SELECTIVE SURGICAL INDICATION IN THE MANAGEMENT OF NEUTROPENIC CHILDREN PRESENTING WITH ACUTE ABDOMEN

As the treatment of pediatric malignancies improves and survival increases, the diagnosis of acute abdomen in these patients also becomes more common. Nevertheless, the management of this a condition is still controversial. The authors report their experience in treating 12 neutropenic children with acute abdomen. The charts of 12 neutropenic patients with a diagnosis of acute abdomen treated at Boldrini Children's Cancer Center in Campinas, Brazil, between 1991 and 1996, were reviewed. Therapeutic strategy included an initial period of bowel rest, general supportive measures, and broadspectrum antibiotics while waiting for the neutrophil count to rise. Three patients recovered completely without surgery, 8 under went late surgery without complications, and 1 died due to uncontrolled sepsis before surgery. The treatment of acute abdomen in neutropenic children remains controversial. As shown in the present series, an initial nonoperative approach with selective surgical indication appears to be safe and to yield good results. Supportive treatment, until the neutrophil count rises, followed by surgery, if necessary, appears to be a sound therapeutic approach for neutropenic children with acute abdomen.     

CONSERVATIVE MANAGEMENT OF GUILLOTINE AMPUTATION OF THE FINGER IN CHILDREN

A prospective study has shown that the guillotine amputation of the finger in small children can be treated conservatively by dressing only and that there is no need for hospital admission or operation for this condition.     

ACUTE POISONINGS OF CHILDREN IN OSLO

ABSTRACT. A one year prospective study of all children under 15 years of age presenting for acute poisoning in Oslo is reported. There were 181 admissions in 179 children, of which 97 (54 %) were boys, giving an annual incidence of 2.3 %. All children survived without sequelae. Most poisonings were accidental and only two suicidal attempts were recorded. Of all poisonings 68 per cent occurred between the age of 1 and 2 years. The dominating toxic agents were drugs (44 %), tobacco (22 %) and petroleum products (9 %). Most poisonings were mild and only 7 (4 %) classified as severe. Seventy-two per cent of all children were admitted within the second hour after the ingestion of the toxic agent. Therapy should therefore be directed towards emptying the stomach with emetics or gastric lavage, unless corrosives or petroleum products are ingested. Childhood poisonings still call for better preventive measures since the toxic agent was found inappropriately stored in 86 % of the accidental poisonings.     

ARTIFICIAL VENTILATION IN THE MANAGEMENT OF RESPIRATORY INSUFFICIENCY IN ACUTE BRONCHIOLITIS

Nine patients who developed severe respiratory insufficiency as a consequence of acute viral bronchiolitis were artificially ventilated. Seven of the patients are now alive and well. One died because the procedure was undertaken as a last desperate measure when irreversible damage had occurred; the other died as a result of a blockage in a nasotracheal tube.     

L-ASPARAGINASE TREATMENT OF ACUTE LEUKAEMIA IN CHILDREN

The results of asparaginase-prednisone therapy in children are reported. In 12 children with untreated acute lymphoblastic leukaemia 9 remissions were obtained, there were 2 failures and in one patient therapy had to be stopped because of an anaphylactic shock. One child with an acute myelocytic-granulocytic type of acute leukaemia did not respond. One child with an acute monocytic-monoblastic leukaemia was given asparaginase only. He responded very well. Four patients with a relapse of an acute myeloblastic leukaemia were treated: there were two failures, one child died too early from an infection to be evaluated. One child showed a very good reaction. Serious side-effects were few, the drugs gave many biochemical disturbances including a constant hypofibrino-genaemia, but these were well tolerated and reversible.     

