Evaluation of short stature in children

Within a year 429 children referred for short stature have been evaluated. The age at consultation ranged from 5 months to 17 1/2 years. Healthy but small children came at 5 to 7 and 10 to 13 years, while those with different pathologies attended the clinic at all ages. The stature of 43% of the investigated children ranged within normal limits (till -2 SDS), while 57% had a small stature. 68% of the children could be considered healthy, 32% had different endocrine and nonendocrine diseases responsible for their growth retardation. Retarded bone age (greater than 2 SD below the mean) was observed in 65% of the significantly short but otherwise healthy children and in only 28% of the healthy children with heights above -2 SD. Extreme short stature was mainly associated with a recognized disease of chronic and genetic origin, low birthweight and malnutrition. The high incidence of hypopituitarism (15 patients) is due to the fact that this study was performed in an endocrine clinic.

[Cholestyramine in the treatment of refractory diarrhea of the newborn]

Eleven infants with severe protracted diarrhea were studied. All of them were treated with cholestyramine, 2 g/kg/day in three or four doses. Feces became normal in two to four days in ten out of eleven infants. Tolerance to cholestyramine was good. Fat balance was performed in five patients showing steatorrhea in all of them, ranging from 15 to 42%. Reduction in resin doses was followed by normal fat excretion. Three infants died. One of them did not show improvement with cholestyramine therapy and developed Salmonella typhimurium sepsis. The other two, even though they normalized their stools, died because of Salmonella typhimurium and bacteroides sepsis respectively.

[Tolazoline in postoperative period of diaphragmatic hernia (author's transl)]

During the last ten year period, 78 newborns with congenital diaphragmatic hernia were seen at the Clinica Infantil "La Paz", Madrid. Twenty seven cases died immediately after delivery and 51 were operated. Necropsy findings showed pulmonary hypoplasia and patent ductus arteriosus. Mortality rate in operated cases was 29%. It seems that pulmonary hypoplasia increases pulmonary vascular resistance resulting in a state of fetal circulation with right-to-left shunting through ductus arteriosus. In these cases right to left shunt with umbilical and temporal artery catheters measuring pre and postductal pO2 must be demonstrated. Authors show their experience with two cases of newborns with Bockdalek hernia treated with tolazoline in postoperative period. Both survived.

[Diagnosis and treatment of toxoplasmosis by means of radionuclide]

Using antibodies against Toxoplasma gondii labelled with indium-113 metaestable we obtained scan of rats infested with this disease in a simple and harmless way. Also using the same antibodies, but labelled with iodine-131, we destroyed by radiolysis the toxoplasmas of experimental animals with the Medial Lethal Dose obtained "in vitro" experiments. The experimental results are very encouraging and their use in human beings are in currently research in our laboratory and will be the object of a future communication.

Resistance to Nocardia brasiliensis infection in mice immunized with either Nocardia or BCG

Different vaccination procedures to increase the mechanisms of host resistance to Nocardia brasiliensis were studied in mice. When mice were challenged in the footpad, 2 x 10(8) N. brasiliensis 20 days after footpad inoculation with either viable or killed N. brasiliensis, the mice demonstrated significant resistance to infection when compared with noninfected and nonimmunized mice. The degree of resistance seems to be correlated with the delayed-type hypersensitivity response in the vaccinated animals. Vaccination with another acid-fast bacilli, BCG, afforded both a mild protection and low DTH reactivity. Antibody levels to Nocardia were similar in either Nocardia- or BCG-treated groups indicating that they do not play an important role in resistance to infection by N. brasiliensis.

[Tuberculous cerebral abscess. Morphopathologic study (author's transl)]

A 73-year-old patient with a cerebral abscess of tuberculous etiology localized in the left parietooccipital region is presented. Clinically it had behaved like an expansive process. The inside of the abscess contained a purulent exudate with polynuclear cells and necrotic material. The wall of the abscess was formed by a predominantly histiocytic internal layer and an external one composed by histiocytes with the morphology of epithelioid cells. No tuberculous granulomas were found. The histiocytes contained a large number of acid-alcohol resistant bacilli. In the exudate Mycobacterium tuberculosis hominis was bacteriologically isolated. After the surgical operation the patient developed an acute tuberculous sepsis with tuberculous exudative meningitis and miliary dissemination in various organs. As regards the pathogenesis of the tuberculous cerebral abscess the authors consider the possible influence of a deficitary immune state of the patient and the aggressiveness of the infective organism.

[Early onset group B streptococcal neonatal sepsis (author's transl)]

Seventy one per cent of neonates had a gestational age longer than 37 weeks. Sixteen showed respiratory distress, and shock occured in twelve cases. The onset of illness happened within the first 12 hours of life, in 15 cases. No differences were observed among preterm and term infants. Differential leukocyte count were altered in all infants, being particularly relevant the fact that the relation between immature neutrophil/total neutrophil, was elevated in 50 per cent of cases. Mortality rate was 52 per cent. Clinical alert and early treatment with penicillin, together with the use of fresh blood exchange transfusion, can be considered useful methods in the treatment of these cases.

[Cholestyramine in the treatment of acute bacterial diarrhea in infants]

32 infants admitted to Hospital "Roberto del Río" with infectious diarrhea and dehydration were assigned random to two groups, one of them receiving the usual therapeutic regimen of rehydration, refeeding and furazolidone and the other group the same treatment plus cholestyramine. The patients were studied with balance technique on days 1st, 3rd., and 5th. after admission, analyzing clinical progress, features of the stools, total digestive transit time, pH of the feces and the presence of reducing substances, volume of the stools, water excretion and sodium, potassium and chloride elimination in the feces. The patients receiving cholestyramine showed an earlier improvement in the appearance of the stools, less excretion of feces and water and diminished sodium and potassium elimination. Chloride excretion was similar in both groups. Cholestyramine tolerance was excellent. No side effects or complications were observed.

[Study of the pathogenicity of Conidiobolus coronatus in experimental animals]

The pathogenicity of a strain of Conidiobulus coronatus isolated from Aenolamia postica was investigated in 152 mice, 42 guinea pigs and 47 hamsters. Four routes of inoculation were used: intraperitoneal, subcutaneous, intratracheal and scarification in the oral mucosa. Each animal was inoculated 3 times at 3 week intervals. Animals were sacrificed at 1, 8, 15, 45 of 225 days after the first inoculation. Observations of macroscopic lesions (nodules, abscesses, adhesions, etc.) direct examinations, cultures and histopathological studies of different tissues were performed. The aforementioned lesions of tissue were the most frequently found and all of them were resolved by spontaneous cure. The animals inoculated intraperitoneally and subcutaneouslly presented the highest number of postive results. The histopathological features at the 1st and 8th days after inoculation showed an acute inflamatory infiltrate with well preserved fungus filaments; at the 15th day granulomas with giant cells were observed containing fragmented and disintegrated fungal hyphae; at the 45th and 225th days a fibrosis reaction was observed and no fungal filaments, could be found. In no animal was rhinoentomophthoromycosis never reproduced, and according to these results it is considered that either this strain is not a pathogen or its pathogenicity is very low.

[Digestive associated malformations in esophageal atresia. A study of 125 patients (author's transl)]

The incidence of digestive malformations associated to esophageal atresia and tracheoesophageal fistula is reviewed in a series of 125 surgically treated patients during the last five years' period. A correlation is drawn with other associated malformations. Its influence upon the mortality rate is stressed.