Retrobulbar hydatid cyst: Assessment of two cases

A 54-year-old man with a unilocular hydatid cyst within the infero-posterior angle of the orbit and a 6-year-old male child with a unilocular hydatid cyst within the supero-medial angle of the orbit are presented. The retrobulbar cysts were diagnosed with computed tomography and ultrasonography and were treated after serologic confirmation.     

Mycobacterial infection in an inner city children's hospital

Childhood tuberculosis is perceived by many as a disease of the past. Experience in a children's hospital serving a deprived population suggested that tuberculosis and other mycobacterial infections were not declining in clinical practice. Fifty three tuberculous and 11 atypical mycobacterial infections were identified between 1978 and 1992. There was no decline in tuberculosis and nine of the 11 atypical infections occurred in the last five years. Altogether 40% of cases of tuberculosis were in non-Asian children; 32% had arrived in the UK or visited family overseas in the previous year; and 38% had a history of tuberculosis contact, usually a close adult relative. Nationally, the previous decline in tuberculosis in all ages has reversed. In the local health districts in London's east end, childhood tuberculosis has also stopped declining and seems to be increasing. It is regrettable that BCG vaccination has been abolished by some districts in the UK, against current recommendations. Childhood tuberculosis is still common in the practice described here, including among children who do not fall into conventionally recognised high risk groups. Inner city dwellers and junior doctors are both highly mobile populations, adding to the risk that paediatricians, particularly those in training, may encounter tuberculosis with little or no previous experience of the condition.     

Protein nutrition, faecal flora and iron metabolism: the role of milk-based formulae

This paper explores the role of milk-based formulae in achieving four aspects of nutritional health in infants and toddlers: in the suckling, to mimic the amino acid metabolism and the faecal flora of a breast-fed baby; in the weanling, to achieve adequate protein intakes in later infancy and beyond and to achieve satisfactory haemoglobin concentrations in the early toddler years. Milk-based formulae have two roles in infant nutrition: as so-called breast milk substitutes and as a safety net during the weaning period; the latter role may be the more important.     

Malnutrition as a prognostic factor in lymphoblastic leukaemia: a multivariate analysis

One hundred and twenty eight Brazilian children with lymphoblastic leukaemia were intensively treated with a Berlin-Frankfurt-Munich based protocol. More children had a white cell count above 50 x 10(9)/l (31%) then observed in developed countries. After a median follow up of 31 months (11-58 months), the estimated probability of relapse free survival was 41% (7%) for the whole group. After adjustment in the Cox's multivariate model, malnutrition was the most significant adverse factor affecting duration of complete remission. Age above 8 years and high peripheral white cell count were also significant adverse factors. Among the nutritional indices, the height for age and weight for age z scores were both significant, whether the cut off points of z-2 or z = -1.28 were chosen to define malnutrition. A strong statistical association between the two indices was found; the contribution of height for age z score to the prediction of relapse free survival was more significant. Children with height for age z score < -2 had a relapse risk of 8.2 (95% confidence interval 3.1 to 21.9) relative to children with z score > -2. The results of this study suggest that socioeconomic and nutritional factors should be considered in the prognostic evaluation of children with leukaemia in developing countries.     

Estimates of maintenance requirement of growing lambs.

1. Total body energy retention (ER) and metabolizable energy intake (MEI) values from experiments with 231 lambs (Suffolk male x (Border Leicester male x Cheviot female) female) housed indoors and given thirteen forage diets were used to estimate the metabolizable energy (ME) required for maintenance. 2. ER was measured using the comparative slaughter technique, and the lambs were fed at several planes of nutrition above maintenance between 2 and 5 months of age. 3. The daily ER and MEI results were scaled to live weight (kg0.75) and linear regression lines fitted to the values for individual diets. Extrapolation of the fitted lines to zero ER gave estimates of maintenance requirement ranging from 141 to 466 kJ ME/kg0.75 per d and values for the efficiency of utilization of ME for growth and fattening (Kf) of 0.25-0.53 (mean 0.39). 4. An alternative analysis constrained the estimated maintenance requirement to be the same for all diets. An iterative search procedure indicated minimal residual variation at 339 kJ/kg0.75 per d. This common value of ME for maintenance gave Kf values ranging from 0.30 to 0.54 (mean 0.39). 5. The implications of the technique were considered together with some discussion of the variability of the estimate. Allowing the minimum RSD to vary by 10% gave a maintenance requirement of between 231 and 408 kJ/kg0.75 per d.     

CT colonography: pitfalls and interpretation

A knowledge of normal colonic anatomy and its variants as demonstrated on CT colonography is essential to limit false positive results and ensure a high sensitivity for polyp detection. Interpretive and perceptual errors undoubtedly decrease with increasing operator experience. To provide a confident and accurate report, radiologists must be familiar with common pitfalls and pseudolesions on CT colonography.