review with Radiologic - Pathologic correlation. Radiographics, 23, 1 6 1 3 - 1637.
7. M. Nelson, C. Diebler et al (1991).
Paediatric medulloblastoma: atypical Tfeatures at presentation In the SlOP II trial.
Neuroradiology 33, 140-142.
8. Park TS, Hofman HJ, Hendrick EB, Humphreys RP, Becker LE (1983).
Medulloblastoma: clinical presentation and
management—experience at the Hospital for Sick Children, Toronto, 1950-1980, J Neurosurg 58, 543-552.
9. P. Tortori-Donati, M. P. Fondelli et al (1996). Medulloblastoma in children: CT and MRI findings. Neuroradiology 38, 352-359.
10. L. Taillandier, F. Doz, V. Bernier, P.
Chastagner (2006). Medulloblastomes, Eneyelopedie Medico - Chirugleale, 1-15.
Summary
THE VALUE OF MRI IN THE DIAGNOSIS OF MEDULLOBLASTOMA
Access the value of MRI In the diagnosis of Medulloblastoma. Methods and materials: A cross - sessional descriptive study of 324 patients diagnosed posterior fossa tumor and perated in Viet Due hospital from 2005 to 2008, including 41 patients who had their histological results of Medulloblastoma. Results: In the group of medulloblastoma patients, the age from 3 to 8 years aeeountel for 41.5%) and the position in the vermis 85.5%). The accuracy of MRI in the diagnosis of medulloblastoma was 100%), the sensitivity 90.2%, the specificity 97.5%). The sensitivity of the differential diagnosis between medulloblastoma and ependymoma was 87,8%, the specificity 85.7%. Conelustion: Medulloblastoma is the most counmon in the children's posterior fossa tumors, especially in the vermis. MRI plays an very Important role in the diagnosis of medulloblastoma in the regard of difflnitive diagnosis and differential diagnosis from Ependymoma.
Keywords: Medulloblastoma, MRI
M 6 | TU'ONG QUAN Gll/A LAM SANG VA
MOT S6 DAU AN SINH HOC LIEN QUAN D^N TJNH TRANG BENH NANG Cy TRE SO SINH
Khu Thj Khdnh Dung, Tru'ang Le Thi Benh Vipn Nhi Trung uong
Ty lp tir vong a tre sa sinh vin cdn cao tai Bpnh vipn Nhi Tmng Uang do bpnh dwpe phit hipn vi ean thipp mudn. Muc tieu: Tim hieu moi twang quan giiia tinh trpng bpnh npng vdi cic chi so LDH huyit thanh, lactate, va magie a tre sa sinh liic nhpp vipn va 24 gid sau khi nhap vipn. Dii twang va phuong phip: Tit ca cic b$nh nhan nhpp vipn vao khoa diiu tri tich ci/c sa sinh, Bpnh vien Nhi tmng wang tir 2- 4/2010; Tham kham lim sing; Xet nghipm dwdng miu, LDH, lactate, AST, ALT, va Mg liic nhap vipn vi 24 gid sau khi nhpp vipn; Phdng vin gia dinh bpnh nhin sii dung bang eiu hdl vi thu thpp thdng tin tir ho sa bpnh an ciia bpnh nhan. Kit qua: Tong so 359 doi twpng nghidn cim (65,2% nam vi 38,4% nir), trong dd, 44,8% ia tre de non vi 42,9% phai thd oxy.
Trong eae chi so nghien ciru, chi sd LDH, lactate, vi AST li dac bipt khic nhau (p < 0,001) glQ-a thdi diim nh$p vipn vi 24 gid sau khi nhpp vipn, trong khi sw khic bipt eua ALT va Mg lan iwp/t la p = 0,214 vi p = 0,73. Khdng cd swkhae bipt dang ke ddi vdi glucose, LDH, lactate, AST, vi Mg giCra tre de non va du thing. Tuy nhien, c6 sty khac bipt khi rd giim glucose, LDH, lactate, va AST d nhdm tre phai thd oxy, va cd soc (p < 0,01). Kit lupn: C6 sw thay doi ding ki vi ndng dp LDH, lactate, AST tai thdi diem nhpp vipn vi 24 gid sau khi nhpp vipn. Cd mOt 94
TAP CHI NGHIEN CU'U Y HOC
sir khie bipt rd rpt nong dp mpt so ehi so tmng huyit thanh a nhung tre bj benh nang nhw sdc va suy hd hap, nhung khdng cd sw khie biet nio glCra cic tuoi thai khac nhau.
