Enteroviral myocarditis and dilated cardiomyopathy

The Pediatric Oncology Group (1986-1990) conducted a study in which 48 children <3 years of age with intracranial ependymomas were treated with prolonged postoperative chemotherapy (CT) and delayed RT. Thirty-one children, 0-23 months of age at diagnosis (Gp A) received 2 years of CT followed by RT; while 17 children, 24-36 months of age at diagnosis (Gp B) received CT for 1 year followed by radiation. One-year survivals were 87% (Gp A) and 94% (Gp B) and 2-year survivals were 67% (Gp A) and 82% (Gp B). In subsequent years a significant divergence in survivals according to age has been noted (p = 0.04). Five-year survivals were 25.7% (Gp A) vs. 63.3% (Gp B). The curves began to diverge 1 year following diagnosis. Other than age, the only significant prognostic factor was degree of surgical resection: 5-year survivals were 66% (total resection) vs. 25% (subtotal resection). Neither the presence of metastases, degree of anaplasia nor the degree of surgical resection varied significantly according to age at diagnosis. The most likely reason for the difference in survivals between the two age groups relates to the timing of radiation following CT, i.e., 1-year delay in children 24-36 months of age compared to a 2-year delay in children 0-23 months of age. An alternative but less likely hypothesis is that ependymomas in the younger children have a more aggressive biology. In contrast, survivals in the 24- to 36-month group are much better than previous reports in the literature suggesting that prolonged postoperative CT may allow both a delay in CRT as well as provide improved survivals. Based on these results, future treatment trials should emphasize maximal surgical resection and a delay in radiation of no more than 1 year.     

Sleep patterns of children sleeping in residential care, in kibbutz dormitories and at home--a comparative study

The present study compares sleep patterns of two groups of children sleeping away from their families, in residential care (n = 31, age 3.7 +/- 1.7 years) and kibbutz (n = 29, age 3.7 +/- 1.8 years) dormitories, with age-matched children sleeping at home (n = 21, age 3.7 +/- 1.8 years). Sleep was monitored by wrist-worn actigraphs for three consecutive nights and assessed by sleep questionnaires, which were completed by parents of the kibbutz children and caretakers at residential care. Children in the residential care settled to sleep significantly earlier and slept longer than those children living in a kibbutz or at home. The longest period of uninterrupted sleep was more extended for children sleeping at home, compared to those sleeping in communal dormitories. Correlation analysis between various assessments of sleep and waking behaviors revealed a different pattern for kibbutz and residential care children. For the kibbutz children, there were significant correlations between difficulties falling asleep and various attributes of daytime tiredness. Conversely, in the residential care, difficulties falling asleep were significantly and positively correlated with parameters associated with daytime alertness. This pattern of correlations and the actigraphic data indicate that difficulties in falling asleep for children in residential care are probably a consequence of being put to bed too early and according to a rigid schedule, and not the result of emotional factors.     

Mental disorders in the offspring of alcoholic fathers (children from an early age to 28)

The examined groups included 175 children whose fathers were alcoholics and 73 individuals from nonalcoholic parents. The study group was divided by age into children from infantile age to 15 years and 16-28-year-olds. The wide range of psychopathologic disorders were revealed in children up to 15 years of age: syndrome of hyperactivity, neurotic disturbances, mental retardation, epileptic-like syndrome. Alcoholism was found in sons only (3.77%). Mental disorders were revealed significantly more frequently in sons of alcoholic fathers than in their daughters. Their incidence increased with the age of the sons. The disturbances occurred significantly more frequently in the test group as compared with the control one (19 and 6.38%, respective by). In the older group (16-28-year-olds) the spectrum of mental disorders consisted of alcoholism, mental retardation, psychopathic-like and neurotic disorders. Alcoholism occurred most frequent and its rate depended on the age and sex. Frequency of alcoholism was 66.7% in sons aged 21-28 years and 15.38% in daughters of the same age. The conclusion was made about multiple risk for children of alcoholic fathers. More vulnerable contingent was the sons for which the risk of alcoholism was very high.     

