[Incidence of complications of otitis media]. / Incidencia de complicaciones de otitis media.

OBJECTIVE: Determine the incidence of otological and endocranial complications of acute otitis media, taking into account previous treatments and the development of complications. MATERIAL AND METHODS: Retrospective follow-up study between March 1996-2003 including 16 patients: 9 men, 7 women. RESULTS: Nine patients (56.25%) had intracranial complications and seven otological ones. In the first group, 6 developed meningitis by Streptococcus pneumoniae, one sigmoid sinus thromboflebitis, one multiple abscesses, and one subdural empiema and encephalitis. Otological complications were six acute mastoiditis and the other one a facial paralysis. The child with thromboflebitis underwent mastoidectomy and closed meningeal comunication; 5 of the acute mastoiditis were operated on and the other received traditional treatment. The meningitis received medication. Two died, one because of a subdural empiema and the other due to meningitis. CONCLUSION: Despite the advances made by antibiotherapy and diagnosis, the complications of otitis media are still frequent. The pediatrician and otorhinolaryngologist should be on the alert for these as well as for Pneumococcus and its high resistance.

Diagnostic and prognostic significance of platelet-bound IgG measurement in immune thrombocytopenic purpura.

The test proposed by Dixon et al. is an important contribution to the technique for detection of platelet-associated antibody. This test measures platelet-associated IgG by a complement-mediated red blood cell lysis-inhibition technique. We have used the direct Dixon test to study 44 cases of immune thrombocytopenic purpura and 90 controls, including subjects with nonimmune thrombocytopenic purpura and healthy subjects. Increased PAIgG was noted in 86.3% of ITP patients. However, the pretreatment values of PAIgG were not helpful for predicting the therapeutic response to either prednisone or splenectomy. Six patients in long-term clinical remission had normal platelet counts and distinctly abnormal PAIgG values. This condition was associated with qualitative platelet functional defects. This latter finding seems to be of diagnostic interest and deserves further investigations.

Idiopathic thrombocytopenic purpura and pregnancy. Maternal platelet count and antiplatelet antibodies do not predict the risk of neonatal thrombocytopenia.

The aim of this study was to try to better characterize, on the basis of maternal platelet count and antiplatelet antibodies, women with ITP or a history thereof at risk of being delivered of a child affected by neonatal thrombocytopenia. Results show that either clinical classification or maternal platelet count were not effective in predicting the occurrence of neonatal thrombocytopenia. Effects of prednisone on platelet-bound and unbound antibodies were studied prospectively in 12 non-pregnant women with ITP; no increase of these parameters was observed after treatment. Thus, the risk of corticosteroid therapy in the management of pregnant ITP patients remains hypothetical and unproven.

Increased production of mononuclear cell procoagulant activity in Hodgkin's disease.

Procoagulant activity of peripheral blood mononuclear leucocytes was studied in 24 consecutive patients with Hodgkin's disease. Mononuclear cells, tested immediately after isolation, expressed very low activity which was, however, somewhat higher than that of cells from a matched control group (P = 0.063). Procoagulant activity generated by patients' mononuclear cells following stimulation with bacterial endotoxin was significantly higher than that produced by control cells (P less than 0.01). There was no apparent relation between procoagulant activity and pathological staging. The increased capacity of mononuclear phagocytes to produce procoagulant activity might help explain activation of blood coagulation and subsequent fibrin deposition in patients with Hodgkin's disease.

Bleeding on patients with autoimmune thrombocytopenic purpura and normal platelet count.

80% of patients with chronic autoimmune thrombocytopenic purpura (ATP) may reach normalization of platelet count after steroids or splenectomy. In some of these cases a bleeding tendency may still persist and this has been attributed to abnormalities of platelet function resulting from the effect of platelet-bound antibodies. We have studied 49 ATP patients in order to assess the frequency and the pattern of this immune thrombopathia, and the correlation with the levels of platelet associated IgG (PAIgG). Only 3 patients (6%) had prolonged bleeding time and persistence of mucocutaneous haemorrhages, whereas 36% presented an altered platelet aggregation pattern. Platelet serotonin content, platelet and plasma beta-thromboglobulin concentration, and malondialdehyde generation after thrombin stimulus were found also altered, but the findings were not clearly correlated with the concentration of PAIgG.