Cerebral malaria in children. Comparative study between heparin, dexamethasone and placebo

From January 1987 up to April 1990, sixty two patients diagnosed as cerebral malaria were admitted to the Department of Child Health, Medical School Sam Ratulangi University, Gunung Wenang General Hospital were included in this study. They were treated with quinine dihydrochloride intravenously continued orally for a total of 7 days combined with fansidar by nasogastric tube for 2 days. All patients were also receiving intravenous fluid drips and other symptomatic treatment. They were divided into three groups. Group I received heparin 300 u/kg body weight intramuscularly once daily for 3 consecutive days; group II received dexamethasone 0.5 mg/kg body weight intravenously, three times daily for three consecutive days; group III didn't receive dexamethasone nor heparin. The mortality rate of the three group combined was 1 out of 21 patients (1.61%). In group I, all 21 patients were alive. One out of 21 patients of group II died (4.76%). In group III, all 20 patients were alive. The average period of regaining consciousness was 1.45 days in group I, 2.85 days in group II and 2.76 days in group III. There was a significant difference between group I and II, and also between group I and III. The average duration of fever was 2.60 days in group I, 2.40 days in group II and 3.69 days in group III. There was a significant difference between group I and III and also between group II and III. The average hospitalization days was 8.0 days in group I, 11.1 days in group II and 10.5 days in group III.(ABSTRACT TRUNCATED AT 250 WORDS)     

In vivo demonstration of maturational changes of the chronotropic response to alpha-adrenergic stimulation

In vitro studies suggest that neonates and adults may have different cardiac chronotropic responses to alpha-adrenergic stimulation. To investigate these differences in vivo, three groups of dogs were studied. Group I = 12 puppies, ages 3-7 days; group II = 12 puppies ages 8-15 days, and group III = seven adult dogs. Heart rate and blood pressure determinations were made in the control setting and then after combined beta-adrenergic and parasympathetic blockade (propranolol 0.6 mg/kg and bilateral vagotomies). Alpha-stimulation was then achieved with phenylephrine given in doses of 0.5, 1.0, and 10.0 micrograms/kg/min. A second, high dose of propranolol (1.0 mg/kg intravenously) was administered after the highest phenylephrine infusion dosage to assure complete beta-blockade. Finally, alpha-blockade was achieved with phentolamine (groups I and II: 0.5 mg intravenously; group III: 5.0 mg intravenously). An alpha-mediated positive chronotropic effect was observed in 42 and 100% of subjects in groups I and II, respectively, but never observed in the adults. Whereas alpha-blockade with phentolamine resulted in a large decrease in heart rate of all puppies (groups I and II), it had no effect on adults. Blood pressure responses were similar in all three groups. Thus, there are important maturational changes in the chronotropic response to alpha-adrenergic stimulation and blockade demonstrable in the intact neonatal canine.     

Inhaled corticosteroids during and after respiratory syncytial virus-bronchiolitis may decrease subsequent asthma

Respiratory syncytial virus (RSV) bronchiolitis in infancy can lead to bronchial hyper-reactivity or recurrent obstructive bronchitis. The aim of the present study was to determine whether the type of treatment has an influence on respiratory status after RSV bronchiolitis. The study involved 117 infants (mean age 2.6 months), who needed hospital treatment because of RSV bronchiolitis. The patients were divided randomly into three groups. All received the same symptomatic treatment. Group I children received symptomatic treatment only, group II children were treated for 7 days with inhaled budesonide, 500 µg three times per day, administered via a nebulizer. Group III children received nebulized budesonide, 500 µg twice per day for two months. Follow-up consisted of out-patient check-ups 2 and 6 months after the infection, and telephone contact two years after the infection. Statistically significant differences were seen between the groups. In group I 37% of the children had asthma, in group II 18%, and in group III 12%. According to the present study it seems that inhaled corticosteroid treatment during and after the acute phase of infant RSV bronchiolitis may have a beneficial effect on subsequent bronchial wheezing tendency.     

