Search

Pediatric multisystem inflammatory syndrome (PMIS) appears to be a relatively rare complication of COVID-19 in children, occurring in less than 1% of children with confirmed SARS-CoV-2 infection. This condition can appear several weeks after the acute SARS-CoV-2 infection and is assumed to be a delayed immune response to coronavirus disease 2019 which can lead to a severe cardiovascular involvement. In this retrospective study, our main purpose was to summarize the clinical data from three types of onsets in patients diagnosed with PMIS and report the experience to the known data in the literature. We put the emphasis on the course of management considering the three different presenting faces of the PMIS in children. All patients received IV immunoglobulin and antiplatelet treatment, 66% (2 of 3) necessitated inotropic support, corticosteroid therapy (metilprednisolon), anticoagulation, 33% (1 of 3) received Anakinra (antagonist of the interleukin 1 receptor). All of them received cardiac remodeling treatment with Lisinopril and Bisoprolol (associated or not with Spironolactone and Furosemide). Evolution was good with discharge in approximately 2 weeks from admission, without symptoms, and with cardiac improvement at echocardiography. PMIS is an alarming situation that necessitate multidisciplinary approach and a complex management. The cardiac evaluation is crucial in risk evaluation and guidance for a correct approach of the disease.

Kawasaki disease is a challenging diagnosis even in typical forms of presentation. The features are represented by long lasting fever, specific mucocutaneous signs and coronary artery dilations as expression of medium artery vasculitis of unknown origin. Kawasaki-like disease emerged as a variant of pediatric multisystem inflammatory syndrome (PMIS) associated with COVID-19 infection. A 1 year 9-month-old boy who presented with fever, semi-consistent stools, vomiting, facial edema and hepatomegaly was transferred in our hospital with suspicion of myocarditis due to the clinical presentation, inflammatory markers and systolic dysfunction. In a few days after presentation, also, dilation of the coronary artery appeared while the child had persistent constant symptomatology. Gradually, a pediatric multisystem inflammatory syndrome (PMIS) developed, but without positive markers of COVID-19 infection, which remained negative (both antigen and antibodies). So, in front of all elements of PMIS except exposure to SARS-CoV-2, we concluded for an atypical Kawasaki disease with elements of PMIS. But the debate between the elaborated criteria British and American for PMIS are circling around the demonstration of the infection, past or present, making some cases difficult to diagnose. In this high affluence of Kawasaki-like disease, with intricated elements of myocarditis and multisystem inflammatory syndrome it is more and more difficult to establish a clear diagnosis. While the diagnosis looks complex, the curative treatment goes in the same direction – immunoglobulin, immunosuppressive treatment, inotropic and antiaggregant or anticoagulant treatment.

We present the case of a newborn diagnosed with perinatal asphyxia and secondary renal injuries, transposition of the great vessels and low systemic blood flow, treated with Prostaglandin, atrioseptostomy, followed by arterial switch surgery After the cardiac surgery the patient is oliguric and requires hemodiafiltration for 12 days, after which renal function is restored. In evolution, however, AVB (atrioventricular block) grade III occurs, followed by implanta-tion of permanent pacemaker, but another postoperative complication – chylothorax – leads to stopping electrical stimulation followed by severe cardiac dysfunction and, consequently, recurrent renal injury and anuria. Re-estab-lishing hemodiafiltration for another 7 days without recovery of renal function. Perinatal asphyxia, cardiac heart disease with low systemic blood flow, prostaglandin, atrioseptostomy, cardiac rhythms disturbances, chylothorax, sepsis, cardiac arrest are intriguing factors that bring renal injury. Their association greatly decreases the chance of survival even if the patient benefits from supportive treatment and early hemodiafiltration.

