[Maternal-fetal transmission of HIV in Catalonia and the Balearic Islands]. / Transmisión materno-infantil de la infección por el virus de la inmunodeficiencia humana (VIH) en Cataluña y Baleares.

Two hundred and ninety three cases of children born of HIV positive mothers have been observed between January 1984 and June 1988 in Catalonia and Balearic Islands, with a ration of 9.5/10,000 newborns. Sex was not significant in the infected group. Most of the cases (68%) have been detected since 1987 and represent a significant increase in HIV positive children and thus of those who will present with clinical manifestations of this infection.

Optic pathway gliomas in neurofibromatosis.

Two patients, a 5-year-old girl and a 3-year-old boy, with documented neurofibromatosis (NF-1) and visual pathway gliomas are reported. In the first patient, the tumor was a typical pilocytic astrocytoma confined to the proximal half of the right optic nerve just near the globe. The tumor was excised; after a follow-up of 7 years recurrence has not occurred. The second patient had a glioma of the left optic nerve, with involvement of the chiasm, optic tracts, probably lateral geniculate body, optic radiations and basal ganglia. Biventricular hydrocephalus, possibly due to the occlusion of Monro's foramina, was also noted. In this case, magnetic resonance imaging (MRI) was superior to computed tomography for visualizing the posterior extension of the lesions. The patient received X-ray therapy and after a follow-up of 3 years the clinical symptomatology remains stationary. It is suggested that the optic pathway involvement detected by MRI may represent a dysplastic element NF-1 rather than a truly neoplastic change.

[The environment and the bronchospasm crisis]. / Medio ambiente y crisis de broncoespasmo.

Clinical data of 893 asthmatic crises treated in the Pediatric Emergencies Service of Hospital de "Nuestra Señora del Mar" (Barcelona) between January 1st 1983 and december, 31, 1984, have been examined. Age, sex, number of hospitalised cases related to the total emergencies have been analysed, and a correlation is established with atmospheric contamination, meteorological data and pollen levels. The highest incidence of bronchospastic processes has been observed in Autumn. No significant relation is observed between asthmatic attacks and meteorological data or pollen levels. During the highest contaminated days the number of asthmatic attacks does not increase, but there is a significant association between asthmatic crises in children over 3 years old and the SO2 level. Bronchospastic processes in children under 3 years old are influenced by temperature, february is the coldest month and the highest incidence occurs. These results must be considered with caution. Only the continuity of the study in next years can provide definitive conclusions.

Acetylation phenotype and hepatotoxicity in the treatment of tuberculosis in children.

We studied the relationship between acetylation phenotype and the appearance of biochemical and clinical signs of liver damage in 73 tuberculous children treated with isoniazid and rifampin. No significant differences were found with respect to the distribution of acetylation phenotype between tuberculous patients and a control group consisting of 256 children. Hepatotoxicity manifested in 27 cases (37%), of which only five (7%) had clinical signs. Application of the Fisher exact probability test did not show a relationship between acetylation phenotype and hepatotoxicity.

Pneumonia associated with meningococcal bacteremia and/or meningitis.

Four children between 5 and 12 years of age had pneumonia as a secondary complication of meningococcal bacteremia and/or meningitis. The diagnosis of meningococcal disease was established by culture of blood and/or cerebrospinal fluid. Fine inspiratory rales were found in one patient. In the other three cases pulmonary infiltrates were evidenced on chest roentgenogram. All patients recovered with penicillin G sodium therapy.

Erythema nodosum associated with infectious mononucleosis.

Erythema nodosum is an immunoallergic epiphenomenon appearing during the course of various conditions; it has been exceptionally observed in association with infectious mononucleosis. A 9-year-old girl with clinical manifestations of infectious mononucleosis developed cutaneous nodules of erythema nodosum over the shins, which cleared after 12 days. Diagnosis was based on the presence of atypical mononuclear cells, detection of antibodies against Epstein-Barr virus, and positive ox red blood cell hemolysis. Coincidence of both diseases is not surprising because infectious mononucleosis may exhibit diverse immunologic reactions. On the other hand, commonest etiologies were excluded in this case.