TCr khoa: dilu trj tich circ, chi sd huylt thanh, tuang quan lam sang
I. DAT
V A NDt
Theo to ChiPC y t l T h i Gidi (1996) hdng nam tren todn d u ed han 8 trieu tre sa sinh tip vong, chilm 2/3 tong sd tir vong eua tre dudi 1 tuoi, trong do 2/3 so tre sa sinh tip vong trong tuan ddu vd phan Idn tip vong trong 2 gid diu.
TO' vong sa sinh ed su khac nhau glQ'a cae quIc gia, ede khu vyc ty Id va nguyen nhan tip vong sa sinh eung khdng hoan toan giong nhau. Cy nude ta, trong nhO'ng nam qua ty le tip vong d tre em dudi 5 tuoi giam rd ret nhung ty le tu vong sa sinh glam cham.
NhO'ng diu hieu lam sang sdm trong cac benh nang d tre sa sinh thudng khdng diln hlnh vd rit da dang. Tre sa sinh khi bj benh nang hay gap suy glam chiPC nang eua mpt hoac nhieu he thong ea quan do su mit tuang xipng glu'a tudn hoan d cac md trong ca thi.
NhO'ng benh nang thudng gay giam nong dp oxy trong mdu gay thieu mau cue bp trong t l bao va din din su thieu hut nang lugng trong t l bdo. Sy thilu hut nang lugng dd se khdi dong hang loat eae phan irng xay ra tren mang te bdo vd trong t l bao. Cae enzym: Lactate dehydrogenase (LDH), Aspartate aminotransferase (AST) va Alanine aminotransferase (ALT), lactate va mdt vdi dien giai (magnesium) tip t l bdo vdo mau.
Theo Karisson, M nghien eiPU tren 246 tre so sinh, trong dd 205 tre cd diu hieu suy ihai, 41 tre ed thilu mdu nao eho thiy thay doi ndng dd LDH ed gid trj nhit trong phat hien sdm tre bj thilu oxy vd thieu mdu nao vdi dp nhay 100% vd dd ddc hidu Id 97% [6].
Mdt nghien cu'u khac d Odi loan ve moi lien quan glQ'a ndng dd LDH, AST huylt thanh vdi b$nh xuit huylt ndo d tre sa sinh can nang rit thap cho thiy cd sy khde biet rd ret v l nong dp LDH d nhom tre xuat huylt nao nang vdi
p < 0,05, cde tac gia cung nhan thiy gia tri tien lugng eua LDH rit eao trong nguy ca xuit hien xuit huylt nao ndng vdi dp nhay, dp dac hieu, gia tri tien lugng am tinh, duang tinh lin lugt la 76,9%, 89,7%, 95,3% va 58,8% [7]. Theo Zonardo V nghien ciru hoat dp eua LDH, AST, ALT tren tre sa sinh non thang bi loan san khi quan phoi (PBD) tai cac thai diem 3, 10, 20, 30, 60 ngay sau sinh. Kit qua cho thdy, sau 3 ngdy, hoat dp LDH va AST deu tang cd y nghTa so vdi mu'c blnh thudng [11].
Tai Viet nam, trong nghien CLPU cua Trin Minh Dien cQng nhan thiy lactate mau ed gia tri tien lugng tren tre soc nhiim khuan va nhiim khuin nang. Oe giiip cac thay thuoc co the phat hien ddu hieu nang sdm d l tai dugc tiln hanh vdi muc tieu:
Khao sat ndng dp LDH, Lactat, Magie cua tre sa sinh khi nhap vien va sau 24 h nim vien
Moi tuang quan glQ'a tinh trang lam sang nang vdi mdt s l dau I n sinh hpe nghien cu'u.