Renal functional impairment in preterm neonates related to intrauterine indomethacin exposure

Renal function was measured during the first 4 postnatal days in 9 preterm neonates (gestational age 26.2 to 31 wk) exposed to indomethacin during the last 2 days of pregnancy (group I). The data were compared to those obtained from nine control neonates (gestational age 28 to 34.5 wk) (group II). Five of the nine neonates in group I were markedly edematous at birth, none of group II were edematous. Urine production in group I was low (32.2 +/- 16.8 ml/kg.day on day 1 increasing to 68.6 +/- 21.4 ml/kg.day on day 4) and differed significantly from group II [75.2 +/- 26.8 ml/kg.day on day 1 increasing to 84.8 +/- 20.9 ml/kg.day on day 4 (p less than 0.001)]. Fluid intake was adapted to urine production when necessary. A continuous inulin infusion was started directly after admission and continued for 5 days. Renal function was evaluated for 3 consecutive days after at least 48 h of insulin infusion. The values of the inulin clearance, serum creatinine, urine osmolarity, osmolar clearance, and free water clearance were stable in both groups during the study period. Inulin clearance was lower in group I than in group II (p less than 0.001), whereas serum creatinine was higher in group I than in group II (p less than 0.0001). Urine osmolarity was higher in group I (p less than 0.01), whereas osmolar clearance and free water clearance were lower in group I (p less than 0.02, respectively, p less than 0.01). There was no difference in fractional sodium excretion between the groups.(ABSTRACT TRUNCATED AT 250 WORDS)     

Role of ethamsylate in preventing periventricular-intraventricular hemorrhage in premature infants below 34 weeks of gestation

OBJECTIVE: To determine the role of ethamsylate in prevention of PVH-IVH in premature infants <34 weeks gestational age. DESIGN: Prospective, randomized, controlled study. METHODS: Infants less than 34 weeks gestational age were included in the trial. Neonates with congenital malformations, family history of bleeding disorders and with Apgar scores <5 at 5 minutes were excluded. Subjects were randomized into two groups--Group A infants received intravenous ethamsylate (12.5 mg/kg) six hourly for four days and Group B infants served as a control group. Regular cranial ultrasounds to detect the presence of PVH-IVH were done between days 3-5, 10-14 and 28-30 of post natal age, and before hospital discharge in all infants and weekly in infants detected to have PVH-IVH on earlier scans. Various antenatal and postnatal factors known to affect the incidence of PVH-IVH were recorded. RESULTS: A total of 192 infants underwent the trial, 93 in Group A and 99 in Group B. Antenatal corticosteroids (1 or 2 doses) were administered to 32 ( 34.4%) and 36 (36.3%) women in Group A and Group B, respectively. None of the mothers received phenobarbitone, vitamin K or indomethacin antenatally and none of the infants received phenobarbitone, vitamin E or indomethacin postnatally during the study period. PVH-IVH was seen in 26 infants in Group A, of which Grade I IVH occurred in 9, Grade II in 14, Grade III in 2 and Grade IV in one infant. Twenty-nine infants had PVH-IVH in Group B of which 11 had Grade I, 15 Grade II and 3 Grade III. None of the differences were statistically significant. CONCLUSION: Postnatal administration of ethamsylate did not decrease the incidence of PVH-IVH in the study infants.     

