Antranik Manissadjian

Meningite bacteriana no período neonatal evolução clínica e complicações em 109 casos: clinical evolution and complications in 109 cases

Bacterial meningitis has special clinical features in the newborn infant. Major complications and sequelae result from the infectious involvement of the CNS in the majority of these children. We studied 109 newborn infants with bacterial meningitis accompanied from January 1977 to April 1987. The mortality rate was 34.8%. Perinatal risk factors were not found. The majority (80.5%) were term newborn infants. The main signs at admission were convulsion (53.2%), bulging fontanel (37.6%) and apnea (20.2%), and the main symptoms were neurosensorial depression (64.2%), nursing refuse (64.2%), fever (50.5%) and irritability (35.8%). Complications during hospitalization were ventriculitis (34.9%), inappropriate antidiuretic hormone secretion syndrome (27.5%), subdural collection (8.3%), brain abscess (4.6%) and brain infarction (2.8%). Inappropriate antidiuretic hormone secretion syndrome and ventriculitis were closely associated with high mortality. Seventy one children survived: 44 (62%) had gross abnormalities at the neurologic examination, and 29 (40.8%) developed hydrocephalus. Neurological follow-up of these children is important. Prognostic can change along the course of long time follow-up.Bacterial meningitis, has special clinical features in the newborn infant. Major complications and sequelae result from the infectious involvement of the CNS in the majority of these children. We studied 109 newborn infants with bacterial meningitis accompanied from January 1977 to April 1987. The mortality rate was 34.8%. Perinatal risk factors were not found. The majority (80.5%) were term newborn infants. The main signs tat admission were convulsion (53.2%), bulging fontanel (37.6%) and apnea (20.2%), and the main symptoms were neurosensorial depression (64.2%), nursing refuse (64.2%), fever (50.5%) and irritability (35.8%). Complications during hospitalization were ventriculitis (34.9%), inappropriate antidiuretic hormone secretion syndrome (27.5%), subdural collection (8.3%), brain (abscess (4.6%) and brain infarction (2.8%). Inappropriate antidiuretic hormone secretion syndrome and ventriculitis were closely associated with high mortality. Seventy one children survived: 44 (62%) had gross abnormalities at the neurologic examination, and 29 (40.8%) developed hydrocephalus. Neurological follow-up of these children is important. Prognostics can change along the cours of long time follow-up.Bacterial meningitis, has special clinical features in the newborn infant. Major complications and sequelae result from the infectious involvement of the CNS in the majority of these children. We studied 109 newborn infants with bacterial meningitis accompanied from January 1977 to April 1987. The mortality rate was 34.8%. Perinatal risk factors were not found. The majority (80.5%) were term newborn infants. The main signs tat admission were convulsion (53.2%), bulging fontanel (37.6%) and apnea (20.2%), and the main symptoms were neurosensorial depression (64.2%), nursing refuse (64.2%), fever (50.5%) and irritability (35.8%). Complications during hospitalization were ventriculitis (34.9%), inappropriate antidiuretic hormone secretion syndrome (27.5%), subdural collection (8.3%), brain (abscess (4.6%) and brain infarction (2.8%). Inappropriate antidiuretic hormone secretion syndrome and ventriculitis were closely associated with high mortality. Seventy one children survived: 44 (62%) had gross abnormalities at the neurologic examination, and 29 (40.8%) developed hydrocephalus. Neurological follow-up of these children is important. Prognostics can change along the cours of long time follow-up.

Teniposide plus cytarabine as intensification therapy and in continuation therapy for advanced nonlymphoblastic lymphomas of childhood.