Relation between age, immunophenotype and in vitro drug resistance in 395 children with acute lymphoblastic leukemia--implications for treatment of infants

The prognosis of infant ALL, characterized by a high incidence of the immature CD10 negative B-lineage ALL (proB ALL) is poor. This study aimed to determine the resistance profile of infant ALL cells. In vitro drug resistance was determined by the MTT assay of 395 children with ALL at initial diagnosis: there were 21 infants <1.5 years of which nine <1 year, 284 children aged 1.5-10 years (intermediate age group) and 90 children >10 years. Immunophenotyping resulted in 310 cALL/preB ALL, 69 T-ALL, 15 proB ALL and one unknown cases. The following drugs were tested: daunorubicin, doxorubicin, mitoxantrone, idarubicin (Ida), prednisolone (Pred), dexamethasone (DXM), vincristine (VCR), Asparaginase (Asp), 6-MP, 6-TG, AraC, VM26 and 4-HOO-ifosfamide (Ifos). Infants <1.5 years were significantly more resistant to Pred (>500-fold), Asp (11-fold) and VM26 (2.7-fold) but significantly more sensitive to Ara-C (2.3-fold) compared to the intermediate age group. When analyzing infants <1 year of age similar results were found. ProB ALL cells (seven infants <1.5 years; eight children >1.5 years) were significantly more resistant to glucocorticoids, Asp, thiopurines, anthracyclines and Ifos compared to cALL/preB ALL but more sensitive to Ara-C. Cells from children >10 years were significantly more resistant to Pred, DXM, Asp, Ida and 6-MP. T-ALL cells showed a strong resistance to Pred, Asp and VCR and a mild but significant resistance to all other drugs except thiopurines and VM26. We conclude that the poor prognosis of infant ALL is associated with a resistance to glucocorticoids and Asp. However, ALL cells from infants show a relatively high sensitivity to Ara-C which suggests that infants with ALL might benefit from treatment schedules that incorporate more Ara-C than the current treatment protocols.     

Association entre l'attachement mère-enfant et les récits d'attachement à la période scolaire.

The objective of the present study was to examine which narrative dimensions distinguish attachment groups. Children's attachment pattern with mother was assessed at age 6 (n = 127; M = 75 months; SD = 12.55) using the Main and Cassidy (1988) separation-reunion classification system. Two years later (n = 109; M = 103 months; SD = 7.13), these children completed the Narrative Story Stem Battery (Bretherton, Oppenheim, Buchsbaum, Emde, & The MacArthur Narrative Group, 1990). In line with predictions, secure children depicted significantly fewer conflict themes in their narratives than did disorganized- controlling children. Secure children also produced significantly more discipline themes than avoidant children and had higher coherence scores than did ambivalent children. Furthermore, girls' narratives were more likely to evoke discipline and affection/affiliation themes, and to be more coherent than boys' narratives. These results suggest that attachment narratives are a promising way of evaluating internal working models of attachment during the school-age years. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The predictive value of elevation in specific serum enzymes for subsequent development of hypoxic-ischemic encephalopathy or intraventricular hemorrhage in full-term and premature asphyxiated newborns

To estimate the surgical efficacy of decompressive craniotomy, 23 children under 2 years of age with acute shaken/impact baby syndrome were treated with medical or surgical methods over the past 6 years. Six children (group A) with lower intracranial pressure (ICP, less than 30 mm Hg) were treated with medical therapy, and 17 children with high ICP (more than 30 mm Hg) of which 7 children were treated with medical therapy (group B) and another 10 children (group C) were treated with decompressive craniotomy. Bifrontal craniotomy was performed on 5 children with generalized brain swelling. A large frontotemporoparietal craniotomy was performed on another 5 children with unilateral swelling. A mean of 32 ml of subdural hematoma was removed. The mean ICP was reduced by 80% in the craniotomy group, p < 0.05. Children in groups A and C performed better on the Children's Outcome Scale than those in group B, p < 0.05. Mortality was significantly lower (0/10) in group C than in group B (3/7), p < 0.05. Hearing preservation was better in group C than in group B, p < 0.05. Bifrontal and frontotemporoparietal craniotomies may reduce mortality and morbidity for acute shaken/impact baby syndrome with high ICP. Patients with ICP less than 30 mm Hg may be treated successfully with medical therapy and patients with ICP more than 30 mm Hg are better treated with decompressive craniotomy.     

