Central nervous system and renal vasculitis associated with primary varicella infection in a child.

A 7-year-old girl with primary varicella presented with encephalopathy and focal neurologic deficits 10 days after her first skin lesions appeared. She was discovered to have bilateral wedge-shaped renal infarctions, and ischemic lesions in the conus medullaris, cerebral cortex, and deep gray matter consistent with a medium and large vessel arteritis on magnetic resonance imaging. This complication has never before been reported in an immunocompetent child with primary varicella infection, and it represents a rare but serious complication of childhood chickenpox.

The female gender protects against pulmonary injury after trauma hemorrhagic shock.

BACKGROUND: Previously, we have documented that lung injury after trauma-hemorrhagic shock (T/HS) is related to gut injury and that females are more resistant to T/HS-induced lung injury than males. However, it is not known if the estrus cycle stage at the time of injury influences the female rat's resistance to T/HS-induced lung injury. Therefore, the goal of this study was to determine if the protective effect of the female gender on lung injury after T/HS is estrus cycle stage-specific. To test this hypothesis, female rats were subjected to trauma (laparotomy) and hemorrhagic shock (T/HS) during different stages of the estrus cycle. Female animals subjected to trauma with sham hemorrhagic shock served as the control. METHODS: Female Sprague-Dawley rats during the proestrus, estrus, metestrus, or diestrus stages of the menstrual cycle were subjected to a midline laparotomy (trauma) and either hemorrhagic shock (MAP = 30 mm Hg x 90 min) or sham shock. The total volume of blood necessary to induce and maintain the shock state was recorded. At the end of the shock period, the animals were resuscitated with their shed blood. At 6 h postresuscitation, the animals were sacrificed and lung permeability was measured using the Evans blue dye technique and by determining the bronchoalveolar (BALF) to plasma protein ratio. Additionally, pulmonary leukosequestration was quantitated by measuring pulmonary myeloperoxidase levels. RESULTS: T/HS-induced lung injury and increased pulmonary leukosequestration were not observed in female rats in the proestrus or estrus stages of the menstrual cycle. In contrast, pulmonary permeability was increased significantly in the diestrus stage animals after T/HS. That is, the diestrus females subjected to T/HS had increased pulmonary permeability to Evans blue dye than sham or T/HS proestrus, estrus, and metestrus rats (6.49 +/- 1.33% versus 1.7 +/- 0.87%, 1.57 +/- 0.54%, 1.78 +/- 0.82%, 3.33 +/- 0.68%, p < 0.01, respectively). Similar results were obtained with the BALF protein/plasma protein ratio (0.15 +/- 0.017 versus 0.09 +/- 0.009, 0.09 +/- 0.03, 0.08 +/- 0.022, 0.11 +/- 0.029 p < 0.05, respectively). Although the T/HS metestrus rats had mildly increased lung permeability, this increase in T/HS-lung permeability did not reach statistical significance. Pulmonary myeloperoxidase levels after T/HS displayed a similar trend, with diestrus rats subjected to T/HS having the highest level of MPO (p < 0.05 versus sham or T/HS proestrus and estrus but not metestrus groups). Linear regression analysis of MPO versus Evans blue dye leak revealed a significant correlation between pulmonary neutrophil sequestration and lung leak (r = 0.9549; p < 0.0001). CONCLUSION: Protection against T/HS-induced lung injury was greatest during the estrus and proestrus stages of the menstrual cycle and decreased with progression to diestrus. During the diestrus stage of the menstrual cycle when gonadal hormone levels are lowest, the rats are more sensitive to T/HS-induced lung injury, indicating that gonadal hormones modulate T/HS-induced lung injury.

The efficacy of divalproex sodium in the prophylactic treatment of children with migraine.

OBJECTIVE: To determine the beneficial use of divalproex sodium as a prophylactic treatment for migraine in children. BACKGROUND: Previous studies for treatment of migraine in adults have shown a greater than 50% reduction in migraine attack frequencies. Few data exist, however, regarding the efficacy and safety of divalproex sodium use in children with migraine. METHODS: We studied the incidence of headache relief in our patients with migraine aged 16 years and younger treated with divalproex sodium prophylactically at our institution from July 1996 to December 1998 to determine medication dosage used, concomitant headache medications, and possible adverse effects. RESULTS: A total of 42 patients, ranging in age from 7 to 16 years (mean age, 11.3 years), were treated with divalproex sodium for headache. All had a history of migraine with or without aura. Baseline headache frequency during a minimum 6-month period was one to four headaches per month. Divalproex sodium dosage ranged from 15 mg/kg/day to 45 mg/kg/day. Of the 42 patients, 34 (80.9%) successfully discontinued their abortive medications. After 4 months' treatment, 50% headache reduction was seen in 78.5% of patients, 75% reduction in 14.2% of patients, and 9. 5% of patients became headache-free. CONCLUSION: These results indicate divalproex sodium to be an effective and well-tolerated treatment for the prophylaxis of migraine in children.