PURPOSE AND METHODS Thirty-nine consecutive children (age, 2 to 11 years) with nonlymphoblastic (NL) lymphomas were treated uniformly with chemotherapy based on the LNH-II-85 protocol. The protocol consisted of a remission-induction phase that lasted 30 days and started with cyclophosphamide (CTX) 1.2 g/m2 on day 1, followed by vincristine (VCR) 1.5 mg/m2 on days 3, 10, 17, and 24, daunomycin (DAUNO) 60 mg/m2 on days 12 and 13, and prednisone 40 mg/m2/d for 30 days. If a complete remission was achieved, an intensification regimen was given that consisted of eight courses of teniposide (VM-26) 165 mg/m2 plus cytarabine (ARA-C) 300 mg/m2 every 4 days according to bone marrow tolerance. A continuation phase was subsequently started, with alternating courses of thioguanine (6-TG) 300 mg/m2/d for 4 days plus CTX 1.2 g/m2 on day 5; hydroxyurea 2.5 g/m2/d for 4 days plus DAUNO 45 mg/m2 on day 5; VCR 1.5 mg/m2 plus methotrexate (MTX) 120 mg/m2 (24 hours apart); mercaptopurine (6-MP) 500 mg/m2/d for 4 days plus MTX 40 mg/m2; and VM-26 plus ARA-C for 3 courses (4 days apart), by the end of 48 weeks. CNS prophylaxis consisted of intrathecal administration of MTX, ARA-C, and dexamethasone according to age, administered three times during remission induction and every 6 weeks afterwards. RESULTS By the end of the analysis in July 1991, 38 of 39 patients had attained a complete remission and 36 were event-free survivors. Two failures that occurred after completion of therapy were second malignancies (acute lymphocytic leukemia and acute nonlymphocytic leukemia). CONCLUSION These results are significantly better than those obtained with less intensive former regimens performed in our institution before the availability of VM-26. The favorable impact of an intense consolidation phase with VM-26 is remarkably exemplified by three additional patients not included in this study whose families withdrew them from therapy after the intensification phase, all three of whom have been in remission.

A serological inquiry for the detection of antibodies against the Human Immunodeficiency Virus (HIV) in children in a general ward

Sao apresentados os resultados de um inquerito sorologico para a deteccao de anticorpos contra o Virus da Imunodeficiencia Humana (VIH), em grupo nao selecionado de criancas, internadas numa enfermaria geral de pediatria. Foram testados 441 pacientes pelo metodo ELISA, com uma positividade de 1,1 %, cujos resultados foram confirmados pelos testes de Western-Blot e/ou ImunoBlot. Nenhum dos cinco pacientes com teste positivo apresentou historia de transfusao anterior, enquanto que 4,3% dos pacientes estudados apresentaram historia transfusional. Todas as maes apresentaram tambem testes ELISA positivos. Em quatro casos, pelo menos um dos genitores referiu uso de drogas por via endovenosa. Em todas as criancas, o modo de transmissao foi vertical. A partir desses achados sugere-se a necessidade de a equipe de saude tomar precaucoes quando da manipulacao de sangue ou secrecoes. Recomenda-se a realizacao de inqueritos anonimos em enfermarias de hospitais gerais para auxiliar na determinacao da real prevalencia das infeccoes pelo VIH.The results of a serum inquiry for detection of antibodies against the Human Immuno-deficiency Virus in a non selected group of children, patients of a general pediatric ward, are reported. Of the 441 cases, the ELISA test gave a positive result for 1.1% of them. This result was confirmed by the Western-Blot or ImmunoBlot test. None of the five children who tested positive had a previous history of blood transfusion. These childrens mothers showed positive results to the ELISA test. Of four cases, at least one of the parents was IV drug addicted. In every case the transmission was vertical. On the basis of these findings, it is suggested that hospital staff should take the necessary precautions when manipulating blood and secretions and it is recommended that serum inquiries be made on the wards of general hospitals in the attempt to establish reliable data on the prevalence of HIV.

Inquérito sorológico para a detecçäo de anticorpos contra o vírus da imunodeficiência humana (VIH) em crianças internadas em enfermaria geral

Sao apresentados os resultados de um inquerito sorologico para a deteccao de anticorpos contra o Virus da Imunodeficiencia Humana (VIH), em grupo nao selecionado de criancas, internadas numa enfermaria geral de pediatria. Foram testados 441 pacientes pelo metodo ELISA, com uma positividade de 1,1 %, cujos resultados foram confirmados pelos testes de Western-Blot e/ou ImunoBlot. Nenhum dos cinco pacientes com teste positivo apresentou historia de transfusao anterior, enquanto que 4,3% dos pacientes estudados apresentaram historia transfusional. Todas as maes apresentaram tambem testes ELISA positivos. Em quatro casos, pelo menos um dos genitores referiu uso de drogas por via endovenosa. Em todas as criancas, o modo de transmissao foi vertical. A partir desses achados sugere-se a necessidade de a equipe de saude tomar precaucoes quando da manipulacao de sangue ou secrecoes. Recomenda-se a realizacao de inqueritos anonimos em enfermarias de hospitais gerais para auxiliar na determinacao da real prevalencia das infeccoes pelo VIH.The results of a serum inquiry for detection of antibodies against the Human Immuno-deficiency Virus in a non selected group of children, patients of a general pediatric ward, are reported. Of the 441 cases, the ELISA test gave a positive result for 1.1% of them. This result was confirmed by the Western-Blot or ImmunoBlot test. None of the five children who tested positive had a previous history of blood transfusion. These childrens mothers showed positive results to the ELISA test. Of four cases, at least one of the parents was IV drug addicted. In every case the transmission was vertical. On the basis of these findings, it is suggested that hospital staff should take the necessary precautions when manipulating blood and secretions and it is recommended that serum inquiries be made on the wards of general hospitals in the attempt to establish reliable data on the prevalence of HIV.