Rapid shift in peak melatonin secretion associated with improved performance in short shift work schedule

OBJECTIVE: To describe the changes in the characteristics of human immunodeficiency virus (HIV)-related deaths in children with perinatally acquired infection. METHODS: A retrospective review of all deaths that occurred in HIV-infected children managed at The New York Hospital-Program for Children with AIDS during a 7-year period from January, 1990, to December, 1996. Differences in the characteristics at death between 15 children who died in 1990 and 10 children who died in 1996 were analyzed. RESULTS: Fifty-eight deaths in our cohort of HIV-infected children were identified during the 7-year period. The mean age at death was 4.43 years. Sixty-nine percent of children were black, 55% were male and 94% were receiving Medicaid. The mean weight/age Z score was -3.9 and the mean CD4 index was 0.067 with 65% having <50 CD4 cells/microl at the time of death (TOD). The most common organ/organ systems to be involved at the TOD were lung (78%) and central nervous system (61%). Mycobacterium avium complex (MAC) was the most common isolate at the TOD (26%) followed by Pneumocystis carinii (20%) and Pseudomonas aeruginosa (17%). The leading non-infectious cause of death was cardiac failure (9%). Comparison of the characteristics at the TOD between 1990 and 1996 revealed significant differences in mean age (2.1 vs. 9.2 years, P < 0.0001), mean CD4 count index (0.18 vs. 0.02, P < 0.03), mean number of organ/organ system involvement (3.9 vs. 5.9, P < 0.05), percent receiving antiretroviral therapy (33% vs. 70%, P < 0.02), mean number of years receiving antiretroviral therapy (0.88 vs. 3.86 years, P < 0.01), percent receiving P. carinii pneumonia prophylaxis (27% vs. 100%, P < 0.001), percent receiving MAC prophylaxis/therapy (0% vs. 100%, P < 0.0001), and cause of death from P. carinii pneumonia (53% vs. 0%, P < 0.01). CONCLUSIONS: Compared with children who died in 1990, HIV-infected children who died in 1996 were significantly older, more lymphopenic and more likely to have a greater number of organ system involvements and to have received antiviral therapy and antimicrobial prophylaxis. In 1996 no child died of P. carinii pneumonia. In 1996 MAC and P. aeruginosa were the two most important opportunistic infections causing death. These changes in the characteristics at death will warrant review of resources used in treating these children and may be critical in advising parents and care givers about the prognosis of this chronic infection.     

A retrospective study of the clinical presentation and outcome of herpes zoster in a tertiary dermatology outpatient referral clinic

BACKGROUND: This is a retrospective study of the epidemiology and morbidity of herpes zoster and the risk factors for herpes zoster morbidity in Singapore. RESULTS: The mean age of 164 patients with herpes zoster seen at our dermatology clinic between January 1994 and December 1995 was 48.8 years, with a sex ratio of 1:1. The common presenting symptoms were pain (90%), feelings of helplessness and depression (20%), and flu-like symptoms (12%). The commonest prodromes were pain (41%), itching (27%), and paresthesia (12%). Prodromal pain was more frequently experienced by patients aged more than 50 years (42%) than by patients aged less than 30 years (25%). The thoracic (45%) and cervical (23%) dermatomes were the most commonly affected in all age groups. There was no statistically significant difference in the frequency of dermatomal distribution among the different age groups and between the sexes. Pain was experienced by almost all (95%) patients during the course of their disease. It tended to be more severe in older patients. Burning (26%), stabbing (15%), and shooting (15%) pain were the most common types experienced. Post-herpetic neuralgia was significantly more common in older patients. The prevalence of post-herpetic neuralgia decreased over time in all age groups. A higher proportion of older patients (more than 50 years of age) (20%) suffered from post-herpetic neuralgia compared with younger patients (less than 30 years of age) (7%) (not significant). Patients in all age groups considered acute pain (46%) and persistent pain (25%) to be their most unbearable symptoms during the course of herpes zoster. The most significant problems caused by herpes zoster pain were insomnia (25%), misery (feeling helpless and depressed) (20%), limitation of movement (9%), and inability to continue work (8%). Insomnia was significantly more commonly experienced by patients more than 50 years of age (36%) than those less than 30 years of age (P = 0.026). Few patients (9%) consulted their general practitioner (GP) during the prodrome or on the day of appearance of skin eruptions. Most patients (45%) consulted their GP within the first 3 days of the onset of skin eruptions; 33% sought treatment more than 3 days after the appearance of zoster symptoms. Only 30% of patients were willing to pay more than S$200 for antiviral therapy. Most (43%) were only prepared to pay for antiviral treatment if it cost less than S$200. The most important features the patients wished to derive from antiviral therapy were a shortening of the duration of skin lesions (55%) and a reduction in the severity of pain (acute and chronic) (30%). CONCLUSIONS: Our study indicated that older patients (aged more than 50 years) were at a higher risk of developing post-herpetic neuralgia. They were also more likely to suffer morbidity, e.g. insomnia. There is a need to educate patients at risk to identify the prodrome and skin eruptions of herpes zoster so that early antiviral therapy can be considered.     

