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Biomedical subjects

C R Leone

Publications and source records attributed to C R Leone.

At least 19 recordsLinked to original sources
PubMed2006

Neonatal arterial hypertension in nephro-urological malformations in a tertiary care hospital.

An increase in the survival of neonates with antenatal diagnosis of malformations was achieved by the recent technical advances in neonatal intensive care units. The aim of this article is to describe the experience with neonatal arterial hypertension, in newborns with nephro-urological malformations, in a tertiary care referral Nursery, in a period of 4 years. Newborn medical records from the Nursery Annex to the Maternity of Hospital das Clinicas, School of Medicine, University of Sao Paulo, with the diagnosis of nephro-urological malformations and systemic arterial hypertension (SAH) at hospital discharge, in a period from January 1999 to January 2003, were retrospectively analysed. Among 10.278 live newborns in the studied period, 15 (0.15%) newborns were compatible with our inclusion criteria. Of these 15 newborns, 12 (80%) were male and three were premature (20%). In relation to aetiology, 13 (87%) showed urological malformations, 1 (6%) chronic renal insufficiency secondary to kidney dysplasia and one (6%) autosomal recessive polycystic kidney disease. SAH control was achieved with monotherapy in eight patients (53%), five patients (33%) needed an association of two drugs (calcium-channel blocker and angiotensin converting enzyme (ACE) inhibitor), one child used three types of antihypertensive drugs (calcium-channel blocker, ACE inhibitor and hydrochlorothiazide) for pressoric control and one child's blood pressure (BP) was controlled exclusively by peritoneal dialysis. The incidence of nephro-urological malformations in our service during the studied period was 0.89%. SAH incidence among these newborns was 19%. Our data reinforce previous studies pointing to the necessity to consider children with nephro-urological malformations as a risk group for SAH, who should have the BP evaluated since the neonatal period.

Female↗
PubMed2003

Role of plasma and urinary calcium and phosphorus measurements in early detection of phosphorus deficiency in very low birthweight infants.

AIM: To analyse the role of serum and urinary calcium and phosphorus levels in early detection of mineral deficiency in very low birthweight (VLBW) infants born appropriate (AGA) and small for gestational age (SGA). METHODS: 64 VLBW infants were included in a cohort study and divided into two groups: AGA (n = 30) and SGA infants (n = 34). Then, they were divided according to the presence of radiological signs of metabolic bone disease (MBD): with MBD (n = 21) and without MBD (n = 34). Blood samples and 6 h urine collections were obtained for calcium, phosphorus, alkaline phosphatase activity and creatinine determinations between 3 and 5 wk of life. RESULTS: There were no biochemical differences between AGA and SGA. Higher values of urinary calcium (MBD = 31.9 +/- 20.2, without MBD = 19.8 +/- 15.4; p = 0.017), calciuria (MBD = 2.3 +/- 0.3, without MBD = 1.4 +/- 0.8; p = 0.037) and alkaline phosphatase activity (MBD = 369 +/- 114, without MBD = 310 +/- 93; p = 0.04) were found in infants who developed MBD. Both groups showed high tubular phosphorus reabsorption indicating mineral deficiency. CONCLUSION: Serum calcium and phosphorus levels are not good markers in early detection of mineral deficiency. However, the monitoring of calcium urinary levels may be helpful in early detection of mineral deficiency.

Alkaline Phosphatase↗
PubMed2001

[Critical analysis of pathophysiological, diagnostic and therapeutic aspects of metabolic bone disease in very low birth weight infants]

OBJECTIVE: To perform a systematic review on the pathophysiology, diagnosis and approach of metabolic bone disease in very low birth weight infants. SOURCES: Literature review of articles published in Medline within the last twenty years. SUMMARY OF THE FINDINGS: The higher survival of very low birth weight infants was concurrent with the increased incidence of metabolic bone disease. The process of bone mineral acquisition suffers some alterations during the neonatal period, including low bone mineral content at birth, insufficient mineral supply in the neonatal period, and regulatory disorders, which may compromise growth and development on the long run. The diagnosis is based on the association of risk factors, and biochemical and radiological alterations. The early intervention in the neonatal period prevents the development of severe metabolic bone disease, reducing complications during the first year of life. CONCLUSIONS: The early diagnosis of metabolic bone disease allows for early intervention, thus preventing complications that may originate from the alterations in bone mineral acquisition.

