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Intravenous Immunoglobulin Treatment in Children with Guillain-Barre Syndrome

Guillain-Barre syndrome is an acquired demyelinating polyneuropathy that is presumed to be immune-mediated. On the basis of this assumption, intravenous immunoglobulin (IVIG) has been used in the treatment of Guillain-Barre syndrome in recent years and found to be effective. To test this we performed a randomized study in patients with Guillain-Barre syndrome by giving IVIG (1 g/kg body weight per day over 2 consecutive days) in 9 children who were compared with 9 patients who were observed but not given specific therapy. We concluded that intravenous immunoglobulin is a safe and effective treatment for childhood Guillain-Barre syndrome which shortens the time to recovery.

Acute immune thrombocytopenic purpura: A comparative study of very high oral doses of methylprednisolone and intravenously administered immune globulin☆☆☆★

We compared very high doses of methylprednisolone with intravenously administered immune globulin for treatment of acute idiopathic thrombocytopenic purpura. Fifty-seven children were randomly assigned to receive the immune globulin preparation, 0.5 gm/kg per day for 5 consecutive days (n = 19), orally administered methylprednisolone, 30 mg/kg per day for 7 days (n = 19), or orally administered methylprednisolone, 50 mg/kg per day for 7 days (n = 19). There were no differences in the response of the platelet counts among the groups. We conclude that these two therapies were equally effective; choice between them may be made according to cost and therapy-related risks.

Hypersensitivity vasculitis induced by cefoperazone/sulbactam

BackgroundCefoperazone has not been reported to cause vasculitic complications before. Here, we report a case of hypersensitivity vasculitis associated with cefoperazone/sulbactam.Case presentationA 13-year-old girl with appendicitis developed hypersensitivity vasculitis on the fifth day of cefoperazone/sulbactam therapy. Hypersensitivity vasculitis resolved gradually after removal of the agent on the seventh day and did not recur. Although hypersensitivity vasculitis has multiple causes, coexistence of hypersensitivity vasculitis and cefoperazone treatment, and the quite resolution of the disease after removal of the drug, strongly favours a causative relationship.ConclusionTo our knowledge, this is the first report of a hypersensitivity vasculitis associated with cefoperazone.

Cardiac involvement due to Salmonella typhi infections in children

Sixty-six patients with Salmonella typhi infections were evaluated in terms of cardiological events in the Department of Pediatrics of Ondokuz Mayis University Hospital for a period of 14 years. Cardiac involvement is described in three cases of typhoid fever during that time. One patient had myocarditis only but another two cases had myocarditis and pericarditis. In addition to antibiotic therapy, pericardiocentesis and pericardiectomy were used. We present three cases of myocarditis caused by Salmonella typhi infections.

Factors Affecting Prognosis of Neonatal Tetanus

Neonatal tetanus is associated with a high mortality rate, despite intensive care. Although it can be prevented by immunization of expectant mothers and by good hygiene and asepsis during delivery, neonatal tetanus is still a common cause of neonatal mortality in underdeveloped countries. In our study, hospital records of 133 newborns with neonatal tetanus were evaluated to identify the possible factors affecting prognosis of neonatal tetanus; 79 were males and 56 females, and 54 (41.6%) of the 133 died. Sex and birth weight did not affect the prognosis. As a result of our study, we found that age on admission < 10 days, symptoms < 5 days and presence of risus sardonicus and fever indicate a poor prognosis in neonatal tetanus.

The value of immunoglobulin and complement levels in the early diagnosis of neonatal sepsis

Serum IgG, IgGl, G2, G3, G4, IgM, C3c and C4 concentrations were measured in 24 term neonates with sepsis and 17 healthy normal neonates of similar age, sex and weight (control group). The serum IgG, IgG1, G2, G3, G4, IgM, C3c, and C4 levels were similar in the patients with sepsis and the control group (p > 0. 05). In the neonates with sepsis, serum IgG, G1, G2, IgM and C4 levels were not significantly different between the 1st and 10th days, while there were significant differences for IgG3, G4 and C3c (p < 0. 05). We conclude that the serum levels of IgG, IgG1, G2, G3, G4, IgM, C3c and C4 concentrations are of no value for the early diagnosis of neonatal sepsis.

Cecal duplications: a rare cause for secondary intussusception.

Duplications of the alimentary tract are rare congenital anomalies that mayoccur at any level from mouth to anus. While the oesophagus and the ileum are the most common sites, duplications of the colon are rare. Two cases of ileocolic intussusceptions in 8-month-old girl and 6-month-old boy who were admitted to our hospital with acute abdomen findings are presented. Intraoperatively, cecal cystic duplications leading intussuception were revealed. Intussusception is one of the most important surgical emergence in infancy and typically, it does not involve a lead point in childhood. Although duplication cyst may act as lead point, the review of literature reveals its rarity.

Significance of Pleural Fluid Cholesterol and Beta-2 Microglobulin Levels for the Differentiation of Pleural Effusions in Childhood

We studied 60 children, ages 3-15 years, with pleural effusions to determine the usefulness of different criteria for the separation of transudates from exudates. Twenty of these effusions were classified as transudates and 40 as exudates. Pleural cholesterol (P chol), pleural/serum cholesterol ratio (P/S chol), and pleural/serum 12 microglobulin (P/S 12 m) were determined to characterize pleural effusions and were compared with Lights criteria (pleural/serum protein ratio, pleural LDH, pleural/serum LDH ratio). With a threshold of 0.3, the sensitivity and specificity of P/S chol for diagnosis of exudates were 95 and 90%, respectively. With a threshold of 1.3, the sensitivity of P/S 12 m was 77.5%, and its specificity was 95%. Our findings indicate that determination of P chol and P/S chol, as well as Lights criteria, is of value for characterizing pleural effusions in childhood, but the measurement of P/S 12 m is less sensitive in distinguishing transudates from exidates and it should not be used routinely.

Effects of ascaris infection on iron absorption in children.

Twenty-six Ascaris-infected children and 21 control children (10 of whom had iron-deficiency anaemia) were subjected to haematological and oral iron absorption tests. The levels of oral iron absorption by the infected children and by the healthy controls were similar, whereas the level of absorption by the children with iron deficiency anaemia was relatively high. It therefore appears that Ascaris infection does not lead to iron malabsorption and iron deficiency anaemia in children.

Postpneumonic empyema in childhood

Fifty-six patients with postpneumonic empyema were treated by sulbactam/ampicillin or cephalothin and netilmicin. Dose of sulbactam/ampicillin was 200mg/kg per day and of cephalothin was 200mg/kg per day, and of netilmicin was 5mg/kg per day. Sulbactam/ampicillin alone was used in 27 patients. Twenty-nine patients were treated with cephalothin plus netilmicin. Days on intravenous antibiotics, days with chest tube, decortication rate, and duration of hospitalization were significantly shorter in sulbactam/ampicillin treatment group compared to cephalothin plus netilmicin group. This study shows that sulbactam/ampicillin is a safe and effective agent in the treatment of postpneumonic empyema in childhood.