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Biomedical subjects

G Enríquez

Publications and source records attributed to G Enríquez.

At least 19 recordsLinked to original sources
PubMed2006

Polycystic ovaries after precocious pubarche: relation to prenatal growth.

BACKGROUND: In 1998, we revealed a sequence departing from prenatal growth restraint in girls and evolving, through precocious pubarche (PP) in mid-childhood, towards anovulatory and hyperinsulinaemic hyperandrogenism. The latter condition fulfilled the criteria for the diagnosis of polycystic ovary syndrome (PCOS), which was then defined independently of the presence of polycystic ovaries (PCOs). Since 2003, the diagnosis of PCOS has been extended by adding PCO as an alternative criterion. We verified longitudinally over 28 +or- 2 years the prevalence of PCO and its potential relationship to growth before birth in a group of post-PP women (n=14, mean age=28 years; body mass index=24.3 kg/m2) belonging to the original cohort of 35 girls in whom the PP-PCOS sequence was described. METHODS: Endocrine-metabolic variables, body composition (by dual-energy X-ray absorptiometry), carotid intima-media thickness (IMT) and ovarian morphology by transvaginal ultrasonography were assessed in all women. RESULTS: Post-PP women with a birthweight (BW) in the lowest quartile, when compared with post-PP women with a higher BW, had smaller ovaries (mean volume=4.0 versus 9.0 ml; P=0.004) and a much lower prevalence of PCO (0 versus 67%; P=0.006). The remaining variables were similar between BW subgroups. CONCLUSIONS: The presence of a PCO morphology in women with a PP history was found to relate to prenatal growth. It would be of interest to verify whether a similar relationship exists in anovulatory and/or hyperandrogenic women without PP history.

Adolescent↗
PubMed2004

Prevalence of neurological damage in monochorionic twins with selective intrauterine growth restriction and intermittent absent or reversed end-diastolic umbilical artery flow.

OBJECTIVE: To assess the incidence of parenchymal lesions on early and late neonatal brain scans and its association with the presence or absence of intermittent absent or reversed end-diastolic umbilical artery flow velocity (A/REDV) in monochorionic twins complicated by selective intrauterine growth restriction (IUGR), as compared to dichorionic twins and monochorionic twins without selective IUGR. METHODS: This was a prospective cohort study involving 42 monochorionic twins diagnosed with selective IUGR and managed expectantly. The presence or absence of intermittent A/REDV was recorded in all cases. This study group was compared to dichorionic twins (n = 29) and monochorionic twins without selective IUGR (n = 32) delivered at 26-34 weeks during the study period. All infants underwent an early neonatal brain scan (at or before the fourth day of postnatal life) and at least one follow-up scan during the first 28 days of postnatal life. Perinatal outcome and the incidence of neurological damage were compared between the study groups. RESULTS: The incidence of intrauterine fetal death (IUD) and periventricular leukomalacia was significantly increased in monochorionic twins complicated with selective IUGR, as compared with the other study groups. Intermittent A/REDV was observed in 22/42 (52.4%) twin pairs, and was always present in the growth-restricted twin. The incidence of IUD (overall 9/44 (20.5%) vs. 0/40, P < 0.001; smaller twin 6/22 (27.3%) vs. 0/20, P < 0.05) and parenchymal brain damage (overall 7/35 (20.0%) vs. 2/40 (5.0%), P = 0.07; larger twin 7/19 (36.8%) vs. 1/20 (5.0%), P < 0.05) was significantly higher in pregnancies with intermittent A/REDV than in those without intermittent A/REDV. Brain damage usually occurred in the larger twin, irrespective of whether the smaller twin was liveborn or not. CONCLUSIONS: The presence of intermittent A/REDV in monochorionic twins with selective IUGR identifies a subgroup with an elevated risk of intrauterine demise of the smaller twin and neurological damage in the larger twin; this latter finding is not restricted to cases with IUD of the cotwin.

