Sonographic detection of multiple brain abscesses in a newborn with IgA deficiency.

We report the case of a neonate with selective IgA deficiency and multiple brain abscesses diagnosed with sonography. Brain sonography revealed multiple abscesses in the left hemisphere; the abscesses ranged from 10 to 20 mm. Cultures obtained from the cerebrospinal fluid and blood were positive for Proteus mirabilis. The neonate responded promptly to broad-spectrum antibiotic therapy and had no neurologic sequelae. Because IgA deficiency is associated with infections, we believe it was a predisposing factor for the brain abscesses.

Congenital tracheal stenosis treated with dilatation.

Congenital tracheal stenosis is a rare anomaly characterized by a broad spectrum of variations. Affected segments differ in the grade extent of stenosis, from thin webs to more severe stenoses such as short-segmental, funnel-like, or long-segment tracheal stenosis. A 5-month-old infant with persistent congenital stridor and acute respiratory distress is presented. Radiographic and tracheobronchoscopic investigations confirmed the diagnosis of congenital tracheal stenosis without associated vascular, pulmonary or gastrointestinal anomalies. The stenosis was of a fibrous nature and segmental morphology affecting the initial tracheal section. Dilatation was performed by a rigid tracheobronchoscope with favorable outcome. The reported case was classified into class 1 lesions, which are associated with low mortality and good prognosis. Dilatation performed with a rigid bronchoscope proved to be a rational therapeutic approach in this case. The possible diagnostic and other therapeutic approaches to congenital tracheal stenosis are also discussed.

Right atrial reduction for tachyarrhythmias in Ebstein's anomaly in infancy.

A 20-month-old girl with Ebstein's anomaly developed supraventricular paroxysmal tachycardia, which seemed to be a result of the wall tension of the giant right atrium. Right atrial resection reduced the wall tension and overall dimensions of the right atrium and finally resolved the tachycardia and ectopic electrical conduction. Six-year follow-up electrocardiograms confirmed continuing normal sinus rhythm without occurrence of supraventricular paroxysmal tachycardia or other ectopic electrical activity The follow-up echocardiograms showed the size of the right atrium to be unchanged from the time of operation. There are few data in the available literature about performing right atriotomy to resolve a tachyarrhythmia associated with Ebstein's anomaly and none, to the best of our knowledge, about performing right atrial resection for this purpose.

Gastroesophageal reflux, allergy and chronic tubotympanal disorders in children.

The purpose of this study is to examine the relation between gastroesophageal reflux and allergy as possible causes of chronic tubotympanal pathology. The 30 examined children (ages 2-13) were divided into two groups based on the otological criteria. The 16 examined children suffered from a secretory otitis, which lasted more than four months. Upon further examination with a microscope, seven of these children exhibited symptoms of the adhesive process of the middle ear. Furthermore, 14 patients suffered from a recurrent otitis, i.e. more than five cases of otitis per year, while five patients from this group suffered from a chronic otitis with a central defect of the tympanum. The method used for the examination of the gastroesophageal reflux consisted of a continual 24 h esophageal pH monitoring. The particular apparatus used for this included antimony electrode (Synetics Medical, Sweden), while the analysis we performed was processed through the PC software program Gastrosoft Inc. The reflux index higher than five was considered pathological. At the time of the gastroesophageal reflux examination, we also performed the allergological analysis. The presence of allergy was confirmed by three methods: the positive allergological anamnesis, the positive skin pick test and by the elevated quantities of specific IgEs (Pharmacia CAP system). The examination resulted in the following: 18 of the examined children suffered from the pathological gastroesophageal reflux (60%); further seven of our patients tested positive on the allergological test (23%); and the four who tested positive for allergy also suffered from the pathological gastroesophageal reflux (13%). In comparison with allergies, the pathological GER was substantially more frequent in the patients who suffered from chronic tubotympanal disorders.

Primary bronchomalacia and patent ductus arteriosus: simultaneous surgical correction in an infant.

