Primary pelvic pyomyositis in a neonate.

Primary pyomyositis is a bacterial infection occurring in skeletal muscle with no obvious local or adjacent cause. It is classically an infection of the tropics, although it is reported in temperate climates with increasing frequency. Tropical pyomyositis occurs predominantly in children aged between 2 and 5 and in adults aged between 20 and 45 years, whereas most temperate pyomyositis cases occur in adults. Using a magnetic resonance imaging scan, we made the diagnosis of staphylococcal pelvic pyomyositis in a Swiss term-born infant with an initial working diagnosis of septic hip osteoarthritis.

Long-term followup of renal functional reserve capacity after unilateral nephrectomy in childhood.

PURPOSE: We establish renal function and renal reserve capacity in the long-term followup of unilateral nephrectomy in childhood. MATERIALS AND METHODS: We recalled 37 subjects who underwent unilateral nephrectomy during childhood (age less than 16 years) to determine glomerular filtration rate, renal plasma flow and functional renal reserve capacity after oral protein loading. Interval since nephrectomy was 0.5 to 10 years in 10 cases, 11 to 20 in 13 and more than 20 years in 14, during which regular repeated renal function tests were done at our hospital. None of the patients had hypertension or significant proteinuria and all developed normally into adults. A group of 7 healthy normal subjects with 2 kidneys served as controls. RESULTS: Creatinine clearance increased 34% immediately after surgery from a mean plus or minus standard error value of 78.6 +/- 6 to 105.4 +/- 7.2 ml. per minute per 1.73 m.2, peaked 2 to 6 months postoperatively and then plateaued (approximately 125 ml. per minute per 1.73 m.2). This level of renal function was sustained for more than 20 years. At the present testing glomerular filtration rate and renal plasma flow were not different from those of the controls. Renal reserve capacity was normal (stable) only during the first decade after unilateral nephrectomy (approximately 6% decrease), and it decreased by 50% at 10 to 20 and 66% at 20 to 30 years later. CONCLUSIONS: This long-term followup study demonstrates that a single remnant human kidney continues to function normally for more than 20 years. The prolonged increased workload does not interfere with normal development and maturation. The renal reserve capacity decreased significantly during the years may, however, indicate a vulnerability of the single kidney and raises the possibility of renal functional impairment with much longer followup.

High-versus low-dose erythropoietin in extremely low birth weight infants. The European Multicenter rhEPO Study Group.

OBJECTIVE: To investigate whether a weekly 1500 IU/kg dose of recombinant human erythropoietin (rhEPO) is more effective than a dose of 750 IU/kg/week in preventing anemia and reducing the transfusion need in infants with birth weights less than 1000 gm. STUDY DESIGN: In a randomized, double-blind, multicenter trial, 184 infants with birth weights between 500 and 999 gm were treated with either rhEPO 750 (low-dose group) or 1500 IU/kg/week (high-dose group) from day 3 of life until 37 weeks' corrected age. RESULTS: Thirty-two percent of the infants in each group did not receive any transfusion during the treatment period. The total volume of erythrocytes received was similar in each group. The success rate, defined as no transfusion needed and hematocrit value 0.30 L/L or greater, was 27.6% in the low-dose and 29.5% in the high-dose group (p = 0.96). CONCLUSION: Doubling the rhEPO dose of 750 IU/kg/week is not indicated in infants with birth weights less than 1000 gm.

Early nasal continuous positive airway pressure treatment reduces the need for intubation in very low birth weight infants.

UNLABELLED: Nasal continuous positive airway pressure (CPAP) applied shortly after birth is said to be an effective treatment of respiratory distress in very low birth weight infants (VLBW). We tested the hypothesis that the use of early nasal CPAP (applied as soon as signs of respiratory distress occurred, usually within 15 min after birth) reduces the need for intubation, the duration of intermittent mandatory ventilation and the incidence of bronchopulmonary dysplasia. All liveborn VLBW infants (birth weight < 1500 g) admitted to our tertiary neonatal intensive care unit in 1990 (historical controls) and in 1993 (early nasal CPAP group) entered the study. The intubation rate was significantly lower after introduction of nasal CPAP (30% vs 53%, P = 0.016). Median duration of intubation was 4.5 days (interquartile range 3-7 days) before versus 6.0 days (2.8-9 days) after nasal CPAP was introduced (P = 0.73). The incidence of bronchopulmonary dysplasia was not reduced significantly (32% vs 30%, P = 0.94). Survival until discharge was 89.5%, before versus 92.9% after introduction of nasal CPAP (P = 0.54). CONCLUSION: Early nasal CPAP is an effective treatment of respiratory distress in VLBW infants, significantly reducing the need for intubation and intermittent mandatory ventilation, without worsening other standard measures of neonatal outcome. We found no significant decrease in the incidence of bronchopulmonary dysplasia.