Journal Article↗
PubMed2000

Human milk mineral intake and serum concentrations of calcium and phosphorus in newborn term infants: influence of intrauterine growth restriction.

UNLABELLED: A prospective case-control study was performed to test the hypothesis that the milk Ca and P contents of term, small-for-gestational-age (SGA) newborns' mothers differs from that of term, adequate-for-gestational-age (AGA) newborns' mothers. We studied 71 pairs of mothers and newborns, divided into two groups: I (control): 41 pairs of mothers and term AGA newborns and II (study): 30 pairs of mothers and term SGA newborns. This latter group was subdivided according to type (symmetric: birthweight, length and head circumference <10th percentile; asymmetric: birthweight <10th percentile) and severity ( P3 - P3 - <P10 group. CONCLUSION: These findings suggest a tendency towards differences in human milk between AGA and SGA newborns regarding longitudinal variations.

Calcium↗
PubMed1999

Is glycosuria a reliable indicator of adequacy of glucose infusion rate in preterm infants?

CONTEXT: Adequacy of glucose infusion may be monitored via the glycosuria levels, as there is a relationship between glycemia and glycosuria regulated by the renal glucose threshold. In the neonatal period, however, this relationship is not so clear. OBJECTIVE: To evaluate the occurrence of glycosuria in preferm infants submitted to glucose infusion and to verify the relationship between glycosuria and blood glucose level. DESIGN: Accuracy study. SETTING: Neonatal intensive care unit of General Maternity Hospital. PATIENTS: 40 Preterm newborns receiving glucose infusion. PROCEDURES: 511 concomitant determinations of glycemia and glycosuria were performed. These 511 pairs were divided into stable and unstable, according to the clinical status of the newborn at the time of data collection, and they were studied in relation to the gestational age, birth weight and glucose infusion rate. RESULTS: The results revealed a greater frequency of glycosuria in gestational age < or = 30 weeks, birth weight < 1500 g and glucose infusion rate > 6 mg/kg/min. Eight (25.8%) episodes of positive glycosuria occurred in the absence of hyperglycemia, indicating only a moderate concordance between them. CONCLUSION: Glycosuria alone is an unreliable marker of blood glucose concentration and adequacy of glucose infusion rate. It is therefore necessary to monitor blood glucose levels in infants submitted to continuous glucose infusion.

Biomarkers↗
PubMed1999

Prediction of length of hospital stay in neonatal units for very low birth weight infants.

OBJECTIVE: To develop models for estimating the length of hospital stay (LOS) of very low birth weight infants (VLBW), based on perinatal risk factors present during the first week of life and during the entire hospitalization period. STUDY DESIGN: The files of 155 VLBW were analyzed, and the influence of individual risk factors were initially evaluated by univariate analysis, using multiple-regression. Two mathematical models were built to estimate the LOS. RESULTS: The first model, using risk factors present during the first 3 days of life, is as follows: LOS = -0.074A + 22.06B + 22.85C - 16.78D - 2.07E + 10.51F + 203.12 (R2 = 0.63). (The letters are added to show what each number represents: A: birth weight; B: occurrence of respiratory distress syndrome; C: endotracheal intubation during resuscitation; D: 1-minute Apgar score; E: gestational age; F: presence of complications during delivery.) The second model, using factors present during the entire hospitalization period, is: LOS = 0.61G + 29.19H + 24.68I + 14.21J + 23.56K + 9.54L + 7.41M + 20.43 (R2 = 0.82). (G: age receiving nutritional support of > or = 120 kcal/kg per day; H: occurrence of systemic candidiasis; I: birth weight < 1000 gm; J: presence of delivery complication; K: occurrence of bronchopulmonary dysplasia; L: birth weight > or = 1000 gm and < or = 1249 gm; M: occurrence of anemia). CONCLUSION: Both models are applicable for estimating the hospitalization period, and the addition of variables present during the entire hospitalization period improved the accuracy of the model.

Brazil↗
PubMed1998

[Predictive value of the "Clinical Risk Index for Babies" for the risk of neonatal death].