II. 0 6 l TU-QNG vA PHU'QNG
P H A P o i l tugng nghien CLPU: Toan bp tre sa sinh vao nhap khoa sa sinh benh vien Nhi Trung Lfang tCr thang 2 din thdng 4 nam 2010.Phuang phap nghien CLPU: SLP dung phuang phap nghien cu'u d t ngang, nghien CLPU tuang quan de tim mil lien quan glQ'a cac diu hieu lam sang va kit qua xet nghiem cua benh nhdn lue nhap vien vd 24h sau nhap vien.
Phuang phap thu thap thdng tin: Kit hgp glLPa phdng vin ngudi nha bdng bd eau hdi soan sin va su' dung benh an mdu chung eho t i t c a benh nhan.
Dja diem: Khoa Sa sinh, benh vien Nhi Trung uang.
XLP li so lieu: Su' dung phan mem SPSS 16.0 va EPI info 6.01 va phuang phdp thong ke y hpc de xii' ly so lieu.
III. K^T QUA
Nghidn ciru tren 359 tre sa sinh < 28 ngdy tuoi tu' thdng 2-4/2010 tai khoa sa sinh bdnh vidn Nhi Trung uang, trong so dd cd 55,2% Id tre dO thdng 44,8% tre de non. Gidi nam 234 benh nhdn (65,2%)), nu- 125 bdnh nhdn
(34,8%). 67,6% tre du thdng khdng phai thd oxy, 55,9%) tre de non phai thd oxy. Bdnh chinh: Suy hd h i p 196 bdnh nhan (54,6%), nhiim khuan mdu 98 benh nhdn (27,3%), shock nhiim khuan 48/98 benh nhdn, vidm rudt hogl tiy 36 benh nhdn (10,0%), ngat 29 benh nhdn (8,1%)).
Bang 1. Khao sat SIP biln ddi ciia mot sd enzyme, lactate va magie
Loai XN T B ± S D Trung vj
nhdp vidn LDH
735,03 ±
756,99 535,1
> 24 gid 586,86 ±
525,74 441,5
Lactate
nhdp vidn 6,43 ± 4,59 5,2
> 24 gid 4,68 ±3,18 3,9
AST
nhdp vidn 120,01 ±
456,19 49,7;
Pham vi 51,8-7577,0
162,3 4809,3
0,2-31,7 1,0-29 10,1 -6570,3
ALT
Maaid Glucose
> 24 gid nhap vien
> 24 gid nhap vien
> 24 gid nhdp vien
71,37 ±153,55 29,6^ ± 66,97 23,44 ± 38,68 0,834 ±0,135 0,814 ±0,201 4,87 ± 5,09
39,25 15,00 14,45 0,83 0,81 3,80
9,9-2024,1 4,0 - 737 3,4 - 466,9 0,30-1,60 0,46 - 3,9 0,1 -37,8 Nhdn xdt: Ndng dp eua mdt so chf so (glucose, LDH, lactate, AST) thay doi rd rdt trudc vd sau 24 gid nhdp vidn (p<0,01).
Bang 2. Mdi tyang quan glQ'a ndng do ciia cac chi sd trong mau ciia tre du thang va de non
Cdc thdng s6 IgGlueose
IgLDH
< Ig Lactate IgAST IgALT IgMagil
Dii thdng 0,539 ± 0,376 0,438 ± 0,466 0,722 ± 0,301 1,766 ±0,392 1,326 ±0,357 -0,884 ± 0,047
Thilu thang 0,528 ± 0,404 0,438 ± 0,402 0,709 ± 0,268 1,708 ±0,358 1,156 ±0,256 -0,803 ± 0,78
Gia trj p P = 0,98 P = 0,11 P = 0,50 P = 0,78 P<0,01 P = 0,20
TCNCYH 74 (3)-2011
TAP CHI NGHIEN CU'U Y HOC Nhdn xdt: Khi so sanh cdc gid tri ciia cdc biln mdi ed phdn bd ehuan, khdng ed sy khde ihau v l ning dd ciia mdt sd chl sd sinh hpc trcng mdu glQ'a ede nhdm tuoi thai.