Birth Weight↗
PubMed2000

Low-dose high-resolution CT of the chest in children and young adults: dose, cooperation, artifact incidence, and image quality.

OBJECTIVE: The radiation dose, artifact incidence, and image quality of high-resolution chest CT examinations performed with standard and low doses and patient cooperation were investigated in children and young adults. SUBJECTS AND METHODS: Three successive controlled studies were conducted in different groups of children and young adults, totaling 203 patients. Dosimetry of high-resolution CT was performed at 180, 50, and 34 mAs in three groups of 25 patients. Streak artifact incidence using alternating 50- and 34-mAs slices was assessed and correlated with patient compliance with breath-holding commands in 44 children. Image quality was evaluated in scans obtained with 34 versus 180 mAs in cooperative patients (n = 42) and in scans obtained with 50 versus 180 mAs in noncooperative patients (n = 42). Artifacts and image quality were assessed by controlled repeated interpretations. RESULTS: Radiation dose was 5.4+/-1.6 mSv for 180 mAs, 1.5+/-0.5 mSv for 50 mAs, and 1.1+/-0.3 mSv for 34 mAs. Cooperation was obtained in 66% of the patients. Artifacts were more frequently seen in scans of noncooperative patients (30%) and in 34-mAs scans (47%); the highest incidence was found using 34 mAs in noncooperative patients (60%, p = 0.02). No differences in image quality scores were seen in scans obtained with 50 mAs versus those obtained with 180 mAs in noncooperative patients (p<0.05), and small differences were found in scans obtained with 34 mAs versus those obtained with 180 mAs in cooperative patients for fissures (p = 0.005) and peripheral structures (p = 0.02). CONCLUSION: Low-dose high-resolution CT provided a significant reduction in radiation dose (72% for 50 mAs and 80% for 34 mAs) and good-quality images of the lung when performed with 50 mAs in noncooperative and 34 mAs in cooperative pediatric and young adult patients.

Adolescent↗
PubMed1998

Pediatric pancreas: an overview.

Pancreatic disorders are not rare in children. Modern imaging equipment allows recognition of many pancreatic diseases that were difficult to identify in the past and therefore were considered to be unusual. Within the scope of this article we include information on imaging modalities for studying the pancreas and a description of the radiologic manifestations of the most common congenital, inflammatory, tumoral, traumatic and systemic disorders.

Child↗
PubMed1995

Sonography of the eye in children: imaging findings.

Real-time sonography is a well-accepted technique for evaluating abnormalities of the eye. Most previous reports on sonography of the eye have been in adults [1]. In this pictorial essay, we illustrate normal and abnormal findings of ocular sonography in children.

Adolescent↗
PubMed1994

[Does Bolande's malignant tumor exist?].

Congenital mesoblastic nephroma (CMN) is a rare renal neoplasm which Bolande differentiated from Wilms tumour given its benign nature. We describe 7 cases of CMN which have been treated over the last ten years, in order to highlight to what extent a tumour which is generally considered to be benign can have an aggressive behaviour. 5 patients were diagnosed during their neonatal period (3 of them prenatally) and 2 after the third month of life. Clinical presentation, simple abdominal radiology, echography and abdominal CT scan, which showed characteristic images, led us to a final diagnosis. Tumoral resection was carried out in the 6 typical CMN. The atypical or aggressive CMN was urgently operated under critical circumstances due to spontaneous tumoral rupture. The pathological study showed a CMN of cellular variety with a sarcomatous component. Despite adjuvant chemotherapy, there was a tumoral recurrence which required a surgical second-look and subsequent chemotherapeutical treatment. Bolande's tumour is generally benign, but there is an aggressive cellular variant that fits into the intermediate zone of a pathological spectrum. This aggressive variant have different clinical, radiological and anatomo-pathological features and therefore it involves radical surgical treatment and additional chemotherapy with a rigorous follow-up in the short and the long term.

