[Pediatric AIDS through vertical transmission]

We report here the first paediatric immunodeficiency acquired syndrome (AIDS) in Spain, acquired by vertical-transmission and a second infant case with the same transmission and classified as AIDS related complex. We also mention the incidence and characteristics, of the neonatal population born in the last eighteen months to HIV positive mothers in our geographic area. The AIDS patients, was a female drug addicted parents born to who died at 22 month. Her parents are HIV positive and have ARC. The second patient was a boy, born to a sexual HIV positive partner of a member of a high risk group who died pat 17 month. Review of the literature until September 1986, revealed 369 AIDS paediatric patients, the number is lower 265 (7 Spanish), if only vertical transmitted AIDS is considered. For this reason, we considered pertinent to provide some information about clinical manifestations and laboratory, radiologic and necropsy findings in our patients.

Inhibition of catecholamine secretion from bovine chromaffin cells by adenine nucleotides and adenosine

ATP, ADP, and adenosine have been found to inhibit acetylcholine-stimulated secretion from isolated cells of bovine adrenal medulla (chromaffin cells). Maximal inhibition is approximately 30% under the conditions studied; half-maximal inhibition occurs at nucleotide concentration in the micromolar range. Cells must be incubated with ATP for approximately 90 s for maximal inhibition, but inhibition by adenosine occurs much faster, an observation suggesting the possibility that ATP and ADP exert their effect after being converted to adenosine. Experiments with cells preloaded with the fluorescent calcium chelator quin 2 indicate that external ATP can diminish the rise in cytosolic Ca2+ concentration that follows stimulation by acetylcholine.

Estero real virus: a new virus isolated from argasid ticks Ornithodoros tadaridae in Cuba

Isolation and serologic identification of a virus isolated from argasid Ornithodoros tadaridae ticks collected in the province Sancti Spíritus in Cuba are described. The virus was named according to the isolation locality El Estero Real. The virus circulation in nature is discussed.

Mouth occlusion pressure (P0.1) in acute respiratory failure

We studied 20 unselected patients admitted to our Intensive Care Unit (ICU) suffering from acute respiratory failure (ARF), who needed mechanical ventilatory support. In all of them we followed a prospective protocol to investigate the value of mouth occlusion pressure (P0.1) as an indicator for weaning. Fifty-two tests were classified into three groups: a need to be reconnected to mechanical ventilation (MV), stable on intermittent mandatory ventilation (IMV), or spontaneous breathing on a T-tube (TT). The results showed that at increased values of P0.1 there were more difficulties in weaning patients from MV. Seventy-eight percent (78%) of the occasions where weaning was successful, values of P0.1 were less than or equal to 4.2 cm H2O, in chronic or non-chronic patients. Eighty-nine percent (89%) of the times when P0.1 values were higher than 4.2 cm H2O the same patients required ventilatory support, total (MV) or partial (IMV). These differences were statistically significant (p less than 0.01). We conclude that the P0.1 is an easily obtained non-invasive parameter, that can contribute along with other more conventional measurements to a superior indication for weaning.

Flow-injection analysis of catecholamine secretion from bovine adrenal medulla cells on microbeads

Bovine adrenal medullary cells have been cultured on microbeads which are placed in a low-volume flow system for measurements of stimulation-response parameters. Electronically controlled stream switching allows stimulation of cells with pulse lengths from 1 s to many minutes; pulses may be repeated indefinitely. Catecholamines secreted are detected by an electrochemical detector downstream from the cells. This flow-injection analysis technique provides a new level of sensitivity and precision for measurement of kinetic parameters of secretion. A manual injection valve allows stimulation by higher levels of stimulant in the presence of constant low levels of stimulant. Such experiments show interesting differences between the effects of K+ and acetylcholine on cells partially desensitized to acetylcholine.

Cerebral computed tomography in maple syrup urine disease

Maple syrup urine disease (MSUD) is an inherited metabolic disorder due to decreased decarboxylation of branched chain keto acids triggering an accumulation of leucine, isoleucine, and valine. We describe two infants with biochemically confirmed MSUD in whom computed tomography (CT) revealed cerebral edema. In one of these cases repeat CT 40 days after institution of appropriate therapy revealed that the edema had disappeared and the ventricles had enlarged.

The commissural neurons of the inferior colliculus of the rat

During systematic observation of the cellular subnuclei of the inferior colliculus of adult rats, it was noted that in the zone of the intercollicular commissure, numerous neuronal perikaria appear intermingled between the commissural fibers. The neurons were studied using Golgi and TEM methods and classified according to their dendritic pattern in the isodendritic (15%), allodendritic (19%) and intermediate forms (66%) of neurons. A fourth neuronal group, situated between the commissure and the upper periventricular zone, is also in relation with the commissural fibers. The constancy of these neurons and their frequently axodendritic and axosomatic synapses suggest that they play an important role in the whole function of the commissure which, at present, is not well understood in spite of the number and distinct origin of their afferents.