Bang 3. Mdi tu'ang quan giipa ndng do ciia cac chi s6 trong mdu vo'i tinh tra- nang ciia tre khi nhap vien
Cac thdng sd Thd" oxy Khdng thd' oxy Gid trj p IgGlueose 0,542 ± 0,492 0,529 + 0,288 P<0,0''
IgLDH 0,453 ± 0,472 0,426 ± 0,372 P< 0.001
Ig Lactate IgAST IgALT IgMagle
0,762 ± 0,339 1,834 ±0,482 1,288 ±0,406 -0,0791 ± 0,830
0,681 ± 0,234 1,67 ±0,253 1,221 ±0,248 -0,089 ± 0,614
P<0,Oi P < 0,001
P = 0J2 P = 0,195 Nhdn xet: Ndng dp ciia mdt so ehi s l (glucose, LDH, lactate, AST) thay ddi rd ret d nhdm tre phai thd oxy ngay khi vdo vidn (p<0,01), ddy Id nhu'ng trudng hgp ed bilu hien ridng khi vdo vien.
Bang 4. Mdi tipang quan giii'a ndng do ciia mot sd chi sd trong mau vai tinh trang shock d' tre sa sinh liic nhdp vien (n=48)
Markers IgGlueose
IgLDH Ig Lactate
IgAST IgALT IgMagld
Co sdc 0,628 ± 0,749 0,490 ± 0,046 1,030 ±0,313 2,213 ±0,611 1,550 ±0,585 -0,383 ± 0,921
Khdng sdc 0,527 ± 0,342 0,433 ± 0,041 0,689 ± 0,268 1,699 ±0,321 1,223 ±0,282 -0,887 ± 0,068
Gia trj p P = 0,186 P < 0,001 P < 0,001 P < 0,001 P<0,01 P< 0,001 Nhdn xdt: Nong dp LDH, lactat va mdt sd enzym khde thay doi rit ed y nghTa tren nhdm benh nhdn cd shock ngay trong 24 gid dau tien khi nhdp vien (p<0,01).
IV. BAN LUAN
Ddc dilm benh nhdn nhdm nghien cii'u.
Lira tuoi: trong nghjdn eiPu cua chimg tdi thiy 55,2% Id tre dii thdng, nam gdp nhilu han nCp, nghidn eO'u ndy tuang ty ciia Oinh Phuang Hda, Trin Minh Diin [2].
V l tinh trgng khi vdo vidn: Nguydn nhdn hdng diu vdo vidn trong nghidn eiru ciia chung 161 Id do suy hd hip d d hai nhdm tuoi de non
vd dii thdng. Tuy nhien nhdm tre de non suy hd hip khi nhdp vidn cao han ehllm ty Id 55,9%;
32,4%. Tinh trgng suy hd hip khi vdo vien ed Hdn quan chat ehe din nguy ea tii' vong [2], [3].
Cde ehi s l nghien eiru: Lactate, LDH Id chl so ehi dilm cho tinh trgng glam tudi mdu md, hdu qua eiia ehuyen khda yim khf. Theo ddi ehi s l ndy ehiing tdi nhdn thiy gid tri LDH,
lactate, AST luc vdo vien va sau nhdp vien 24 gid ed sy khae bidt ed y nghTa thing kd vdi p <
0,001. Tuy nhidn khi so sanh cdc gid trj ciia ede biln mdi ed phdn bd chuan, khdng ed sy khac nhau v i ndng dd eiia eae chl so trdn trong mdu glu'a cde nhdm tuoi thai. Kit qua nay tuang ty kit qua eua Trin Minh Dien lactate sau vdo vien 24h thay doi cd y nghTa thong ke vdi p<0,05[2]..