The relationship of partner support to outcomes for teenage mothers and their children: a review

OBJECTIVE: To examine the growth response over 3 years of growth hormone deficient (GHD) and non-GHD children who have received growth hormone (GH) in Australia. METHODOLOGY: A retrospective study of a group of patients (1362 children) who commenced GH prior to 1 September 1990. Data were collected at 12 growth centres located in major cities throughout Australia. The data were transferred after informed consent to the national OZGROW database located at the Royal Alexandra Hospital for Children, Sydney, NSW. Of the 1362 children, 898 had received 3 years or more GH therapy and were eligible for this analysis. This cohort was then categorized by diagnosis. Growth response was assessed using height standard deviation score, estimated mature height, growth velocity (GV), GH dose and bone age (years). RESULTS: For children who completed 3 years therapy, the baseline characteristics among diagnostic groups were similar with mean height standard deviation score (SDS) less than -3 SDS (except for the malignancy group) and mean GV ranging from 3.5 to 4.4cm/year. The GV during the first year improved in all groups (7.7-9.4cm/year)followed by an attenuated response during the second and third years of therapy. After 3 years GH therapy the GHD group with peak levels <10 mU/L demonstrated the greatest change in estimated mature height and height SDS. The GHD group with peak levels between > or = 10 but <2OmU/L had a growth response similar to the non-GHD children for all outcome parameters. Change in bone age ranged from 3.1 to 3.8 years with no differences being noted between the diagnostic groups, nor consistently with pubertal status. CONCLUSIONS: Australian GH guidelines have targeted very short children when compared to other series. This large cohort of non-GHD children has demonstrated short-term benefits of GH therapy; however, the long-term benefit remains unclear until these children reach final adult height.     

Manipulation of genes causing diseases]

This study investigated the severity of retinopathy of prematurity (ROP) and its relationship to childhood development. The subjects were 21 children with a birthweight of 2500 g or less who were tested for flash visual evoked potential (FVEP) at conceptual ages ranging from 1 to 3 years. We also examined 73 children with a birthweight of 1500 g or less, using the Developmental Quotient (DQ) test, at 2 1/2 years of age. Twenty-five of this group were given an Intelligence Quotient (IQ) test at 6 to 7 years of age. The P100 latency of FVEP in the severe ROP group was significantly longer than that of the mild ROP group (P < 0.05). The main DQ in the severe ROP group was 99.1 +/- 17.9, significantly lower than the 108.7 +/- 15.5 of the mild ROP group (P < 0.05). No significant IQ differences were found between the two groups. The proportion of children with verbal-performance IQ discrepancies was, however, significantly greater in the severe ROP group than in the mild ROP group (P < 0.05). Since infants with severe ROP are more likely to suffer developmental disorders, long-term follow-up is absolutely necessary and must be done in cooperation with pediatricians.     

