DTI parameters in neonates with hypoxic-ischemic encephalopathy after total body hypothermia

BACKGROUND AND PURPOSE

MR imaging provides means for discriminating different patterns of Hypoxic-ischemic encephalopathy (HIE) and may distinguish most severe cases from less severe but is unable to predict long-term outcome. Diffusion tensor imaging (DTI) offers information for a more complete characterization of HIE. The purpose of this study is to compare the modifications of DTI parameters in newborns one week and six months following total-body cooling to healthy controls.

METHODS

Forty-seven cooled newborns were studied with MRI, 20 underwent follow-up at 6 months. 12 healthy newborns and nine children at 6 months were enrolled as control groups (HC). Inferior Longitudinal Fasciculus (ILF), Corpus Callosum Fasciculus (CCF), Corticospinal Tract (CST), Optical Tract (OT), Optic Radiation (OR) were generated in all subjects. DTI parameters were evaluated in basal ganglia (BG), thalamus (TH) and tracks. Statistical analysis was performed with MANOVA.

RESULTS

In newborns HIE versus HC, there were significantly lower fractional anisotropy (FA) on OR and CST and higher axial diffusivity (AD), apparent diffusion coefficient (ADC) and radial diffusivity (RD) values on CST, BG and TH in HIE-N. At 6 months there were no significant grouping effects. The analysis showed a significant increase of FA, decrease of ADC, AD, RD after 6 months for HIE and HC.

CONCLUSIONS

We observed modifications of parameter values in HIE newborns vs HC; however normalization of values at 6 months suggests that changes of parameters cannot be considered early biomarkers for evaluation of therapeutic hypothermia in newborns with moderate HIE and normal conventional MRI.

[PCA in the control of acute and chronic pain in children]

BACKGROUND

This study was undertaken to verify the efficacy and safety of patient controlled analgesia (PCA) in preschool and older than 6 years children with acute postoperative and chronic oncologic pain.

METHODS

Sixty-two children, aged 4-17 yr, with postoperative (n = 37) or chronic (n = 25) pain received PCA with morphine at the following dosages: bolus = 10-20 gamma kg-1; starter dose = 10-30 gamma kg-1; background infusion = 10-50 gamma kg-1 h-1. Lockout was 5 to 15 minutes. In some children with oncologic pathology adjuvant drugs were also used.

RESULTS

Analgesia was considered satisfactory in all children, while a mild sedation was observed only in two children. PCA was also successfully used in preschool children (11%), aged 4 to 6 yr. Side effects were observed in 8 patients, but only in one of them a transient respiratory depression was recorded. The mean PCA duration was 5.3 +/- 5.5 days (min.2; max 24).

CONCLUSIONS

These results indicate that PCA is an effective and safe method to control acute postoperative pain as well as to manage chronic oncologic pain in children.

[Acute cocaine poisoning in a body packer. Clinical case]

This report takes into consideration the complications due to "body packers" cocaine absorption. In particular we report a clinical case in which severe dysrhythmias occurred. We think an early insertion of a pacemaker able to rid ectopic focus by overdriving is essential by comparison with an effective anti-dysrhythmic therapy. We also examine the cocaine metabolites values in the patient's serum and urine.

[Acute poisoning caused by cantharidin ingestion for aphrodisiac purposes. A clinical case]

We report a case of a man who died after ingestion of cantharidin as aphrodisiac. After evaluating the toxicology, we examined the development and therapeutic possibilities of handling the poisoning including charcoal hemoperfusion.

[Acute poisoning from arsenous anhydride ingestion. A clinical case]

A clinical case of acute poisoning after ingestion of arsenic trioxide is reported. We have, in particular, underlined the importance of identification of arsenic in faeces and urine for diagnosis and therapy.