Microbiological aspects of diaper dermatitis.

BACKGROUND: The microbiological basis of diaper dermatitis is not clearly elucidated, although a better knowledge of microbial colonisation can be of importance with regard to an adequate treatment. OBJECTIVE: To investigate the relevance of candida sp. and Staphylococcus aureus colonisation in diaper dermatitis and to determine the correlation between the extent of colonisation and the severity of disease. METHODS: Growth of candida sp. and S. aureus in the perianal, inguinal and oral regions was determined by positive/negative and semi-quantitative analysis in an open, multi-centre (n = 3) study. Forty-eight children with healthy skin and 28 with diaper dermatitis were analysed. The severity of diaper dermatitis was assessed using a total symptoms score. RESULTS: Colonisation by candida sp. was significantly more frequent in children with diaper dermatitis as compared to those with healthy skin (perianal 75 vs. 19%; inguinal 50 vs. 10%; oral 68 vs. 25%, p < 0.0003), whereas colonisation by S. aureus at the 3 swab locations was not different (p > 0.34). There was a highly significant, positive correlation between severity of disease and extent of candida sp. colonisation at all swab locations. CONCLUSIONS: Limited microbial colonisation in diaper dermatitis is of questionable relevance, but extensive colonisation seems to aggravate the symptoms; therefore, we suggest that semi-quantitative evaluation should be preferred to the positive/negative assessment for a differential diagnosis.

Effects of cisapride on ventricular depolarization-repolarization and arrhythmia markers in infants.

To study prospectively the effects of cisapride on ventricular repolarization, depolarization, and arrhythmia markers in neonates, we determined before and three days after starting cisapride (1 mg/kg/day): corrected QT interval (QTc) and QT dispersion (QTd) on standard ECGs, and duration of filtered QRS (fQRS) and of low amplitude (<40 microV) terminal signals (LAS40, ms) and root mean square of the last 40 ms (RMS40, microV) using high-gain signal-averaged ECG (SAECG). Twenty-four term and 11 preterm infants (gestational age 23-35 weeks) were studied at a median chronological age of 32 days. QTc and QTd were not different between term and preterm infants. Cisapride lengthened QTc (mean +/- SD; ms: 396.6 +/- 24.8 before vs. 417.0 +/- 35.2 after, p < 0.001). Three term and two preterm infants (5/35 = 14%; 95% CI: 5-30%) had a QTc >450 ms after cisapride. QTd after cisapride increased significantly in all infants with prolonged QTc. Filtered QRS, LAS40, and RMS40 before and after cisapride were within our normal values. We conclude that cisapride prolongs ventricular repolarization in neonates and infants without altering depolarization. Although no clinical arrhythmias were observed the dose of 0.8 mg/kg/day should not be exceeded.

[Primary cysts of the spleen: apropos 3 cases with a review of the literature]. / Le cisti primitive della milza: a proposito di 3 casi con revisione della letteratura.

The splenic cyst occurs rarely, is benign and often asymptomatic. Surgery is the therapy of choice as soon as the size reaches 2 centimeters. Following the exclusion of an echinococcus infection, the cyst can be treated either by complete resection or by fenestration. Recently laparoscopy has been demonstrated to be a useful alternative to open surgery in the treatment of selected splenic cysts. We report 3 cases successfully operated with conventional surgical procedures and, based on the literature, we review the history, the physical signs, the investigations and the surgical procedures.

[Group A beta-hemolytic streptococcal meningitis in a pregnant woman]. / Méningite à streptocoque beta-hémolytique du groupe A chez une femme enceinte.

A case of group A streptococcal meningitis in a normally healthy pregnant woman is described, with a review of the literature. Streptococcus pyogenes is a very rare cause of bacterial meningitis and especially affects immunocompetent subjects. The evolution is often associated with severe neurologic deficits, but the prognosis is favourable under treatment with penicillin. In the light of the recrudescence of invasive infections, this germ could assume a more important role in bacterial meningitis comparable to that in the pre-antibiotic era.