Survival of infants with malignant astrocytomas. A Report from the Childrens Cancer Group

BACKGROUND: Very young children with central nervous system malignant brain tumors have a poor prognosis. As compared with older children, survival is less likely, and those children who do survive frequently have severe impairment of growth and cognitive abilities, resulting partly from treatment with radiotherapy. Therefore, an intensive chemotherapeutic regimen was used to treat children younger than 2 years of age with a diagnosis of malignant astrocytomas. PATIENTS AND METHODS: Thirty-nine children younger than 24 months of age who were diagnosed with malignant astrocytoma were treated on a Childrens Cancer Group protocol with an eight-drug chemotherapeutic regimen (vincristine, carmustine, procarbazine, hydroxyurea, cisplatin, cytosine arabinoside, prednisone, and dimethyl-triazenoimidazole-carboxamide) after surgery and postoperative staging. Radiation therapy was to be deferred until the completion of chemotherapy. RESULTS: The objective response rate after two cycles of chemotherapy was 24%. Most patients did not receive radiotherapy. Progression-free survival (PFS) and survival at 3 years was 36% (standard error, 8%) and 51% (8%), respectively. The PFS of those children with anaplastic astrocytoma was 44% (11%), significantly better than that of glioblastoma multiforme (GBM) (0%). Extent of resection was not associated significantly with PFS, but tumors within the cerebral hemispheres were associated with a more favorable prognosis. Tumor progression occurred locally in almost all cases and early in treatment (median PFS, 8 months). CONCLUSION: Chemotherapy appears to be effective primary adjuvant treatment for some very young children with anaplastic astrocytomas. Overall, however, survival remains poor, especially for children with GBM. Strategies to improve outcome require early intervention, because tumor progression occurs soon after diagnosis in the majority of patients.     

Frequency of nucleated red blood cells in maternal blood during the different gestational ages

PURPOSE: To study the course and visual outcome of Vogt-Koyanagi-Harada (VKH) syndrome in children. METHODS: The medical records of 97 consecutive patients with VKH syndrome were reviewed. Patients had been seen at King Khaled Eye Specialist Hospital in Riyadh, Saudi Arabia. The records were divided into two groups: those in whom the onset of the disease occurred at the age of 14 years or younger (pediatric group) and those in whom the disease manifested after the age of 14 years (adult group). RESULTS: Eight (61%) of the 13 children required cataract surgery compared to 14(17%) of 84 adult patients. Despite medical and surgical therapy, eight (61%) of the pediatric group had a final visual acuity of 20/200 or worse compared with 22 (26%) of the 84 adult patients (p=0.0103). CONCLUSION: The course of early-onset VKH (before the age of 14 years) appears to be aggressive. The ocular complications are more severe in children than in adults, leading to rapid deterioration in vision. Despite therapy, the final visual outcome of VKH in children is poor.     

Age at onset of puberty following high-dose central nervous system radiation therapy

OBJECTIVE: To determine if a relationship exists between age at irradiation, sex of the patient, and age at onset of puberty and pubarche in children treated with high-dose radiation to the central nervous system. DESIGN: Case series. SETTING: Tertiary care institutional practices and clinics. PATIENTS: Thirty-six children treated with high-dose irradiation (hypothalamic pituitary dose, 30-72 Gy) by conventional (n = 29) or hyperfractionated (n = 7) schedules. Girls were treated before age 8 years and boys before age 9 years. Twenty-six of the 36 children also received chemotherapy. All tumors were distant from the hypothalamic-pituitary region. MAIN OUTCOME MEASURE: Age at onset of puberty and pubarche. RESULTS: In girls, the median age at onset of puberty was 9.3 years vs 10.9 years for controls (P < .01); pubarche occurred at 9.4 years vs 11.2 years for controls (P < .01). In boys, the median age at onset of puberty--genital II--was 11.0 years vs 11.5 years for controls (P = .30); pubarche occurred at a median age of 10.5 years vs 12 years for controls (P = .25). A censored-data normal linear regression model was used to account for children (n = 6) who had not reached puberty. Age at diagnosis (P < .01) and sex (P = .01) were significant predictors of age at onset of puberty. Body mass index SD score (z score) was inversely related to age at onset of puberty (r = -0.77) and was greater at onset of puberty in girls than in boys. CONCLUSION: In children who have received high-dose cranial radiation therapy, a significant positive correlation exists between age at diagnosis and age at onset of puberty in boys and girls.     

