Erythema nodosum in pregnant patients with coccidioidomycosis

Pregnant patients with coccidioidomycosis develop dissemination and serious disease more frequently than do the general population. To assist in prognosis and management, we analyzed the significance of erythema nodosum in pregnant patients with coccidioidomycosis. Sixty-one pregnant patients (mean age +/- SD, 26.4 +/- 6.3 years) were evaluated. Seventy percent of the patients were Hispanic; 15%, African American; 13%, Caucasian; and 2%, unknown race. Of the 30 patients (49%) who developed erythema nodosum, 0 had disseminated disease (P = .001), 1 (3%) with pulmonary involvement required therapy for > 1 year, and 29 (97%) recovered (P = .0008). Of the 31 patients (51%) without erythema nodosum, 11 (35%) had disseminated disease, 12 (39%) required therapy for > 1 year, 17 (55%) recovered, 1 (3%) died, and 1 (3%) had an outcome that was unknown. Erythema nodosum appears to be a salient marker of a positive outcome for pregnant patients, more so than for the general population.     

Erythema nodosum and associated diseases. A study of 129 cases

BACKGROUND: Erythema nodosum (EN) is associated with many infectious diseases. The purpose of this study was to evaluate the relative prevalence of associated diseases in a large series of EN, and to review the previously described causes of EN. MATERIALS AND METHODS: A total of 157 inpatients with a diagnosis of EN made in Strasbourg, France between 1960 and 1995 were studied retrospectively, but only 129 patients with confirmed EN were evaluated. A biopsy was taken in 30 patients with atypical clinical symptoms. Chest radiography, blood cell count, throat swab, and anti-streptolysin dosage were performed systematically. Viral investigations and serodiagnoses for various bacterial infections were carried out in approximately half of the patients. All investigations were analyzed retrospectively and compared with the world literature. RESULTS: The female: male ratio was 5 : 1 and the mean age was 31 years. We found 28% confirmed streptococcal infections, 11% sarcoidosis, 1.5% enteropathies, 1.5% Chlamydia infections, 0.8% Mycoplasma infections, 0.8% Yersinia infections, 0.8% hepatitis B, and 0.8% tuberculosis (one case). The causative factor could not be determined in 55% of patients. CONCLUSIONS: Our data confirm the predominance of streptococcal infections and sarcoidosis among patients with EN. Tuberculosis has virtually disappeared, since the last case was observed in 1962. Various viral or bacterial diseases are rarely associated with EN, but all patients were not thoroughly investigated. A large and prospective study should be performed in order to determine the true prevalence of associated diseases in EN. In the absence of specific symptoms, exhaustive investigations are not cost-effective.     

Percutaneous renal biopsy in children: a 27-year experience

BACKGROUND: The introduction of automated biopsy devices and the localization of the kidney by ultrasound were aimed at optimizing efficacy and safety of the percutaneous renal biopsy procedure. We evaluated these technological advances in our renal biopsies performed in children. METHODS: We sequentially used the Silverman needle (1969-1974), the TruCut needle (1974-1990), and the automated Biopty device (1990-1996). Fluoroscopy was used to localize the kidney until 1985, ultrasound examination prior to biopsy from 1985 to 1992, and direct ultrasound guidance since 1992. A total of 962 native kidney biopsies and 119 allograft biopsies were performed. RESULTS: In the native kidney biopsies, the introduction of the Biopty device and ultrasound guidance were independently associated with fewer passes required to obtain adequate tissue and more glomeruli per specimen. The rate of biopsies yielding more than 9 glomeruli increased from 69 to 92% (p < 0.05). The number of glomeruli harvested per centimeter core length was inversely related to patient age (p < 0.01). More appropriate cortical tissue was retrieved in renal allograft biopsy specimens with the application of the new techniques. The occurrence of macroscopic hematuria (9. 6%) in the native kidney biopsies was not affected by the puncture or localization technique applied, but subcapsular hematomas were documented more often with the Biopty device (42%) than with the TruCut needle (16%), probably due to improved ultrasound equipment. In the whole series 2 patients died, and 3 others required renal surgery and 4 blood transfusions. CONCLUSIONS: The automated ultrasound-guided procedure is a feasible and reliable technique for percutaneous renal biopsy in children. It gives a greater yield of diagnostic tissue without increasing the rate of clinical complications.     

