[The impact of psychological preparation for pediatric surgery on postoperative recovery]

OBJECTIVE

Fear of surgery affects recovery in the emotional and behavioral state that leads the child to call the nurse more often or to ingest more sedatives after the operation. The present work evaluated the effects of psychological preparation for surgery during the pre-surgical period on the post-surgical recovery during the hospital stay in order to evaluate the effects that this preparation had on the recovery of the child.

PATIENTS AND METHODS

The sample was composed of 60 pediatric patients of both sexes between 7 and 14 years of age admitted for minor scheduled surgery. Fear and five indicators of recovery were evaluated during the post-surgical period (call to the nurse, ingestion of sedatives and liquids, miction and sleep). The children were assigned randomly to one of the following four groups: filmed modeling, coping skills, filmed modeling plus coping skills, and control.

RESULTS

The results indicated that the prepared children showed less fear, called the nurses less often, were administered fewer doses of sedatives and slept better after the operation. Analysis of the size of the effect showed that the programs that included coping skills training obtained the most benefits in the post-surgical recovery.

[Neisseria meningitidis strains with decreased susceptibility to penicillin and ampicillin]

Thirty-eight patients (31 children and 7 adults) with meningococcal infection (sepsis and/or meningitis) were studied. The strain most frequently isolated was B (44.7%), followed by C (31.6%). Of the strains isolated, 52.6% were moderately resistant to penicillin (91.6% if only strain C was considered). No resistance to cephotaxime or chloramphenicol was found. Even though patients with moderately resistant strains treated with penicillin G evolved satisfactorily (minimum inhibitory concentrations 0.12-0.50 microgram/ml), the possible appearance of more resistant strains and/or of strains that produce beta-lactamase leads us to the conclusion that cephotaxime is the treatment of choice until an antibiogram is available.

[Complete triploidy in a live newborn infant. Review and contribution of a new case]

A preterm newborn with complete triploidy and serious hyaline membrane disease is reported. Characteristic pattern of malformations (large, posterior fontanelle, low-set malformed ears, hypertelorism, exophthalmos, micrognathia, syndactylies of the third and fourth digits of all extremities, micropenis and cryptorchism), and abnormal hematologic features (decreased number of red blood cells and increased RBC indices) suggested diagnosis which was confirmed by a 69,XXY karyotype. As factors with possible causal responsibility authors remark first-month abdominal radiation and chronic exposure to industrial toxic during pregnancy in the mother and no specific trend toward chromosome rupture in the father, and second trimester pre-eclampsia. No familial previous cases of chromosome anomalies nor congenital malformations were referred. From the review of 56 published reports they conclude that triploidy syndrome has a characteristic and recognizable array of phenotype abnormalities.

[Fasciitis with eosinophilia: Shulman syndrome. Report of a case and review of the literature]

A twelve year-old boy who developed, after a period of strenuous physical work, an illness characterized by thickened skin over his right thigh and hemiabdomen, flexion contractures in right wrist and elbow and in right metacarpophalangeal joints without Raynaud's phenomenon or other visceral symptoms is presented. Pertinent laboratory studies showed hypereosinophilia and hypergammaglobulinemia. Deep-fascia biopsy showed typical findings of fasciitis with eosinophilia. Prednisone therapy resulted in sustained improvement. Periarticular osteopenia of the right hand and mast cell infiltration in fascial biopsy are remarkable features. Authors stress striking differences between fasciitis with eosinophilia or Shulman's syndrome and scleroderma. Clinical picture, laboratory changes, typical histology and a usually rapid response to corticosteroids, as well as some autoimmune diseases possibly associated, suggest a different disease and an immunological pathogenesis. From literature review authors conclude that cases of Shulman's syndrome reported in children are very limited and that this disease should by ruled out in every child with thickened skin changes and articular flexion contractures.

