Arq Bras Endocrinol Metab vol 47 nº 2 Abril 2003 198 RESUMOA necrose de tecido adiposo subcutâneo (NASC) do recém nascido é uma hipodermatite aguda que aparece nas primeiras quatro semanas de vida. Desenvolve-se em crianças vítimas de parto complicado ou de sofrimento fetal. Formam-se placas ou nódulos subcutâneos inflamatórios de coloração violácea e tamanhos variados que costumam regredir espontaneamente dentro de um ano. Pode ser acompanhada de hipercalcemia, por vezes grave, pondo a vida da criança em risco. Descrevemos um caso de NASC em que as lesões não eram visíveis e o cálcio plasmático atingiu níveis de 24,5mg/dL. Apesar da hipercalcemia extremamente elevada, o paciente teve evolução satisfatória sendo tratado com hidratação, corticoesteróides e dieta restritiva de cálcio e vitamina D. Alguns aspectos fisiopatológicos e de tratamento são discutidos. The necrosis of the subcutaneous fat tissue (NSFT) of the newborn is an acute hypodermatitis that has its onset during the first four weeks of life. It occurs in children born after complicated labors or who suffer fetal distress. Inflammatory purplish plaques or subcutaneous nodules of different sizes appear, usually waning spontaneously after a year. These lesions may be associated to hypercalcemia which can be serious and lifethreatening. We describe a case of NSFT in which the lesions were not visible and serum calcium levels reached 24.5mg/dl. Despite the extremely severe hypercalcemia, the patient had a good outcome, being treated by hydration, corticosteroids, and diet with low calcium and vitamin D levels. Some fisiopathologic aspects and treatment are addressed. N ECROSE DO TECIDO ADIPOSO subcutâneo (NASC) do recém nascido é uma hipodermatite aguda rara, de evolução benigna e de etiologia incerta, na qual ocorrem lesões em pele freqüentemente sobre proeminên-cias ósseas e extremidades (1-2). Geralmente acomete neonatos nascidos a termo com história de dificuldade durante o parto envolvendo hipotermia, aspiração de mecônio e/ou asfixia.As lesões cutâneas requerem apenas tratamento sintomático, mas às vezes vêm acompanhadas de uma condição que pode pôr a vida do recém-nascido em risco, que é a hipercalcemia (3). Esta se desenvolve de alguns apresentação de caso
Ambulatory blood pressure monitoring (ABPM) has demonstrated a high prevalence of white coat hypertension (WCH) in adults, but few studies exist in obese and overweight children and adolescents. We can define WCH as elevated casual blood pressure (BP) with normal 24-hr mean BP, but ABPM in adults has shown that BP load( % of BP readings Ͼ 95th percentile) is better to predict hypertensive end-organ injury than mean BP. Our objective was to evaluate the prevalence of hypertension (HTN) and WCH in overweight and obese children and adolescents by both mean BP criteria and BP load criteria. From January 1999 to June 2000, 39 patients ( 22M/17F) from 10 to 17 years old were evaluated and in all, ABPM were performed. They were evaluated by two cardiologists and the BP was measured two times by each one, with 5 minutes interval. HTN were considered when the average of these 4 measures (systolic or diastolic) Ͼ 95th percentile. In relation to ABPM, BP was measured 3 times/hr from 8 am to 10 pm and 2 times/hr from 10 pm to 8 am. Wake and sleep period were defined by patient self-report. WCH was defined by mean BP criteria as wake systolic BP (SBP) and diastolic BP (DBP) Ͻ 95th percentile (Task Force for HTN Control in Children and Adolescent) and by BP load criteria as 24-hr SBP and DBP load Ͻ 30% (using 24-hr 95th percentile normative pediatric ABPM data). The criteria used for overweight and obesity were defined by body mass index (BMI) according to Expert Committee on Clinical Guidelines for Overweight in Adolescent Preventive Service. The prevalence of HTN was 28.2% (11/39), being 54.6% females (6/11) and 90.9% (10/11) were obese. The prevalence of WCH defined by mean BP criteria was 45.4% (5/11) and 80% were girls (4/5) and 80% (4/5) were obese. BP load was normal (Ͻ 30%) in 27.2% (3/11) for SBP and 81.8% (9/11) for DBP. The prevalence of WCH by BP load criteria (SBP and DBP Ͻ 30%) was 27.2% (3/11), being 66.6% girls (2/3) and 66.6% obese (2/3); 27.2 % (3/11) of patients had WCH by both criteria (mean BP and BP load). The HTN and WCH in obese and overweight children and adolescents are common and they occur more often in girls and obese. ABPM should be used in hypertensive obese and overweight children to avoid mistaken for casual HTN that may lead to unnecessary use of medication and expensive diagnostic approaches.Key Words: white coat hypertension, ABPM, children hypertension P-616 HOW OFTEN IS WHITE COAT NORMOTENSION IN OVERWEIGHT AND OBESE CHILDREN AND ADOLESCENTS?Luciano R. Cavichio, Rui Povoa, Suzana Simão, Fan H. Wen, Miriam Shirassu, Katia Cavalcante, Sheila Christo, João Pimenta. 1 Cardiology, Hospital do Servidor Publico Estadual, São Paulo, SP, BrazilWhite coat hypertension (WCH) is a very well documented situation, where the casual blood pressure (BP) is elevated and the ambulatory blood pressure (ABP) means are normal. But, there is one another situation called white coat normotension (WCN), where the casual BP is elevated with normal ABP means. Few studies have examined this situation, particularl...
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