Unusual evolution of Wilms tumor in a patient with Wiedemann-Beckwith syndrome

A very unusual case of Wilms tumor in a child with Wiedemann-Beckwith syndrome is presented. The patient had his first metastasis after a disease-free interval longer than three years. Later, he developed spinal epidural involvement. Both data emphasize the oncogenic potential of Wiedemann-Beckwith syndrome in children and support the contention that Wiedemann-Beckwith syndrome worsens the prognosis of Wilms tumor. Patients with Wilms tumor associated to Wiedemann-Beckwith syndrome should receive intensive therapy as well as close and prolonged follow-up in spite of apparent tumor remission.

Idiopathic hypercalciuria in children: pathophysiologic considerations of renal and absorptive subtypes

Sixteen children with idiopathic hypercalciuria and seven control children were observed. Patients were classified into two groups by means of an orally administered calcium loading test. Individuals with renal hypercalciuria (five children) had a high fasting urinary calcium/creatinine concentration ratio (0.27 +/- 0.05), a mild increase of this value after calcium administration (0.29 +/- 0.07, P less than 0.05), and elevated mean serum parathyroid hormone (PTH) concentrations (0.95 +/- 1.14 ng/ml). Patients with absorptive hypercalciuria (11 children) had fasting urinary calcium/creatinine concentration ratio of 0.11 +/- 0.04, a large increase of this index after calcium loading (0.25 +/- 0.06, P less than 0.0005), and normal levels of serum PTH (0.29 +/- 0.10 ng/ml). Next, we examined the effects of two different calcium intakes on urinary calcium excretion, serum calcium, PTH, and 1,25-dihydroxyvitamin D3 concentrations. In patients with absorptive hypercalciuria, the increased calcium intake resulted in significant increments of calciuria (P less than 0.0005), mild elevation of serum calcium concentration (P less than 0.05), and reduction of serum 1,25-dihydroxyvitamin D3 concentrations (P less than 0.005). By contrast, these values were not modified in children with renal hypercalciuria. Serum PTH did not change within each group. After dietary calcium supplementation, serum ratios of 1,25-dihydroxyvitamin D3 to calcium, phosphate, and PTH concentrations decreased significantly only in the group of children with absorptive hypercalciuria. Our data support the contention that 1,25-dihydroxyvitamin D3 metabolism is different in the two groups of patients with hypercalciuria.

Primary bronchopulmonary malignant melanoma. Case report

A case of pulmonary melanoma is presented. Because of the tumor's evolution and clinical features and, in particular, its pathoanatomic characteristics, we believe that it complied with sufficient criteria for classification as primary bronchopulmonary malignant melanoma. The literature is briefly reviewed.

Peritoneal dialysis in chronic renal failure in children: a six year study

A six year study was conducted to evaluate the long-term use of chronic peritoneal dialysis in children with end-stage renal failure at a single center. All patients maintained satisfactory clinical status and achieved good biochemical control. No significant changes in developmental continuum as measured by weight and length/height were observed in these patients upon institution and maintenance on peritoneal dialysis. The incidence of peritonitis was one episode every 12.3 patient-months. The overall incidence of catheter replacement was one change every 15 patient-months. Our results serve to underscore the effectiveness of long-term peritoneal dialysis in children.

Hypercalciuria associated with long-term administration of calcitriol (1,25-dihydroxyvitamin D3). Action of hydrochlorothiazide

Urine calcium excretion was evaluated in 19 patients before and after calcitriol (1,25-dihydroxyvitamin D3) treatment that was followed up for a five- to seven-year period. The effects of increases of calcitriol dosage and modifications of calciuria with hydrochlorothiazide were systematically examined. The urine calcium excretion before calcitriol therapy was 2.3 +/- 0.8 mg/kg/day (mean- +/- SEM) and the urine calcium-creatinine concentration ratio was 0.12 +/- 0.04. With the dose of calcitriol at 23 ng/kg/day, these values increased to 3.2 +/- 0.8 mg/kg/day and 0.19 +/- 0.04, respectively. Following double dose of calcitriol (44 ng/kg/day), increments in calciuria and urinary calcium/creatinine concentration of 1.4 +/- 0.6 mg/kg/day and 0.10 +/- 0.03, respectively, were observed. With concomitant administration of hydrochlorothiazide (1 to 2 mg/kg/day) therapy at maintenance dose and calcitriol (31 ng/kg/day), the urine calcium excretion effectively decreased by 1.3 +/- 0.6 mg/kg/day and the urine calcium-creatinine concentration ratio by 0.05 +/- 0.02. The results suggest that children with calcium-phosphate disorders who require long-term treatment with calcitriol must be carefully monitored in terms of urine calcium excretion, especially when the dosages are increased to achieve maximal therapeutic efficacy. Calciuria induced by calcitriol administration is effectively reversed by addition of hydrochlorothiazide to the treatment regimen.