AMPHETAMINE ADDICTION AND PREGNANCY

Abstract. Billing, L., Eriksson, M., Larsson, G. and Zetterström, R. (Department of Paediatrics, Karolinska Institute, St. Göran's Children's Hospital, Stockholm, Sweden). Amphetamine addition and pregnancy. Acta Paediatr Scand, 69: 675, 1980.—Sixty-six infants born to amphetamine-addicted mothers were followed during their first year of life. The children were divided into three groups, according to whether or not the mother stopped her abuse in early pregnancy (Group I) or continued (Group II) and whether or not the latter children were placed in foster homes immediately after birth (Group III). All but 2 of 16 mothers in Group I stayed off drugs and mostly met non-addicted friends. In Group II, on the contrary, all but 2 of 36 mothers continued their abuse one year after delivery. At the age of one year, all but one child in Group I were in their mothers' custody and all children in Group III had remained in foster care. In Group II one-third of the children lived in foster homes after revocation of the maternal custody. Several infants in Group II had experienced multiple transfers between the biological home and different foster homes. There were indicators that maternal amphetamine abuse causes temporary drowsiness in the infants during the first months after birth. However, all children at the age of 12 months, regardless of group, had a somatic and psychomotor development in accordance with the normal Swedish standard. In all groups there was an increased rate of medical care mainly because of infections. Some infants in Group II compared to none in Groups I and III were hospitalized be-cause of failure to thrive or suspected physical abuse. Symptoms indicating emotional disturbance were more common in infants of Group II than in infants of Groups I and III.     

Experimental empyema in rats through intrapleural injection of bacteria

OBJECTIVE: To evaluate empyema formation in rats through the injection of two bacteria (Pasteurella multocida and Staphylococcus aureus), using a simple, easy-to-use surgical technique. METHODS: Twenty four anesthetized Wistar white rats, 250-300g in weight, submitted to right anterior thoracotomy, muscular retraction and injection of a 0.2ml solution into pleural space according the following scheme: Group I (n=12): injection of 10(10) Pasteurella multocida cultured in brain heart infusion broth. Group II (n=8): injection of 10(10) Staphylococcus aureus cultured in brain heart infusion broth. Group III (n=4): injection of bacterium-free brain heart infusion (control). The rats were sacrificed after seven days, and pleural reaction was assessed by macroscopy. Mortality, and intrathoracic liquid volume were evaluated, and bacteriological tests were also performed. RESULTS: Seven rats died within the first 48 hours in Group I (Pasteurella multocida); five completed the experiment, but none of them presented empyema. Only one animal died within the first 24 hours in Group II (Staphylococcus aureus); seven (88%) presented empyema at the time of sacrifice. All animals survived in Group III (control), without empyema or thoracic abnormalities. Pleural inoculation of Staphylococcus aureus (Group II) was significantly associated with empyema formation (P<0.001). In this group, the amount of pleural liquid ranged from 0.9 to 3.9ml. CONCLUSION: It is possible to induce empyema in rats through Staphylococcus aureus pleural injection by a simple surgical technique. Differently from other experiments, the pleural injection of Pasteurella multocida did not provoke empyema in rats.     

Miltefosine in children with visceral leishmaniasis

Sixty four children (38 boys and 26 girls), aged 1 yr to 14 yr, presenting with fever, splenomegaly and positive LD body in splenic smear examination, admitted to pediatric ward of Nalanda Medical college and Child care center between 1st July 03 to 30th June 04 were taken for study. Patients were categorized into two groups: 44 were in Group I (Patients who had not received prior antileishmanial drug) and 20 in Group II (Patients who had received 30 days course of SAG; 20 mg per kg per day). All patients were given Miltefosine in dose of 2.5 per kg per day od or bid per orally to a maximum of 100 mg and were followed at completion of therapy, 1 month and 6 months for clinical response, splenic size and parasite density. 63 patients had parasitological cure with relapse in one patient of Group I during follow up. One patient in Group II had no response with first course but became parasitologically negative with 2nd course of Miltefosine. In Group I, one patient had persistent splenomegaly and found to have associated portal hypertension. GI side effects i.e. diarrhea and vomiting were observed in 26 and 23 patients respectively. Majority of patients had pancytopenia. Elevated ALT (> 3 times of normal) were seen in 28 and 11 patients of Group I and Group II respectively which returned to normal in subsequent follow up. The final cure rates were 93.2 percent and 95 percent in Groups I and II respectively.     