Long-term prognosis of Henoch-Sch?nlein nephritis in adults and children. Italian Group of Renal Immunopathology Collaborative Study on Henoch-Sch?nlein purpura

BACKGROUND: The aim of this multicentre collaborative study was to compare the progression of renal disease in children and adults with Henoch-Sch?nlein purpura (HPS) nephritis selected on the basis of IgA-dominant renal deposits and biopsy material available for review. METHODS: The analysis was performed in 152 patients (95 adults and 57 children < 16 years old at diagnosis) with a follow-up (> or = 1 year up to 20 years (4.9 +/- 3.4 years in adults and 4.8 +/- 3.9 years in children). RESULTS: Renal histology and clinical presentation were similar in both age groups: crescents were found in 36% of adults and 34.6% of children (in only 2.7% of adults and 1.9% of children involving > 50% of glomeruli), nephrotic-range proteinuria in 29.5% of adults and 28.1% of children and functional impairment in 24.1% of adults and 36.9% of children. The outcome was similar for both age groups (remission, 32.5% of adults and 31.6% of children; renal function impairment, 31.6% of adults and 24.5% of children). Endstage renal disease was observed in 15.8% of adults and in 7% of children. Renal function survival at 5 years was not significantly different in the two groups (85% in adults and 95% in children) and at 10 years it was approximately 75% in both groups. None of the children died and adult survival was 97% at 5 years. In adults at presentation, renal function impairment (P < 0.02) as well as proteinuria higher than 1.5 g/day (P < 0.02) and hypertension (P < 0.001) were negative prognostic factors. Multivariate analysis stressed the main statistical relevance of proteinuria (relative risk 2.37, P < 0.02). Conversely, in children no definite level of proteinuria, hypertension or other data were found to be associated with poor prognosis. CONCLUSIONS: Among patients with a clinical presentation which warrants renal biopsy, HSP nephritis has a similar prognosis in children and adults. The evolution is more predictable in adults than in children.     

Successful salvage using mismatched umbilical cord blood transplant in an adult with recurrent acute myelogenous leukemia failing autologous peripheral blood progenitor cell transplant: a case history and review

OBJECTIVE: To investigate the relationship between asthma and obesity in children and adolescents. DESIGN: Medical record review. SETTING: Urban community health center. PARTICIPANTS: One hundred seventy-one children aged 4 to 16 years, 85 with asthma and 86 nonasthmatic controls. MAIN OUTCOME MEASURES: Diagnosis of asthma, age, and sex-adjusted body mass index (weight in kilograms divided by the square of the height in meters). RESULTS: Seventy-eight percent of the sample was Hispanic, 17% was African American, 2% were white, and 3% were other minorities. There were significantly more children with asthma (30.6%) who were very obese (> or =95th body mass index percentile) compared with controls (11.6%) (P=.004). Children with asthma were also significantly more overweight than controls (mean+/-SD, 22.5%+/-28.3% vs 12.0%+/-19.6% overweight; P=.004). The difference in obesity between children with asthma and controls was significant for both sexes and across the 4.5 to 10.9 years and 11 to 16 years age groups. Asthma severity was not related to obesity. CONCLUSION: Asthma is a risk factor for obesity in children and adolescents.     

National Survey of Ambulatory Surgery: 1994

In 1994, 27.7 million surgical and nonsurgical procedures were performed during 18.4 million visits to ambulatory surgery settings. Eighty-five percent of the ambulatory procedures (23.4 million) were performed in hospital-based settings and 15 percent (4.3 million) were in freestanding settings. More than half of the ambulatory procedures were in three major categories: operations on the digestive system, the eye and the musculoskeletal system. The leading ambulatory procedures were extraction of lens (performed almost 2 million times), endoscopy of large intestine with or without biopsy (1.8 million) and insertion of prosthetic lens (1.6 million). Women had significantly more ambulatory surgery procedures than men. The ambulatory procedure performed most frequently on children under 15 was myringotomy. Also common for children were tonsillectomies and adenoidectomies. For those aged 15-44, frequently performed ambulatory procedures included endoscopies of large and small intestine; dilation and curettage of uterus; bilateral destruction or occlusion of fallopian tubes; and arthroscopy of knee. In the 45-64 year old group, endoscopies of large and small intestine were the most commonly performed ambulatory procedures. Extraction of lens and insertion of prosthetic lens were the leading ambulatory procedures for those 65 years and older, though endoscopies of large and small intestine were also performed frequently for this age group.     

