Cerebral and coronary embolization of a valvular tumor.

Stroke and myocardial infarction are not commonly seen in children; the occurrence of both conditions in the same well child is unusual. Undifferentiated cardiac tumors are rarely encountered in the pediatric population. We present a case of stroke and myocardial infarction as a consequence of an undifferentiated valvular tumor in a previously healthy child. This case emphasizes the critical importance of serial clinical examinations as part of a complete stroke workup. It suggests the need for additional research on the use of thrombolytic therapy for pediatric cerebral and myocardial infarction and stresses individualization of cardiac tumor treatment plans.

A randomized trial of magnesium in the emergency department treatment of children with asthma.

STUDY OBJECTIVE: Magnesium sulfate has been shown to benefit asthmatic children and adults with poor responses to initial beta(2)-agonist therapy in the emergency department. We sought to determine whether the routine early administration of high-dose magnesium would benefit moderate to severely ill children with acute asthma. METHODS: This was a randomized, double-blind, placebo-controlled trial of 54 children 1 to 18 years of age who presented to the ED of a tertiary care children's hospital with a moderate to severe asthma exacerbation. After receiving a nebulized albuterol treatment (0.15 mg/kg) and methylprednisolone (1 mg/kg), patients were randomly assigned to receive either 75 mg/kg of magnesium sulfate (maximum 2.5 g) or placebo. Thereafter, all patients were treated with frequent nebulized albuterol following a structured protocol. The main outcome was degree of improvement as assessed by Pulmonary Index scores over 120 minutes. Secondary outcomes included hospitalization rates and time required to meet discharge criteria. RESULTS: The mean change in Pulmonary Index score from baseline to 120 minutes was 2.83 for the magnesium group compared with 2.66 for the placebo group (95% confidence interval -1. 24 to 1.60). Eleven (46%) of 24 magnesium-treated patients were hospitalized compared with 16 (53%) of 30 in the placebo group (95% confidence interval -19% to 34%). There were no statistically significant differences between the groups with respect to time required to meet discharge criteria. CONCLUSION: The routine administration of high-dose magnesium to moderate to severely ill children with asthma, as an adjunct to initial treatment with albuterol and corticosteroids, was not efficacious.

Ecthyma gangrenosum as a manifestation of Pseudomonas sepsis in a previously healthy child.

We present a case of Pseudomonas aeruginosa sepsis heralded by ecthyma gangrenosum in a previously healthy 15-month-old child. Pseudomonas infection and its uncommon skin manifestation are rarely encountered in an immunocompetent child. This case highlights the critical importance of identifying ecthyma gangrenosum to institute optimal antimicrobial therapy.