Jorge Las Heras B

Colitis eosinofílica por alergia a proteína de leche de vaca

Eosinophilic colitis is one of the clinical manifestations of allergy to cows milk during the first year of life. We report a series of 9 infants who, under 9 months of age and while clinically well, presented rectal bleeding of variable magnitude, with or without diarrhea, shortly after a cows milk-based formula was initiated (n = 6); yet, 3 cases received only breast feeding. Bleeding disappeared in all patients after milk withdrawal from the diet. Challenges were planned after 12 months of treatment; three patients have not yet reached this moment, 3 had a negative challenge at 12, 18 and 28 months of age and are on a complete diet, and 3 are still on cows milk free diet because ingestion of milk at 12, 18 and 25 months still induced rectal bleeding. This series of patients gathered in 3 years, follows the trend reported in many countries that there is a relative increase of patients diagnosed with allergy conditions early in life.

Síndrome nefritis intersticial aguda y uveitis

A nine year old male patient was admited to a metropolitan general hospital at Santiago, Chile, because ofunexplained severe anemia (hematocrit 18%) and redness of the right eye. Uveitis was confirmed by ophthalmologi-cal examination. Laboratory work up showed an erithrocyte sedimentation rate of 101 mm • h, marked nitrogenretention (BUN 91 mg/dl), creatinine clearance was 9 ml/rnin • 1,73 sq m, serum IgG and IgM immune globulinconcentrations were 2,368 mg/dl and 263 mg/dl respectively, over the normal range for age, with almost absentserum IgA and reduced T cell populations. Negative rheumathoid factor, antinuclear antibodies and anti smoothmuscle antibodies reactions were obtained, together with normal levels of €3 and C^ fractions of complementand normal urine sediment. Renal biopsy specimen included 25 glomerulae, one of them was wholy sclerotic, anothertwo had periglomerular fibrosis and the remaider showed only slightly increased mesangial matrix. Heavymononuclear inflammatory interstitial infiltration, with granulomatous structures including giant multinuclear cellsas those seen in foreign body reactions (fig 1) and PAS possitive intraluminal tubular crystals were also observed.In spite of steroidal treatment, which was complicated by an inflammatory brain granuloma that healed in co-incidence with parenteral antibiotic therapy, the patient evolved toward chronic renal failure. We think that theavailable evidence strongly suggests an immunological disorder as a very likely explanation for this case.(Key words: interstitial nephritis, uveitis.)

Ictericia colestásica del primer trimestre de vida

The records ot 5 ] patients with neonatal cholestasis, which were seen from January 1980 throughout July 1991 , were rewieved to stimulate timely diagnosis and therapy. Clinical features, laboratory findings and final diagnosis are described. Fifty three percent of the patients were refeied to the gaslroenterology unit at or after age two months even though 65% of the whole sample had acholia. The differentiation between intrahepatic and extra hepatic... bile duel, disease was based on hislopatologic features, hepatic scintigrafy and evolution. Among forty two patients with intrahepatic cholestasis, twenty two had idiopatic neonatal hepatitis and twenty had specific etiologies. Of nine paiienis with extrahepalic disease, eight had biliary atresia and the other one had an extrinsic cornpfesion of the billiary tree, caused by local and limph node Inflamatory reaction. The outcome of the patients with intrahepatic disease was satisfactory in 30 cases, which are already alive and without hepatic dammage. Only one of the nine patients wilh extrahepatic bile duct disease survived at the end of this study.

Nefroblastoma quístico parcialmente diferenciado

The case of a patient with a cystic partially differentiated nephroblastoma (CPDN) is reported, Careful his-tological study is essential to distinguish CPDN and other types of multicystic kidneys (specially cystic nephromaor multilocular cyst of the kidney). Because of the rare potential for aggresive behavior of this tumor, nephrec-tomy alone is the therapy of choice. However, its relationship with WHms tumor is an indication for a regularclinical follow up.(Key words: tumors, k idney, cystic partially differentiated nephroblastoma.)

Linfangiectasia Intestinal Secundaria a Pericarditis Constrictiva

A patient with intestinal lymphangiectasia secondary to constructive pericarditis is reported. He presented with retarded growth, asymmetrical and generalized oedema, low serum proteins, lymphopenia and low serum gammaglobulin. The diagnosis was based on the observation of dilated lacteals of the villi in a biopsy of intestinal mucosa and by the augmented excretion of Cr-51 labelled proteins in the feccs. Echocardiographic findings were compatible with constrictive pericarditis. The diagnosis was confirmed at surgery, which was follovcd by clinical improvement. (

Nasopharyngeal Carcinoma in a boy

A 1 3 yeat old girl was seen because of persistent upper respiratory symptoms and bilateral cervical lymph nodeenlargement Needle aspiration of a right pharyngeal tumor, biosy, computed axial tomography, thorax and bone X rayfilms were compatible with a stage IV nasopharrygeal carcinoma, Serological evidence of previous infection by EpsteinBair virus was also found. Some lymph node enlargement persisted after appropriate radiation therapy, but goodsubsequent response to chemotheraphy was observed. This malignancy has low incidence in pediatric patients.Diagnosis is based on computed axia! tomography of the nasopharyngeal region and biopsy of tumoral mass or involvedlymph nodes. There is a frequent association with previous Epslein Barr virus infection. Prognosis depends on clinicalstage of the disease and current treatment consist in irradiation and chemotherapy.(Key words: Nasopharingeal neoplasm, carcinoma, Ebstein Barr virus.]