Erythema multiforme: a review of twenty cases

AIM: Evaluation of the clinical suitability of a new analytical method for the determination of bone mineral density (BMD) by means of SEQCT as well as a comparison with the established method. METHODS: In order to verify the stability of both systems, phantom measurements were performed on a lumbal spine torso as well as on 78 patients. 44 patients were examined by means of the established method and 34 according to the new method. Parallel measurements were possible in 15 patients. RESULTS: The phantom measurements proved a high stability of both methods. Regarding the absolute BMD the new method resulted in higher BMD values. This result was confirmed by parallel measurements in 15 patients. The new method demonstrated increased suitability due to less time consuming preparations. Dose reduced scan parameters could not be achieved in all patients, so that the time saving effect could not be considered. In these cases manual settings were required. CONCLUSION: A substitution of the established method for BMD measurement by means of SEQCT with the new method seems to be possible. However, the results will have to be corrected by the percentage of deviation from the default value of the quality phantom.     

Prevalence of fibromyalgia in children: a clinical study of Mexican children

OBJECTIVE: To determine the prevalence of fibromyalgia (FM) in schoolchildren according to the 2 stage classification process proposed by the 1990 American College of Rheumatology (ACR) Multicenter Criteria Committee on Fibromyalgia. METHODS: Stage 1: we administered a pain questionnaire to a sample of 548 schoolchildren (264 boys, 284 girls; mean age 11.9 yrs, range 9-15). Stage 2: two rheumatologists examined all children with diffuse pain. Using thumb palpation, they examined 18 fibromyalgia tender points and 3 pairs of controls points followed by dolorimetry. Additionally, a random sample of 79 children with no pain were selected as controls, following the same procedures (thumb palpation and dolorimetry). The Wilcoxon test was used to compare the distribution of tenderness thresholds between FM and non-FM groups. Kappa statistics for multiple raters was used to assess interobserver agreement. RESULTS: Seven children, all girls, fulfilled the ACR diagnostic criteria for FM. Thus, the prevalence of FM in this group of schoolchildren reached only 1.2%. The girls with FM had a mean of 14 tender points, whereas controls (n = 79) had 2.4. Pain thresholds were 3.4 kg in children with FM and 5.1 kg in controls (p = 0.004). CONCLUSION: The prevalence of FM in our study was 5-fold lower than a previous report. This variance may be due to (1) racial and sociocultural differences between populations; and (2) differences in methodological approach. The difficulties of making accurate estimates of FM across different studies are highlighted.     

Anorexia nervosa in children: a follow-up study

Thirty children seen between 1954 and 1970 with the diagnosis of anorexia nervosa were contacted between five and twenty years after initial treatment. Patients outcomes in terms of education, weight in adulthood, medical problems, marriage, psychiatric treatment, and recurrence of anorexia were surveyed. Results corroborate those of earlier studies suggesting that adjustment in adulthood is related to personality type.     

Chronic hepatitis C in children: a clinical and immunohistochemical comparative study with adult patients

A retrospective analysis of clinical and laboratory data was made of all in-vitro fertilization (IVF) patients with tubal pathology who had their first ever embryo transfer cycle between January 1st, 1992 and September 1st, 1996. The aim of the study was to determine the effect of the presence of a hydrosalpinx, whether or not visible by ultrasound, on pregnancy, multiple pregnancy and implantation rates in our patient population. The IVF success rate was also analysed by calculating cumulative ongoing pregnancy rates of the same patient group using the lifetime table approach. In the presence of an ultrasound-visible hydrosalpinx, rates of pregnancy and multiple pregnancy appeared reduced, but the differences were not significant. The rates of implantation, clinical implantation and ongoing implantation were significantly lower in the presence of an ultrasound-visible hydrosalpinx (odds ratios 0.33-0.46, C.I. 0.21-0.96). The cumulative chance of achieving an ongoing pregnancy after one or more IVF cycles was significantly reduced in the presence of an ultrasound-visible hydrosalpinx (relative hazard 0.36, C.I. 0.22-0.59). In the presence of a hydrosalpinx not visible by ultrasound the IVF outcome was not reduced. This retrospective study confirms that patients with hydrosalpinges have an impaired IVF outcome. Unique to this study and previously unobserved is the finding that there is a subgroup of patients with hydrosalpinges, those with ultrasound-visible hydrosalpinges, which is exclusively responsible for this impaired outcome.     

Digital replantation in children: a long-term follow-up study

Symptoms of conduct disorder (CD), antisocial personality disorder (ASP), alcohol abuse, drug abuse, and somatization were tabulated for the families of 35 delinquent, substance-abusing (multiple-problem) adolescent male probands and 35 age-matched control males. Alcohol abuse, CD/ASP, and somatization were assessed with either the Diagnostic Interview Schedule (DIS) (for participants aged 18 and up) or the Diagnostic Interview for Children and Adolescents (DICA) (for participants aged 12 to 17). Drug abuse for all participants was assessed with the Substance Abuse Module (SAM) of the Comprehensive Interview for Diagnostic Evaluation (CIDE). As expected, proband groups had significantly more (p < .0001) CD/ASP, alcohol abuse, and drug abuse symptoms than control groups. A significant (p < .01) positive correlation among CD/ASP, alcohol abuse, and drug abuse was found for each group. Somatization was not differentially associated with proband status. It was concluded that identifying male multiple-problem youths also identifies families with a high incidence of similar problems.     