Prezentăm cazul unui nou-născut diagnosticat cu suferintă perinatală și injurie renală secundară, transpoziție de vase mari și debit sistemic scăzut, tratat cu prostaglandină, atrioseptostomie, urmate de operația de switch arterial. Postoperator, pacientul este oliguric și necesită hemodiafiltrare pentru 12 zile, după care funcția renală este restabilită. În evoluție, apare bloc atrioventricular (BAV) grad III, urmat de implantare de stimulator cardiac permanent, dar o altă complicație postoperatorie – chilotorax – duce la oprirea stimulării electrice, urmată de disfuncție cardiacă severă și, consecutiv, injurie renală recurentă și anurie. Se reinstituie hemodiafiltrarea pentru încă 7 zile, fără recuperarea funcției renale. Asfixia perinatală, malformația cardiacă cu debit sistemic scăzut, prostaglandina, atrioseptostomia, circulația extracoroporeală, tulburările de ritm, chilotoraxul, sepsisul, stopul cardiac sunt factori intricaţi care aduc injurie renală importantă. Asocierea lor scade major șansele de supraviețuire chiar dacă pacientul beneficiază de tratament suportiv și hemodiafiltrare precoce.

Duct-dependent congenital heart disease requires attentive therapeutic management since the only source of pulmonary blood flow in newborns is provided by the patent ductus arteriosus. The patency of the duct is the main objective in the first hours of life and it is guaranteed by prostaglandin E1 infusion, but it is not a long-term solution for this type of cardiac malformation. In order to augment pulmonary blood, there are two types of interventions that can be performed: a classical surgical shunt or stenting of the ductus arteriosus, a fairly new alternative to cardiac palliative surgery. Case selection for this type of procedure is essential regarding the patients’ outcome. We present the management of a newborn diagnosed with (pseudo)atretic pulmonary valve, large ventricular septal defect and patent ductus arteriosus, who underwent an interventional procedure to secure pulmonary blood flow by placing a drug-eluting stent in the ductus arteriosus. The patient’s evolution was not uneventful, several complications appeared, but after three months of neonatal intensive care we were able to discharge him in good clinical condition.

Introduction. Obtaining vascular access that allows long-term hemodialysis of children with stage 5D chronic kidney disease is a priority in the management of these patients. Complications of central venous catheters and arteriovenous fistula are directly correlated with the morbidity and quality of life of these children. The objective of the study was to assess complications of vascular access in children on long-term hemodialysis by arteriovenous fistula or central venous line. Methods. We followed 40 patients in the hemodialysis program for a period of 18 months; in 22, vascular access was by arteriovenous fistula, and 18 were dialyzed on a central venous line. Results. All 22 patients were accepted for AVF at a vein diameter of at least 3 mm, and this probably contributed to the high rate of primary maturation (86%). In the majority of these patients (64%) was brachiocephalic fistula versus radiocephalic (18%), in most cases the decision being supported by small diameters of radial artery and distal cephalic vein. Three of the arteriovenous fistulas performed had a primary failure, and one a secondary failure; 2 of the patients with arteriovenous fistula failure had to be subsequently dialyzed by central venous line and one by peritoneal dialysis, while the fourth benefited from a new arteriovenous fistula. Six patients developed fistula aneurysms, one of them evolving into a pseudoaneurysm with spontaneous rupture and hemorrhagic shock and requiring emergency ligation. Two patients developed significant vein stenosis in the proximity of the anastomosis. All 6 patients with aneurysmal fistula had hypertension, and 3 of them had thrombotic venous stenoses/occlusion in the main deep veins upstream of the fistula in the context of prolonged use of central venous lines in the jugular veins and subclavian veins. The average age of the children was 13.35 years (range 9-18 years) and the average weight was 38.6 kg (range 23-58 kg). Of the patients on dialysis on central venous lines, 76% (16 patients) had at least one episode of sepsis that required hospitalization, and all patients who were dialyzed on the catheter (from the beginning or after fistula failure) experienced at least one episode of vein thrombosis that required catheter change. In 8 (38%) of the 21 patients using central venous lines, thrombotic occlusion/stenosis of at least one persistent deep vein was observed at 3 months after the removal of the central venous line from the venous axis. Conclusions. Complications of venous access in children with hemodialysis are very common and have a major impact on the morbidity and quality of life of these patients. In this context, a multidisciplinary team (pediatric nephrologist, specialist in vascular imaging, and vascular surgeon) is needed to follow these patients in order to prevent and treat these complications.

