Endoscopic coagulation of choroid plexus in three children with severely advanced forms of hydrocephalus.

OBJECT: The development of modern neuroendoscopic technology brought back the use of choroid plexus surgery for the treatment of some patients with hydrocephalus. This study explored the use of endoscopic coagulation of the choroid plexus (ECCP) for the treatment of severely advanced forms of hydrocephalus in three children. PATIENTS AND METHODS: Three children with markedly dilated ventricles underwent ECCP. The first child had fetal hydranencephaly, the second had holoprosencephaly, and the third had severe hydrocephalus associated with other congenital malformations. All three children had had previous ventriculoperitoneal (VP) shunts, and ECCP was done because of shunt malfunction. All three children underwent computed tomography and magnetic resonance imaging to confirm the presence and to measure the size of the choroid plexus before surgery. ECCP was performed through a right frontal burr hole. A rigid neuroendoscope and monopolar coagulator were used to achieve choroid plexus coagulation. RESULTS: The first child died 21 days after surgery because of generalized infection originating from the lungs. The second child needed a ventriculoatrial shunt 45 days after ECCP, and the third child needed VP shunt 3 months after ECCP. CONCLUSIONS: ECCP, although not an alternative to ventricular shunt, is a safe procedure and should be tried in some children with severe advanced, low progressive, and hopeless forms of hydrocephalus. Long-term watchful follow-up is mandatory after surgery. When the risk of complications after VP shunting is relatively high in children with severe forms of hydrocephalus, ECCP seems to be worth trying. Delayed timing of VP shunting after ECCP would be meaningful for children with a high risk of shunt complications.

Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient.

CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia.

Miliary tuberculosis with positive acid-fast bacilli in a pediatric patient

CONTEXT: Tuberculosis is an important public health issue. The Brazilian government reported 78,460 new cases in 1999. Miliary tuberculosis is a severe form of this disease. OBJECTIVE: To report on an uncommon clinical presentation of miliary tuberculosis in a child. CASE REPORT: A 5-year old boy presented in the emergency room with fatigue and weight loss. He had had Staphylococcus aureus pneumonia 7 months before. Chest radiography revealed lobar consolidation and miliary pattern associated with small cavities in both upper lobes. Antibiotic therapy was started. The sputum was positive for acid-fast bacilli and hence the treatment recommended for tuberculosis (rifampicin, isoniazid [INH], pyrazinamide) was started. The patient was treated for 9 months and at the end of the follow-up period he had made a complete clinical recovery. CONCLUSION: Although in some particular cases sputum can be positive for acid-fast bacilli in children, limitations to the sputum test have forced pediatricians to base tuberculosis diagnosis on epidemiological data, clinical findings and radiographic pattern. In this particular case, we hypothesize that the sputum bacillus test was positive because bacilli grew inside residual pneumatoceles that were produced during previous pneumonia