OBJECTIVE: Several indicators, mainly birthweight and gestational age, have been used to predict the mortality risk in neonatal intensive care units. In order to assess the potential value of CRIB in predicting neonatal mortality, the score was used over the first 12 hours of life of the newborns admitted to this unit, during the year of 1996. METHOD: The inclusion criteria consisted of all infants without inevitably lethal congenital malformations, birthweight below 1,500 g and/or gestational age less than 31 weeks. Newborn children who died within 12 hours after delivery were excluded. The CRIB score covers birth weight, gestational age, the presence of congenital malformations (not inevitably lethal) and three indexes of physiological status during first 12 hours after birth-maximum and minimum appropriate fraction of inspired oxygen and maximum (most acidotic) base excess. RESULTS: In a prospective cohort, seventy one newborn children were studied. The birthweight (average) was 1,119 +/- 275.6 g, gestational age 30 weeks 4/7 +/- 2 weeks 3/7; male (57%); Apgar 1(0) min. score < or = 3 (36.2%) and Apgar 5 degrees min. score < 5 (5.8%). The mortality rate was 29.6% (gold standard). But mortality rate by birthweight less than 1,000 gr. or gestational age lower than 29 weeks was 60.0% and for the CRIB score above 10 was 100%. DISCUSSION: The specificity and predictive positive values for CRIB score above 10 were greater than any other two parameters. The area under the receiver operating characteristic (ROC) curve for predicting death was significantly greater for CRIB than for birthweight alone. It was concluded that the CRIB score is a better predictive indicator for mortality than are birthweight and gestational age.

Birth Weight↗
PubMed1997

[Clinical-epidemiologic indications for echocardiographic assessment in the neonatal period. Value of risk groups].

PURPOSE: An echocardiographic study was performed in newborns from risk groups, with the aim of to determining prevalence and to evaluate the indications for this test in the neonatal period. METHODS: One hundred fifty six newborns were studied. They were admitted to the Newborn ward of the Department of Obstetric of the HC-FMUSP, in the period of November 91 to April 93, from mothers with congenital heart disease or diabetes, low birth weight newborns, with extracardiac malformations, cardiac signs and/or congenital infections. RESULTS: The observed prevalence was 21.8%, greater than that of the general population (0.8-1.2%). The group composed by 27 children with extracardiac abnormalities presented the largest prevalence when compared with the other groups (40.7%). These data justify the use of echocardiography in high risk newborns for the detection of congenital heart disease.

Female↗
PubMed1995

Conjunctivodacryocystorhinostomy with buccal mucosal graft.

Conjunctivodacryocystorhinostomy with a borosilicate glass tube (Pyrex tube, Gunther Weiss, Scientific Glass Blowing Co, Beaverton, Ore) is the usual procedure for a total canalicular block; however, in patients in whom the tube comes out, there is a high incidence of closure of the tract. Full-thickness buccal mucosa was used to line the conjunctivodacryocystorhinostomy tract in 17 patients to determine whether the conduit would function adequately without a tube. Four patients elected to go without tubes and have remained improved with positive results of primary dye tests. The remaining 13 chose to retain their tubes.

Adolescent↗
PubMed1994

Safe management of dermolipomas.

Most reports on dermolipomas describe the serious complications arising from their removal. The aim of this article was to describe a safe and effective method of removing dermolipomas. Forty-five consecutive eligible patients underwent surgical removal of their dermolipomas over a 20-year period. Of the two complications, only one, a restrictive symblepharon, required further surgery. The techniques for excising simple dermolipomas and dermolipomas associated with a deformity of the lateral canthal angle are described. Safe removal of dermolipomas may be accomplished with minimal resection of the conjunctiva, including the pilosebaceous area, identification of contiguous structures, and removal of only that portion of the dermolipoma anterior to the lateral orbital rim.

Conjunctival Neoplasms↗
PubMed1993

Limb deficiency with or without Möbius sequence in seven Brazilian children associated with misoprostol use in the first trimester of pregnancy.

Misoprostol, a synthetic analog of prostaglandin, has been widely used in Brazil as an abortifacient. Abortion is illegal in Brazil. An uncertain number of these abortion attempts are unsuccessful and the pregnancy continues. We report on 7 patients whose mothers attempted to abort using this drug in the first trimester of gestation without success. The 7 patients presented with limb defects and in 4 of them a diagnosis of Möbius sequence was made.