Since the introduction of modern phototherapy in 1903 by Nobel Prize-winner Niels Ryberg Finsen, the usage of this therapy in the medical field has grown, techniques have been refined and developed, and it has gained widespread acceptance. Psoriasis vulgaris, parapsoriasis, lichen planus, atopic dermatitis, neonatal jaundice, urticaria, morphea, vitiligo, granuloma annulare and cutaneous T cell lymphoma are only a few dermatological indications that come along with satisfactory results. Most often, it is a 2nd or 3rd line therapy being an alternative in more severe or refractory diseases. Despite the side effects that may occur after phototherapy, which are often minor, the benefits can be significant. Unfortunately, the absolute contraindications limit the use of this type of treatment and implicitly the management of these patients. The current review aimed to combine the recommendations of phototherapy in dermatology, the types of phototherapy that can be suitable for certain dermatological diseases and to emphasize its importance in certain conditions that are associated with significant remission rates.

Long considered a skin-limited condition, psoriasis is currently defined as a chronic, immune-mediated inflammatory disease, presenting, besides the skin changes, important systemic manifestations, the most common being: psoriatic arthritis, cardiovascular disease, metabolic syndrome, diabetes, inflammatory bowel disease and nonalcoholic steatohepatitis. It is a disease with a strong psycho-emotional and social impact, both through skin changes such as pruritic, scaly erythematous plaques, and through the association of comorbidities that influence morbidity and mortality. It has been shown that psoriasis is an independent cardiovascular risk factor, with patients developing ischemic heart disease/acute coronary syndrome, hypertension, peripheral arterial disease, or stroke. The chronic inflammatory status of psoriasis and the production of specific cytokines may be the etiopathogenic link to atherosclerosis and cardiovascular disease. Biological therapy may affect atherosclerosis, leading to the arrest of the evolution or even regressing the changes in the atheromatous plaque. The aim of this review was to re-evaluate the current knowledge regarding the cardiovascular comorbidities associated with psoriasis for optimal management of the patients.

Acne is a chronic inflammatory condition affecting the pilosebaceous unit that was traditionally viewed as a disease of the adolescence. However, over the past several years, an increasing number of adult women have been reported to suffer from this condition. The prevalence of adult female acne ranges between 12 and 54%. Two clinical types can be distinguished in this population, a 'retentional' and an 'inflammatory' type, which usually tend to overlap. In terms of evolution, three main subtypes can be identified: Persistent acne, which is the most frequent subtype, late-onset acne and recurrent acne. This type of acne is mainly mild-to-moderate in severity and may be refractory to conventional treatment. The etiopathogenesis is complex and has yet to be fully elucidated. It appears to involve an interaction among genetic predisposition, hormonal factors, and chronic activation of the innate immune system overlapping with external factors, such as daily stress, Western-type diet, use of tobacco and cosmetics. The treatment may be challenging and a holistic approach is required, with special attention to the individual needs and particularities of adult women. Both topical and systemic treatments are available, with hormonal therapies being of special value in this population. The aim of the present article was to provide up-to-date, evidence-based information on the clinical presentation, etiopathogenesis and treatment of adult female acne.

Psoriasis is one of the most common immune-mediated chronic inflammatory skin disorders, involving hyperproliferative keratinocytes and infiltration of T cells, dendritic cells, macrophages, and neutrophils. Multiple factors appear to play important roles in the pathogenesis of psoriasis. These environmental (e.g., infectious agents and trauma), genetic, and immunologic factors are reviewed in this article. Although the pathogenesis of psoriasis remains to be established, data suggesting immune cell dysregulation in the skin are available. The involvement of the immune system, particularly T cells, in the etiopathogenesis of psoriasis is discussed in this review, indicating a potential justification for innovative treatment intervention. Besides describing pathogenic T cells, the aim of the review was to assess the function of newly identified antimicrobial peptides (AMPs), interleukin (IL)-23, IL-17, and tissue resident memory cells (TRMs), and their role in psoriasis. Furthermore, new insights were presented regarding TRMs, a recently identified subset of memory T cells, and the role they play in the local memory of disease, making them a potential new therapeutic target in psoriasis. Finally, current developments in T-cell research and cytokine-targeted therapy for psoriasis treatment are reviewed.

