The role of echocardiography in the diagnosis of fetal and pediatric cardiac tumors

В исторически план развитието на образните методи на изследване при сърдечните тумори позволи преминаването от аутопсионна към прижизнено поставена диагноза. Ехокардиографията е лесно достъпен, неинвазивен и високо информативен диагностичен метод на първи избор.Представени са възможностите на съвременното комплексно ехокардиографско изследване за ранно, включително и пренатално, откриване на туморите на сърцето, придружаващите сърдечни аномалии и извършването на коректна хемодинамична оценка. Включени са и наши собствени наблюдения на пациенти с различни по вид сърдечни тумори, диагностицирани както фетално, така и след раждането.Ехокардиографското изследване е утвърден, бърз, удобен и информативен метод за пре- и постнатално диагностициране на сърдечните тумори в детската възраст, както и за тяхното пре- и постоперативно проследяване.The development of different imaging techniques allows the diagnosis of cardiac tumors to be made before the death of a person, and not as it used to be made - following a post mortem. Echocardiography is easily available, noninvasive and a highly informative diagnostic method of choice.We`re presenting the possibilities of current echocardiography examination for the early, including prenatal, diagnosis of cardiac tumors, concomitant congenital heart diseases and hemodynamic evaluation. In this report we also include the observations of our own patients with different kinds of cardiac tumors, which were diagnosed prenatally and after birth. Echocardiography is an approved, quick, convenient and informative prenatal, and postnatal, diagnostic method for cardiac tumors in childhood, as well as for their preoperative and postoperative follow-up

Intralobar Pulmonary Sequestration – Clinical Case In A Three-Year-Old Child

Pulmonary sequestration is a rare congenital lung anomaly, which presents with a solid or cystic primitive tissue that has no function. Commonly, this formation does not communicate with the tracheobronchial tree and has an anomalous blood supply, most often from the systemic circulation. There are two types of pulmonary sequestration – intralobar (intrapulmonary) and extralobar (extrapulmonary).We present a 3-year-old boy from normal pregnancy and delivery through Cesarean section with intralobar pulmonary sequestration. The child is with normal physical and neuropsychological development, has had all the necessary vaccinations, and suffers from frequent respiratory infections with recurrent cough. The anomaly was discovered accidentally during another hospitalization due to cough, but without a fever, and with suspected inflammatory changes in the radiography, with a wider mediastinal shadow. The performed chest CT with contrast revealed a cystic formation in the posterior-basal left lung with an anomalous supply from the thoracic aorta. Despite the controversial behavior in sequestration, without or with mild symptoms, the child was referred for consultation with a pediatric surgeon and for possible surgical treatment.Pulmonary sequestration is a rare congenital anomaly with the intralobar type being more frequent. A distinctive feature for the latter is the absence of clinical symptoms, especially in childhood. However, it has to be suspected in cases of a chronic cough and recurrent pneumonias. Non-invasive imaging techniques, such as CT angiography, MRI, echography, including fetal one, are the preferred diagnostic tool

Ammonium hydrogen (RS)-[(5-methyl-2-oxo-1,3-oxazolidin-3-yl)meth­yl]phospho­nate

In the title compound, NH4 +·C5H9NO5P−, the five-membered methyl­oxazolidin-2-one unit is disordered over two positions, the major component having a site occupancy of 0.832 (9). A three-dimensional network of O—H⋯O and N—H⋯O hydrogen bonds stabilizes the crystal structure

Therapeutic approach to idiopathic hypertrophic cardiomyopathy

Идиопатичната хипертрофична кардиомиопатия е рядко срещана в детска възраст с висок потенциален риск от фатален край. Отличителен белег е миокардната хипертрофия при липса на хемодинамична причина. От първия описан случай на експериментално лечение на кърмаче през 1971 г. бета-блокерите имат водеща роля в медикаментозното лечение с вариации в дозовите режими. По последни литературни данни и клинични проучвания употребата на високи дози бета-блокер неоспоримо показва значим процент на преживяемост в дългосрочен план.Представяме клиничен случай на 11-месечно кърмаче, което постъпва в нашата клиника с данни за сърдечна недостатъчност. От проведените образни изследвания - рентгенография на гръден кош и ехокардиография, се установи изразена симетрична хипертрофична необструктивна кардиомиопатия. Започна се медикаментозно лечение с пропранолол в постепенно покачваща се доза до 5 мг / кг / 24 часа. Няколко седмици по-късно при контролно ехокардиографско изследване се установи значително подобрение в диастолната функция на лява камера с известна регресия в хипертрофията на миокарда. Контролираното прилагане на високи дози бета-блокери би могло съществено да подобри прогнозата и дългосрочната преживяемост при пациентите с идиопатична хипертрофична кардиомиопатия.Idiopathic hypertrophic cardiomyopathy is a rare disease in childhood with a high potential of a lethal outcome. The hallmark of the disorder is myocardial hypertrophy that occurs in the absence of an obvious hemodynamic stimulus. Since the first case of an experimental treatment of an infant described in 1971, beta blockers have become one of the leading medication options with variations of the dose regimens. According to the current literature data and clinical trials the use of beta blockers in high doses is consistent with a high percentage of survival.We`re presenting a clinical case of an 11-month old infant, who was admitted to our clinic with symptoms of congestive cardiac failure. The chest radiography and echocardiography results showed a severe symmetric hypertrophic cardiomyopathy without an obstruction in the left ventricular outflow tract. The treatment was started with Propranolol in a titrating dose until reaching the dose of 5mg/kg/24hours. Several weeks later, echocardiography examination showed a significant improvement in the left ventricle diastolic function with some degree of regression of myocardial hypertrophy.The use of high doses of beta blockers together with the monitoring of the clinical state could improve the prognosis and survival in patients with idiopathic hypertrophic cardiomyopathy

