Papers by Angela Butnariu
DOAJ (DOAJ: Directory of Open Access Journals), Sep 1, 2012
Boala Kikuchi este o afecţiune rară, benignă şi autolimitată, de etiologie necunoscută, care ar t... more Boala Kikuchi este o afecţiune rară, benignă şi autolimitată, de etiologie necunoscută, care ar trebui inclusă în algoritmul diagnostic al adenopatiei cervicale. Diagnosticul de certitudine este histopatologic, modifi cările specifi ce fi ind necroza paracorticală ganglionară, histiocitele cu nuclei în formă de semilună şi numeroşii corpi apoptotici. Se prezintă cazul unui pacient de 13 ani cu diagnosticul de boală Kikuchi, afecţiune rar descrisă la vârsta pediatrică. Cuvinte cheie: adenopatie, copil, boala Kikuchi PREZENTĂRI DE CAZ INTRODUCERE Boala Kikuchi, cunoscută şi sub denumirea de limfadenită histiocitară necrotizantă, a fost descrisă pentru prima dată de anatomopatologul japonez Kikuchi M., în anul 1972. (1) În acelaşi an boala a fost descrisă şi de anatomopatologul Fujimoto Y. (2), re găsindu-se astfel în literatură sub denumirea de boala Kikuchi-Fujimoto. Boala Kikuchi-Fujimoto este o afecţiune rară, benignă şi autolimitată, de etiologie necunoscută, care interesează sistemul limfoganglionar. Pentru clinician ridică probleme de diagnostic diferenţial al adenopatiilor.
Revista română de pediatrie, Dec 31, 2013
DOAJ (DOAJ: Directory of Open Access Journals), Jun 1, 2010
Hipertensiunea arterială pulmonară asociată malformaţiilor cardiace congenitale are o serie de pa... more Hipertensiunea arterială pulmonară asociată malformaţiilor cardiace congenitale are o serie de particularităţi care o fac distinctă de alte forme de hipertensiune pulmonară. La copiii cu boală cardiacă congenitală asociată cu şunt stânga-dreapta non-restrictiv, hipertensiunea arterială pulmonară este iniţial reversibilă, aceasta fi ind singura formă de hipertensiune arterială pulmonară în care este recunoscut clinic un stadiu reversibil. Speranţa de viaţă la pacienţii cu sindrom Eisenmenger este mai mare decât în alte forme de hipertensiune arterială pulmonară. La pacientul netratat cu hipertensiune arterială pulmonară idiopatică supravieţuirea medie este de 2,8 ani, în timp ce bolnavii cu sindrom Eisenmenger pot supravieţui până la o vârstă de 40-50 de ani. La pacienţii cu şunt stângadreapta non-restrictiv la nivel post-tricuspidian în peste 50% dintre cazuri se dezvoltă boală vasculară pulmonară ireversibilă şi progresivă în primii ani de viaţă, ducând în fi nal la sindrom Eisenmenger. În leziunile cardiace cu şunt stânga-dreapta la nivel pre-tricuspidian, cu o creştere izolată a fl uxului sanguin către plămâni, boala vasculară pulmonară se dezvoltă semnifi cativ mai puţin frecvent şi mult mai târziu în cursul vieţii. Netrataţi, doar 1/10-1/5 din pacienţii cu o comunicare interatrială importantă din punct de vedere hemodinamic vor dezvolta în fi nal boala vasculară pulmonară, mai ales în decada a 3-a sau a 4-a de viaţă. Pentru a înţelege relaţia dintre hipertensiunea pulmonară coexistentă şi o malformaţie cardiacă congenitală la un pacient individual şi pentru a defi ni în mod adecvat prognosticul şi tratamentul, este necesară evaluarea progresiei bolii vasculare şi caracterizarea adecvată a malformaţiei cardiace din punct de vedere morfologic şi fi ziopatologic.
Pneumologia (Bucharest, Romania), Apr 1, 2005
In the tip-to-date medical literature a topic for discussion is the variety of asthma clinical ph... more In the tip-to-date medical literature a topic for discussion is the variety of asthma clinical phenotypes. The knowledge of the various clinical asthma phenotypes is very important as regards the appropriate treatment approach, and the prognostic assessment of the patients with asthma. This allows a better understanding of pathophysiologic mechanisms, and of the phenotype-genotype correlation. A diagrammatic classification of clinical asthma phenotypes includes following criteria: onset age, inflammatory profile, severity pattern. According to the onset age, asthma clinical phenotypes specific for children and clinical phenotypes more frequent in adulthood are known. The main childhood asthma phenotypes are: transient infant wheezing, non atopic wheezing of the toddler and early school years, persistent IgE-mediated wheezing/asthma, late-onset childhood asthma. Other asthma phenotypes like aspirin-induced asthma, asthma related to chronic, persistent respiratory infection, are rare in childhood. It is reported a prevalence of 2-5% for the aspirin-induced asthma among pediatric patients. According to the airway inflammation pattern there are two phenotypes to distinguish: eosinophilic and non-eosinophilic asthma. The majority of the patients have an eosinophilic inflammation, but there is also a meaningful percentage of patients with noneosinophilic asthma which is neutrophil mediated. Clinical phenotypes of severe asthma are rarely described in childhood: near-fatal asthma, asthma with fixed airflow obstruction, and corticosteroid-resistant asthma.