Cardiac emergencies in children represent an extremely important issue in medical practice. In general, interventional treatment could be optional in many situations, however it can be indicated in emergency conditions. There are many diseases at pediatric age that can benefit from interventional treatment, thus reducing the surgical risks and subsequent complications. Balloon atrioseptostomy, patent ductus arteriosus (PDA) closure, percutaneous or hybrid closure of a ventricular septal defect, pulmonary or aortic valvuloplasty, balloon angioplasty for aortic coarctation, implantation of a stent for coarctation of the aorta, for severe stenosis of the infundibulum of the right ventricle, or for PDA correction are among the procedures that can be performed in emergency situations. This review aims to present the current state of the art in the field of pediatric interventional cardiology.

Introduction: Hemolytic uremic syndrome is the most frequent cause of acute renal failure in children, commonly after gastrointestinal infections with E. coli or Salmonella, and it is characterized by progressive renal failure associated with microangiopathic hemolytic anemia and thrombocytopenia. Cardiac involvement is frequently encountered and can be potentially fatal in hemolytic uremic syndrome. It is usually determined by overhydration, hypertension, anemia, diselectrolytemia, acid-base disorders and tendency to form thrombi, and it consists in the following conditions: pericarditis, myocardial infarction, dilated cardiomyopathy, cardiac failure, and arrythmias. Objective: The aim of this study is to observe the incidence of cardiovascular complications in children with acute hemolytic uremic syndrome, underline which are the most useful tools in establishing an accurate diagnosis, and discover the treatment protocol that has the most powerful impact upon the cardiovascular manifestations. Materials and methods: We studied a number of 50 children who checked in the Nephrology Department of “M. S. Curie” Emergency Clinical Hospital in Bucharest, Romania, between January 2016 and August 2020. We performed the clinical examination of all patients as well as several paraclinical tests such as electrocardiogram, transthoracic echocardiography, arterial blood pressure monitorization, and vascular Doppler ultrasound. Patients included in the study were aged between five and 40 months. Discussion and results: The majority of these children were diagnosed with arterial hypertension and some of them with cardiac failure and profound venous thrombosis. Transthoracic echocardiography revealed pathological aspects such as left ventricular hypertrophy, diastolic dysfunction, systolic dysfunction of the left ventricle, mitral regurgitation, aortic regurgitation, and pericarditis. Cardiac ultrasound findings were reversible in the majority of patients, most of them being treated with ACE inhibitors (eventually in association with other antihypertensive drugs).

Paracetamol (N-acetyl- para-aminophenol) also known as acetaminophen is a chemical compound used in medical practice for analgesic and antipyretic effects. The mechanism of action is related to the cyclooxygenase (COX) activity, which is not full inhibit as for nonsteroidal anti-inflammatory. Paracetamol selectively inhibits COX activities in the brain, indirectly by reducing COX, which must be oxidized in order to function. In addition to analgesic and antipyretic effects, modulating the prostaglandin synthesis by selective inhibition of COX, a vascular modulator effect was described recently on the closure of the patent ductus arteriosus (PDA). This effect has been described in premature newborns, perhaps by decreasing the prostaglandin production. We present the case of a neonate, 39 weeks gestational age, normal birth weight who presented in the 10 th day of life with a cardiac murmur. Echocardiography evidenced a hemodynamically significant PDA, left ventricular enlargement, severe mitral regurgitation, patent foramen ovale and pulmonary hypertension. Although she was a 10-day- old full-term neonate paracetamol administration was attempted. Paracetamol was administered orally in the therapeutic dose of 15 mg/kg/dose, three times a day for three days. The effect was significant by reducing the diameter of the arterial duct (~50% of initial diameter), reducing the size of the left cardiac chambers, reducing the degree of mitral regurgitation from severe to mild, and disappearance of pulmonary hypertension. In conclusion, paracetamol use can change prognosis through the vaso-modulator on the PDA, at the age of 10 days, on a full-term neonate with a normal birth weight. This effect may also be present in full-term newborns and not only in preterm. Even if the PDA was not closed after three days, the hemodynamic impact disappeared and the child could avoid surgical ligation.