The effects of chronic absence of active nasal respiration on the growth of the skull: a pilot study.

Oral respiration associated with an obstructed nasal airway is common in orthodontic patients. For several years chronic oral respiration has been implicated as a prime causative factor in the development of "adenoid facies or the "long-face syndrome. The animal experiment reported here begins a series designed to study, as separate variables, the 2 components of chronic oral respiration: (1) chronic absence of active nasal respiration and 2) chronic mouth opening to find out what dentofacial changes can be attributed to chronic absence of active nasal respiration alone. In this pilot study, 5 growing dogs underwent tracheotomy so that significant active nasal respiration was not possible and oral respiration was not essential.

A study of craniofacial growth in infant heart transplant recipients receiving cyclosporine.

BACKGROUND: Cyclosporine is an effective immunosuppressive drug that has found widespread application in organ transplantation. However, a few studies have implicated cyclosporine as adversely affecting craniofacial growth in the pediatric population. The purpose of this study was to evaluate the possible untoward effects of cyclosporine long-term on craniofacial growth in a group of infant heart transplantation recipients. METHODS: A prospective group (n = 28) of 18 Caucasian (white) children (9 female and 9 male, ages 4-10 years) and 10 Hispanic children (3 female and 7 male, ages 4-10 years) were evaluated. No attempt was made for either study group to delineate on individuals specific country of origin. None of the subjects had undergone orthodontic therapy. All subjects had heart transplantations before 6 months of age and followed the Loma Linda University International Pediatric Heart Transplantation Immunosuppression protocol. The primary immunosuppression agent was cyclosporine with azathioprine or methotrexate. Rescue therapy for graft rejection consisted of glucocorticoid and/or polyclonal antibody therapy. None of the subjects received the immunosuppressant tacrolimus (FK506). Using lateral cephalometric radiography, seven skeletal angular measurements (SNA, SNB, ANB, GoGn-SN, NA-Pog, ArGoMe, NPog-AB) were examined and compared to contemporary growth standards. Hand/wrist radiographs were evaluated for bone age. Also, longitudinal height, weight, and head circumference data was obtained and compared to standardized growth and development curves. RESULTS: Descriptive statistics were used to summarize the data. Cephalometrically, 86% (N = 24), showed minor deviation from mean normative values. Four of the subjects (14%) exhibited cephalometric measures indicative of individuals with a vertical growth pattern. Analysis of the hand/wrist radiographs showed all but one subject to have normal bone age. Height, weight, and head circumference data revealed a wide range of growth percentiles for the entire group with mean percentiles in the range of 25% to 50%. CONCLUSIONS: The findings of this pilot study indicated that, in general, skeletal growth of the craniofacial complex as well as axial skeletal growth was not statistically significantly altered by the immunosuppressive regimen of cyclosporine over the time period evaluated. Further longitudinal data of this study's subjects may shed more light on the possible adverse effects of cyclosporine on craniofacial growth and development in spite of the fact that no untoward correlation was found over the time period studied.

Persistent preceding focal neurologic deficits in children with chronic Epstein-Barr virus encephalitis.

Epstein-Barr virus encephalitis is a self-limiting disease with few sequelae. Persistence of neurologic deficits prior to and after the acute illness has yet to be described in children. We describe five children with persistent cognitive and focal neurologic deficits due to chronic Epstein-Barr virus encephalitis with various T2-weighted magnetic resonance imaging abnormalities. Clinical features were a 9-year-old boy with aphasia and apraxia, an 11-year-old girl with impulsivity and inappropriate behavior, a 17-year-old boy with deterioration of cognitive skills and judgment, a 5-year-old boy with complex-partial seizures, and a 6-year-old girl with obsessive-compulsive behavior. All patients had elevated serum Epstein-Barr virus titers for acute infection, with cerebrospinal fluid polymerase chain reaction positive for Epstein-Barr virus in four patients. Three children were treated with methylprednisolone with minimal improvement without changes on magnetic resonance imaging. Epstein-Barr virus encephalitis can present with chronic and insidious neurologic symptoms and should be considered in the differential diagnosis of children with acute or chronic neurologic illness of unknown etiology.

Extrapontine myelinolysis with involvement of the hippocampus in three children with severe hypernatremia.