Russian Journal of Cardiology, 2014
PubMed, Mar 16, 2006
Introduction: The relationship between fever and the severity of acute infant bronchiolitis has b... more Introduction: The relationship between fever and the severity of acute infant bronchiolitis has been little studied, and the results of the few published studies are not concordant. Aim: To assess the significance of fever in children aged under 1 year with acute bronchiolitis. Material: 83 children aged between 0-1 year; hospitalized with the diagnosis of acute bronchiolitis during the winter of 2004-2005, assigned to two groups, with febrile bronchiolitis and afebrile bronchiolitis, respectively. Method: The evaluation of patients using a clinical score including respiratory effort, O2 saturation, respiratory rate, and the statistical processing of results comparatively in the two study groups. Results: The mean duration of hospitalization was 5.8 days for febrile patients compared to 4.4 days for afebrile patients (p = 0.003). Infants with febrile bronchiolitis had a more severe clinical picture, evaluated by the clinical score, compared to afebrile patients (p = 0.03). Conclusion: Fever associated with acute bronchiolitis in children aged 0-1 year has the significance of a higher clinical severity and prolonged evolution of the disease.
Archives of Disease in Childhood, Nov 1, 2008
Romanian Journal of Pediatrics
Oxigenoterapia este principala metoda de tratament în insuficienţa respiratorie acută la copil. M... more Oxigenoterapia este principala metoda de tratament în insuficienţa respiratorie acută la copil. Metoda administrării oxigenoterapiei cu izoleta la sugar reprezintă o metodă frecvent folosită în practica pediatrică. Obiective. Evaluarea eficacităţii oxigenoterapiei administrate cu izoleta la sugarul cu insuficienţă respiratorie acută de cauză pneumogenă prin compararea a două metode de măsurare a saturaţiei în oxigen a hemoglobinei: din sânge capilar arterializat şi prin pulsoximetrie. Material şi metodă. Au fost luaţi în studiu 30 de sugari, cu insuficienţă respiratorie acută de cauză pneumogenă. S-a utilizat un scor clinic de apreciere a insuficienţei respiratorii acute, care evaluează frecvenţa respiratorie, bătaia aripioarelor nazale, tiraj, cianoza, senzoriu, înainte şi după oxigenoterapie. Din sângele capilar arterializat s-a măsurat presiunea parţială a oxigenului şi saturaţia în oxigen a hemoglobinei şi s-a citit cu analizorul Automatic Blood Gas System. Concomitent s-a măsur...
Romanian Journal of Pediatrics, 2010
Hipertensiunea arterială pulmonară asociată malformaţiilor cardiace congenitale are o serie de pa... more Hipertensiunea arterială pulmonară asociată malformaţiilor cardiace congenitale are o serie de particularităţi care o fac distinctă de alte forme de hipertensiune pulmonară. La copiii cu boală cardiacă congenitală asociată cu şunt stânga-dreapta non-restrictiv, hipertensiunea arterială pulmonară este iniţial reversibilă, aceasta fi ind singura formă de hipertensiune arterială pulmonară în care este recunoscut clinic un stadiu reversibil. Speranţa de viaţă la pacienţii cu sindrom Eisenmenger este mai mare decât în alte forme de hipertensiune arterială pulmonară. La pacientul netratat cu hipertensiune arterială pulmonară idiopatică supravieţuirea medie este de 2,8 ani, în timp ce bolnavii cu sindrom Eisenmenger pot supravieţui până la o vârstă de 40-50 de ani. La pacienţii cu şunt stângadreapta non-restrictiv la nivel post-tricuspidian în peste 50% dintre cazuri se dezvoltă boală vasculară pulmonară ireversibilă şi progresivă în primii ani de viaţă, ducând în fi nal la sindrom Eisenme...