Contrast agents are among the most frequently used drugs in medical practice. The aim of our study was to evaluate the incidence of complications associated with the use of different contrast agents in an angiography lab dedicated to pediatric patients with congenital heart disease. Between June 2015 and December 2017, 166 patients with congenital heart disease were diagnosed and/or treated in the angiography lab. Of these patients, 38 were excluded because they did not require contrast substance administration. As interventional procedures we performed pulmonary valvular dilatation in 17 cases (10.2%), stent implantation in coarctation of the aorta in 9 cases (5.4%), PDA closure in 62 cases (37.3%), atrial septal defect (ASD) closure in 36 patients (including patients without contrast agent�s administration) (21.7%). In the group of 129 patients who received contrast agents, the median age was 5.8 years (range 0.1-19 years) and median weight 22.8 kg (range 2.8-72 kg). Average consumption of contrast media per procedure was 79 ml/procedure (range 5 - 400 mL) and 4.3 mL/kg (range 0.4 - 22.7). We used iomeprol (24%), iohexol (8.5%), iopromide (67.4%). No contrast related complications are reported in this group. In conclusion, the contrast agents we used seem to be safe and are not associated with renal complications.

Severe acute respiratory coronavirus 2 (SARS-CoV-2) is a novel coronavirus discovered in 2019 that caused the coronavirus disease 2019 (COVID19). During the last year, over 70 million people were infected and more than 1.5 million people died. Despite the tremendous number of people infected, children were less affected and presented milder forms of the disease. A short time after the pandemic was declared, a new hyperinflammatory syndrome resembling Kawasaki disease (KD) was described in children with confirmed or suspected SARS-CoV-2 infection named multisystem inflammatory syndrome in children (MIS-C). The incidence of MIS-C is low and it has a polymorphous clinical presentation, making the diagnosis difficult. Although the incidence is reduced, there is a high risk of cardiovascular complications. In order to raise awareness, we present the cases of two pediatric patients diagnosed with MIS-C in our clinic.

Over the last few years, prenatal diagnosis of congenital heart diseases experienced an important development. Overall survival of patients with congenital heart disease was improved in the last decade due to the advanced diagnostic methods and progression of cardiovascular surgical procedures in this field. Due to the significant increase of the long-term survival rate, currently, in most developed countries, there are departments dedicated to monitoring the adults with congenital heart malformation due to the particularities and special needs of this type of patients, compared with the regular cardiac pathology of adults. This article proposes a review of existing data at this moment related to the prenatal and postnatal diagnosis and their impact on the evolution regarding the most common cyanotic congenital malformation – Tetralogy of Fallot. In the following pages, we is emphasize the importance of knowing the precise fetal pathology for early determination of medical behavior in the postnatal period for the best care of these children.