[Acute transient myositis after influenza]

The clinical picture, biological findings and outcome of acute myositis during recovery from influenza are so characteristic that can clearly cut-off it from other diseases affecting the muscles. Five cases of acute bilateral lower-limb myositis are described. A flu-like illness had begun to wane before the onset of severe leg pain, preventing the children from walking. All had abnormal serum CPK and SGOT levels. Virological studies were performed with negative findings. The pathogenic mechanism is unknown. We though that more aggressive studies are not justified in view of the transient nature of the patient's illness and their complete recovery. We stress the need of recognizing such disease in every child complaining of lower leg pain associated with very painful walking into a epidemiological setting of a "influenza-like" illness. We also have reviewed the published bibliography is considered.

[Wolman's disease]

We present two brothers with Wolman's disease under its child form. Adrenal calcification, a diagnostic suspicion sign, was present in the second brother only. Vacuolated cells in bone marrow and intestine villi shown in pathological study, and cholesterol crystals in Kupffer cells were determinative. Acid esterase (0.85 nmol/mg/m) in fibroblast culture in the second brother was pathognomonic (normal values: 30 nmol/mg/m). Enzymatic values in parents were normal. Evolution in both cases was to early death, five and eight months respectively. Enzymatic study in amniotic cells culture over fifteen week of a third bearing was normal.

[Arterial pressure in the school-age child; distribution and correlation with chronological and anthropometric variables]

The aim of the present study is to establish the normal patterns of blood pressure and the correlations with chronologic and anthropometric variables (age, body, weight, body height and body surface) in childhood. Blood pressures were taken in 1,310 children (727 male, 583 female) ages 4-14 years employing mercury sphygmomanometer, and taking for assessment of diastolic pressure Korotkoff's fifth phase. Study of single correlations showed significant increase of systolic blood pressure with every variable (p less than 0.001); the more predictable was body weight, and the less one, age. There were not significant relationships between diastolic pressure and any other variable; in the same way, there were not significant differences of blood pressures between both sexes. Multiple correlations established the following predictive order: Body weight, age and height. Authors show empirical and theoretical percentiles of blood pressure in relationship with variables: Age, body height and body weight.

[Goldenhar syndrome. Discordance in monozygotic twins]

Child here described is a new-born male, the firstborn twin, who showed clinical-radiological manifestations compatible with an oculo-auriculo-vertebral syndrome or Goldenhar's syndrome. A comparison of chromosomes, identification of serological types and determination of antigens of histocompatibility (HLA) showed them to be similar in both twins, thus showing identity of monozygots . Of great importance in the anamnesis is a radiological study--cholecystography--which was practiced between 4th and 6th weeks of pregnancy. Differences shown and possible intervention of radiation as etiology mark the especial interest of this case.

[Familial cryptorchism (author's transl)]

Cryptorchism is a frequent finding in children, but the presence of several cases in the same family has been rarely published. In this paper a series of twelve families with several cases in each one is reported. The histologic study of testicular biopsy in all cases has not been meaningful because of the various lesions observed. After reviewing medical literature the possibility of an ignored hereditary factor is considered.

[Subacute necrotizing encephalomielopathy. Leigh syndrome (author's transl)]

A 6-month-old girl with familiar history of two dead sisters few months old, was admitted to the Hospital with a neurological process. After her admission progressively worsened until her death. The patient had clinical manifestation of proximal tubular acidosis. Levels of lactic and piruvic acid were normal. Necropsic study was compatible with the diagnoses of subacute necrotizing encephalomielopathy of Leigh syndrome.

[Height alterations and calcium metabolism after prolongated phenobarbital treatment (author's transl)]

In order to know if small children subjected to a long-term treatment with phenobarbital can suffer some alterations in their lineal growth or in their osseous maturity in the same way as those showed by epileptical mother's sons, 85 patients between six months and three years old, who had suffered fit convulsions during a fever process, 20 of them subjected to antithermic treatment, and the 65 left who received a phenobarbital treatment in doses of 5 mg./kg./day have been controlled. In each child, at the beginning of the control and after 12 months, their height, diaphysial diameter and cortical thickness of the metacarpal bones, and bone age is valued. At the same time a calcium, phosphorous and phosphatase-alcaline control was done. The group who had received anti-convulsivants drugs, showed a significant decrease in their lineal growth and in calcium concentration in blood. The control group didn't present any significant variation in any of the controls performed.