Abnormalities, Drug-Induced↗
PubMed1992

Supervoltage orbital radiotherapy in 36 cases of Graves' disease.

Thirty-six patients who had clinically progressive Graves' dysthyroid orbitopathy were treated with supervoltage orbital radiotherapy. Twenty-three of the patients had discontinued the use of orally administered prednisone after developing intolerable side effects. Medical contraindications prevented seven patients from receiving systemic corticosteroid treatment. Six additional patients declined to take prednisone and chose orbital radiotherapy as their primary treatment. All patients were treated with one radiotherapy protocol wherein a 6 MV linear accelerator delivered 2,000 cGy to the midplane of both orbits in ten fractions. None of the 36 patients was treated with corticosteroids during the orbital radiotherapy treatment interval. We encountered three patients who failed to respond to orbital radiotherapy and required supplemental immunosuppression to arrest progression of Graves' disease. The remaining 33 patients experienced stabilization or clinical improvement of their condition. None of the patients experienced complications from orbital irradiation. We believe supervoltage orbital radiotherapy is an effective means of treating Graves' dysthyroid orbitopathy.

Adult↗
PubMed1992

Seizure recurrence in infants with neonatal convulsions. A follow-up study.

Twenty three infants with neonatal seizures were followed prospectively to a mean age of 11 months. Only 2 were pre-term and birth weight ranged from 1700 to 4230 grams, with 17 male and 6 female infants. Hypoxic-ischemic encephalopathy was the most common etiology (82.6%). Focal clonic convulsions were the predominant seizure type, present in 7/16 infants in which the seizure type could be identified. All infants had a neurological examination and EEG, and 18 had a cranial ultrasonography performed at the follow-up. Anticonvulsant medication was discontinued, if follow-up EEG and neurological examination were normal. At the follow-up, seizure recurrence was observed in 7/23 (30%) infants. Abnormal EEG, neurological examination and cranial ultrasonography were statistically correlated with seizure recurrence. We conclude that infants with neonatal seizures can remain free of anticonvulsant medication provided they have normal neurological examination, EEG and cranial ultrasonography.

Echoencephalography↗
PubMed1990

Bipedicle myocutaneous flap repair of cicatricial ectropion.

We present a new approach to the bipedicle myocutaneous upper eyelid to lower eyelid flap in the repair of cicatricial ectropion in lower eyelid reconstruction, and in the release of tension caused by a previous cheek rotational flap. By incorporating the pedicles into the flap design, we prevent the persistent lymphedema and the raw tissue placed against exposed epidermis encountered in previous bipedicle myocutaneous flaps. Although there may be disadvantages associated with this procedure, we have not encountered any to date. Advantages of this procedure include the double source of blood supply and the superior cosmetic result as well as the avoidance of a second operative procedure. We recommend the use of the bipedicle myocutaneous flap in selected cases.

Cicatrix↗
PubMed1990

Correction of superior sulcus defects after enucleation.

Anophthalmic patients can develop a deep recess or sulcus in the upper lid, usually associated with enophthalmos. If due to an absence or loss of a socket implant, a secondary one can be implanted. In those cases with a socket implant, one method of treatment is directed at adding a silicone block to the inferior orbit to cause a forward movement of fat to fill out the upper eyelid as well as reducing the enophthalmos. Another approach, particularly if enophthalmos is minimal, is to directly implant a dermis-fat graft into the upper eyelid. The graft is taken from above the iliac crest and the amount implanted should create a slight overcorrection, allowing for some fat absorption.

Adipose Tissue↗
PubMed1990

The success rate of silicone intubation in congenital lacrimal obstruction.

In our series of 100 patients who had unsuccessful probing for congenital nasolacrimal duct obstruction, all had silicone intubation associated with infracturing of the inferior turbinate. The age range was from 7 months to 4 years at the time of intubation. Sixty patients had tubes in for 1 year, and all but one, a 3-year-old girl, were treated successfully. Of the 40 who had tubes in place for less than 1 year, 38 were treated successfully. The two unsuccessful cases were those of a 3-year-old boy and a 4-year-old boy, whose tubes were removed at 3 and 4 months, respectively. The overall success rate in our series was 97%; all patients younger than two years old at the time of intubation were treated successfully.

Child, Preschool↗