The combined antenatal corticosteroids and vitamin K therapy for preventing periventricular-intraventricular hemorrhage in premature newborns less than 35 weeks gestation

We prospectively evaluated whether combined antenatal corticosteroid and vitamin K administration have any benefit, over and above that of corticosteroid or vitamin K used alone, in reducing the frequency and the degree of PIVH in premature newborns less than 35 weeks' gestation. All of these 280 pregnant women were randomly allocated into five groups according to the in-patient sequence. Group A (vitamin K1 group) including 38 pregnant women (40 newborns) received antenatal intramuscular or intravenously injection of vitamin K1 10 mg per day for 2-7 days. Group B (single dose corticosteroid group) including 57 pregnant women (63 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 1 day. Group C (two dose corticosteroid group) including 62 pregnant women (70 newborns) received antenatal intramuscular or intravenously injection of dexamethasone 10 mg per day for 2 days. Group D (combined using dexamethasone and vitamin K1) including 41 pregnant women (44 newborns) received dexamethasone 10 mg per day for 1 day and vitamin K110 mg per day for 2-7 days. Control group, including 82 pregnant women (87 newborns) were received neither dexamethasone nor vitamin K1 injection. The results showed PIVH was diagnosed in 17 of 40 (42.5%) in Group A, 34 of 63 (54.0%) in Group B, 36 of 70 (51.4%) in Group C, 14 of 44 (31.8%) in Group D, and 57 of 87 (65.2%) in control infants (p = 0.004). More infants in the control group had grade III or IV intracranial hemorrhage after birth (p = 0.049). After antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly. The total and severe incidence of PIVH in Group B (single doses dexamethasone) and Group C (two courses dexamethasone) there were no significant difference. It showed that after antenatal supplement of dexamethasone and vitamin K1, both the total incidence of PIVH and the frequency of severe PIVH decreased significantly, and combined antenatal corticosteroid and vitamin K administration have much benefit, over and above that of corticosteroid or vitamin K used alone.     

Comparative efficacy of E-17β and GnRH administration on day 0 of a controlled internal drug release (CIDR) based protocol on synchrony of wave emergence,ovulation and conception rates in Murrah buffalos (Bubalus bubalis)

The study was undertaken to compare the efficacy of an estradiol-17β + CIDR based protocol with the conventional ovsynch + CIDR based protocol for synchrony of wave emergence and ovulation in Murrah buffalos. In group I (n=25), on day 0 (beginning of experiment), buffaloes were administered a CIDR device (1.38 g P₄) and concurrently received 1.5 mg E-17β. On day 9, the CIDR was removed and a prostaglandin (PG) F₂α analogue (500 µg) was administered. On day 11, buffaloes were administered a gonadotropin releasing hormone (GnRH) analogue (20 µg) and inseminated twice at 12 h and 24 h following GnRH injections. Group II (n=25) protocol was based on an ovsynch regimen plus CIDR for 7 days followed by double insemination at induced estrus. Group III (n=10) served as control and was not given any hormone on day 0 of the protocol. In groups I, II and III, the duration of new follicular wave emergences were observed on days 4.22 ± 0.12, 3.12 ± 0.33 and 5.14 ± 0.42, respectively. In group I, synchrony of wave emergence was more and the diameter of pre-ovulatory follicles was larger (P<0.05) compared to groups II and III. The first service conception rate (FSCR) was higher (P<0.05) in group I while ovulation rates were not different between groups I and II. In conclusion, more synchrony of wave emergence, larger diameter of dominant follicles and higher first service conception rate was observed following the E-17β + CIDR based protocol in buffalos.Key Words: Buffalo, Conception rate, Estradiol, Ovulation, Wave emergence     

Intravenous lipid emulsions in the treatment of essential fatty acid deficiency: studies in young pigs

