Spontaneous resolution of recurrent tonsillitis in pediatric patients on the surgical waiting list.

OBJECTIVE: To assess the impact of the waiting list on the spontaneous resolution of recurrent acute tonsillitis in children. METHODS: We have evaluated 623 cases placed on the waiting list for elective tonsillectomy (with or without adenoidectomy) between February 1994 and May 1999 at our institution. In each child, age, time on the waiting list, type of procedure and outcome were registered. There were two possible outcomes after the preoperative evaluation: tonsillectomy was still indicated or tonsillectomy was not necessary. RESULTS: Mean length of time on the waiting list was 10.8 months (range: 3.0-35.6 months; median: 8.2 months). In 507 of the 623 children (81.4%), the operation was still indicated. However, 116 patients (18.6%) did not need surgery because of spontaneous resolution of the clinical picture. No relation was found between outcome and age, time on the waiting list or type of procedure (P>0.05). CONCLUSION: There was no clinical evidence for claiming that resolution of recurrent acute tonsillitis in children is spontaneous with time.

[Vitamin D3 poisoning and irreversible sequela]. / Intoxicación por vitamina D3 y secuelas irreversibles.

Twenty-four children with vitamin D intoxication and a follow-up of one to thirteen years old (means: four years and seven months) are reviewed. Over-dosage was prescribed by medical order in 66.6% of patients and by the mother herself in 16.6%. Intensity of clinical symptoms (renal, neurologic, digestive) were related with daily dose administered whilst final secuelae depends on duration of overdosage. Hipercalcemia was easily corrected by association of low calcium diet, corticoesteroids and/or furosemide in least than a month in 81% of cases. Two patients died during the acute fase and 22.7% remain with permanent damage (five in chronic renal failure, one in haemodialysis and three with low IC).

[Recurrent urinary infection in girls. Natural history and therapeutic response]. / Infección urinaria recurrente en niñas. Historia natural y respuesta terapéutica.

A group of 39 girls with urinary tract infection are studied to analyse the clinical findings, response to treatment and natural history of the disease. All of them had more than three episodes of infection per year and renal function and initial cysto-urographic study were normal. Mean age at diagnosis was 4.8 years and the mean follow-up 3.4 years. In 7.6% of cases familial incidence was observed. During infection free periods, 35.8% of patients had urinary incontinence. 25% of recurrences were asymptomatic. Only one case developed during the follow-up a unilateral polar scar associated with grave II vesicoureteral reflux. Recurrence rate/girl/year, decrease from 3.8 during the first year to 1.5 at 5th year of follow-up. Patients who received prophylaxis with nitrofurantoin showed a clear decrease in rate of recurrence.

[Peculiarities of urinary infection in 145 infants younger than 3 months of age]. / Peculiaridades de la infección urinaria en 145 lactantes menores de cuatro meses.

Authors have analized retrospectively 145 children with urinary tract infection (UTI) within the first 120 days of life. 67% were males, 45% of patients presented an acute onset with fever and septic appearance and 55 with a chronic illness with digestive symptoms and malnutrition (95%). Breast feeding could be a protective factor against UTI. In 66% of those less than one month old, existed perinatal infectious risk factors. This fact and the presence of septic signs and positive blood cultures (71%), give rise to the possibility that the hematogenous route be the principal infectious via in this age group. The high incidence of parenchymatous participation (75%) have no relation with the presence of obstruction. At onset 29 showed no anomalies on cysto-urography, 48% vesicoureteral reflux of various degrees and 23% obstructive anomalies. The mortality rate was 1,3% due to septic shock.

[Symptomatic urinary infection in infants less than 4 months old: outcome in 129 cases]. / Infección urinaria sintomática en lactantes menores de cuatro meses: evolución de 129 casos.

A series of 129 children with urinary infection during the first 120 days of life, were followed-up for periods ranging from to 1 to 16 years (means = 4 1/12 year). They have been separated in two groups, depending on urocystographic findings: (I) with mild lesions and/or reflux (99 cases) and (II) with obstructive uropathy (30 cases). All the patients in group II and those with reflux of grade IV received surgical treatment. The remaining ones received chemoprophylaxis. During the follow-up, all grade I refluxes disappeared, and so did 86% of grade II and 58% of grade III. Pyelonephritic scars are present in 34% of those kidneys with grade III reflux, 56% of grade IV and 88% of those of the group II. Permanent alteration of renal function was found almost exclusively in patients with grade IV reflux or obstructive anomalies bearing no relation with the number of recurrences of infection during the follow-up.

[Idiopathic hematuria in childhood (author's transl)]. / Hematuria idiopática en la infancia. A propósito de seis casos.

Idiopathic hematuria is a clinical condition of unknown etiology; it is defined as persistent or recurrent, macro or microscopic hematuria in the absence of systemic or local disease and with normal renal function. Six patients who had these criterions were studied. There were all girls. The age of the first episode was between one and four years. There was no other family or personal history of renal disease or deafness. Only two patients had their episodes of macroscopic hematuria within flu-like illness or exercise. All had normal renal function and no proteinuria was found. Serum C'3 and C'4 were normal. Microscopic and immunofluorescence studies were negative. We remark the convenience of a triple criteria clinical, histopathologic and evolutive to select a patient into the "idiopathic hematuria" group. We comment the usefullness of renal biopsy in the investigation of unexplained hematuria.