Heart implication in Duchenne muscular dystrophy usually is present in the form of dilated cardiomyopathy, manifested as heart failure and arrhythmias. To delay progression, including heart deterioration, prednisone is recommended as preventive treatment. We report the case of an 11-year-old boy diagnosed with Duchenne muscular dystrophy at the age of seven, who was on preventive treatment with oral prednisone (0.75 mg/kg/day) and beta blocker (metoprolol, 1 mg/kg/day). Suddenly, the patient presented acute chest pain, vomiting and sweating. The electrocardiogram showed ST elevation in inferior leads. Troponin T was increased to 30814 pg/ml (normal values

Duchenne disease is known as a hereditary musculopathy which affects also the heart muscle. Related to the cardiomiopathy, almost all reports in literature describe a slow onset pattern for cardiac impairment and deterioration. Only exceptionally this can take an acute form. We present the case of an 11-year-old boy who was hospitalised for typical anginal retrosternal pain, nausea, vomiting and sweating, with the onset 12 hours prior to admission. The patient is known with progressive Duchenne muscular dystrophy since 2012, genetic diagnosis being confirmed in France and he was under treatment with prednisone and metoprolol. Besides the clinical evolution, typical ECG changes were noted (inferior ST elevation, necrotic Q wave, QS wave in inferior and then lateral leads). Biological investigations performed on admission objectified: leukocytosis with increased neutrophils, slightly inflammatory syndrome (CRP 24.8 mg/L – then 42 mg/L on the 4thday from admission). LDH, AST, ALT, troponin T – up to 30 814 pg/ml (NV Echocardiography highlighted posterolateral myocardial wall hypokinesia, being consistent with the electrocardiographic changes of ST segment elevation in the inferior leads. Because of the severe onset mimicking an acute myocardial infarction, we had to perform a coronary angiogram. This showed normal epicardial coronary arteries. Myocarditis serology was negative. Cardiac MRI showed changes of myocardial fibrosis localised in the postero-inferior wall consistent with the ECG and echocardiography and absence of myocardial inflammatory modifications. In the light of these changes, the dose of prednisone was increased to 60 mg/day, for 5 days, then returning to levels of 30 mg/day after reduction of the troponin about 10 times. Enalapril 1 mg/kg/day, furosemide (1 mg/kg/day) and spironolactone (1 mg/kg/day) were introduced into the treatment. Conclusions In Duchenne muscular dystrophy cardiac changes generally take the appearance of dilated cardiomyopathy, but rarely can have acute character mimicking an acute myocardial infarction.

Unroofed coronary sinus (UCS) is an extremely rare malformation. Bilateral superior vena cava is much more rare than the isolated form of UCS (only eight cases reported in literature). We present the case of a teenager, aged 12 years, overweight, who presented with exertional dyspnea. Clinical and echocardiographic evaluation highlights systemic saturation decreased to 93%, and dilated right cardiac chambers. It raises the suspicion of a complex systemic venous malformation back into the left atrium and left-to-right shunt. After complex investigation, by transesophageal echocardiography with contrast administration, angio CT multi-slice, cardiac catheterization, the diagnosis was made and the patient underwent surgical correction: attaching left superior vena cava to the right atrial appendage, anterior wall septation of the coronary sinus with patch of bovine pericardium on the absent entire length. Conclusion This is an example of an extremely rare case in which the clinical signs are mild or even absent that after complete diagnosis underwent directly into the operating room due to the risk of cianosis, systemic embolization, cerebral abscess, pulmonary hypertension, Eisenmenger syndrom.

There are 120 years since the myocarditis was described for the first time in children and infants. At that time, Emmet Holt said “Myocarditis may...occur at any age, even in foetal life”. We describe two cases of Coxsackie B4 neonatal myocarditis. Both appeared almost in the same period of time, at 3 and 4 week-old, female and male newborns and had a similar course. The onset was with rhythm and conduction disturbances: ventricular ectopies, nonsustained ventricular tachicardia, supraventricular tachicardia, sinoatrial block, atrioventricular block, blocked extrasystoles. From the beginning both had the myocardial enzymes persistently elevated: CK-MB and troponin T, which maintained elevated levels even at distance from the onset. No inflammatory response and no kinetics disturbancies were noted neighter at admission nor at 2 months distance from the onset. Serology for Coxsackie B4 was first in progressively increasing, then decreasing titers. MRI confirmed a small degree of myocardial oedema for both of them, compatible with focal myocarditis. They received IV immunoglobulin, 2 g/kg/one dose in the second day from admission and the rhythm and conduction problems were treated with Propafenone, 10 mg/kg/day. They did not tolerate beta blockers (aggravated cardiac blocks). After 2 weeks, the rythm disturbancies almost disapeared. They remained on maintenance treatment with propafenone for a three months period. Conclusion: Neonatal myocarditis must be taken into consideration at any paediatric age, even in asymptomatic patients. Rhythm problems could aggravate the progression towards dilated cardiomyopathy and early treatment could interrupt a possible deterioration.