Abdomen↗
PubMed1985

[Pancreatic pseudocyst in childhood].

Pancreatic pseudocysts are rare in children, with different etiology and prognosis than adults. We report four cases of post-traumatic pancreatic pseudocysts with their follow-up by echography and CT scan. Spontaneous resolution has been observed in three patients while one case was operated on. The better prognosis of the pancreatic pseudocyst in childhood, confirmed by our clinical observations and literature, lead us to promote a more conservative management and follow-up than in adults.

Accidents, Traffic↗
PubMed1984

[Importance of ultrasound in the study of cerebral pathology in childhood].

Results of 491 studies of the brain with gray-scale sonography in 341 patients with ages ranging from one day to one year are reported. Sonographic appearance of normal brain, cerebral abscesses and hemorrhages in neonates, together with sonographic findings of some congenital brain anomalies are described.

Brain↗
PubMedDate not supplied

[Mitral valve disease in infants. Anatomical and functional evaluation by echocardiography].

To describe the incidence of mitral valve abnormalities among infants aged 0 to 24 months, their anatomic features, site of lesion, severity and associated heart defects, the records of 3,583 such patients submitted for bi-dimensional ultrasound and pulsed Doppler cardiac studies by presumptive heart disease were analyzed. Mitral valve abnormalities were thus detected in 88 of these cases, and were also documented by clinical examination (n: 88), heart catheterization and angiocardiography (n: 11), surgery (n: 17) and necropsy (n: 2). Seventy five cases had additional heart disease, most commonly aortic stenosis (27%), aortic coarctaction (26%) and ventricular septal defects (43%). Papillary muscle deformities at the subvalvar mitral apparatus were considered to be the most frequent mechanism for congenital mitral stenosis (100%), and annulus dilatation was the most frequent cause of mitral insufficiency (49%). Relative incidences of mitral valve stenosis and insufficiency among the whole studied sample were 0.5% and 1.48% respectively. There was a rough correlation between Doppler transmital gradient or regurgitation jet area and the corresponding mitral valve abnormality. This kind of noninvasively obtained data about mitral architecture and function seems to be a very useful and sensitive guide to define and manage this patients.

Cardiomyopathies↗
PubMedDate not supplied

[Serum digoxin in children treated with beta methyl digoxin].

Concentrations of serum digoxin were measured by the polarized immunofluorescence Abbot TDx11 method in 59 samples from 53 children under treatment with mean beta methyl digoxin doses of 8.9 +/- 2.0 micrograms.kg.day. The therapeutic range for serum digoxin concentration was estimated to be 0.9 to 2.25 ng/ml. Simultaneous Na, K and creatine serum concentrations were measured. In 36 samples mean serum digoxin level was 1.52 +/- 0.45 ng/ml -within therapeutic range- and in only one of these cases clinical evidence of toxicity was apparent. In 15 samples digoxin level was above the therapeutic range and 11 patients of this group (73%) showed clinical signs of toxicity, consisting in arrythmias (six cases: supraventricular in 5 patients, ventricular in one child) and gastrointestinal symptoms (eight patients). Six patients with digoxin levels over therapeutic range and signs of digitalis toxicity had coincidental acute renal failure, which in 4 cases was subclinical--in 2 of these late it was pre-renal- and, in spite of this, all were inadvertently given the usual dosage of beta methyl digoxin. Almost invariably there was clinical evidence of toxicity when digoxin serum levels were above 2.4 ng/ml, so established maximal therapeutic level at 2.25 ng/ml seems adequate. Signs of digitalis toxicity must be looked on systematically in children treated with such drugs. In the critically ill or in children with acute renal failure it is necessary to monitor serum digoxin concentration. Among the clinical signs of toxicity, gastrointestinal symptoms are more frequent in children. An oral dose from 7 to 10 micrograms.kg.day of beta methyl digoxin in recommended.

Acute Kidney Injury↗