Roumanian archives of microbiology and immunology
Last consensus in celiac disease in 2008 conducted under the aegis of the European Society of Ped... more Last consensus in celiac disease in 2008 conducted under the aegis of the European Society of Pediatric Gastroenterology, Hepatology and Nutrition jointly with North American Society of Pediatric Gastroenterology, Hepatology and Nutrition reveals the following: "celiac disease is a chronic immune-mediated enteropathy characterized by sensitization to gluten. That can affect any organ or system, with a wide range of clinical manifestations of variable severity". Thus, in recent years, clinical picture of celiac disease has changed the old paradigm--bowel disease with villous atrophy and malnutrition, being replaced with the new paradigm--multi-organ autoimmune disease, affecting many organs and systems throughout but with more less specific symptoms, which undiagnosed leads to delayed diagnosis, at a late-onset disease and long-term major complications as the risk of cancer. According to this consensus "the serological diagnosis of celiac disease is based on high sensi...
Asian Cardiovascular and Thoracic Annals, 2013
A 39-year-old man was referred with a diagnosis of double aortic arch. Chest radiography showed m... more A 39-year-old man was referred with a diagnosis of double aortic arch. Chest radiography showed mild enlargement of the upper mediastinum. Chest computed tomography revealed a right-sided aortic arch with specular transposition of the epiaortic vessels and a Kommerell’s diverticulum at the origen of the left subclavian artery (Figure 1(A) and (B)), as well as a left-sided hypoplastic aortic arch (Figure 1(C) Asian Cardiovascular & Thoracic Annals 21(2) 243–244 The Author(s) 2012 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0218492312450022 aan.sagepub.com
Clinical Laboratory, 2011
According to the 2008 celiac disease working group run by Dr. A. Fassano under the auspices of th... more According to the 2008 celiac disease working group run by Dr. A. Fassano under the auspices of the Federation of International Societies of Pediatric Gastroenterology, Hepatology and Nutrition, celiac disease is a chronic immune-mediated enteropathy characterized by gluten sensitivity, which can affect any organ or system, having a wide range of clinical manifestations of variable severity. The serological diagnosis of celiac disease is based on high sensitivity and specificity tests. The measurement of IgA anti-tissue transglutaminase antibodies by ELISA is universally accepted in the screening of celiac disease. Using the gold standard represented by IgA anti-endomysium antibodies in a group of 890 children investigated during 2008-2009, we aimed to evaluate IgA anti-tissue transglutaminase antibodies (tTG IgA), as well as to establish their prevalence in associated diseases. Following the measurement of tTG IgA in the entire group, we obtained: sensitivity 773%, positive predicti...
Pneumologia, 2005
INTRODUCTION The relationship between fever and the severity of acute infant bronchiolitis has be... more INTRODUCTION The relationship between fever and the severity of acute infant bronchiolitis has been little studied, and the results of the few published studies are not concordant. AIM To assess the significance of fever in children aged under 1 year with acute bronchiolitis. MATERIAL 83 children aged between 0-1 year; hospitalized with the diagnosis of acute bronchiolitis during the winter of 2004-2005, assigned to two groups, with febrile bronchiolitis and afebrile bronchiolitis, respectively. METHOD The evaluation of patients using a clinical score including respiratory effort, O2 saturation, respiratory rate, and the statistical processing of results comparatively in the two study groups. RESULTS The mean duration of hospitalization was 5.8 days for febrile patients compared to 4.4 days for afebrile patients (p = 0.003). Infants with febrile bronchiolitis had a more severe clinical picture, evaluated by the clinical score, compared to afebrile patients (p = 0.03). CONCLUSION Fev...
Pneumologia, 2005
In the tip-to-date medical literature a topic for discussion is the variety of asthma clinical ph... more In the tip-to-date medical literature a topic for discussion is the variety of asthma clinical phenotypes. The knowledge of the various clinical asthma phenotypes is very important as regards the appropriate treatment approach, and the prognostic assessment of the patients with asthma. This allows a better understanding of pathophysiologic mechanisms, and of the phenotype-genotype correlation. A diagrammatic classification of clinical asthma phenotypes includes following criteria: onset age, inflammatory profile, severity pattern. According to the onset age, asthma clinical phenotypes specific for children and clinical phenotypes more frequent in adulthood are known. The main childhood asthma phenotypes are: transient infant wheezing, non atopic wheezing of the toddler and early school years, persistent IgE-mediated wheezing/asthma, late-onset childhood asthma. Other asthma phenotypes like aspirin-induced asthma, asthma related to chronic, persistent respiratory infection, are rare ...
Kikuchi disease is a rare, benign, self-limiting disease of unknown etiology, which should be inc... more Kikuchi disease is a rare, benign, self-limiting disease of unknown etiology, which should be included in the diagnostic algorithm of cervical adenopathy. The certainty diagnosis is histopathological, specifi c changes including paracortical lymph node necrosis, histiocytes with crescent shaped nuclei and many apoptotic bodies. The case of a 13-year-old patient diagnosed with Kikuchi disease, a disorder rarely described at pediatric age, is presented.
