Influence of ablation therapy on the quality of life in children with supraventricular tachycardia

OBJECTIVE

Numerous restrictions, which are imposed on children with arrhythmia, influence their quality of life (QoL) and may have a negative impact on their further development. Ablation is a highly successful treatment leaving patients free from arrhythmia and other related limitations. There are very few studies evaluating the influence of ablation on the QoL in children with arrhythmia, based on small groups of patients. The aim of this study was to evaluate the impact of ablation on the QoL in children with supraventricular tachycardia (SVT).

PATIENTS AND METHODS

We included 122 children with SVT who underwent a successful ablation. The Qol was assessed before and after the ablation, using the WHOQOL-BREF and the Pediatric Arrhythmia Related Score (PARS) - a specific questionnaire developed by the authors.

RESULTS

Six months after the ablation, WHOQOL-BREF showed a significant improvement in the QoL in the physical (Phd) (p < 0.0001), psychological (Psd) (p = 0.0014) and social relationships (SRD) (p = 0.0165) domains. PARS showed a significant improvement in the QoL in the Phd (p < 0.0001), Psd (p = 0.0307) and medical satisfaction domains (Msd) (p < 0.0001). No improvement in Psd was revealed in children who had been off medications before the ablation. In the youngest children, a significant improvement was observed in all the measured domains in both questionnaires (p < 0.05), while in older children the greatest improvement after the ablation was noted in the area of physical functioning.

CONCLUSIONS

Ablation in children with SVT significantly improved general satisfaction with health and with the QoL and had a positive impact on QoL scores. The youngest patients and those on antiarrhythmic medication before the ablation, benefit most from the procedure.

Immunohistochemical detection of galectin-1 in renal biopsy specimens of children and its possible role in proteinuric glomerulopathies

AIMS

Galectin-1 is an endogenous lectin that specifically binds to beta-galactoside structures. It has been associated with developmental mechanisms ranging from differentiation to apoptosis and exerts immunoregulatory functions in autoimmune diseases. The aim was to determine the immunohistochemical expression of galectin-1 in renal biopsy specimens of children with primary idiopathic proteinuric glomerulopathies.

METHODS AND RESULTS

We examined 18 children with minimal change disease (MCD), 30 with diffuse mesangial proliferation (DMP) and 11 with focal segmental glomerulosclerosis (FSGS). An indirect immunohistochemical protocol using a polyclonal antibody directed against galectin-1 was applied. Galectin-1 was detected in renal podocytes in DMP and FSGS cases, while control glomeruli and MCD were negative. Galectin-1 immunoreactivity was found within parietal epithelial cells in patients with FSGS.

CONCLUSIONS

These results suggest a possible role for galectin-1 in the pathogenesis of primary glomerulopathies in children as a kind of podocyte-related self-protective activity and probably involvement of epithelial cells of Bowman's capsule in inflammatory processes. Immunohistochemistry using galectin-1 antibodies may further be helpful in histological distinction between MCD and DMP.

[Electrolyte abnormalities and ventricular arrhythmias in children with mitral valve prolapse]

The aim of this study was to determine plasma concentration of magnesium, potassium, calcium and sodium in children with mitral valve prolapse (MVP) and to establish the relation between electrolyte abnormalities and ventricular arrhythmias (VA). The study group consists of the 113 children with MVP (age +/- SD: 10.7 +/- 4.3 years). The 101 healthy children (age +/- SD: 13.0 +/- 3.2 years) were enrolled into the control group. All patients underwent clinical examination, standard ECG, 24 hr ECG Holter monitoring and echocardiography. Blood samples were taken 3 times in fasting state in separate days. All patients were in sinus rhythm. Cardiac arrhythmias were observed more frequently in children with MVP (53%) than in control group (31%, p < 0.0008). VA were recorded in 39% MVP patients, compared with 13% of the healthy children (p < 0.0001). There were no differences in K, Na and Ca concentrations in children with MVP comparing to control group. Serum Mg concentration was significantly lower in MVP group (0.88 +/- 0.08 mmol/l) comparing to healthy children (0.91 +/- 0.07 mmol/l, p < 0.002). A marked decrease in Mg concentration was recorded in patients with MVP and ventricular arrhythmias compared with those without ventricular arrhythmias (0.83 +/- 0.07 vs 0.90 +/- 0.06 mmol/l, p < 0.0001). This study demonstrates that potentially serious dysrhythmias are common in pediatric patients with MVP. It would appear that ambulatory ECG monitoring should be part of the complete evaluation of children with MVP. Since decreased plasma concentration, magnesium supplementation seems to be a prudent approach in children MVP with frequent ventricular premature beats and in children with ventricular tachycardia.