[Nutritional impact of supplemented food in relation to the duration and severity of infectious episodes]

The nutritional impact of three different programs of supplementary feeding implemented with children aged 6-24 months, was examined in relation to the duration and the severity of infectious diseases. After a 2-month intervention, statistically significant changes in weight for length were found in two of the groups (those supplemented with rice and beans, and those supplemented with rice cereal enriched with oil). No significant changes in weight for length were found in the other groups (those supplemented with banana cereal and the control group), nor were statistically significant changes found in any of the four groups in relation to weight for age, nor length for age. No statistically significant changes were found on the incidence, duration, and severity of infectious diseases. As a result of these findings it can be postulated that despite a high frequency of infectious episodes, often severe and of long duration, supplementary feeding on the early part of life can be effective when there is a high risk of malnutrition.

Percutaneous techniques in the management of urological complications in renal transplant patients

Obstruction of urine flow and urine leaks are potentially life-threatening complications in renal transplant patients. The diagnosis is difficult, and definite treatment may therefore be delayed. This paper reviews the clinical course of ten renal transplant patients with urologic complications, discusses the limitations of the standard tests used to investigate such problems, and describes the role of percutaneous antegrade pyelography and nephrostomy drainage catheter placement as safe and accurate diagnostic and therapeutic procedures.

[Juvenile malignant osteopetrosis. Clinico-radiological study of 7 cases]

Clinical and radiological studies of seven patients with autosomic recessive malignant osteopetrosis are presented. Diagnosis was established before the age of 3 months in six cases and at 7 months in one. In all cases the presenting signs were pallor and hepatosplenomegaly with associated neurological involvement in five. All patients had normocytic normochromic anemia, leucopenia and thrombocytopenia with features of extramedullary hematopoiesis. Radiological studies revealed increase in the density of bones with "mask" appearance of facial bones and diminished size of optic foramina. Long bones showed absence of normal trabeculae and anomalies in modeling with methaphiseal bands and "bone within bone" images. There was hypocalcemia and hypophosphatemia with slight increases in alkaline phosphatase; parathormone was normal. Clinical course was characterized by progressive pancytopenia, recurrent infections and neurological deterioration with convulsions, nistagmus and optic atrophy. Five out of the seven patients died after a median of 3 months, due to infections or haemorrhage. The patient diagnosed at 7 months of age presented bilateral optic atrophy and moderate anemia; no other complications appeared after 2 year follow-up. Histological findings included substitution of bone marrow by chondro-osseous tissue; focal obsteoblastic and osteoclastic activity in calcified cartilage, and myeloid metaplasia in liver, spleen, lymph nodes and kidneys. The lesions are in agreement with the concept of a defect in bone formation-resorbtion balance; dysfunction of both osteoclasts and osteocytes is implicated in the pathogenesis. Unlike experimental disease, osteopetrosis in man is probably an heterogeneous disease and appropriate therapy should be individualized. Nevertheless, at present, the only favorable results have been obtained with bone-marrow transplantation.

The significance of efficient scatter removal in chest radiography

The conventional approach to the removal of secondary radiation in chest radiography is by using an air gap or a radiographic grid. However, grids become ineffective at high kVp levels. This study evaluated efficient scatter removal by radiographic scanography versus the conventional technique. Nylon spheres simulating lung nodules were attached to a standard radiographic thorax phantom and to a special chest phantom of our own design. Conventional and scanographic films were made of the phantoms using the same conditions. The films were read in a double-blind fashion. The results indicated that scanograms permitted appreciation of the simulated nodules over the lungs better than did the conventional films, particularly at higher kVp levels. However, the marked increase of contrast resulted in an underpenetration of the mediastinum. If properly penetrated, the lung fields were overexposed, which resulted in a decrease of the detectability of lesions in spite of a higher normalized contrast. Scanography is a promising technique for improving the detection rate of lung nodules on chest films, provided that means can be found to penetrate the mediastinum without overexposing the lungs.

Nephrostolithotomy: percutaneous techniques for urinary calculus removal

Recently the technique of percutaneous nephrostomy has been modified to allow the percutaneous extraction of urinary calculi. This communication describes experience with the percutaneous extraction of 63 calculi from the urinary tract. An overall success rate of 87%, a low incidence of complications (about 3%), a fast recovery, and sooner return to work are obtained. Several technical variants including grasping, fragmentation, flushing, and removal under direct vision have been used. In most cases, a combination of the different techniques has to be used in one patient. Essential to the technique is the introduction of large dilators into the kidney.

