Helvetica paediatrica acta最新文献

Concentrations of alpha-1-antitrypsin (AT) in random fecal samples from 68 infants (92.7% outpatients) with acute diarrhea and 32 healthy controls were determined. The mean +/- s.d. for AT in infants with diarrhea was 2.07 +/- 1.88 mg/g dry stool (mg/g d.s.) compared with 1.29 +/- 0.72 mg/g d.s. (p less than 0.05) in controls. Fecal AT was significantly greater than that of the controls only for diarrhea caused by Rotavirus or Salmonella. Salmonella patients also had significantly higher fecal levels of AT than patients with diarrhea caused by Campylobacter. Fifty percent of the infants with Salmonella infections excreted more than 2.73 mg/g d.s. AT, which is above the control mean + 2 s.d. Fecal excretion of AT was highest in patients with macroscopic intestinal bleeding, but it still depended more on the causative agent than on bleeding per se. This finding of increased intestinal protein loss during acute diarrhea, even in the less severe diseases, emphasizes the necessity to rapidly restart adequate nutritional intake.

The effectiveness of early single volume exchange transfusion (ET; 80 ml/kg) was compared with that of early double volume exchange transfusion (160 ml/kg) for treatment of hemolytic disease of the newborn caused by AB0 incompatibility. Twenty full-term infants with AB0 hemolytic disease were randomized into the two treatment groups. The groups were comparable for gestational age, body weight, hemoglobin values, reticulocyte count, maximum serum bilirubin levels, rate of rise of serum bilirubin before ET, antibody titer, and age at time of ET (all p greater than 0.05). The efficacy of treatment was similar in both groups taking into account the mean bilirubin level after ET, post-ET bilirubin, duration of phototherapy following ET, and frequency of second ET (all p greater than 0.05). However, platelet count immediately after ET was lower in the double volume ET group as compared to the single volume ET group (p less than 0.01). Hemoglobin values immediately after ET were higher in the double volume ET group (p less than 0.01). At ten days of life no differences were detectable. The results of this study indicate that the effectiveness of single volume ET for treatment of full-term infants with jaundice due to AB0 incompatibility is at least comparable to that of double exchange ET. Furthermore, the lesser aggressive approach determines less complications such as a decrease of platelet count.

Accidental rectal administration of 27 mg/kg of the narcotic analgesic Tramadol to a five-week-old infant resulted in severe cerebral depression, which had to be treated with Naloxone during 48 hours. The severity and the duration of this intoxication are not explained solely by the high dosage of Tramadol. A decreased elimination kinetics and an increased permeability of the blood-cerebrospinal fluid barrier probably also account for the pattern of the present intoxication.

Association of prolonged neonatal cholestasis with hypoglycemia, small penis and congenital hypothalamo-hypopituitary derangement is presented. The infant's jaundice was unresponsive to thyroxine replacement therapy but resolved rapidly with hydrocortisone therapy. The time relationships between persistent jaundice and thyroxine and cortisol deficiencies are discussed.

Three siblings with deprivation dwarfism are described. Special investigations did not reveal any pathological findings apart from retarded bone age in two children and metaphyseal growth lines. The three siblings demonstrated immediate catch-up growth after removal from the deprivating environment. Problems of etiology, diagnosis and treatment are discussed.

The article is concerned with the problem of the education of pediatricians. The main controversial developments are overspecialization and lack of understanding the psychodynamics of the patient and his environment in the education of young pediatricians. Solutions of this dilemma are proposed, for which a change of medical attitude seems necessary and to acknowledge the subjective reality of the patient.

The incidence of isolated CNS-relapse in the SPOG ALL studies 1976-1986 was analyzed and the prophylaxis of meningosis leucaemica of the different studies was compared. In the SPOG ALL high-risk study 1979-1983, the incidence of isolated CNS-relapse was significantly higher (17/71, 24%) than in the other studies. In this period, radiotherapy was omitted and the prophylactic treatment consisted only of moderately high doses of intravenous methotrexate and intrathecal methotrexate. In other studies, it was shown that the prophylactic combination of CNS-radiotherapy and intrathecal methotrexate, or the periodic administration of combined intrathecal chemotherapy alone, during the whole therapy of 2 1/2 years, produced comparably good results. The prophylaxis with the combined intrathecal chemotherapy was less neurotoxic and allowed the use of a curative radiotherapy in case of a CNS-relapse.

Hypergammaglobulinemic purpura is a rare syndrome characterized by long-standing recurrent purpura of the lower limbs, polyclonal hypergammaglobulinemia, increased erythrocyte sedimentation rate and high titer rheumatoid factor positivity. The syndrome can occur isolated or in association with a systemic disease. Few cases have been described in childhood. We report two cases together with a review of the paediatric literature.

Prolonged CAPD is reported to cause a gradual loss of ultrafiltration capacity. The composition of the dialysis fluid and the occurrence of recurrent peritonitis episodes are assumed to be responsible for this diminished ultrafiltration. A group of 22 infants and young children (mean age 3.8 years) is described. CAPD was performed in these children for a mean period of 17.8 months. There was no loss of ultrafiltration capacity, determined by the repeated volume method, in the first 18 months of treatment. Urea clearance remained stable. These data could be calculated in half of the patients, the other patients behaved clinically in the same way. In one patient ultrafiltration capacity decreased after 4 years of treatment. It is concluded that, in young children, CAPD is a reliable renal replacement therapy, although peritonitis remains a matter of concern.

Nuclear Magnetic Resonance (NMR) was first observed over 40 years ago and has recently also entered the field of human medicine. It currently attracts increasing attention from biologists and clinicians alike, and the scope of its different applications is in a phase of explosive development. Two principle developments of the MR method are taking place over the recent years and are of special interest for pediatricians and neonatologists. One involves the possibility of obtaining images from any part of the human body, somewhat similar to those obtained with computer tomography (CT), but without any radiation hazard. Today clinicians are most familiar with this mode of MR application. The other development tries to adapt the MR method of elucidating the structure of molecules used in physics, molecular biology and organic chemistry for applications in medicine, allowing to study metabolism in vivo under non-invasive conditions. Again, such studies pose no health hazards and are, therefore, applicable to neonates and small infants. They will enhance our understanding of metabolic processes during normal development and disease, especially in organs like the brain, where biopsies are virtually impossible. Recent developments combine the two methods mentioned above, in order to obtain morphological as well as metabolic information from the same organ at the same time, which may provide even better insight into pathophysiological mechanisms and their response to therapeutic measures. This article attempts to give an overview to the medical researcher, the clinician, and especially the pediatrician and neonatologist of what MR is and what we can expect from it.