A new high-throughput liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for the qua... more A new high-throughput liquid chromatography tandem mass spectrometry (LC-MS/MS) assay for the quantification of carvedilol in human plasma was de veloped and validated. The separation was performed on a Zorbax SB-C18 column under isocratic conditions usi ng a 34:66 (v/v) mixture of acetonitrile and 0.2% ( formic acid in water at 42 oC with a flow rate of 0 .3 mL/min. The detection of carvedilol was performe d in multiple reaction monitoring (MRM) mode (m/z 222, 224, 283 from m/z 407). The human plasma samples (0.2 m L) were deproteinized with methanol, and aliquots of 1 5 �L from the supernatants obtained after centrifugati on were directly injected into the chromatographic sys tem. The method shows a good linearity (r > 0.9979) , precision (CV < 12.9 %) and accuracy (bias < 7.8 %) over the range of 1.63-180.9 ng/mL plasma. The lower li mit of quantification (LLOQ) was 1.63 ng/mL and the recove ry was between 95-109.8 %. The method is not expens ive, it needs a minimum time...
Oxygen therapy is the main treatment method for acute respiratory failure in children. The method... more Oxygen therapy is the main treatment method for acute respiratory failure in children. The method consisting in the administration of oxygen therapy by head box to infants is frequently used in pediatric practice. Objectives. To evaluate the effi ciency of oxygen therapy administered by head box to infants suffering from pneumogenic acute respiratory failure by comparing two methods for measuring hemoglobin oxygen saturation: in arterialized capillary blood and by pulse oximetry. Material and method. 30 infants suffering from pneumogenic acute respiratory failure were studied. We used a clinical appraisal score for acute respiratory failure, which appraises respiratory rate, nasal fl aring, recession, cyanosis, sensorial, before and after oxygen therapy. In arterialized capillary blood we measured partial pressure of oxygen and hemoglobin oxygen saturation, and we used an Automatic Blood Gas System analyzer. We also measured hemoglobin oxygen saturation using a pulse oximeter. Deter...
The association of the celiac disease with sugar diabetes has been demonstrated by the common gen... more The association of the celiac disease with sugar diabetes has been demonstrated by the common genetic aspect (HLA-DR3,) which correlates with the serious evolution of the type I diabetes. Object and method: During 2008-2009, we followed the quantification of the associated autoimmune phenomena through immunoenzymatic reactions on a group of 40 children with sugar diabetes of type I. Results: The immunologic markers' prevalence was: liver-kidney anti-microsomal antibodies 2.5%, soluble liver antigen 0%, glutamic acid anti-decarboxylase antibodies 35%, anti-tyrosine phosphatase antibodies 55%, anti-insulin antibodies 50%, cytoplasmic anti-insulin antibodies 2.5%, anti-thyroglobulin antibodies 11.1%, antithyroidperoxidase antibodies 23.1% and tissular antitransglutaminase antibodies IgA 25.7%. The main associations of the IgA tissular antitransglutaminase antibodies were with the glutamic acid anti-decarboxylase antibodies r=0.33 (p=0.027). Conclusion: Since the presence of the glu...
Uploads
Papers by Angela Butnariu
Objectives. The study of the clinical and paraclinical evolution of dilated cardiomyopathies in children, unresponsive to conventional treatment with angiotensin converting enzyme inhibitors, diuretics, digoxin, requiring the association of carvedilol; the study of the pharmacokinetics of carvedilol in children.
Materials and metods. 16 children with severe dilated cardiomyopathy and left ventricular ejection fraction
≤ 31% were clinically evaluated according to the ROSS / NYHA score and echocardiographical. The measurement of carvedilol in human plasma, high performance liquid chromatography associated with mass spectrometry the external standard method, was used for 7 patients.
Results. Of the 16 children with dilated cardiomyopathies treated with carvedilol as adjuvant medication to
conventional therapy, 14 evolved towards clinical and echocardiographic improvement and two towards
death. Clinically, the children tolerated carvedilol well, the NYHA score improved and the left ventricular
ejection fraction increased from 31% to more than 40%. The study of the pharmacokinetics of carvedilol was
performed for 7 subjects. It was demonstrated that the absorption rate does not change with the increase of
the administered dose. The time to reach peak concentration is identical for all subjects. The mean half-time
is 2.88 hours, being much shorter than in adults. The mean residence time of carvedilol in the body varies
similarly, 4.28±1.52 hours.
Conclusions. At the pediatric age, dilated cardiomyopathies unresponsive to conventional treatment with angiotensin-converting enzyme inhibitors, diuretics and digoxin benefi ted from the association of betablocking medication – carvedilol, with the improvement of the NYHA/ROSS score and of the left ventricular ejection fraction. The study of the pharmacokinetics of carvedilol in children evidenced a mean half-time of 2.88 hours and a mean residence time in the body of 4.28±1.52 hours.