Examination of extraintestinal tissue cysts of Isospora belli

A highly polar saponin mixture from pods of Acacia concinna (Leguminosae) was hydrolyzed with alkali to yield five new triterpenoidal prosapogenols named concinnosides A (6), B (3), C (7), D (4), and E (8), together with four known glycosides, acaciaside, (2), julibroside A1 (10) julibroside A3 (9), albiziasaponin C (5), and their aglycone, acacic acid lactone (1). The structures of these new prosapogenols were elucidated based on spectroscopic means. A less polar saponin fraction from the pods gave spinasteryl glucoside and its dihydro derivative.     

Transient leukemia followed by megakaryoblastic leukemia in a child with mosaic Down syndrome

A case is presented of a child with mosaic Down syndrome, who presented at birth with a transient leukemia and later progressed to megakaryoblastic leukemia. Evidence is presented that both leukemias were of megakaryoblastic lineage and evolved from a trisomic hematopoietic precursor. This case is unique in the poor course of the initial transient neonatal leukemia with improvement following chemotherapy. It also highlights the form of leukemia and associated myelodysplasia that occurs in children with Down syndrome. This form of leukemia and transient leukemia are interrelated and are unique to children with Down syndrome.     

A steroid-responsive nephropathy in a child with human immunodeficiency virus infection

Benign paroxysmal positional vertigo developed in a patient with perilymph fistula 3 years after closure of the fistula which was in the lower margin of the annular ligament. The patient's symptoms were long-lasting and intractable. The macula utriculi and utriculoampullary nerve were irradiated by argon laser beams through the stapedectomized oval window. Singular neurectomy was performed using Argon laser, although the nerve could not be identified. After surgery, the patient's symptoms disappeared. Pure tone average of the operated side was 50 dB which remained unchanged after surgery. The macula utriculi may have been completely destroyed. Ocular counter-rolling was indicative of hypofunction of the irradiated utricle. The singular nerve may or may not have been sectioned. The ampullary nerves to the lateral canal and probably the anterior canal were intact, judging from the normal caloric reaction.     

Mediastinitis due to Mycobacterium fortuitum infection following Fontan operation in a child

Here we report a case of mediastinitis due to Mycobacterium fortuitum infection in a child after a Fontan operation. To our knowledge this is the first report of atypical mycobacterial mediastinal infection after congenital heart surgery. Atypical mycobacteria can be the cause of "culture negative" sternal and thoracotomy wound infections. A brief review of the literature is included in the discussion.     

Transient diabetes mellitus and peripheral insulin resistance following Tacrolimus intoxication in a child after renal transplantation

OBJECTIVE: Cord entanglement is a common complication of monoamniotic twins and it is associated with high perinatal mortality. Apart from preterm delivery, no treatment has previously been used to reduce the risks of this complication. We postulated that reducing amniotic fluid volume would stabilize fetal lie and reduce the risk of cord compression. STUDY DESIGN: Cord entanglement was documented in three cases of monoamniotic twins in the midtrimester. Sulindac was administered to the mother. Amniotic fluid index, fetal urine output, and umbilical artery and ductus arteriosus Doppler waveforms were investigated before and during treatment by use of real-time and pulsed Doppler techniques. RESULTS: Sulindac was associated with a dose-related reduction in amniotic fluid index and fetal urine production without alteration in fetal flow velocity waveforms. Fetal lie stabilized after commencement of treatment. All six twins were delivered with no complications. CONCLUSION: Medical amnioreduction with sulindac is a new management option in monoamniotic twins to reduce cord complications.     

Chronic parvovirus infection mimicking myelodysplastic syndrome in a child with subclinical immunodeficiency

1. The effect of cyclo(D-Trp-D-Asp-Pro-D-Val-Leu) (or BQ123), a selective ETA receptor antagonist, on the vasoconstrictor and diuretic responses elicited by endothelin-1 (ET-1) was examined in conscious sheep with chronic indwelling renal arterial cannulae. 2. Using low dose close renal arterial infusion, ET-1 has potent effects on the kidney causing a marked decrease in effective renal plasma flow and an increase in urine output and free water clearance in the normally hydrated animal. 3. The vasoconstrictor response to renal arterial infusion of ET-1 at 5 micrograms/h was blunted by renal arterial infusion of the ETA receptor selective antagonist, BQ123 (400 micrograms/h). 4. In contrast, the effect of ET-1 on urine production and free water clearance was not affected by this dose of BQ123. 5. The differential effect of BQ123 on renal blood flow and urine production suggests that these effects of endothelin on the kidney are mediated through different receptor mechanisms.     