Essential fatty acid deficiency (EFAD) occurs in infants fed fat-free mixtures of glucose and amino acids. Although infusion of lipid emulsion rapidly reverses clinical symptoms, little is known about effects on tissue fatty acids. To study this question, five groups (n = 4/group) of neonatal pigs were studied. Three groups (I, II, and V) were made EFAD by feeding diets without essential fatty acids (EFA) for days 5 to 33 of life. Groups III and IV were fed a control diet. By 33 days, animals fed the deficient diet showed clinical symptoms and biochemical signs of EFAD. On days 33 to 54 of life, group I animals were fed the EFA-deficient diet and infused with lipid emulsion, providing 3.6% of energy as linoleic acid; group II animals were fed the deficient diet and infused with linoleic acid at 7.2% of energy; group V animals were fed the deficient diet with no lipid emulsion; group III and IV animals were fed the EFA-deficient diet and provided EFA intravenously. Infusion of lipid emulsion rapidly reversed clinical symptoms of EFAD and returned plasma phospholipid omega 6 fatty acids levels to normal. However, erythrocyte and liver phospholipid omega 6 fatty acid content and adipose tissue reserves of omega 6 fatty acids normalized more slowly. Three weeks of infusion of linoleic acid at 3.6% of energy and 2 weeks of infusion at 7.2% of energy were required to return erythrocyte phospholipid fatty acids to normal. Liver phospholipid fatty acid composition still showed biochemical evidence of EFAD in animals treated with linoleic acid at 3.6% of energy for 3 wk.(ABSTRACT TRUNCATED AT 250 WORDS)     

卡介苗素注射液对儿童肾病综合征继发感染预防的初步探讨

目的 观察卡介苗素注射液对小儿单纯性肾病综合征(SNS)继发感染的影响。方法38例初治SNS患儿随机分卡介苗素治疗组(Ⅰ组,n=22)和单纯强的松对照组(Ⅱ组,n=16)。2组均采用强的松中程疗法,Ⅰ组在此基础上给卡介苗素0.5mg(1ml)肌肉注射,隔天一次,疗程3～6个月。观察治疗阶段患儿8周内缓解率、继发感染率、感染控制时间、复发率及用药前和用药3个月后血清、尿可溶性白介素2受体(sIL一2R)及血浆IgG、IgA、IgM的变化。结果 Ⅰ组和Ⅱ组8周内缓解率无显著差异,继发感染率和复发率Ⅰ组均显著低于Ⅱ组。感染后治愈天数Ⅰ组显著少于Ⅱ组[(5.0±1.6)d vs(8.0±2.0)d,P<0.05]。Ⅰ组感染后有6例出现病情反复,但感染控制后尿蛋白即消失,而Ⅱ组感染后有8例复发,感染控制后尿蛋白有5例仍阳性,需恢复激素用量才转阴。血清sIL-2R用药后Ⅰ组下降显著高于Ⅱ组,与正常组比已无显著差异,而Ⅱ组仍显著高于正常组。尿sIL-2R与血清sIL-2R一样也发生上述显著变化。血浆IgG用药后Ⅰ组上升显著高于Ⅱ组,与正常组比较已无显著差异。而Ⅱ组仍显著低于正常组。血浆IgA、IgM用药前后两组比较均无差别。结论卡介苗素在佐治SNS中具有预防和降低感染、减少和预防复发、避免反复大量应用激素的作用,此机制可能在于其降低SNS患儿血、尿sIL-2R水     

