Food poisoning as a cause of acute liver failure

We report a 9-year-old girl with cereulide-producing Bacillus cereus food poisoning, who developed fulminant hepatitis, renal and pancreatic insufficiency, shock, and prolonged seizures. She was transferred to our institution for hepatic transplantation before her diagnosis was established. As a result of rapid identification of the microorganism and supportive care, liver transplantation was avoided, and she recovered fully.     

Pancreatic heterotopia as a cause of an acute abdomen

A 6-year-old boy with fever, vomiting, abdominal pain, and leucocytosis was found to have a small nodule of heterotopic pancreatic tissue in the wall of the jejunum. Leakage of pancreatic enzymes caused inflammation and hemorrhagic necrosis of adjacent smooth muscle. Excision of the lesion was followed by prompt and permanent relief of all signs and symptoms. Small intestinal pancreatic rests can cause acute and chronic abdominal complaints and should be carefully sought at laparotomy when no other etiology is encountered.     

Ruptured adrenocortical carcinoma as a cause of paediatric acute abdomen

Adrenocortical carcinoma (ACC) is rare in children. Its presentation is usually related to hormonal activity of the tumour. We report a case of childhood ACC that presented as an acute abdomen due to tumour rupture. This is the first reported case of a ruptured ACC as a cause of paediatric acute abdomen.     

Pneumothorax as a cause of acute and recurrent neonatal hypoxia

In 191 children suffering from RDS treated by mechanical ventilation or CPAP + PEEP according to the same protocol the incidence of pneumothorax was determined with 23% (44 infants). Mean birthweight and mean gestational age were lower in infants who developed pneumothorax. Pneumothorax occurred more frequently in children with bad pre- and perinatal history. Children who developed pneumothorax had received a lower fluid intake than those without. Incidence varied with severity of RDS and intensity of respiratory assistance. We tried to asses the duration and severity of hypoxia by means of transcutaneous pO2 measure and arterial blood gas analyses. As fast diagnosis and therapy helps to shorten the duration of hypoxia, we listened up the most frequent alternations of vital signs associated with pneumothorax. We found cyanosis, changes in heart rate and respiratory rate, arterial blood pressure and decrease of paO2. Hints to avoid a pneumothorax are given.     

Respiratory virus infection as a cause of prolonged symptoms in acute otitis media

We studied respiratory viruses in 22 children with acute otitis media who had failed to improve after at least 48 hours of antimicrobial therapy. The mean duration of preenrollment antimicrobial therapy was 4.8 days. For comparison we studied 66 children with newly diagnosed acute otitis media. Respiratory viruses were isolated from middle ear fluid or from the nasopharynx, or both, significantly more often in the patients unresponsive to initial antimicrobial therapy than in the comparison patients (68% vs 41%, p less than 0.05). Viruses were recovered from the middle ear fluid in 32% of the study patients and from 15% of the comparison group. Bacteria were isolated from the middle ear fluid of four (18%) children in the study group; one child had an isolate resistant to initial antimicrobial therapy. All four children with bacteria in the middle ear fluid had evidence of concomitant respiratory virus infection. Our results indicate that respiratory virus infection is often present in patients with acute otitis media unresponsive to initial antimicrobial therapy, and may explain the prolongation of symptoms of infection. Resistant bacteria seem to be a less common cause of failure of the initial treatment.     

Congenital metabolic diseases as a cause of acute illnesses in the neonatal period

Inborn errors of metabolism occurring in the neonatal period both comprise diseases with clinical onset immediately after birth and diseases with clinical onset after a symptom free interval. Organ damage caused by inherited metabolic diseases can occur already in utero or--depending on oral food intake--during the first postnatal days. Unselective screening methods are applied in neonatal mass screening programs for the early detection of metabolic diseases. In cases of unspecific clinical symptoms selective screening procedures may provide an effective diagnostic tool. If a patient with suspected metabolic disease dies, body fluids and organ biopsies should be preserved for further investigations. The establishment of a genotypspecific (enzyme) diagnosis needs time and cost consuming biochemical procedures. It is a prior condition for prenatal diagnosis in further pregnancies.     

Lung sequestration as a cause of acute cardiac decompensation in a 3-week-old newborn infant

A 3 week old neonate developed congestive heart failure after the operation of an omphalocele. The clinical aspect first suggested to us a persistent ductus arteriosus. Cardiac catheterisation then revealed a bronchopulmonary sequestration, a rare congenital malformation. Children usually become symptomatic with chronic respiratory tract infections, although there are also asymptomatic courses. Only a few cases are reported with congestive heart failure being the initial symptom. Many patients show additional malformations--so did our baby with an omphalocele and a mild peripheral pulmonary stenosis. Once the diagnosis is made, resection or lobectomy is the therapy of choice. In the preoperative diagnosis angiography is mandatory to demonstrate the abnormal vascular supply.