Intavenous immunoglobulin for the management of intractable epilepsy in a boy.

BACKGROUND: The involvement of the immune system in the pathogenesis of certain types of epilepsy has been supported in the past. The use of intravenous immunoglobulin in the treatment of neurologic diseases has shown a progressive trend over the last years. CASE REPORT: We report the case of a 9.5-year-old boy with refractory epilepsy who was admitted for investigation of his persistent seizures and severe psychomotor regression. He experienced persistent tonic-clonic over the preceding six months and long lasting atonic seizures since the age of six and did not respond to multiple anticonvulsant drugs. The administration of intravenous immunoglobulin achieved seizure control and cognitive improvement. CONCLUSION: This case underscores the efficacy of intravenous immunoglobulin in the treatment of refractory epilepsy in children. HIPPOKRATIA 2017, 21(1): 55-57.

Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: Scintigraphic features that contribute to the early diagnosis / Discordancia entre los hallazgos de resonancia magnética y gammagrafía ósea en niño con osteomielitis aguda complicada: aportación de patrones gammagráficos característicos en el diagnóstico precoz

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin - Ceftriaxone scheme to surgical intervention (AU)

El diagnóstico precoz y el tratamiento adecuado de la osteomielitis aguda es de suma importancia en los niños, ya que pueden prevenir el daño irreversible del hueso. La resonancia magnética (RM) por su superior resolución espacial y ausencia de radiación ionizante es la técnica utilizada en la práctica habitual antes que la gammagrafía ósea. El aumento del flujo sanguíneo y el incremento de captación focal del radiotrazador mostrado en la gammagrafía ósea de tres fases son los hallazgos gammagráficos típicos de osteomielitis aguda. Además, la captación difusa en la diafisis de huesos largos y una lesión focal "fría" son dos características especiales muy sugerente de periostitis, sepsis en tejidos blandos y formación de un absceso subperióstico, debido a la pérdida de unión del periostio al hueso durante la infancia. Presentamos un caso de osteomielitis complicada en un niño con RM no concluyente correctamente diagnosticada sobre la base de los hallazgos gammagráficos característicos originando el cambio de tratamiento de doble esquema de Vancomicina - ceftriaxona iv a intervención quirúrgica (AU)

Discordance between MRI and bone scan findings in a child with acute complicated osteomyelitis: scintigraphic features that contribute to the early diagnosis.

Early diagnosis and prompt treatment of acute osteomyelitis are of paramount importance in children because they can prevent irreversible bone damage. Magnetic resonance imaging (MRI) with its superior spatial resolution and lack of ionizing radiation is routinely preferred over bone scan for this purpose. Increased blood flow, hyperemia and focally increased tracer uptake shown by "three phase" bone scan are the typical scintigraphic findings of acute osteomyelitis. In addition, diffuse uptake along the shaft of long bones and focal "cold" lesions are two special features that may be highly suggestive of infective periostitis, soft tissue sepsis and subperiosteal abscess formation, due to the loose attachment of periosteum to bone during childhood. We present a case of complicated osteomyelitis in a child with inconclusive MRI correctly diagnosed on the basis of these special scintigraphic findings resulting in treatment change from double i.v. Vancomycin--Ceftriaxone scheme to surgical intervention.

Reduced placental prolyl hydroxylase 3 mRNA expression in pregnancies affected by fetal growth restriction.

OBJECTIVE: To investigate the role of the hypoxia-inducible factor (HIF) pathway in fetal growth restriction (FGR). DESIGN: A case-control study. SETTING: Research laboratory and gynaecology clinic. SAMPLE: Twenty placentas from normal pregnancies and 20 from FGR pregnancies. METHODS: RNA extraction, cDNA synthesis, quantitative real-time polymerase chain reaction (qRT-PCR) assay, statistical analysis. MAIN OUTCOME MEASURES: mRNA expression of HIF-1α, HIF-2α and HIF-ß (ARNT), along with prolyl hydroxylase domain 3 (PHD3), which leads to proteasomal degradation of HIF-α subunits. RESULTS: No statistically significant differences in the transcription levels of ARNT and HIF-2α were found between FGR and normal placentas. By contrast, PHD3 and HIF-1α mRNA were downregulated in FGR placentas. PHD3 mRNA expression was associated with gestational age at delivery (P = 0.008), birthweight centile (P = 0.029) and abnormal umbilical artery (UA) Doppler measurements (P = 0.034). CONCLUSIONS: As PHD3 regulates the HIF-mediated hypoxic response in FGR, we deduce that fetal adaptation to hypoxia ranges from impaired to adequate, as observed by the gradient of PHD3 downregulation in relation to the severity of FGR.