Efecto de dosis altas de budesonida y función suprarrenal de niños asmáticos severos / High doses of inhaled budesonide and adrenal function in children with severe asthma

Background: The use of inhaled steroids is common in the treatment of bronchial asthma in children. Aim: To assess adrenocortical function in children with severe asthma receiving inhaled budesonide for six or more months. Material and methods: Children with severe asthma that required 800 µg/day or more of inhaled budesonide and that did not required systemic steroids for more than six days in the last four months to control their disease, were studied. Serum cortisol was measured one hour after administration of 0.25 mg of ACTH (Cosyntropin®) intravenously. The test was considered normal if post stimulation serum cortisol was over 18 µg/ml. Results: Twenty children (aged 5 to 14 years, 15 males), were studied. The stimulation test was normal in 17 children. Conclusions: Alterations in adrenal function are present in a small proportion of asthmatic children who require 800 µg/day of inhaled budesonide.

Densitometría ósea en niños leucémicos al completar el primer mes de quimioterapia / Bone mineral density in leukemic children after completing one month of chemotherapy

Background: An important loss of bone mineral density, associated to pain and fractures, has been reported in children with acute lymphoblastic leukemia (ALL). Aim: To measure bone mineral density among children with acute lymphoblastic leykemia (ALL) that completed the remission induction phase with chemotherapy, that lasts 30 days. Patients and methods: children with ALL, admitted to the oncology unit of a general hospital were considered eligible for the study. body composition and bone mineral density were measured by dual energy x ray absorptiometry (DEXA). each child with ALL was paired with a healthly control. Results: Fourteen children age 1 to 11 years, completed the study, Spine and femoral bone mineral desities were significantly lower than in their matched controls. No differences in total body bone mineral density or content were observed. Children with ALL had a lower fat free mass and a higher fat mass than their matched controls. There was a significant correlation between fat free mass and bone mineral content. Conclusions: After one month of chemotherapy, children with ALL had a lower bone mineral density in the spine and femur and a lower fat free mass.

Tiroiditis aguda supurada en un paciente pediátrico / Acute suppurative thyroiditis: report of a pediatric case

Acute suppurative thyroiditis (AST) is an uncommon condition because thyroid gland is remarkably resistant to infections. In children, anatomic defects such as a left pyriform sinus fistula or a thyroglossal duct remnant predispose to this infection. Once the diagnosis is confirmed by ultrasound or computed tomography, antimicrobial therapy based on the culture and Gram staining must be started. After two or three weeks of treatment, predisposing anatomic defects must be sought cautiously. We report a 13 years old girl presenting with cervical pain and fever. A cervical ultrasound showed an enlarged thyroid lobule with hypoecogenic zones that suggested a supurative collection. Cefotaxime and cloxacillin were started. A needle aspiration of the collection obtained a purulent material. The culture of this material yielded a Streptococcus Pneumoniae. The clinical condition of the patient improved and she was discharged in good conditions. Two months later a contrast esophagus X ray did not show predisposing anatomic defects.

Densidad mineral ósea en escolares nacidos prematuros / Bone mineral density in school age children born preterm

The age at which children born preterm normalize their bone mineral density, is not well known. Aim: To study if children born preterm have normalized their bone mineral density at age 5 to 7 years. Patients and methods: Twenty six infants born preterm (14 male), were studied at age 5 to 7 years. Birth weight, present weight and height, bone age, calcium and phosphate intake at the first year of life and at the current age were assessed. Bone mineral density was measured by single photon X ray absorptiometry in the dominant forearm. A blood sample was obtained to measure insulin growth factor 1 (IGF-1). As a control group, 105 healthy age-paired infants born at term, were studied. Results: Bone mineral density was significantly lower in infants born preterm than in their term counterparts (0.273±0.01 g/cm2 and 0.302±0.01 g/cm2 respectively, p <0.001). There was a positive correlation between bone mineral density and IGF-1 (r=0.49, p=0.01). No correlation with the other measured parameters was observed. Conclusions: Infants that were born preterm have a lower bone mineral density at 5 to 7 years of age than their term controls. Bone mineral density correlates with IGF-1 (Rev Méd Chile 2003; 131: 1289-94).