Nong do eua riidt so ehi sd (glucose, LDH, lactate, AST) trong nghien eiru cua chiing tdi thay doi rd ret d nhdm tre phai thd oxy ngay khi vao vien (p < 0,01), day la nhO'ng trudng hgp ed bilu hien nang khi vdo vien. Nghien eiru ndy tuang ty cua mdt so tdc gia [8,10,11],
Nghien cu'u tren nhdm tre shock eho thiy nong dp LDH, AST, lactat vd mdt so enzym khde thay doi rit ed ^ nghTa tren nhdm bdnh nhdn ed shock ngay trong 24 gid diu tidn khi nhdp vidn (p < 0,01). Tuang ty, nghien ciru nam 1996 eiia Gerd M.Laekmann eung eho thiy LDH va AST vd lactate trong huylt thanh eiia 24 tre sa sinh bj nggt ndng ed bleu hidn shock vd 16 tre sa sinh khdng nggt d ede mdc thdi gian 0, 12, 24,72 vd 144 gid sau sinh, ed sy khde bidt rd ret, hogt dp hai men trdn eua nhdm bj nggt tang han ed y nghTa thdng kd so vdi nhdm khdng bj nggt LDH vd AST Id nhu'ng ehi so ed the sii' dung lam y l u td tidn lugng cho dl chirng ngat. Francesco Morini vd cdng sy nghidn cu'u nam 2008 tren nhdm tre viem rudt hogi tii' ed sde vd nhdm tre khdng ed bleu hidn viem rudt hogl tii" cQng cho thdy LDH, GOT eao han rd ret p < 0.05.
Tuy nhidn, gid tri ALT, Magld lue nhdp vidn vd 24 gid sau khdng ed sy khde bidt (p = 0,21-4 vd p = 0,73). Khde vdi nghien eiru eua ehung tdi, Sariei SU nghidn cu'u tren 39 tre sa sinh tgi Tho NhT Ky cho thiy tre cd hdi chu'ng suy hd hip tii' vong cd mO'C Ion Mg eao han rd rdt so vdi nhO'ng tre song sdt. Oieu ndy dugc giai
thich Id do qud trinh di chuyen Mg (Ion chu ylu trong t l bdo) tu" ndi bao ra ngodi tdng len, hdu qua cua glam oxy mau, nhiim toan vd ton thuang t l bao trong pha dau cua ROS. Tde gia d l nghj sir dung k i t qua djnh lugng Ion Mg Nhu mdt y l u to tien lugng trong chin dodn vd dliu tri RDS.
V. K^T LUAN
NhO'ng kit qua nghien ciru trdn eho phdp rut ra mdt sd kit ludn sau:
- Cd sy thay doi ndng dp LDH, lactate, AST glQ'a hai thdi diem lue vac vidn vd sau khi vdo vien 24h(p< 0,01).
- Benh nhdn thg oxy ed lidn quan rd ret din thay doi ndng dp ciia glucose, LDH, lactate, AST (p< 0,01).
Thay d l l LDH vd Lactat Hdn quan rd ret din tinh trang shock (p < 0,01).
Khdng ed sy khac biet glQ'a hai nhdm de non vd dii thdng ve nong dp eua cdc chl so nghidn eiru.
TAI LIEU THAM KHAQ
1. Dao Kim Chi (2004). Chuyin hda glueid. Hda sinh hpe. Bd mdn Hda sinh Trudng Dgi hpc Dugc Hd Ndi.
2. Trdn Minh Diln (2009). Mdt sd ylu td nguy ca trong sdc nhiem khuan d tre em. Tgp chf Nhi khoa 2009, tap 2 sd 3&4, 32-37.
3. Dinh Phu'ang Hda va cong SIP (2005).
Nghidn ciru cde y l u td lidn quan d i n tii' vong trong 24 gid d i u nhdp vien d tre em trong 2 nam 2001 - 2002. Tap chf nghidn cu'u y hoc 35(2), 201 - 205.