Ivalon shavings: technical considerations of a new embolic agent

Ivalon (polyvinyl alcohol sponge) shavings can be used as a permanent embolic material. When injected as a suspension with assorted particles of proper size, congenital arteriovenous malformations can be cured, eliminating the need for surgical excision.

Removal of partially extruded steel coils

The authors use a snare for the antegrade extraction of coils which have become partially extruded during therapeutic embolization.

Unilateral hyperplasia of the coronoid process in a child: a cause of restricted opening of the mouth

A case of unilateral hyperplasia of the coronoid process in a nine-year-old girl is reported. The radiological features are diagnostic; removal of the elongated coronoid process and postoperative physiotherapy will, in most cases, restore full mandibular movement.

Transluminal dilatation of coarctation of the abdominal aorta. An experimental study in dogs

The optimal treatment for recurrent coarctation of the aorta remains undefined. Recurrent stenosis following surgical repair occurs in 6-48% of cases involving the thoracic aorta. Because of the high morbidity and mortality associated with surgery, an alternate approach such as transluminal angioplasty is desirable. To evaluate this possibility, the authors created several experimental lesions to test their capability for dilatation, using the percutaneous transluminal technique. The results indicate that balloon dilatation of coarctation after end-to-end anastomosis is difficult or impossible. Dilatation of other types of suture lines may also be difficult due to the large amount of fibrous tissue at the anastomotic site, which is not amenable to balloon dilatation. Thus surgery remains the preferred form of therapy.

Periventricular calcifications in a newborn associated with aneurysm of the great vein of Galen

A newborn infant who presented with heart failure was diagnosed to have an aneurysm of the vein of Galen. Skull radiographs and CT scan demonstrated multiple periventricular calcifications. This case illustrates a new diagnostic possibility for the radiologic finding of periventricular calcifications in the newborn. It also establishes the importance of performing good skull roentgenographic series in all neonates with unexplained heart failure.

[Intramural duodenal hematoma: conservative treatment in six cases (author's transl)]

Six cases of intramural duodenal hematoma in children less than seven years old are presented. A review of the literature found 143 cases in patients under 15 years. The etiology is traumatic in most cases, although they have also been described in patients with Schönlein-Henoch purpura or coagulation diseases. Contrast X-rays are fundamental elements for diagnosis. The "spring" sign is very valuable. Patients were conservatively treated, although three of them where operated, one for a hepatic rupture and the two other for presumed appendicitis and intussusception respectively. In none was the hematoma drained. Clinical course was excellent and oral tolerance was achieved between three and seven days. Based on this experience and that obtained in the review of the literature, conservative treatment is recommended for intramural duodenal hematomas, when other associated problems needing a laparotomy have been excluded.

[Pediatric retroperitoneal iliac abscesses (author's transl)]

11 cases of retroperitoneal iliac abscesses are reported in patients under seven years of age. Causes have been: sepsis in 2 cases, lumbar traumatism in 1, perforation of the iliac vein in 1, pararenal abscess in 1, following debridement of iliac adenitis in one child and by appendicular mass in another case. The etiology was unknown in the remaining cases. Gram positive germs such as Staphylococcus and Streptococcus predominated in the exudate cultures. The most important clinical manifestations have been: fever, painful mobilization of the psoas, pain in the iliac fossa, limping and antiallergic scoliosis. Among radiological findings obliteration of the psoas line, mass in the iliac fossa, ureteral displacement and vesical compression were the most outstanding. Breathing x-rays and echography were diagnostic procedures in our cases. Diagnosis and differential diagnosis are commented, together with treatment. Authors consider that surgical debridement and drainage and administration of antibiotics are the ideal therapeutical procedures in these processes.

Traumatic pharyngeal pseudodiverticulum in neonates and infants. Two case reports and review of the literature

Thirty one cases of pharyngeal pseudodiverticulum have been reported in the literature; twenty nine were diagnosed during the neonatal period. Respiratory distress, increased oral secretions, difficulty with feeding and the impossibility of passing a nasogastric catheter were the most common symptoms and/or signs. Pneumomediastinum, pneumothorax, cervical emphysema and ectopic location of a feeding catheter, alone or in combination, were identified in the chest roentgenograms of 16 patients. Esophagography and/or endoscopy were the diagnostic methods of choice. The exact location of the perforation was identified in 18 patients. Most of the perforations were in either the posterior pharyngeal wall or in the pyriform sinuses. The survival rate was as good amongst the medically treated patients as in those who underwent surgery.