Clinical approach to inherited peroxisomal disorders: a series of 27 patients

To illustrate the clinical and biochemical heterogeneity of peroxisomal disorders, we report our experience with 27 patients seen personally between 1982 and 1997. Twenty patients presented with a phenotype corresponding either to Zellweger syndrome, neonatal adrenoleukodystrophy, or infantile Refsum disease, 3 of whom had a peroxisomal disorder due to a single enzyme defect. One patient had a mild form of rhizomelic chondrodysplasia punctata, 1 had classic Refsum disease. Finally, 5 patients presented with clinical manifestations that were either unusually mild or completely atypical, and initially did not arouse suspicion of a peroxisomal disorder. They showed multiple defects of peroxisomal functions with one or several functions remaining intact, suggesting a peroxisome biogenesis disorder. The defect in peroxisome biogenesis was further characterized by variable expression in different tissues and/or individual cells in 5 patients. Studies restricted to fibroblasts failed to identify abnormalities in this group. We demonstrate that clinical manifestations of peroxisomal disorders may be very mild or completely atypical, and therefore, peroxisomal disorders should be considered in a variety of clinical settings. Furthermore, we suggest performing extensive peroxisomal investigations in every patient suspected of suffering from a peroxisomal disorder, even when the clinical presentation is typical.     

Anxious children in adulthood: a prospective study of adjustment

OBJECTIVE: To prospectively examine psychosocial functioning in young adulthood for children and adolescents with anxiety disorders. METHOD: This 8-year prospective study compared psychosocial functioning in young adults (mean age 22 years) who had histories of early-onset anxiety disorders, comorbid anxiety and depressive disorders, or no history of psychiatric illness (NPI). Follow-up interviews assessed subjects' residential, educational, occupational, and marital status; utilization of mental health services; and psychological status RESULTS: Anxious subjects without histories of depression were less likely than NPI controls to be living independently. Anxious-depressed subjects were less likely than controls to be working or in school; more likely than purely anxious subjects to utilize mental health services; and more likely than both anxious and control subjects to report psychological problems, most frequently depression. CONCLUSIONS: Overall, results suggest that children with anxiety disorders are relatively well adjusted in young adulthood. However, a history of comorbid depression is prognostic of a more negative outcome.     

Sublingual midazolam premedication in children: a dose response study

Regarding the development of a centrifugal blood pump to be connected directly with small diameter tubings for pediatric use while minimizing hemolysis, we have studied the inlet port side configurations of a pump using both a hemolysis test and computational fluid dynamics (CFD) analysis. We have conducted a hemolysis test on 2 models. The tapered shape inlet has proven to be lower in the index of hemolysis (IH) than the straight shape. CFD analyses utilizing expanded flow paths indicated that the flow velocity decreased as the fluid path became larger within the tapered nozzle. When entering the pump chamber, the flow rushed in at a greater velocity through the straight nozzle due to its small diameter. The straight shape showed an abrupt change in pressure around the entrance of the pump chamber while the tapered shape did not. The flow inlet angle of the straight model was observed to be larger than that of the tapered model because of its smaller turning radius.     

Crossing the midline: a study of four-year-old children

Selenomethionine, an amino acid occurring in proteins in place of methionine, reacts efficiently with oxidants, e.g., peroxynitrite, a biological oxidant generated in inflammatory states, to produce the oxidation product, methionine selenoxide. The present work describes the rapid and efficient reduction of the selenoxide to selenomethionine by glutathione in a stoichiometric reaction utilizing two equivalents of thiol. This nonenzymatic reaction establishes a defense line against peroxynitrite or other oxidants by selenomethionine residues in proteins, maintained by the ubiquitous thiol, glutathione.     

Eosinophilic pleurisy (a study of 27 cases)

After reviewing the specific literature mainly on cytokines role in eosinophilic pleural chemotaxis, the study on 27 cases of eosinophilic pleurisy is presented. Only 3 cases were malignant pleurisies. The ratio between blood and pleural fluid eosinophils has no semiologic significance. Tuberculosis and parasitoses have no special significance. Autonomous eosinophilic pleurisies are regarded as a distinct nosologic entity. Their prognosis is favourable. The glucocorticoids are the choice treatment.