The effect of zinc therapy on damaged testis in pre-pubertal rats

This experimental study was instituted to evaluate whether or not there is an effect of zinc aspartate administration on injured testes. Sixty prepubertal male Sprague-Dawley rats (weighing 180–240 g) were divided into six equal groups each containing ten rats. Group I was the control group. Rats in group II and group III which were blunt testicular trauma groups were subjected to right blunt testicular trauma to rupture the tunica albuginea. Just after this, animals in group III were given 30 mg/kg zinc aspartate intraperitoneally, and this treatment was continued for 30 days at a dose of 10 mg/kg per day. Animals in group IV and group V which were thermal injury groups were subjected to right thermal testicular injury with injection of boiling normal saline. After that, animals in group V were also treated with zinc aspartate as described in group III. Group VI was used as a sham group. After 30 days, both testes were removed and examined. Damage in ipsilateral testes was evaluated with histological scoring methods. Contralateral testes were evaluated with measurement of tubular diameter and percentage of spermatogenesis histologically. Ipsilateral testes from non-treated groups had much greater histological injury than treated groups (p>0.05). Additionally, contralateral testes had no evidence of injury. As a consequence, after acute testicular injury that takes form in a variety of ways, immediate administration of zinc aspartate and its continuation for some period may prevent the progression of the injury and improves the healing process.     

Prostaglandin E1 in infants with congenital heart disease: Indian experience

BACKGROUND: E-type prostaglandins (PGE1) can effectively maintain the patency of the ductus arteriosus in neonates. Its use, therefore and be life saving in infants born with ductus dependent congenital heart disease. Although PGE1 is available for over two decade in western world, it has been introduced in India only since April, 1995. OBJECTIVE: To assess the efficacy of PGE1 at our center. SETTING: Hospital based. METHOD: 65 infants with ductus dependent congenital heart disease were included. Age at time of starting PGE1 infusion ranged from 18 hours to 39 days. Forty two of these were more than a week of age, 19 were more than 14 days, and two were above one month. PGE1 was started in an initial dose of 0.05 microgram/kg/min, decreased to 0.005-0.01 microgram/kg/min for maintenance. The indications for use of PGE1 were to increase pulmonary blood flow in 33 cases with pulmonary atresia, tricuspid atresia or critical pulmonic stenosis (Group I); to increase systemic blood flow in 15 cases with coarctation of aorta, hypoplastic left heart and interruption of aortic arch (Group II); to improve mixing in 13 cases of transposition of great arteries (Group III) and for improving the left ventricular volumes by keeping the duct open in 4 cases of transposition of great arteries with intact ventricular septum (Group IV). The efficacy of the drug was assessed by a rise on PaO2 and SaO2% determined for Group I & III, and by appearance of lower limbs pulses in Group II. Left ventricular volumes were serially measured by echocardiography in Group IV cases. RESULTS: The drug was successful in 62 of the 65 cases. There were two failures. One was a 39 days old baby with Ebstein's anomaly of tricuspid valve and pulmonary atresia and other was an eight days old baby with coarctation of aorta and renal failure. In addition, PGE1 could not be continued in another baby due to development of a linear skin rash locally. Side effects included apnea in 5 (9%) of 56 spontaneously breathing patients. Necrotizing enterocolitis, hyperpyrexia and jitteriness was sent in one case each. Six patients died. Two were related to PGE1, one due to failure, another due to its side effects. Definitive procedure were performed in 51 cases electively. PGE1 was used upto 13 days with sustained benefit. CONCLUSIONS: PGE1 is an effective drug for keeping the ductus open in infants with ductus dependent congenital heart disease. It can be used for neonates beyond the first week of life with efficacy. Apnea is a major side effect and close monitoring is essential.     