Genetic polymorphism of kappa casein and casein micelle size in the Bulgarian Rhodopean cattle breed

The present study aimed to compare the size of casein micelle in cow milk sample in function of kappa casein (CSN3) genetic polymorphism. Sixteen cows from Bulgarian Rhodopean cattle breed were genotyped by PCR-RFLP analysis. Milk samples from the three found CSN3 genotypes (AB, AA and BB) were employed for the determination of casein micelles size by Dynamic Light Scattering (DLS). The results showed differences in the size and polydispersity of the casein micelles between the milks of cows with different genotypes. Hydrodynamic radii of micelles at a scattering angle of 90 °C varied from 80 to 120 nm and polydispersity varied from 0.15 to 0.37. In conclusion casein micelle size of CSN3 AA cows (~ 120 nm) exceed with about 60% cows with AB (~ 80 nm) and BB genotype (~ 70 nm). These results could be useful for improving technological properties of the milk

Betti bases from 4-(3-pyridazo)-1-naphthol: synthesis, coordination behaviour and unusual substitution reactions

A series of Betti bases from 4‐(3‐pyridyl)azo‐1‐naphthol dye, possessing flexible methylene or more constrained aryl‐methyne spaced NH‐containing side‐chains, were obtained and characterized. It was shown by NMR spectroscopy that the ligands exist in keto form. The products’ structure was confirmed by single crystal XRD of a selected sample. A study on the coordination ability of the ligands with silver(I) was performed, leading to an unexpected substitution reaction

Symptomatic arterial hypertension in children - clinical observation

The Symptomatic Arterial Hypertension (SAH) is found rarely compared to the essential. Its incidence is approximately 15 -20% of the whole frequency of the hypertension conditions. From age aspect, as lower is the age on which the high arterial blood pressure is observed, the probability that it is SAH is higher. SAH is a symptom of another already existing disease, which causes the rising of the blood pressure. Most often these are inherited or acquired diseases of the urinary system, of the cardiovascular system, of the endocrine and of the nerve system. The aim of this study is to specify the frequency and etiological belonging of SAH in hospitalized children. From the 134 children with high blood pressure, hospitalized for eight years, in 14.18% we found that this is a SAH. The highest is the number of children with renal parenchimal disease - 14, with renal polycystosis - 3, with stenosis of the renal arteries - 2 and one child with suprarenal tumor. Two of the children with parenchimal disease were in advanced stages, with developed renal insufficiency, and in one of them we had to start haemodialysis. The children with SAH had high levels of blood pressure; some of them were hospitalized after hypertonic crisis, with signs of hypertonic encephalopathy, which were the initial signs of the high blood pressure. SAH, even rare during childhood, is a serious disease, leading to life threatening complications, requiring fast diagnosis and adequate treatment.Scripta Scientifica Medica 2009; 41(2): 133-134

Gaps in Clinical Studies in Patients with Critical Congenital Heart Disease

The purpose of this study was to assess the potential clinical examination in the early diagnosis of patients with CCHD.Patients and Methods: Retrospectively were followed 272 newborns and infants up to 3 months of age with CCHD for 25 years (1987-2011) from the region of North-East Bulgaria. The cardiac malformations were divided into 3 groups: obstructive lesions of the systemic circulation (OLSC) – 103 children, obstructive lesions of the pulmonary circulation (OLPC) – 64 children and non-obstructive mixing cardiopathies (NMCP) – 105 children. It were analyzed the initial clinical symptoms, place and manner of the disease detection, the discharged neonates without established heart disease and those with placed wrong or incomplete primary diagnosis.Results: The incidence of the CCHD was 12.5% of CHD. The mean time of the initial clinical manifestation was 3.45 days, which is shorter in newborns with OLPC – 1.8 days, and the longest is in OLSC – 4.5 days (p<0.05). In 44.4% initial clinical symptoms were established during the first day, and by day 4 – in 81.7%. Most often the first clinical symptom is cyanosis – 65%. In 21% of cases there was no significant murmur. The average age of diagnosis is 8.5 days and was significantly lower in OLPC – 4.2 days, compared to OLSC – 9.5 days and NMCP – 10 days (p<0.05). By day 4 were diagnosed 54% of CCHD and 27.7% of the infants with manifested initial symptoms (81.7%) remained without diagnosis. Usually the initial diagnosis is put in the children’s hospitals – 60% and only 30% in the neonatology units. Without established heart disease are discharged 15.8% of newborns, primarily with coarctation of the aorta, total anomalous pulmonary venous return and transposition of the great arteries. Initial diagnosis was incorrect in 22%.Conclusion: The physical examination in newborn CCHD is unsatisfactory and the diagnosis is often delayed, especially in the cases of OLSC and same of NMCP. That is why screening programs are needed for early detection of these patients to improve their prognosis

(4-Carbamoylphenyl)boronic acid

In the title compound, C7H8BNO3, the molecule lies on an inversion center leading to a statistical disorder of the B(OH)2 and CONH2 groups. In the crystal structure, molecules are linked by N—H...O and O—H...O hydrogen bonds, forming sheets parallel to the bc plane. The B(OH)2 and CONH2 groups are twisted out of the mean plane of the benzene ring by 23.9 (5) and 24.6 (6)°, respectively