Stroke due to fibromuscular hyperplasia of the internal carotid artery.

An 11-year-old girl developed an ischemic stroke syndrome a few minutes after she had been swimming in a swimming pool. The motor deficit of the extremities reversed within 24 hours. The patient was discharged on the 6th hospital week with a completely recuperated neurological function. The left internal carotid arteriogram showed typical "string of beads" appearance of segmental fibromuscular hyperplasia.

Psychologic implications of the maltreated-child syndrome.

A retrospective investigation of 97 psychologically maltreated children showed a clear relationship between clinical symptoms and the intensity of the abuse. Parental neglect resulted in impairment of intellectual and locomotor development and emotional and behavioral disorders. Neurotic manifestations of regressive type appeared in nearly half the preadolescents who suffered severe psychological abuse. Children under 6 years of age presented functional symptoms, including regression in toilet training and sleep disorders secondary to inadequate mothering.

[Hand, foot and mouth disease. Report of 10 cases]. / Enfermedad boca-mano-pie. Observación de diez casos.

Ten children with hand-foot-and-mouth disease are described and their clinical manifestations reported in detail. It is a benign, minor viral disease of childhood, but in our country its real incidence is unknown. Diagnosis in the clinical practice is based on the recognition of typical and atypical localizations of the vesicular eruption, as well as on the identification of extracutaneous and extrabuccal manifestations. The differential diagnosis includes herpangina, aphthous stomatitis, dyshidrosis and erythema multiforme.

Erythema nodosum and kerion of the scalp.

Three children had pustular patches develop over the occipital areas of the scalp. Colonies of Trichophyton mentagrophytes grew on cultures with Sabouraud's dextrose agar with antibiotics. After a week of topical treatment with 1:10,000 potassium permanganate solution and oral treatment with griseofulvin, typical nodules of erythema nodosum appeared over the shins, ranging in diameter from 1 to 4 cm. Nodules on the legs resolved spontaneously within 12 days in the three children. Erythema nodosum occurring in patients with kerion may be interpreted as individual allergic hypersensitivity reactions as a result of the immune host response to allergenic products from the primary site of infection. This possibly may cause immune complexes that precipitate erythema nodosum.

Brucellosis treated with rifampicin.

14 children, aged between 15 months and 14 years, with brucellosis were treated with oral rifampicin only (20 mg/kg per day) for 3 weeks. Laboratory diagnosis depended on blood culture (positive for Brucella melitensis in 11 of the cases), serum agglutination, complement-fixation test, and Coomb's test. Response was good in each child, with fever clearing between the 2nd and 8th day. 2 children relapsed, but one relapse was probably a reinfection from contaminated cheese. Both children were given a further course of treatment (rifampicin and co-trimoxazole) which was successful. Despite the reasonably good results with rifampicin alone, it is advisable to combine the drug with co-trimoxazole when treating brucellosis.

Treatment of childhood meningitis with mezlocillin.

30 children suffering from bacterial meningitis and 2 children suffering from septicemia were treated with 6-((R)-2-[3-methylsulfonyl-2-oxo-imidazolidine-1-carboxamido]-2-phenyl-acetmido(-penicillanic acid sodium salt (mezlocillin, Baypen). The daily dose was 250 mg/kg, divided in three portions. Therapy was successful in all patients. Neither signs of toxicity nor side effects of any kind could be found. Mezlocillin concentrations were measured in serum and cerebrospinal fluid (CSF) mainly on days one and six or seven of therapy. Serum concentrations were in the expected range. CSF concentrations depended on the inflammation of the meninges. On the first day of treatment they ranged from 0.5 to 7.2 to 12.0 microgram/ml. After normalisation of CSF no concentrations of mezlocillin were detectable.