High dose methylprednisolone therapy in nephrotic syndrome

This study was done to determine the efficacy of oral high dose methylprednisolone (HDMP) therapy in the treatment of childhood nephrotic syndrome (NS). Fifteen patients were enrolled in the study. Patients were arbitrarily divided into two groups. Group I received prednisolone (daily 60 mg/m² for 4 weeks, 45, 30, 20, 10, 5 mg/m² on alternate days for 4 weeks) and group II received HDMP (30 mg/kg/d for 3 days, 20 mg/kg/d for 4 days, 10 mg/kg/for a week, before 9 am, orally). The patients were followed-up for a duration of 38.0±5.5 months (range 24–68 months) in group I and 42.1±5.5 months (range 16–72 months) in group II. No significant difference was obtained in the duration of remission between both groups (p>0.05), while HDMP induced early remission than prednisolone (p<0.05). The mean relapse rate was 0.8/year in group I and 0.8/year in group II (p>0.05). Although, the number of the patients were limited in the study it can be recommended that patients with NS can be treated with oral HDMP therapy as an alternative to standard oral prednisolone therapy.     

Cytomegalovirus hepatitis and ganciclovir treatment in immunocompetent children

Ganciclovir treatment in children with cytomegalovirus (CMV) infection is still controversial and only indicated in selected cases. The aim of thi study was to evaluate clinical and demographic features of CMV hepatitis in immunocompetent children and to determine the effect of ganciclovir treatment in these patients retrospectively. The study was carried out in a group o 29 children with CMV hepatitis. All the patients were investigated for signs of infection, inborn errors of metabolism, genetic diseases, extrahepatic biliary atresia and other causes of hepatitis. Two patients with congenital CMV infection and two patients with biliary atresia were excluded from the study group. The patients included in the study were divided into two groups: non-cholestatic hepatitis (n=16) as Group I and cholestatic hepatitis (n=9) as Group II. Four (25%) patients in the non-cholestatic group and four (44.4 in the cholestatic group were treated with ganciclovir for a median of 21 days. The mean age was 9.6+/- 10.9 months (median age 6 months) in Group I, while cholestatic hepatitis patients in Group II were significantly younger, with a mean age of 2.7+/-0.9 months (p<0.01). The most prominent symptoms at admission were diarrhea and vomiting (25%) in Group I. In Group I, all cases (100%) and in Group II, three of four cases (75%) treated with ganciclovir had recovery from acute CMV hepatitis. In the non-cholestatic group, no relapses were observed while one patient in the cholestatic group relapsed and progressed into chronic liver disease. Patients who received supportive treatment showed a marked decrease in GGT, ALT, AST and bilirubin levels spontaneously and no relapses of hepatitis were observed in at least one year of follow-up. Although ganciclovir therapy is not indicated particularly in immunocompetent cases, since most were self-limited infections, in case of progressive and persistent hepatitis, such as in our cases, ganciclovir was a treatment option; no side effect due to ganciclovir therapy was observed in our cases. Although ganciclovir seems to be effective in progressive CMV hepatitis, multicenter randomized studies in a large study group are necessar to determine the efficacy and indications for ganciclovir treatment.     

Chlorambucil dosage in frequently relapsing nephrotic syndrome: a controlled clinical trial

A controlled clinical trial was performed using two dosage regimens of chlorambucil to treat children with frequently relapsing nephrotic syndrome. All children concurrently received prednisone (60 mg/m2 on alternate days). Ten children (Group I) were given chlorambucil as a stable dose (0.2 mg/kg/day) for 56 to 60 days, and 11 children (Group II) received increasing doses (0.2 to 0.63 mg/kg/day) for 42 to 77 days. Two children in each group subsequently relapsed. Follow-up averaged 28.6 and 27.2 months in Groups I and II, respectively. Three children in Group II developed infectious complications. The data indicate that a stable dosage regimen for chlorambucil is as effective as an increasing dose regimen in achieving long-term remission of frequently relapsing nephrotic syndrome.     