Clinical and prognostic aspects of adrenocortical neoplasms in childhood

BACKGROUND: A retrospective study of 54 children was undertaken to define the clinical presentation and secretory patterns of adrenal tumors and to evaluate the outcome of surgical resection and medical therapy. PROCEDURES: Different factors were studied in univariate and multivariate analysis by using the Cox proportional hazard model. RESULTS: Median age at diagnosis was 4 years. Boys and girls were affected equally. The disease was revealed by virilization (61%) or by a palpable mass (39%) with a 0.1-5.5 year delay from initial symptoms. At initial examination, we found that 76% of children were virilized. Ninety-four percent of the tested tumors secreted androgens, which were associated with glucocorticoids in 36%. Adrenal tumors in children were smaller than in adults. Half of them measured less than 10 cm. There were recurrences in 40% of children. The survival rate at 5 years was 49%, 70% if resection was microscopically complete and 7% if not (P < 0.001). CONCLUSIONS: In children, rare adrenal tumors have different diagnostic and prognostic characteristics than in adults; however, recurrences remain frequent. The efficacy of chemotherapy, mainly o,p'-DDD (Mitotane), remains to be evaluated in comparative trials.     

The relationship between gingivitis and the serum antibodies to the microbiota associated with periodontal disease in children with Down's syndrome

Gingival inflammation in Down's syndrome children (DS) develops earlier and is more rapid and extensive than in non-DS children. Abnormalities in host response to the oral flora have been proposed as etiological factors of this gingival inflammation. However, the relationship between gingivitis and the host response to oral microorganisms in DS by age has not been determined. The objective of this study was to clarify this relationship. Sera were obtained from 75 DS subjects (aged 2 to 18 years) and their gingival health assessed using a modified PMA Index (M-PMA). Antibody titers to Porphyromonas gingivalis (Pg), Prevotella intermedia (Pi), Treponema denticola (Td), Fusobacterium nucleatum (Fn), Selenomonas sputigena (Sel), Actinobacillus actinomycetemcomitans (Aa), and Streptococcus mitis (Mi) were determined using the micro-ELISA. DS subjects under 4 years old were found to have significantly more gingival inflammation than did normal children the same age. A significant positive correlation (r = 0.548, P < 0.0001) existed in the relationship between M-PMA score and plaque score for subjects in the G1 age group (deciduous dentition). At G1, the average antibody titers to Aa, Mi, and Fn exceeded those of the normal adult reference serum pool. In addition, IgG antibody titers to Pg, Aa, Fn, Sel, and Mi correlated significantly with the M-PMA scores in the G1 age group. There was a correlation between age (2 to 18 years) and these antibody titers. IgG antibody titers to Pg, Aa, Sel, and Mi increased significantly with increasing M-PMA score. Furthermore, the IgG antibody titers to Pg were higher (P < 0.05) in the most extensive disease group compared to the DS no-disease group. The IgG antibody titers to Pg at G3 (early puberty) were significantly higher when compared to G1 (preschool children). The IgM antibody titers to Aa at G3 were higher (P < 0.05) when compared to G1. This study suggests that colonization by Aa and Fn are closely associated with the onset of gingival inflammation in DS patients under 5 years old. Colonization by Pg, Aa, Sel, and Mi in DS appears to be associated with gingivitis at puberty.     

When and how we perform surgery for inguinal hernia in children

In the course of 15 years in the authors department 4,694 operations of inguinal hernias and hydrocele were performed in children at the age of 0-15 years. Most frequently children aged 2-5 years were involved (45%). There were 4.5 times more boys than girls and the lateral distribution was also consistent with data in the literature. A relapse of hernia occurred in 33 children (i.e. 0.7%) operated in the authors department and in 19 children originally operated elsewhere. The total percentage of relapses in the group is 1.1%. In 25 children factors were identified which predispose for relapses. Relapses were most frequent in children operated before the age of one year (52%). The authors recommend therefore that operations of these children should be entrusted to a paediatric surgeon.