Isoniazid and hypoglycaemia in a premature infant.

Severe hypoglycaemia requiring more than 20 mg/kg per minute glucose infusion was seen in a premature infant. The infant was born to a woman with active tuberculosis, and she was on prophylactic isoniazid. Discontinuation of isoniazid resulted in prompt recovery of hypoglycaemia. Further pharmacological studies may be needed to establish a cause and effect relationship.

Biological considerations in locally advanced breast cancer treated with anthracycline-based neoadjuvant chemotherapy: thymidine labelling index is an independent indicator of clinical outcome.

The present retrospective study aims to determine the clinical value of thymidine labelling index (TLI) together with other established clinical and biological factors in 116 locally advanced breast cancer (LABC) patients treated with anthracycline-based neoadjuvant chemotherapy, surgery, adjuvant chemotherapy and radiotherapy. TLI was determined in 71 LABC patients with a median of 2.62% (0-23.64%) and a mean of 4.71% +/- 5.54. As a result of neoadjuvant chemotherapy, 85 patients (73%) responded to chemotherapy (CT), whereas 31 patients were unresponsive (27%). No relationship has been found between the pretreatment biological variables including TLI, estrogen receptor (ER), progesteron receptor (PgR) status and clinical parameters such as the chemotherapy response rates and axillary lymph node involvement following chemotherapy. Median follow-up was 35 months (18-97 months) and the 3-year overall survival (OS) and disease free survival (DFS) rates were 71.6% and 52.2%, respectively. In univariate analysis, patients with inflammatory breast cancer, high TLI-index (> or = 2.62%), lymph node (LN) positivity or > 3 positive lymph nodes following neoadjuvant chemotherapy and without any response to neoadjuvant chemotherapy were found to have worse DFS and OS-rates and high local and systemic recurrence rates. In multivariate analysis, TLI was estimated as the most powerful independent factor affecting the OS in LABC patients among the other established clinical and biological parameters (p = 0.02). These results suggest that TLI is an important independent indicator of clinical outcome in patients with LABC and these patients with high TLI levels require more effective treatment modalities.

Congenital sialidosis.

Congenital sialidosis is a rare disease resulting from the absence of neurominidase and presenting with hydrops fetalis, hepatosplenomegaly, dysmorphic features, vacuolated lymphocytes and extensive vacuolation of the connective tissue. Elevated levels of sialooligosaccharides in the urine is characteristic. We describe a newborn baby with congenital sialidosis and discuss the difficulties in reaching the diagnosis.

Alternative therapies for neonatal autoimmune thrombocytopenia.

OBJECTIVE: This study was performed to test whether corticosteroids were superior to intravenous immunoglobulins (IVIG) in the treatment of neonatal autoimmune thrombocytopenia (NAT). METHODS: All cases received IVIG, and unresponsive cases received corticosteroids. RESULTS: Of 7 babies who received IVIG, only 1 responded. The 6 remaining cases received corticosteroids thereafter, and all of them responded well to this therapy. CONCLUSIONS: Corticosteroids may be more effective than IVIG in NAT.

Neonatal septicemia in a neonatal intensive care unit. Results of four years.

The outcome of congenital and nosocomial septicemia has been documented in infants who were admitted to a neonatal intensive care unit over a four-year period. The overall incidence of neonatal septicemia in the neonatal intensive care unit was 5.4 percent. Common causes of neonatal septicemia were gram-negative bacilli and staphylococci. Gram-positive microorganisms were the major causative agents for early-onset septicemia. Since the most common pathogen in cases of nosocomial sepsis was gram-negative bacillus, higher mortality rates were observed in nosocomial sepsis. The overall mortality rate in neonatal sepsis was 44.2 percent. The mortality rate in infants in whom nosocomial septicemia developed was significantly higher than in the infants in whom early-onset septicemia developed. However, as gram-negative colonization of the nursery recently changed to gram-positive microorganisms, the mortality rate is hoped to decrease.

Management of late anemia in Rhesus hemolytic disease: use of recombinant human erythropoietin (a pilot study).

The management of (Rhesus) hemolytic disease of the fetus and newborn includes intrauterine transfusions to prevent the development of hydrops, treatment of the possible hyperbilirubinemia in the immediate postnatal period, and treatment of late anemia. Low levels of serum erythropoietin due to suppression of the bone marrow by multiple intrauterine transfusions is a suggested mechanism for this anemia. The aim of our study was to test whether recombinant human erythropoietin reduced the need for erythrocyte transfusions in these infants. Twenty infants with Rhesus isoimmunization were blindly randomized to treatment and control groups at the 2nd wk of life. The number of intrauterine and exchange transfusions and demographic data were similar in both groups. The infants in the treatment group received recombinant human erythropoietin, s.c. 200 U/kg of body weight three times a week for a period of 6 wk, whereas the infants in the control group received a placebo for the same period. In the treatment group, the mean number of erythrocyte transfusions was significantly lower than that of the control group (1.8 versus 4.2). The reticulocyte counts and Hb levels rose earlier in the treatment group. The platelet and neutrophil counts were similar in both groups throughout the study. This study demonstrates that recombinant human erythropoietin treatment decreases the need for erythrocyte transfusions in the late anemia of infants with Rh isoimmunization. Considering the risks of blood transfusions, this decrease in the donor exposure is worthwhile.