THE ROLE OF SERUM FACTORS IN THE LYMPHOCYTE TRANSFORMATION TEST OF CHILDREN WITH ACUTE LEUKAEMIA

ABSTRACT. Révész, T., Szigeti, R. and Schuler, D. (Second Department of Paediatrics, Semmelweis University Medical School, Budapest, Hungary). The role of serum factors in the lymphocyte transformation test of children with acute leukaemia. Acta Paediatr Scand, 63: 715, 1974.—PHA-induced lymphocyte transformation tests were carried out in 14 children who were in full remission of acute lymphoblastic leukaemia and in 12 controls. Stimulation was assessed on the basis of tritiated thymidine uptake. For an adequate testing of lymphocyte reactivity, dose-response curves were established for each child. No significant difference could be observed in either the maximum response, or the shape of the curve, between the leukaemic and the control groups. Supplementation of the culture medium with autologous plasma instead of AB serum did not result in any significant inhibition or stimulation of lymphocyte reactivity to PHA. The lymphocyte response of both leukaemic and control children, however, was greatly reduced when sera from untreated leukaemic children was used. Allogeneic sera drawn from patients in remission exerted little or no inhibitory effect, while that obtained in relapse was again more inhibitory. The observed effect was not due to cytotoxic antibodies, nor due to natural iso-antibodies, but is thought to be a phenomenon closely connected with the active phase of malignant diseases. The exact nature of the agent is still far from being clarified at present.     

小儿急性白血病多药耐药基因表达的动态观察及其临床意义

为探讨小儿急性白血病 (AL)多药耐药基因MDR1表达的临床价值 ,检测2 8例AL患者 4 8份标本的MDR1基因 ,并对其中 2 0例患儿进行了动态观察。结果 ,小儿急性白血病在治疗的不同阶段其MDR1的阳性率不同 :化疗前的阳性率为 2 5 % ,MDR1阳性与MDR1阴性患者的完全缓解率 (CR)分别为 33%和 92 % (P <0 .0 1) ,耐药组的阳性率为 80 % ,而非耐药组的阳性率为 16 % (P <0 .0 1)。复发组的MDR1阳性率为 75 % ,而持续缓解组的MDR1阳性率为 16 % (P <0 .0 5 )。正常人MDR1阳性率为零。结果表明检测MDR1对判断化疗效果和估计预后均有很重要的作用 ,同时可为临床合理选择化疗方案提供一个客观指标     

小儿急性造血功能停滞14例

急性造血功能停滞（又名急性红细胞再生障碍性贫血、急性再障危象等）,小儿少见。本文报道本单位十年来收治的１４例。男１２例女２例,最小年龄６月、最大１２岁,均有一定致病因素,以感染、药物毒性作用稍多。以中、重度贫血为多,网织红细胞明显减低。骨髓象：有核细胞增生活跃１３例,增生减低１例;但粒／红之比最低为１９：１,最高为１０１：１,多数介于３０～５６：１之间：重点讨论了病因、早诊线索及确诊。造血功能停滞恢复时间介于１０～３０天。     

STOOL BACTERIAL AEROBIC OVERGROWTH IN THE SMALL INTESTINE OF CHILDREN WITH ACUTE DIARRHOEA

Abstract. The aerobic flora of 2 groups of children (normal and with malnutrition) with acute diarrhoea was studied, by intubation of the upper and middle small intestine and by stool culture. All the 27 children studied presented bacterial concentrations of 10⁵ germs/ml at one or both levels studied. In 9 cases enteropathogen bacteriae were isolated from stools, and in 6 of these they were also found in the small intestine. The results show the elevated incidence of overgrowth of the small intestinal aerobic flora in children with acute diarrhoea. This fact is mentioned as another etiological factor to be taken into consideration in this pathology.     

急性淋巴细胞性白血病患儿脑脊液腺苷脱氨酶活性的测定

为了探讨脑脊液腺苷脱氨酶（ADA）对中枢神经系统白血病（CNSL）的诊断价值，用比色法对7例急性淋巴细胞性白血病（ALL）伴CNSL和14例无CNSL的ALL患儿进行了脑脊液ADA活性的测定并与15例对照儿的测定值比较。结果，无CNSL的ALL患儿的测定值与对照组比较无明显差别（P＞0．05），而伴CNSL的ALL患儿的测定值明显高于无CNSL的ALL患儿和对照儿的测定值（P＜O．05），并随治疗的好转而明显下降，提示脑脊液ADA活性的测定有助于CNSL的诊断及疗效观察。     

小儿急性白血病外周血NK细胞的变化

本文对20例小儿急性白血病进行了外用血NK细胞活性的测定。男13例、女7例，年龄4～13岁。其中急淋5例、急非淋15例。结果表明：急性白血病患儿NK细胞活性明显下降，与对照组（正常健康儿男12、女15，年龄为5～13岁）相比有显著差异，P＜0.05，并与文献报道相符。文中指出，在白血病的治疗过程中从其缓解、复发时NK细胞活性变化的检测，有益于对病情的了解、感染的存在等估评。例数偏少有待进一步阐明。