We report the clinical course of a 6-month-old girl with recurrent infection of the left lung, persistent wheezing, and a suspected congenital heart anomaly (patent ductus arteriosus. Chest radiography revealed hyperinflation and slight inflammation of the left lung. Tracheobronchoscopy and left-sided bronchography showed a collapsed segment of the left main bronchus, 3 cm long. Computed tomography confirmed hyperinflation of the left lung and atelectasis of the superior lobe. There were no signs of extramural compression. Color-flow Doppler echocardiography confirmed the suspicion of patent ductus arteriosus. To the best of our knowledge, there is no other report in the literature of a patient with this combination of anomalies. After receiving 2 weeks of antibiotic treatment, the patient underwent surgical repair The patent ductus arteriosus was closed by means of a triple-ligature procedure, and during the same operation a bronchopexy was performed, securing the left main bronchus to the closed ductus tissue by means of sutures. There have been no complications in the postoperative period. Clinical follow-up, as well as echocardiography and bronchoscopy, have yielded normal results 14 months after surgery.

Fetal tachydysrhythmia associated with nonimmune hydrops.

A case of fetal tachydysrhythmia with intermittent episodes of bradycardia associated with severe nonimmune hydrops was detected at 36 weeks of pregnancy. Paroxysms of supraventricular tachycardia were documented postnatally. Induction of labor and postnatal administration of digoxin showed to be a rational therapeutic approach in this case. In spite of some unfavorable clinical predictors the treatment resulted in a benign course of the disease.

Naphazoline nasal drops intoxication in children.

Naphazoline, a sympathomimetic and an imidazoline derivative, is used as 0.05-0.1% solution for local decongestion of the nasal and ocular mucosa. In excessive dosage, or if ingested by accident, may cause depression of the central nervous system (disturbances of consciousness progressing to coma), hypothermia, bradycardia and sweating. These naphazoline effects are particularly strongly pronounced in children. Anglo-Saxon pharmacotherapy excludes the application of naphazoline nasal drops in children younger than six years, whereas the Croatian pharmacotherapeutic literature (and practice) allows its use even in infancy. At the Kantrida Paediatric Clinic, Clinical Hospital Centre in Rijeka, 11 children with signs of intoxication with naphazoline nasal drops were hospitalized from 1990 to 1992. The symptoms pertaining to the central nervous system i.e. disturbances of consciousness in the form of somnolence were clearly marked in all children. Some children developed skin pallor, bradycardia, bradypnoea and hypothermia. Resolution occurred within 24 hours and the findings returned to normal values. Clinical picture followed by rapid resolution and normal findings, with a personal history of drug taking, is a safe indication for diagnosis. There are several reasons to account for intoxication (drops difficult to use with children, containers inadequate for proper dosage), but the major factor is the age of the patient--all hospitalized children were younger than six years. It is pointed out that administration of naphazoline drops at an early age is not advisable.

[Determination of the optimal dose of aminophylline in children with severe asthmatic attacks]. / Odredivanje optimalne doze aminofilina u djece s tezim astmaticnim napadajima.

The therapeutic effect of aminophylline in children having severe asthmatic attacks with a special emphasis on an appropriate dose, adequate administration and measurement of serum aminophylline concentrations is presented. The study group consisted of 24 patients with severe asthmatic attacks. The patients were assigned to three groups according to the dosage of aminophylline administered. Patients in Group 1 received a dose of 7 mg/kg body weight, those in Group 2 5 mg/kg body weight and those in Group 3 (previously treated with theophylline) 4 mg/kg body weight. For each patient, clinical and laboratory parameters were followed. The results demonstrated that adequate therapeutic response and optimal serum theophylline concentrations were achieved only in Group 1. Patients in which lower doses of aminophylline were employed (Group 2 and Group 3) showed neither the adequate therapeutic response not did achieve the adequate serum theophylline concentrations, and administration of aminophylline had to be repeated. In the majority of patients, mild hyperglicemia was noticed. The mechanism and the sequence of events how it occurred was not determined. In conclusion, this data show that aminophylline, if administered in an adequate dose, is a drug of choice in the treatment of children with severe asthmatic attacks.