Central pontine myelinolysis is a disorder of unknown etiology linked to overly aggressive correction of hyponatremia. In addition to the typical location of demyelination with preservation of neurons and axon cylinders in the basis pontis, similar lesions have been described in extrapontine locations. Central pontine myelinolysis and extrapontine myelinolysis usually occur together, and are identified at autopsy rather than in life because symptoms of extrapontine myelinolysis are often masked in the critically ill patient. Central pontine myelinolysis is described in children, usually in the clinical setting of hyponatremic dehydration. Extrapontine myelinolysis has not been described in children previously. We report three children with severe hypernatremia and extrapontine myelinolysis involving various combinations of thalamus, basal ganglia, external and extreme capsules, and cerebellar vermis. All three had additional involvement of the hippocampus seen on T2-weighted magnetic resonance imaging. None of the three had detectable pontine lesions. Clinical features of the three cases were dehydration in a 28-month-old girl, respiratory syncytial virus bronchiolitis in a 14-month-old girl, and acute respiratory failure due to anaphylaxis after consumption of walnuts in a 3-year-old boy. Peak sodium values in each child were 195, 168, and 177 mmol/L, respectively; each received aggressive treatment for hypernatremia. We believe this to be the first report of extrapontine myelinolysis in children, the first report of extrapontine myelinolysis without central pontine myelinolysis in children, and the first report in children of hippocampal formation involvement. The pathogenesis of the central and extrapontine myelinolysis complex in children is more complicated than previously believed, and might differ significantly from that of adults.

The rotation of maxillary first molars, mandibular first molars, and maxillary first premolars in acceptable occlusions.

The rotation of the maxillary molars is considered important in the orthodontic treatment of malocclusions. In this study, a computer analysis program was developed to examine the rotations of maxillary molars, mandibular molars, and maxillary first premolars in casts of permanent dentitions with acceptable occlusions. Ninety-three sets of untreated 'acceptable occlusion' models from the collection of the Foundation for Orthodontic Research (FOR) were scanned on a flat bed scanner. The images were analysed using custom software. Measurements were made by relating maxillary first permanent molars to the midline, archform, opposite canine, and mandibular first permanent molars. The mandibular first molars and maxillary first premolars were also analysed and their rotations measured. The mean rotations of the maxillary first molars, measured as the angle between a line joining the tips of the buccal cusps and a line tangent to the appropriate archwire form (from Ricketts' Pentamorphic Arches) at the first molars, were 0.59 and -0.72 degree (positive values represent mesio-lingual rotations) for the right and left, respectively. For the mandibular molars, these means were 6.34 and 8.40 degrees, respectively. The mean differences in rotation between buccal cusp tips of maxillary and mandibular first molars in occlusion were 5.75 and 9.12 degrees for the right and left, respectively, with the mandibular being more mesio-lingually rotated. The differences between left and right were significant for all measurements. The present study brings into question the suitability of our present "straight wire" prescriptions in producing similar occlusions. It also suggests that scanning models for computer analysis may be a practical and precise way to measure similar rotations in untreated normal and treated occlusions.

Deformation of metal brackets: a comparative study.

The purpose of this study was to determine the effect of material and design on the force and stress required to permanently deform metal brackets. Fourteen types of metal brackets were categorized according to raw material composition, slot torque degree, and wing type. Five types of raw materials, three types of slot torque degree, and four types of wing design were tested using an archwire torque test developed by Flores. An analysis of variance (ANOVA) and t-test showed that all three categories had a significant effect on the force and stress needed to permanently deform metal brackets. Of the three, raw material had the greatest effect on the amount of force. Results showed that 17-4PH and 303S had higher yield strengths and regular twin brackets had higher resistance to deformation. Also, as slot torque degree increased, brackets deformed with less force. Result confirmed that brackets requiring the greatest stress to permanently deform were made of steel with the greatest hardness.

The fracture strength of ceramic brackets: a comparative study.

Recent demand for esthetic brackets has led to the development and use of ceramic brackets in orthodontics. The purpose of this study was to compare the fracture strength of different ceramic brackets under different surface conditions and ligation methods using a torsional wire bending force. Five different bracket types (two polycrystalline, two single-crystal, and one metal) were tested using elastic and wire ligation, with half being scratched and the other half remaining unscratched. Results showed a significant difference between bracket types and surface conditions. Non-scratched single-crystal brackets had higher fracture strengths and slightly higher fracture loads than polycrystalline brackets. However, single-crystal brackets were significantly adversely affected by surface damage (scratching), while polycrystalline brackets were not significantly affected by surface damage. The fracture behavior of ceramic brackets followed the Griffith model where fracture strength decreased following surface damage.