Renal tubular acidosis in children. Diagnosis, treatment and prognosis

To delineate the spectrum of clinical expressions of distal, type 1 renal tubular acidosis in children and to update progress in diagnosis, therapy, and prognosis, the medical records of 14 girls and 10 boys, seen over a 7 year period, who met the following criteria, were examined: persistent urinary pH more than 6, net acid excretion less than 70 microEq/min/1.73 m2, simultaneous serum total CO2 less than 17.5 mEq/1, and normal or mild impairment of the glomerular filtration rate. The mean age at diagnosis was 8 months. The presenting signs and symptoms were failure to thrive (50%), vomiting and/or diarrhea (37.5%), dehydration (12.5%), and poor feeding (8.3%). Mean values +/- SD of serum calcium (9.8 +/- 0.8 mg/dl), inorganic phosphate (5.6 +/- 0.8 mg/dl), and alkaline phosphatase (222.6 +/- 96.1 U/l) were normal. Hyperkalemia (serum potassium above 5.0 mEq/l) was present at diagnosis in 13 children. Type 4 renal tubular acidosis was ruled out by the inability to achieve a minimum urine pH. With a mean follow-up period of 28.1 +/- 25.3 months, after alkali therapy at 3.3-3.5 mEq/kg/day had been administered for at least 12 months, the growth parameters improved as follows: the percentile weight (mean +/- SD) increased from the initial 11.8 +/- 7.5 to the final 27.6 +/- 31.3 (p less than 0.003), and the length/height percentile increased from 11.5 +/- 7.3 to 29.7 +/- 24.2 (p less than 0.03). The relationship between urine calcium/creatinine ratio and serum total CO2 showed poor correlation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Schönlein-Henoch syndrome: review of a series of 142 cases]

Clinical and laboratory findings in 142 children with Schönlein-Henoch syndrome are studied. The children were diagnosed during a ten-year period (1974-1984). Purpura, as more significant clinical finding, was observed in all patients, followed by articular signs (61.2%), abdominal complaints (57.7%), renal signs (30.2%) and testicular (4.2%). IgA, IgG, IgM, complement and cryoglobulin alterations, are remarkable factors to assume an immunologic origin for the syndrome.

[Nephropathy of the Schöenlein-Henoch syndrome: long-term prognosis in non-selected patients]

Nephritis plays a major role in long-term prognosis of Schönlein-Henoch syndrome. We have studied a group of 142 children with this syndrome; 43 (30.2%) showed clinical evidence of renal disease. Renal biopsy was obtained in 12 cases. A subgroup of 36 patients have been controlled during a much greater two years period. Thirty-five are asymptomatic and one with minor urinary anomalies. Thereafter in our experience the long-term prognosis (means = five years) of Schönlein-Henoch syndrome is excellent in unselected patients.

Renal amyloidosis complicating a recessive epidermolysis bullosa in childhood

A case of recessive epidermolysis bullosa and secondary renal amyloidosis in a nine-year-old boy is reported. The first case observed in childhood. The clinical relationships of the two conditions are briefly discussed.

Pharmacokinetics of amikacin in children with normal and impaired renal function

The pharmacokinetics of the antibiotic amikacin sulfate were studied in eight children with normal renal function and in ten children with varying degrees of renal impairment. All patients received a single i.v. dose of 7.5 mg/kg of the antibiotic. Amikacin follows a two-compartment open-kinetic model. The serum half-life, which in children with normal renal function has an average value of 1 hour, reached values of 14 hours in children with severe renal impairment. A lineal relationship is established between the beta constant and the creatinine clearance (Clcr) according to the equation beta = 0.001 + 0.005.Clcr, with r = 0,818. From thie equation, the dosage interval is modified to maintain the serum concentrations of the antibiotic within the therapeutic interval.

[Diagnostic value of C reactive protein in neonatal sepsis (author's transl)]

Seric levels of C reactive protein (C.R.P.) were determined in a series of 125 children under one month old. Of them, 75 were clinically healthy and 50 showed signs that suggested infection. In all this infants, in addition to C.R.P., different components of white blood cell differential count were determined, and a bacteriological study was undergone. Authors found high concentration of C.R.P. in 100% of children in which diagnosis of sepsis was bacteriologically confirmed. On the other hand, concentrations of this biological parameter were not substantially modified in newborns used in the control, nor in those other ones in which sepsis was not confirmed. Sensibility of C.R.P. showed itself significantly higher than other hematological indexes in study.

[C reactive protein as a standard of efficience in antiinfectious therapy (author's transl)]

C reactive protein (CRP) levels are sequencially settled in 58 children, divided in three groups in dependence of their illness: acute bacterial pneumopathy, acute pyelonephritis or neonatal sepsis, all of them receiving antibiotic treatment. CRP values are compared with clinical, radiologic and bacteriologic findings, showing in patients of the first two groups a normalization between fourth and ninth day of treatment, together with clinical and radiologic improvement. In contrast, it was shown that normalization of CRP in neonatal sepsis group was quite slow related to the torpid evolution. The sequentially measure of CRP was prove useful as antibiotic treatment control in children affected with different infectious pictures.

[Familial vesicoureteral reflux (author's transl)]

Sixteen members of three families, eight of which had vesicoureteral reflux, are studied. Authors report a high incidence in females (7 cases) and atrophic chronic pyelonephritis (75% of the serie). Only one girl presented disminution of renal function. The types of inheritance was dominant autosomal in the A family and autosomal recessive in the B and C families. Finally the norms of investigation of the familial vesicoureteral reflux are appointed.