Disseminated bacillus Calmette-Guerin infection in an HIV-infected child: a case with cutaneous lesions

The present paper addresses mortality from urinary diseases (ICD9 codes 580-599) in the Italian pediatric population aged 0-19 years, in the period 1979-91. Mortality data were obtained from the Italian National Statistical Institute (ISTAT). A total number of 522 deaths were recorded among people aged 0-19 years, amounting to 0.33% of all casualties. Half of these deaths were due to renal failure (ICD9 codes: 584-586). While mortality from all causes decreased by 35% among the Italian pediatric population, mortality from urinary diseases remained stable during the same period, and even increased in the age range 0-4 years (from 3.47 per million person-years in 1979 to 9.83 per million person-years in 1990; p < 0.001). This outbreak in mortality was entirely due to an increase in casualties from acute renal failure (ICD9 code: 584). In conclusion, since the increase in mortality from urinary diseases among Italian children aged 0-4 years takes place in the presence of a substantial drop in mortality from all causes, attention should be paid to this problem and surveillance systems should be reinforced.     

Mycobacterium ulcerans infection in a child from Angola: diagnosis by direct detection and culture

The purpose of this study is to listen to and interpret the experiences of independent older women in the community regarding their medication use. Their experiences were examined regarding medication information, sources of information, types of medication used, relationships with health care professionals and social support systems. The techniques used for data collection included guided qualitative semistructured interviews based on the principle of empowerment and notions of ideal and nonhierarchical communication. The emergent themes show that for these older women general practitioners were important in their medication experiences. Whilst trusted as carers in the acute care setting, registered nurses did not play a role in the medication experiences of these older women. Registered nurses are perceived as 'traditional carers' associated with medical and acute care settings. Although medication issues emerged that ideally required attention, the older women in this study generally perceived themselves to be capable of actively managing their health and medication use.     

Latrodectism in a child

BACKGROUND: The malmignatte Latrodectus mactans tredecimguttatus, commonly known as a black widow spider, can be found in the Mediterranean region. Its bite is a cause of a rarely seen syndrome called latrodectism. CASE REPORT: During a visit to Corsica, a 13-year-old boy developed abrupt severe abdominal pain and spasmodic muscular contractions, headache and vomiting. The patient was restless and experienced hallucinations including distressing visions of death. His high blood pressure (154/100 mmHg) returned to normal within 3 days. Clinical examination revealed dyspnea and facial edema associated with blepharoconjunctivitis and hyperreflexia, together with a scattered erythema and pruritus. These changes took place within minutes, after a probable black widow spider bite. The abdominal and neuropsychiatric symptoms disappeared after 5 days. Treatment with calcium gluconate, paracetamol, phloroglucinol and hydroxyzine had no effect, but diazepam decreased the acuteness of the symptoms. Anti-venom serum was not used. CONCLUSION: Diagnosis of latrodectism must be based on clinical and epidemiological data. Erroneously diagnosing surgical acute abdomen, renal colic, meningitis, tetanus or opioid withdrawal would entail incorrect treatment.     

Disseminated invasive infection due to Metarrhizium anisopliae in an immunocompromised child

The first reported human case of possible disseminated infection with the insect pathogen Metarrhizium anisopliae var. anisopliae, a fungus which has been used commercially for biocontrol of insects, is described. The patient, a 9-year-old boy, had a 5-year history of pre-B-cell acute lymphoblastic leukemia and had been on chemotherapy throughout this period. After 10 days of profound neutropenia, lesions consistent with ecthyma gangrenosum appeared on his arms and legs. M. anisopliae was grown from specimens from three separate sites, collected at different times over a period of 1 month: a skin biopsy, a swab from the base of a lesion, and the core of another skin lesion which spontaneously discharged. The initial skin biopsy also showed histological evidence of epidermal necrosis and dermal invasion with fungal hyphae. A computed-tomography (CT) scan of the chest demonstrated a lesion in the superior segment of the lower lobe of the left lung. A CT scan of the brain revealed a lesion in the left temporoparietal region of the brain, consistent with an abscess. Despite antifungal treatment including liposomal amphotericin and 5-flucytosine, the patient eventually died. The initial portal of entry is unknown, but hematogenous dissemination to the skin appears likely because of the multiple ecthymic lesions, and the appearances of the brain lesion on the CT scan are consistent with a hematogenous fungal abscess.