[Large deep venous thrombosis in childhood--three cases]. / Gyermekkori nagy kiterjedésû mélyvénás trombózis három eset kapcsán.

Deep venous thrombosis is a rare disease in children under the age of 18, with an estimated incidence of 1/100,000 per year in Hungary. Its typical localization in children is in the extremities, usually occurring in newborns and in teenagers. Both congenital and acquired risk factors can be in the background. Although it is a rarity, we should think of it, because late diagnosis can cause life-threatening conditions like pulmonary embolism or central nervous system thrombosis. Detailed medical history can help the diagnosis. Etiology, possible congenital and acquired risk factors, as well as diagnostic and therapeutic options are discussed through three cases of teenage children. Diagnostic difficulties of deep venous thrombosis in childhood are the following: the occurrence is rarer than in adulthood therefore it is often forgotten as a possible diagnosis, coagulation parameters are age-dependent, and diagnosis with imaging techniques is more difficult.

[Infective endocarditis appearing with meningeal signs]. / Meningealis izgalmi tünetekkel jelentkezo infektív endocarditis.

The authors present the case of a 12-year old girl with infective endocarditis. Following an initial three-day period of malaise, she was admitted to the hospital with meningeal signs. The clinical symptoms and the results of the laboratory examinations, lumbar puncture and hemoculture supported the diagnosis of Staphylococcus sepsis and meningitis. The initiation of antimicrobial therapy resulted in temporary improvement while a systolic cardiac murmur appeared. Transthoracal echocardiogram raised the diagnosis of mitral valve endocarditis. Due to the subsequent deterioration in her condition, the patient was referred to the Pediatric Heart Center of the Gottsegen György National Institute of Cardiology where transoesophageal echocardiogram confirmed the diagnosis. The vegetations were removed by extracorporeal cardiac surgery including mitral valve plasty. Retrospectively, septic embolisation caused multiplex brain infarcts were identified by cranial MRI scan as the underlying cause of the initial clinical symptoms and liquor results. Following her recovery, patient remained well with some mild residual mitral regurgitation and without any residual neurological symptoms.

[Spontaneous splenic rupture as a complication of symptom-free infections mononucleosis]. / Tünetmentes mononucleosis infectiosa szövodményeként kialakult spontán lépruptura.

Splenic rupture is a rare complication of infectious mononucleosis. Although it occurs only in 0.1%-0.5% of cases, splenic rupture remains the most common fatal complication of the disease. Mononucleosis related spontaneous rupture of the spleen without any other characteristic symptoms of the disease is extremely unusual, and threatens with fatal outcome due to its rare and unexpected occurrence. The authors report the case of a 16-year-old boy who needed splenectomy following a spontaneous rupture of the spleen. Serological tests proved an acute Epstein-Barr virus infection in the background but without any signs or symptoms of infectious mononucleosis. The diagnosis and treatment of this infection related to spleen ruptures are also discussed.

[Untreated hyperthyroidism with severe cardiac complication in adolescence--a case study]. / Súlyos cardialis szövodménnyel járó, kezeletlen hyperthyreosis serdülokorban.

A 16-years old boy with poor family circumstances was admitted to hospital due to severe cardiac failure (stagnation in the pulmonary and systemic circulations, ejection fraction: 29%, pericardial fluid, atrial flatter) needing intensive care. Diagnostic tests revealed extreme hyper-function of the thyroid as the underlying cause. After stabilising the cardiac and hormonal states of the patient with medication, subtotal resection of the thyroid was carried out since the poor family circumstances did not make the provision of long-term thyreostatic pharmacotherapy feasible. Cardioversion solved the arrhythmia. The patient was discharged from hospital with stable circulation and normal thyroid functions after 2 months. The authors report the very uncommon complications of an endocrine syndrome with autoimmune origin rarely observed in childhood. They highlight the importance of early diagnosis and the immediate start of adequate therapy for good long-term outcome.