Alpha interferon therapy in children with chronic active hepatitis B and delta virus infection.

Two children with chronic hepatitis B virus and delta virus infection were treated with alpha interferon. Both tolerated the therapy without complications, and one demonstrated clearance of the infection and development of immunity.

Calcium-channel blocking agents as therapy for amphotericin B nephrotoxicity.

Amphotericin B is a broad-spectrum antifungal agent shown to be effective in the treatment of systemic fungal infections. Unfortunately, therapeutic doses are often associated with a variety of adverse effects, including nephrotoxicity. Studies of the deleterious effects of amphotericin B on the renal microvasculature are yielding clues to sparing kidney function. In selected patients, concomitant use of a calcium-channel blocker may prevent the nephrotoxic effects of amphotericin B and allow full therapeutic doses to be used.

Bladder fungus ball: a reversible cause of neonatal obstructive uropathy.

Very low birth weight infants often have multiple predisposing conditions for the development of invasive candidiasis. In patients with systemic candidiasis, the kidney is vulnerable to the formation of cortical abscesses or obstructive intrarenal masses ("fungus balls"), usually at the ureteropelvic junction. Ureteropelvic junction obstructive fungal uropathy necessitates invasive debridement to restore renal function. A very low birth weight infant, infected with Candida, was first seen with hypertension, renal insufficiency, and urine cultures positive for fungus; obstructive bladder fungus ball was diagnosed by ultrasonography. Mechanical disruption with amphotericin B bladder irrigation was accomplished via ultrasonographic guidance, relieving renal obstruction and insufficiency. Systemic antifungal therapy was completed with amphotericin B and flucytosine. The first reported case of bladder obstructive fungal uropathy in a neonate is added to a review of 16 cases of neonatal renal obstructive uropathy.

Hypoplastic right-sided heart complex: a cluster of cases with associated congenital birth defects. A new syndrome?

Fourteen infants, all born within the same geographic area in a two-year period, had hypoplastic right-sided heart complex associated with a high incidence of other congenital defects. No common teratogenic exposure or genetic relationships were discovered. Twelve of the 14 infants were conceived in the spring or summer. Significant elevations in serum antibody titers against coxsackie group B virus and echoviruses were noted in the general referral population during those spring and summer quarters. Cardiac defects included a hypoplastic right ventricle in every case; three types were noted. Varying degrees of right-sided valvular lesions and other intracardiac defects accompanied the hypoplastic ventricle. Eleven infants had extracardiac congenital anomalies: 10 had microcephaly, two had micrognathia with posterior cleft palate, four had low-set ears, and one had arrhinencephaly. The high incidence of extracardiac defects in the syndrome (79%) is in distinct contrast to the incidence reported in the New England Regional Infant Cardiac Program in infants who had pulmonic atresia with intact ventricular septum.