Cognitive and linguistic abnormalities in benign childhood epilepsy with centrotemporal spikes

Aim: To assess the cognitive function and language ability in children with benign partial epilepsy with centrotemporal spikes. Methods: Twenty‐five patients with benign partial epilepsy with centrotemporal spikes were included. They were divided into two subgroups. Group I: 10 patients with rolandic focus who were not treated. Group II: 15 patients with rolandic focus receiving treatment. A third Group of 12 healthy subjects have been studied. All children underwent standardized neuropsychological testing: electroencephalogram recording, Wechsler Intelligence Scale for Children‐revised, Peabody Picture Vocabulary Test‐III (PPVT‐III) and Boston Naming Test (BNT), both during active disease (T1) and 2 years after recovery from epilepsy (T2). Results: At T1 evaluation, no significant differences in group I and II patients about general intelligence, when compared with controls, were found. Group I and II patients were impaired with respect to controls in the receptive and expressive vocabulary evaluated with PCVT‐III and BNT, respectively. At T2 evaluation, group I and II patients showed a normalization of the language abnormalities. Conclusion: Deficits of speech‐related abilities can be detected in children with this type of epilepsy: these dysfunctions seem to be independent of the effects of antiepileptic treatment and are reversible after remission of epilepsy.     

Changes in growth and metabolism in very low birthweight infants fed with fortified breast milk

Human milk is often inadequate nutritionally for preterm infants. We investigated the effect of adding a commercially prepared milk fortifier to human (maternal or bank) milk and measured changes in lower leg length velocity (LLLvel) using knemometry, weight gain and biochemical indices of nutrition. Babies were allocated to one of three feed groups, in a semi-randomized fashion, to receive human milk alone (group I), fortified human milk (group II) or a preterm formula (group III). The birthweights (median and R) and birth gestations (median and R) of the three groups were as follows: group I 1099 g (654-1248 g) and 28 wk (26-32 wk); group II 838 g (742-1340g) and 31 wk (28-36); group III 1136g (624-1552g) and 32 wk (27-36 wk). All babies who received fortified milk either showed significant (p = 0.0004) acceleration in LLLvel during the period studied, or maintained their pre-study period velocity. This increase in LLLvel was comparable to that achieved by a group of babies given a standard preterm infant formula (p < 0.001). By comparison, the control group's change in LLLvel was more modest (p = 0.04). Babies who received human milk with the fortifier added had the lowest serum levels of alkaline phosphatase at the end of the study period when compared to the other two groups. Other biochemical indices were similar in the three feed groups. No adverse clinical events were encountered which could be attributed to the use of the breast milk fortifier.     

Efficacy of protocolized management for congenital diaphragmatic hernia. A review of 100 cases

A review of 100 consecutive cases of congenital diaphragmatic hernia (CDH) treated at our institute focusing on the efficacy of protocolized management (PM) was conducted. Of the 100 cases, 14 who became symptomatic more than 24 h after birth, and seven with fatal anomalies (four cardiac and three chromosomal) were excluded, leaving 79 subjects for this study. Of these, 41 were diagnosed prenatally (PD). Subjects were divided into four groups. Group I: No PD, no PM (n = 34), Group II: No PD, PM (n = 4), Group III: PD, no PM (n = 21), and Group IV: PD, PM (n = 20). PM includes criteria for planned delivery, use of high frequency oxygenation, nitric oxide, echocardiography (EC), and a medication schedule. Overall survival rates for Groups I, II, III, and IV were 73.5% (25/34), 75% (3/4), 38.1% (8/21), and 70.0% (14/20), respectively. Survival rates were higher when PM was used: 70.8% (Groups II, IV) versus 60.0% (Groups I, III). Survival rates were significantly lower if diagnosed prenatally (PD+): 53.7% (Groups III, IV) versus 73.7% (Groups I, II) (P < 0.01). However, in PD+ groups, survival was significantly higher if PM was used (P < 0.05). PM significantly reduced length of hospital stay (35.5 vs. 52.0 days: P < 0.05). EC was found to be a predictor for survival while post-ductal AaDO₂ was not. In 17 cases with cardiac anomalies, PM did not affect survival. Our study suggests that use of PM for prenatally diagnosed CDH cases is associated with improved outcome, although the components of PM need to be tested in prospective trials to determine their true value.