Encysted peritoneal hydatidosis in a child — the effectiveness of pre-operative therapy with a combination of praziquantel and albendazole

A child with encysted peritoneal hydatidosis was found to be completely cured after 3 months of combined therapy with praziquantel and albendazole followed by resection of a huge peritoneal cyst and the removal of numerous, dead, daughter cysts.

Stimulated Raman side scattering in laser wakefield acceleration

Stimulated Raman side scattering of an ultrashort high power laser pulse is studied in experiments on laser wakefield acceleration. Experiments and simulations reveal that stimulated Raman side scattering occurs at the beginning of the interaction, that it contributes to the evolution of the pulse prior to wakefield formation, and also that it affects the quality of electron beams generated. The relativistic shift of the plasma frequency is measured.

The variable clinical phenotype of liver glycogen synthase deficiency

We report two new cases of liver glycogen synthase deficiency (GSD0). The first patient presented at the age of 8 months with recurrent hypoglycemic seizures. The second patient presented at 14 months with asymptomatic incidental hyperglycemia. Glucose monitoring in both patients revealed daily fluctuations from fasting hypoglycemia to postprandial hyperglycemia. Genetic analysis of the GYS2 gene confirmed the diagnosis. GSD0 is more common than previously assumed. Recognition of the variable phenotype spectrum of GSD0 and routine analysis of GYS2 are essential for the correct diagnosis.

Quick identification of febrile neonates with low risk for serious bacterial infection: an observational study

OBJECTIVE

To examine the possible usefulness of simple and quick criteria for identifying febrile neonates with low risk for serious bacterial infection (SBI).

DESIGN

All febrile neonates who were admitted between August 1998 and August 2003 to the Pediatric Emergency Department, HaEmek Medical Center, Afula, Israel, and to the Poriya Hospital, Tiberias, Israel, were included in the study. The recommended evaluation of each neonate included details of medical history and a complete physical examination, including blood culture, erythrocyte sedimentation rate (ESR), white cell count (WBC), and analysis and culture of urine and cerebrospinal fluid. Other tests were carried out as necessary. Patients who met all the following criteria were considered to have low risk for SBI: (1) unremarkable medical history; (2) good appearance; (3) no focal physical signs of infection; (4) ESR <30 mm at the end of the first hour; (5) WBC 5000-15 000/mm(3); (6) a normal urine analysis by the dipstick method.

RESULTS

Complete data were available for 386 neonates. SBI was documented in 108 (28%) neonates, of whom 14% had a urinary tract infection, 9.3% had acute otitis media, 2.3% had pneumonia, 1.3% had cellulitis, 0.5% had bacterial meningitis and 0.5% had bacterial gastroenteritis. The overall incidence of SBI was 1 in 166 (0.6%) neonates who fulfilled the criteria compared with 107 in 220 (48.6%) in the neonates who did not fulfil the criteria (p<0.001). The negative predictive value for SBI of the combination of the low-risk criteria was 99.4% (95% confidence interval 99.35% to 99.45%).

CONCLUSIONS

Fulfillment of the criteria for low risk might be a reliable and useful tool for excluding SBI in febrile neonates.

Eosinophilic pericarditis: a rare complication of idiopathic hypereosinophilic syndrome in a child

We describe an 18-month-old child with idiopathic hypereosinophilic syndrome (IHES) who presented with fever, and cervical lymphadenopathy. Chest X-ray showed marked cardiomegaly, and echocardiogram revealed large pericardial effusion. Other causes of pericarditis were excluded. Despite the initiation of steroid therapy, signs of impending cardiac tamponade developed. Pericardiocentesis yielded bloody fluid with a white blood count of 14,800/mm3, of which 23% were eosinophils. The child recovered after pericardial drainage and prolonged systemic steroid therapy. Eosinophilic pericarditis is a rare but potentially dangerous complication of IHES.

West Nile virus meningoencephalitis complicated by motor aphasia in Hodgkin's lymphoma

A 4 year old boy with Hodgkin's lymphoma was admitted to the paediatric ward with meningoencephalitis dominated by generalised seizures and motor aphasia. Serum IgM specific antibodies to West Nile virus were positive. In view of ongoing neurological deterioration and immunocompromised state he was treated with oral ribavirin for 14 days. A gradual improvement was noted within two weeks of therapy initiation, and with intensive supportive care he recovered completely after four months.

Long-term follow-up of children with retinoblastoma

Twenty-one pediatric retinoblastoma (RB) patients treated between 1976 and 1994 were evaluated for late treatment-related complications. Median age at diagnosis was 24 months; median age at follow-up was 12 years; median follow-up time was 12 years. Of the 21 patients, 14 had unilateral RB and 7 had bilateral RB. Thirteen patients had received external radiotherapy and 8 children were treated by chemotherapy. Twenty-one patients had undergone enucleation. Radiation-induced cataracts were found in 3 patients, radiation retinopathy in 1, enucleation and postradiotherapy contracted socket in 1, very low visual acuity postradiotherapy in 3, severe hypotelorism in 2, growth hormone deficiency in 2, neurocognitive disorders in 6, and orbital deformation due to radiation bone atrophy was moderate-severe in 12 patients. Azoospermia was found in 1 patient treated by cyclophosphamide and vincristine. The most frequent sequela in this group of RB-cured children were postradiotherapy orbital deformation due to bone atrophy and neurocognitive disabilities. Late radiation effects must be avoided by using modern, innovative, and more sophisticated radiotherapeutic techniques. Late treatment-related complications justify the long-term follow-up of childhood RB survivors.

[Pyogenic liver abscess in children]

2 children with pyogenic liver abscesses were hospitalized during the past 2 years. A 6-year-old boy had high fever and hepatomegaly, and a large liver abscess was found in the right hepatic lobe. Streptococcus milleri was isolated from the pus. Treatment with a combination of prolonged drainage of the abscess and antibiotic therapy was successful. A 4-month-old girl who had prolonged fever was found to have osteomyelitis of 3 thoracic vertebrae and 2 liver abscesses in the right lobe. She was treated successfully with broad spectrum antibiotics. Additional workup revealed that she had chronic granulomatous disease.

Sacroiliitis as a sole manifestation of Brucella melitensis infection in a child

A case of a 12-year-old boy with sacroiliitis documented by positive Tc-99m MDP and Ga-67 scans is described. Isolation of brucella melitensis from the blood and bone marrow established the diagnosis. He responded promptly to docycycline therapy. Throughout the course of his disease this boy had neither fever nor other signs of brucellosis, and x-ray was normal.

Acid base balance in blood and cerebrospinal fluid

Thirty four infants were studied; 21 with acute gastroenteritis, dehydration, and metabolic acidosis and 13 who served as controls. All infants with metabolic acidosis and without neurological signs had a normal to near normal cerebrospinal fluid acid base balance, but five with metabolic acidosis and severe neurological signs had cerebrospinal fluid acid base disequilibrium. Acute metabolic acidosis in infants may lead to cerebrospinal fluid acid base imbalance causing cerebral dysfunction.