Potentiation of the antiproliferative effect in vitro of doxorubicin, cisplatin and genistein by new analogues of vitamin D

Numerous vitamin D3 analogues have been synthesised in recent years in order to obtain compounds with a favourable biological and therapeutic (antipsoriatic and/or antitumour) activity. Our results showed that pre-treatment for 72 hours of HL-60 human promyelocytic leukaemia cells with calcitriol or its new analogues significantly potentiated their sensitivity to the antiproliferative effect in vitro of cisplatin, doxorubicin or genistein. Moreover, for all cytotoxic agents tested a synergistic antiproliferative effect was observed. This effect was expressed as a significant decrease of the ID50 (inhibitory dose 50%) values for each cytotoxic agent applied after pretreatment with calcitriol or its analogues of HL-60 cells in comparison with the effect of cytotoxic agent applied alone. The observed in vitro potentiated antiproliferative effect of cytotoxic drugs used in combination with vitamin D or its analogues may raise the question as to whether such an effect could be expected in the in vivo situation.

Intravenous aminophylline increases the degree of saturation of urine with calcium phosphate and struvite

This study was designed to assess the effect of i.v. treatment with aminophylline (AMPH) on the risk of calcium phosphate and struvite stone formation. We administered AMPH in doses of 4 mg/kg body weight in 15-min i.v. infusions to 60 infants with clinical symptoms of obstructive bronchitis with dyspnoea. During 3 hours after infusion we observed a significant increase in urine saturation with brushite, octocalcium phosphate and struvite. This rise in urine saturation may increase the risk of kidney stone formation.

[Dysrhythmias documented by 48-hour electrocardiographic monitoring in children with mitral valve prolapse]

The association of dysrhythmias with mitral valve prolapse (MVP) in pediatric patients was examined by 48-hour ECG monitoring. Fifty unselected children with clinical diagnosis of MVP confirmed by echocardiography were studied. Eight (16%) patients manifested atrial dysrhythmias. Long runs of junctional rhythm with activity were recorded in one patient. Episodes of supraventricular tachycardia were recorded in 4 (8%) children. Seventeen (34%) patients had ventricular dysrhythmias. In 10 (20%) children, ventricular premature complexes (VPCs) were recorded. Four (8%) patients had frequent multifocal VPCs. Ventricular couplets were recorded several times in one patient (2%) and nonsustained ventricular tachycardia was recorded in two (4%) children. Clinical symptoms did not correlate with documented arrythmias. Although the prognostic implications of these findings are uncertain, this study demonstrated that potentially serious dysrhythmias are common in pediatric patients with MVP. It would appear that ambulatory ECG monitoring should be part of the complete evaluation of children with MVP.

[One center's experience with fibrinolytic treatment in children]

Fifteen children treated with fibrinolytic agents are presented. The most frequent indication was thromboembolic disease (TED). Eleven patients received streptokinase, 5-urokinase and 3-tissue plasminogen activator. Concomitant heparin was administered to 9 patients with TED. Total resolution was achieved in 9 children, partial improvement in 5; 1 child died during treatment without any improvement. Bleeding complications were observed in 6 patients, 1 of them died due to haemorrhagic stroke. According to the literature and our own experience, we recommend fibrinolytic agents as the treatment of choice for severe TED also in children.

[Symptomatic cytomegaly in a 6-month old infant]

The aim of our study is to present diagnostic and therapeutic problems in the case of 6-month old infant with cytomegaly infection. We observed typical symptoms of cytomegaly infection (central nervous system and liver damage, coagulopathy, anaemia) as well as electrolyte and serum lipid disturbances and urine densification abnormalities.

[Non-neoplastic tumors of the heart in newborn infants]

Two cases are reported of masses in the cardiac ventricles in newborns with a thrombus, in another case the changes disappeared completely. Despite the diagnosis of congenital heart disease. In one case autopsy examination demonstrated persistent heart disease. The condition of the child improved.