH/SUS), pode corresponder a uma internação de caráter agudo ou a um período delimitado de uma internação de longa duração. Este trabalho apresenta um algoritmo para a composição de dados por internação a partir das AIHs, possibilitando a consideração adequada da mortalidade hospitalar, custos sob a perspectiva do SUS e tempo de permanência hospitalar em internações de longa permanência, típicas, em especial, entre pacientes crônicos/fora de possibilidade terapêutica e psiquiátricos.

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

A autorização de internação hospitalar (AIH), unidade de observação do Sistema de Informações Hospitalares do SUS (SIH/SUS), pode corresponder a uma internação de caráter agudo ou a um período delimitado de uma internação de longa duração. Este trabalho apresenta um algoritmo para a composição de dados por internação a partir das AIHs, possibilitando a consideração adequada da mortalidade hospitalar, custos sob a perspectiva do SUS e tempo de permanência hospitalar em internações de longa permanência, típicas, em especial, entre pacientes crônicos/fora de possibilidade terapêutica e psiquiátricos.

The authorization form for hospital admittance (AIH), an observation unit under the Hospital Information System of the Unified Health System (SIH/SUS), may represent a short-term hospital admittance or a longer hospital stay. This study presents an algorithm for composing admittance data based on the AIH forms, allowing for a proper assessment of hospital mortality, costs under the Unified Health System (SUS), and longer hospital stays, typical of chronic, terminal, and psychiatric patients.

A persistência do canal arterial ocorre com freqüência em neonatos prematuros, provocando um grave quadro de disfunção cardiopulmonar. O tratamento envolve duas abordagens, sendo uma clínica e outra cirúrgica. A operação para a ligadura do canal arterial é praticada desde 1938. O enfoque clínico preconiza o uso da indometacina, com o intuito de promover a oclusão do canal arterial. O presente trabalho tem por objetivo avaliar os resultados obtidos com o tratamento cirúrgico da persistência do canal arterial, através de toracotomia e ligadura em 14 pacientes, incluindo crianças de baixo peso e neonatos prematuros com quadro clínico instável. A principal indicação cirúrgica, nestes casos, foi a presença de insuficiência respiratória aguda e insuficiência cardíaca. A técnica empregada foi a tripla ligadura do canal arterial. Nos 14 casos não obtivemos nenhum tipo de complicação e sem mortalidade. A presença de uma Unidade de Tratamento Intensivo Neonatal (U.T.I) no Hospital foi de extremo valor no preparo dos pacientes e na evolução no período de pós-operatório. Este trabalho comprova a eficácia do método cirúrgico empregado, com baixas taxas de morbidade e mortalidade e a importância da U.T.I neonatal no acompanhamento dos pacientes.

The patent ductus arterious frequently occurs in premature neonates causing serious cardiopulmonary disfunction. The treatment includes two options; one clinic and the other surgical procedure. The surgery for patent ductus arteriosus has been done since 1938. Clinical treatment with indometacin induces closure of the arteriosus ductus. The aim of the article is to analize the surgical results with thoractomy by triple-ligature of the ductus for the treatment of persistent ductus arteriosus in fourteen patients including low weight children and premature neonates with cardiopulmonary disfunction. The indications for surgery in these cases were respiratory distress and congestive heart failure. The technique used was triple-ligature of the patent ductus arteriosus. There were no complications neither mortality. The Neonate Intensive Care Unit was important for the evolution of these patients. Our study showed good results achieved by this technique, with low mortality and morbidity and the importance of the Intensive Care Unit for the evolution of these patients.