Starting a paediatric interventional cardiology program in a developing country like Romania is not an easy task to accomplish. The tremendous need for treating children in order to reduce the morbidity and mortality in paediatric population with congenital heart disease was the main purpose for this project. Methods In 2015 we succeeded to implement such a program with the help of the Ministry of Health and the National Insurance House, on one hand and with the help of the Italian Team from the Bambini Cardiopatici nel Mondo on the other hand. Results Between June 2015 and January 2017, 100 cases of congenital heart diseases were diagnosed and treated in the Compartment of Interventional Cardiology of the ‘Marie Curie’ Emergency Children’s Hospital. From these cases 79% were interventional cases and 21% diagnostic cases. Of all cases 21% were atrial septal defect (ASD) closures using Cocoon Atrial Septal Occluder, 33% were patent ductus arteriosus (PDA) closures using Cocoon Duct Occluder, Oclutech Duct Occluder, PFM coil and Flipper Coil. 18% beneficiated of pulmonary valve dilatation using both Tyshak and Osypka balloons, 5% of all were aortic coarctation with stent implantation using CP Stent Bare or Covered, and 2% were Rashkind atrioseptostomy. 5% were done in children with Down syndrome. 8% were performed in cases of pulmonary hypertension. 11% were done in children less than 1-year-old. The complication and failures rate for the first 100 cases was 5% (most important – ASD device embolization, two failures of pulmonary valve dilatation, one PDA device 4/6 mm withdrawal and changed to a 6/8 mm dimension device). Conclusion After 100 cases performed in our institution the early and intermediate results are very encouraging and are similar with other results reported in the current literature.

Pulmonary hypertension (PH) is mean pulmonary arterial pressure above 25 mmHg at rest. Although considered a rare disease, the prevalence of PH in certain risk groups is higher, from 0.5% in patients with HIV infection to 30% in congenital heart disease (CHD) associating PH. In pulmonary arterial hypertension (PAH) associated with CHD, early changes of the vascular bed are reversible after correction of the defect, but there is a point from where the disease becomes irreversible or progression continues despite correction. Among patients with “operable” and “inoperable” CHD, there is a “gray area” group in between, which is defined by pulmonary vascular resistance equal to 4-8 WU/m and ratio of pulmonary vascular resistance to systemic vascular resistance of 0.3-0.5, measured by cardiac catheterization. In this situation a pulmonary vasoreactivity test is indicated. Pulmonary hypertension is a severe disease with increased morbidity and mortality. Pulmonary hypertension can result in death by decreased cardiac output, and heart failure.

Until now there is a lack of objective methods to evaluate the clinical efficacy of low level lasers (LLL). The reported results in this paper are showing that the cutaneous ultrasound could be a valuable method to be used in order to objectify the results obtained in low level laser therapy (LLLT). 52 patients with osteoarthritis were divided into three groups: Group A:19 patients treated with IR emitted laser diode, CW, 3mW power, 780 nm wavelengths. Group B: 18 patients treated with the same IR laser diode as above and He-Ne laser, CW, 2mW power. Group C: 14 patients exposed to placebo laser. To every patient was done cutaneous ultrasound before and after LLLT and we followed also the clinical evolution. The positive results meaning significant US favorable changes were found in 73.9 percent for group A and 77.7 percent for group B and 21.4 percent for PLACEBO group. We conclude that cutaneous ultrasound could be an objective method to appreciate the clinical efficacy of low power lasers.© (2000) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.