Acta paediatrica Hungarica最新文献

Gender assignment is a neonatal surgical emergency. Early evaluation and treatment of intersexuality must be done as a team approach with a genetist, a paediatric endocrinologist and a paediatric surgeon/urologist taking part in it. Change of gender after 2 years of confusion of gender identity often results in social disaster. Over a period of 20 years the authors managed a total of 27 patients with ambiguous genitalia. They favour early reconstruction of most anomalies at about 3 years of age, which seems to be optimal in terms of surgical feasibility and avoidance of the obvious emotional problems caused by delayed intervention. A detailed description of policy and techniques is given for surgical intervention in the patient to be raised as a female or as a male. They changed the gender in three patients, twice in neonates and once before two years of age.

Influence of D-Penicillamine (DPA) on metabolic and functional activities of neutrophil granulocytes was investigated in vitro by measuring superoxide anion production and beta-glucuronidase release as well as by determining phagocytic and intracellular killing activities of cells. Preincubation with DPA in the concentration range of 0.5-5.0 mM resulted in 28-53% increase in superoxide anion production by granulocytes stimulated with 10(-7) M FMLP. DPA in the same concentration range resulted in 145-371% rise in the FMLP-stimulated beta-glucuronidase release. However, uptake and subsequent killing of viable Staphylococcus aureus was not influenced by incubation of granulocytes with various concentrations of DPA (0.5-5.0 mM). From these results we conclude that DPA may influence the superoxide anion production and beta-glucuronidase release in granulocytes without altering the phagocytic and intracellular killing activities of these cells. We suppose that the unchanged antibacterial activity of neutrophil granulocytes is resulted by the two opposite DPA effects: acting extracellularly reduces free radical level while the direct membrane effect results in enhancing metabolic activity in granulocytes.

The pulmonary functions were measured during resuscitation of eight critically ill newborns by the "Pulmonary Evaluation and Diagnostic System" (PEDS UNIT-M.A.S. Inc.) The asphyxiated infants (Apgar score 0-3; PH 6, 9) required more aggressive ventilator support than "traditional" cases. The danger of the pulmonary injuries was larger in this period. In spite of this, there were no signs of air leaks syndrome and the oxygenation was improved in every case. Worsening or improving the pulmonary mechanics it is possible to change the ventilator settings immediately. This method seems to be advisable to introduce in the everyday routine to prevent iatrogenic pulmonary complications in such critical situation--the reanimation.

Postnatal weight gain during the first 8 weeks of life of 20 very low birthweight preterm infants (gestational age: 28.9 +/- 1.7 weeks, birthweight: 1098 +/- 199 g, mean +/- SD) was compared to the in utero weight gain of theoretical control fetuses. By the end of the study period preterm infants gained significantly less weight than their controls (155 +/- 15 vs 221 +/- 16%, p less than 0.001). During the first 6 weeks of life daily additional weight gain of the preterm infants was less than that of the controls, but after that time no significant difference was seen (7th-8th week: 12.0 +/- 3.6 vs 13.7 +/- 3.9 g/kg/day, study infants vs controls, ns). During the 7th-8th weeks of life positive correlation was found between calorie intake and weight gain (r = 0.33, F = 2.17, p less than 0.05). The changes in serum total protein and albumin levels, including an initial increase by the age of 2 weeks, were statistically not significant.

In 14 very low birth weight (VLBW) infants appropriate for gestational age the absorption and retention of nitrogen and the energy balance were studied on the 8th day and the 6th week of postnatal age. All infants were fed with a human milk formula composed by fresh mother's milk enriched with 6 g freeze-dried human milk/100 ml. The absorption rates of nitrogen and fat increase significantly with postnatal age but even on the 8th day of life they are on high levels (nitrogen absorption: 86.9 +/- 3.2% of intake; fat absorption: 85.7 +/- 4.3% of intake). Despite the higher nitrogen absorption during the 6th week of life the excretion of total nitrogen is lower in comparison to the 8th day of life. Similarly, the percentages of alpha-amino-nitrogen and of ammonium-nitrogen of the total nitrogen excretion in the urine decrease whereas the percentage of urea-nitrogen increases with postnatal age. The results indicate a postnatal development of both the digestive, as well as the metabolic capacity. The postnatal adaptation of the metabolic capacity to utilize nitrogen seems to be the stronger limiting factor for nutrition than the functional capacity of digestion and absorption. Thus, metabolic monitoring is essential for the individual nutrition of VLBW-infants during the first weeks of postnatal life. Urine analysis data are very sensitive for evaluating the metabolic state of these infants.

The serum hormone (T3, FT3, T4, FT4, TSH, hTG, a-hTG, GH, PTH, PRL, Cortisol) concentrations, the inorganic phosphate complexes (HPO2-4, H2PO-4, NaHPO-4, KHPO-4, CaHPO4, MgHPO4) and the enzyme activities (Amylase, Lipase, AP, ACE, GOT, GPT, psi-ChE, CK, gamma-GT, LDH) were investigated in 13 haemodialysed children, 7 kidney-transplanted children and in 15 healthy controls. This study confirmed that the kidney plays an important role in the metabolism of hormones. Prior to kidney transplantation 8 of the 11 tested hormone levels of haemodialysed children significantly differed from those of healthy controls, however, after kidney transplantation only two parameters did. The effect of dialysis is the least on the CaHPO4 complex among the different inorganic phosphate complexes. This may play a role in vascular calcification in chronic renal failure patients. The amylase and lipase activity were elevated in haemodialysed group, while in kidney-transplanted children the angiotensin converting enzyme (ACE) and alkaline phosphatase (AP) differed from those of the control group.

The hydroxyl radical scavenging capability of vinpocetine was studied in vitro by aromatic hydroxylation and deoxyribose degradation methods. Hydroxyl radicals were generated by the Fenton reaction. The effect of vinpocetine was compared to other antioxidants, to mannitol, vitamin E and dimethyl sulfoxide. The antioxidant capacity of vinpocetine is near to vitamin E, and higher than that of mannitol.

The relationship between smoking during pregnancy and minor morphogenetic and anthropometric variants of the fetus was investigated in a case-control study. Sixty infants of mothers admitting to have smoken more than 20 cigarettes a day during pregnancy were matched to 120 infants of non-smoking mothers. No differences in the prevalence of 54 informative morphogenetic variants and in the values of 31 anthropometric measurements and indices were found.

The results of a slimming treatment in which the main features were: energy intake according to expected body weight for height (normocaloric), exercise, education and psychological support, are evaluated after one year of experience. Twenty-four obese adolescents (15 boys and 9 girls), out of thirty who started treatment, completed this stage successfully. Pubertal changes occurred and growth continued normally, mainly of lean body mass, as shown by the increase of lean body weight and muscle area of the mid-upper arm. A substantial loss of fat, expressed in a reduction of fat weight, relative fatness and fat areas of the mid-upper arm was obtained. Body weight for height shifted to lower percentile channels. The results are promising in indicating the successful treatment of obese subjects in a period of rapid growth without affecting their normal development, profiting also from the usually-observed decrease in fatness at this age. In view of the success in motivating most of the subjects to maintain the continuity of diet and physical activity, this method is considered a good choice for treating obese adolescents without severe energy restriction, thus assuring lasting effects instead of the short-term ones commonly reported in the literature.