High-dose intravenous immunoglobulin therapy for rhesus haemolytic disease.

Rhesus haemolytic disease is a continuing problem in the newborn especially in countries where the use of anti-D immunoglobulin is not prevalent. The fetuses may need intrauterine transfusions to prevent hydrops faetalis and they also may need exchange transfusions to treat the hyperbilirubinaemia that develops after birth. These interventions expose the baby to several blood donors, hence the risk of infection and exchange transfusions. This study was performed to test whether the use of high-dose intravenous immunoglobulin soon after the birth of these infants reduced the need for exchange transfusions. After randomization, intravenous immunoglobulin was given at a dose of 500 mg/kg to 22 infants in the treatment group. Nothing was given to the 19 controls. The number of exchange transfusions needed decreased significantly in the treatment group. No side-effects of intravenous immunoglobulins were seen.

[Occlusion of the gastric outlet caused by a trichobezoar]. / Magenausgangsverschluss durch einen Trichobezoar.

Bezoars are concretions formed in the gastrointestinal tract. The trichobezoars are hairballs in the stomach or intestines composed of hair. They are usually found in young girls as in our case which we operated in April 1989 on Surgical Ward in Kartal State Hospital in Istanbul. The postgastrectomy state predisposes to bezoar formation. Persimmon peels or pits, orange or grapefruit pulp are the usual offenders. Bezoars are associated with vague upper gastrointestinal discomfort, nausea, and vomiting. The patients may complain of abdominal pain. Ulceration, bleeding, obstruction, and perforation are the most common complications. Treatment consist of mechanical fragmentation via the endoscope or operative extraction. Dissolution of the undigested bolus by ingestion of proteolytic enzymes such as papain may be tried. As prophylaxis the postgastrectomy patient must be warned of ingesting citrus fruits.

The usefulness and limitations of ultrasonography for the diagnosis of adenomyomatosis of the gallbladder.

Ultrasonography has been popular for the diagnosis of gallbladder diseases since the mid-1970s. Although this technique has replaced oral cholecystography (OCG) for the diagnosis of cholecystolithiasis, it has not gained popularity in the diagnosis of adenomyomatosis of the gallbladder (AMMG). We examined 141 patients with clinically suspected gallbladder disease. Ultrasonography (previously done by a radiologist) had produced no positive findings. On ultrasonographic re-evaluation by the same radiologist, but in the presence of a surgeon from our study group, 64 cases of AMMG were detected. OCG revealed the diagnosis of AMMG in 13 other cases. In the study group there were no false-positive results. However, the false-negative rate of sonography in diagnosing AMMG was 16.9%. Thus, in our opinion ultrasonography is a worthwhile technique in diagnosing AMMG done by a surgeon.

Hair manganese concentrations in newborns and their mothers.

The study was designed to investigate the manganese (Mn) status of mothers and their offspring at delivery. Hair Mn concentrations in 31 full-term, 18 preterm and 12 newborn infants with congenital malformations and their mothers were determined by the flameless atomic absorption technique. Both in infants with congenital malformations and their mothers, hair Mn levels were significantly lower than the full-term and preterm infant-mother pairs. With the exception of mothers of infants with congenital malformations, hair Mn concentrations in mothers were significantly higher as compared with their infants. Low hair Mn concentrations of infants with congenital malformations and their mothers may possibly reflect a state of Mn deficiency in these women. These results imply that 1) Mn deficiency may play a role as one potential factor in intrauterine malformations, 2) Mn is supplied to the fetus by a homeostatic mechanism which is mainly dependent on the Mn status of the mother, 3) prenatal Mn analysis in maternal hair may prove to be a reliable indicator for the risk of intrauterine malformations.

Glucagon-induced hypocalcemia in the rat: effects of maturation and insulin.

In adults of several species including man, a small transient decrease in serum calcium concentration follows glucagon administration in doses of 1 to 10 mg/kg. The effects of maturation and insulin on this phenomenon were assessed by comparing the response of newborn and adult rats to equivalent doses of glucagon with and without prior insulin administration. After injection of 1 microgram/g of glucagon, the decrease in serum calcium concentration at 60 min was significant in the newborn rats (-1.75 mg/dl; P less than 0.001) and not significant in the intact adults (-0.07 mg/dl; P greater than 0.1). In pancreatomized adults, the decrease in serum calcium after the same dose of glucagon became significant (-1.23 mg/dl; P less than or equal to 0.01). This hypocalcemic effect was prevented in the pancreatectomized adult rat if insulin in a dose of 0.01 micron/g was given 15 min before glucagon. In the newborn rats, the same dose of insulin decreased the hypocalcemic effect, but the change was still significant (-0.74 mg/dl; P less than 0.01). Glucagon decreased serum calcium at one hr in newborn rats but not in adults. After pancreatectomy, the adult response to glucagon was significant and similar to that of the newborn. Insulin cancelled this effect of glucagon in the pancreatectomized adults and reduced it in the newborns.