4. Cheung PY, et al (1994). Postoperative lactate concentrations predict the outcome of Infants aged 6 weeks or less after intracardiac surgery: a cohort follow - up to 18 months' The Journal of Pediatrics 125 {5), 763 - 768.
5. Francesco Morini, et al (2008) Lactate 98
TAP CHl NGHIEN CLPU Y HOC dehydrogenase activity is increased in plasma
of infants with advanced necrotizing enterocolitis. Pediatr Surg Int 24, 705-709.
6. Gerd M.Laekmann, et al (1996).
Influence of Neonatal Idiopathic Respiratory Distress Syndrome on Serum Enzyme Activities in Premature Healthy and Asphyxiated Newborns, American J Perinatol
1996 13(6), 329-334.
7. Ho ML, et al (2000). Relationship of serum lactate dehydrogenase, creatine kinase, aspartate aminotransferase concentrations and severe Intraventricular hemorrhage/leukomalaela in very low birth body weight preterm neonates. Acta Paedlatr Taiwan. 2000 May-Jun, 41(3), 129-32.
8. Hussain F, et al (2009). Does lactate
level in the first 12 hours of life predict mortality in extremely premature infants? Journal Paediatrics Child Health 45(5), 263-267.
9. Karisson, M.,et al (2010). Lactate dehydrogenase predicts hypoxic isehaemle encephalopathy In newborn Infants: a preliminary study Acta peadiatrlea 99(8), 1139 -1144
10. Sariei SU, Serdar MA, Erdem G, Alpay F, Tekinalp G, Yurdakok M, Yigit S, Gokcay E, (2004). Plasma ionized magnesium levels In neonatal respiratory distress syndrome. Biol Neonate. 2004, 86(2), 110-115.
11. Zonardo V, et al (1999). Serum enzyme activities in premature Infants with bronchopulmonary dysplasia. Fetal Dlagn Ther. 1999 Nov-Dee14(6), 341-344.
Summary
CHANGES IN SERUM LACTATE AND MAGNESIUM UPON ADMISSION TO THE NEONATAL INTENSIVE CARE UNIT
AT THE NATIONAL HOSPITAL OF PEDIATRICS
The newborn mortality rate remains high at the National Hospital of Pediatries (NHP). One reason is because diseases are discovered late and only newborns with severe signs and symptoms receive Interventions and are brought to the hospital. This research project has been conducted to assist elinieal decision-making for doctors when newborns are brought to the hospital.
Objectives: To investigate serum LDH, lactate, and magnesium concentrations of newborns at and 24 hours after admission. To correlate severe clinical conditions with serum markers. Subjects and Methods: All admitted patients to the NICU at the NHP from February to April 2010; Investigate a correlation of clinical signs/symptoms and blomarkers In serum of babies at and after 24 hours after admission. Interviews were carried out using questionnaire and patient records. Blood test results were collected on glucose, LDH, lactate, AST, ALT, and Mg.Values were subtracted and underwent logarithmic transformation to resemble a normal distribution. Results: A total of 359 subjects were enrolled (65.2%) male, 38.4% female) including 44.8%) were premature and 42.9%
were on supplemental oxygen. Blomarkers Including LDH, lactate, and AST were significantly different (p < 0.001) at and 24 hours after admission, while ALT and Mg were not (p = 0.214 and p
= 0.73, respectively). There were no significant differences for glucose, LDH, lactate, AST, and Mg when controlling for prematurity. However, there significant differences between glucose, LDH, lactate, and AST for newborns requiring supplemental oxygen were observed (p<0.01).
Conclusions: There were significant changes in LDH, lactate, and AST concentrations at and 24 hours after admission. There were great differences in serum blomarkers for severe illnesses like including shock and respiratory distress, but no differences existed in prematurity.
Keywords: Intensive care, serum markers, clinical correlation
