Neuroblastoma. Clinical aspects and therapy]

A general account of questions relating to neuroblastoma is followed by the presentation of 53 personal cases observed between 1955 and 1974. Appraisal of the salient data offers information relating to prognosis and treatment in line with the more extensive series presented in the U.S. literature and elsewhere. Cases diagnosed and treated in the first year of life have a distinctly encouraging prognosis. It is felt that accurate clinical, radiological and laboratory screening should be relied upon in individual cases to decide whether or not surgical management is indicated, whereas the high rate of intra- and post-operative mortality would seem to militate against the resort to desperate attempts to achieve total extirpation, accompanied by damage to essential structures, especially since the pratical results achieved are no more than comparable with those offered by conservative surgery. It is hoped that a strip test suitable for use in routine practice will be evolved, bearing in mind the peculiar features of neuroblastomas.     

Critical reflections on the use of human cultured keratinocytes in children with burns.

The authors report on their experience in the use of cultured keratinocytes in severely burned children, observed in the Surgical Emergency and Pediatric Surgery Department at the Gaslini Institute of Genova. Seventeen cases are described, divided into three groups: patients treated exclusively by autografts; patients treated both by auto- and allografts; patients treated exclusively by allografts. Indications to the various techniques are reported, and the advantages and disadvantages of cultured skin are discussed. Some of the most likely causes of failure are pointed out, with an update review of the literature.     

A rare complication due to sulfuric acid ingestion.

The authors present a case of pyloric and duodenal obstruction in an 8-year-old child, resulting from accidental ingestion of sulfuric acid. A marked pyloric and duodenal cicatrizing stenosis resulting from ingestion of sulfuric acid is seen infrequently, especially in pediatric age. Sulfuric acid produces a coagulation necrosis of the gastric mucosa and submucosa, and the process may involve the entire thickness of the gastric wall, with subsequent ulceration and fibrosis. This dynamic pathophysiologic event imposes postponement of surgical intervention because of various time length between ingestion of acid and onset of gastric outlet obstruction (17 days to 5 years). Clinical features included postprandial epigastric distress, repeated non-bilious vomiting, and marked weight loss. The authors also discuss the various surgical procedures that were employed to relieve the obstruction. Notwithstanding a potential risk of malignant evolution, a gastro-jejunostomy is the treatment of choice because of the age of the patient, and good postoperative results are confirmed by barium studies.     

Azole Resistance in Neonatal Intensive Care Units in Argentina

Abstract

The aim of this study was to determine the antifungal susceptibility profile and to detect resistant strains of yeast species isolated from neonates in Intensive Care Units. 92 strains isolated from 25 bloodstream cultures, 20 venous catheters, 23 suprapubic aspirations and 24 rectal swabs were studied. A Candida glabrata strain resistant to fluconazole was detected. Candida krusei appeared with its inherent resistance to fluconazole and showed cross-resistance to itraconazole. Two Candida albicans strains were resistant to azoles, one to itraconazole and the other to fluconazole with a high minimum inhibitory concentration (MIC) for itraconazole. All Candida tropicalis strains were susceptible to fluconazole but two of them showed resistance to itraconazole. The detection of resistant strains in neonates whom had not received previous antifungal therapy is noteworthy. The variations in the epidemiology of fungal infections observed and the antifungal resistance detected emphasize the importance of performing a regular surveillance to observe and to assess them.