Chromosomal translocation in a mongoloid male child and his normal mother

The presence of a translocation 21/13-15 is related in 46 chromosomes, karyotypes of a mongoloid male child (Downs syndrome). The abnormal chromosome was transmitted by the mother of the patient. The possible deficiency of translocated chromosome 21 and the possible origin of the anomaly in the family was discussed and the presence of a markedly large Y chromosome in the karyotypes of the patient as in those of his father was also noted.

Estado de mal epiléptico em crianças: experiência clínica com o difenilidantoinato de sódio por via parenteral

Os autores realizaram experiencia clinica empregando o difenilidantoinato de sodio em criancas com estado de mal epileptico. Analisam os resultados da acao do medicamento em funcao da idade, tempo de duracao do estado de mal e presenca, ou nao, de hipertermia. Concluem pela inocuidade do medicamento e pela sua eficiencia em um numero de casos (72,3%) suficiente para justificar a sua utilizacao como recurso terapeutico de escolha em casos de estado de mal epileptico.Report on the use of sodium diphenylhydantoin in the management of status epilepticus in children. The data obtained are correlated with age groups, duration of the status epilepticus and hyperthermia. The results indicate that the drug is safe and efficient in a large number of cases (72.3%), justifying its use as a choice drug.

Serological survey for the detection of HIV antibodies in children in a general hospital ward.

Sao apresentados os resultados de um inquerito sorologico para a deteccao de anticorpos contra o Virus da Imunodeficiencia Humana (VIH), em grupo nao selecionado de criancas, internadas numa enfermaria geral de pediatria. Foram testados 441 pacientes pelo metodo ELISA, com uma positividade de 1,1 %, cujos resultados foram confirmados pelos testes de Western-Blot e/ou ImunoBlot. Nenhum dos cinco pacientes com teste positivo apresentou historia de transfusao anterior, enquanto que 4,3% dos pacientes estudados apresentaram historia transfusional. Todas as maes apresentaram tambem testes ELISA positivos. Em quatro casos, pelo menos um dos genitores referiu uso de drogas por via endovenosa. Em todas as criancas, o modo de transmissao foi vertical. A partir desses achados sugere-se a necessidade de a equipe de saude tomar precaucoes quando da manipulacao de sangue ou secrecoes. Recomenda-se a realizacao de inqueritos anonimos em enfermarias de hospitais gerais para auxiliar na determinacao da real prevalencia das infeccoes pelo VIH.The results of a serum inquiry for detection of antibodies against the Human Immuno-deficiency Virus in a non selected group of children, patients of a general pediatric ward, are reported. Of the 441 cases, the ELISA test gave a positive result for 1.1% of them. This result was confirmed by the Western-Blot or ImmunoBlot test. None of the five children who tested positive had a previous history of blood transfusion. These childrens mothers showed positive results to the ELISA test. Of four cases, at least one of the parents was IV drug addicted. In every case the transmission was vertical. On the basis of these findings, it is suggested that hospital staff should take the necessary precautions when manipulating blood and secretions and it is recommended that serum inquiries be made on the wards of general hospitals in the attempt to establish reliable data on the prevalence of HIV.

Distúrbios neurológicos e electrolíticos em nefrótico após diurese rápida provocada pelo ACTH

Report of a case of a 10 year old nephrotic boy that developed convulsions progressing to a coma, severe electrocardiographic and electroencephalographic changes, hyponatremia, hypokalemia, hypochloremia and alkalosis following massive diuresis secondary to the administration of ACTH. The patient remained with a convulsive disorder and a right lateral homonymous hemianopsia. The mechanism of those severe disturbances is commented on.