Neonatal lupus erythematosus with congenital heart block and severe heart failure due to myocarditis and endocardititis of the mitral valve.

We report a case of neonatal lupus erythematosus (NLE) with congenital heart block and severe myocardial failure, which was followed from the 25th week of gestation because of fetal bradycardia. The child was delivered at the 37th week of gestation by elective cesarean section because of echocardiographically documented heart enlargement, pericardial effusion and moderate insufficiency of the mitral and tricuspid valves. In spite of immediate pacing, intubation and supportive treatment, the newborn developed progressive heart failure. Echocardiography showed endocarditis of the mitral valve and diffuse myocarditis. The heart failure resolved under steroid treatment. Our experience supports the early use of steroids in treating myocarditis due to NLE. Intrauterine steroid treatment in the presence of fetal hydrops and congenital heart block is discussed.

Chronopharmacology of methotrexate pharmacokinetics in childhood leukemia.

Survival has been shown to improve when maintenance therapy for acute lymphocytic leukemia in children is given at night rather during the day. We examined the possibility that diurnal variation in methotrexate pharmacokinetics may contribute to this improvement. In a crossover study, we determined the pharmacokinetics of intravenous methotrexate at 10:00 and 21:00 h in six children with standard or high-risk leukemia. During the study, children refrained from concomitant drugs (6-mercaptopurine and trimethoprim sulfamethoxazole). There was a significant fall in methotrexate plasma clearance at night (from 5.6 +/- 3 ml/min/kg to 4.7 +/- 2.3 ml/min/kg p < 0.05). Renal clearance of methotrexate tended to decrease at night and unbound renal clearance decreased significantly (from 17.5 +/- 1.7 ml/min/kg to 8.5 +/- 3.6 ml/min/kg p < 0.05). Creatinine clearance did not exhibit diurnal variation, when comparing two 12-h collections, but there was a significant decrease in the nonglomerular clearance of methotrexate (from 14.8 +/- 5.2 to 6 +/- 4 ml/min/kg). Because it is a weak organic acid, the tubular secretion of methotrexate depends on urinary pH. At night urinary pH is more acidic. This may result in more reabsorption and hence reduced renal clearance.

Decrease of dental treatments over a 15-year period in the Canton of Ticino.

The evolution of the number of therapeutic services rendered within the School Dental Service in the Canton of Ticino over a period of 15 years is presented. A 45% decrease in the number of conservative treatments took place from the school year 1977/78 to 1984/85. New amalgam fillings per year on permanent teeth decreased by 34%, those on deciduous teeth by 46% and composite fillings by 43%. The possible reasons for the decline of tooth decay are discussed. Decrease in treatments rendered is shown to be feasible in a short period of time when institutionalized dental care delivery is put into practice by motivated practitioners.

Diurnal variation of methotrexate disposition in children with acute leukaemia.

There is recent evidence that survival is improved when maintenance therapy for acute lymphocytic leukaemia in children is given at night. We have examined the possibility that diurnal variation in methotrexate pharmacokinetics may contribute to this improvement. In 6 children with leukaemia there was a significant fall in methotrexate plasma clearance at night (from 5.6 to 4.7 ml.kg-1.min-1). Renal clearance of methotrexate tended to fall at night and unbound renal clearance fell significantly (from 17.5 to 8.5 ml.min-1.kg-1 P less than 0.05). Creatinine clearance did not exhibit diurnal variation, whereas there was a significant fall in the non-glomerular clearance of methotrexate (from 14.8 to 6 ml.min-1.kg-1). Since methotrexate is a weak organic acid, its tubular secretion depends on urinary pH. At night urinary pH is more acidic, and this may result in more reabsorption and hence reduced renal clearance.

Interaction between trimethoprim-sulfamethoxazole and methotrexate in children with leukemia.

Because trimethoprim-sulfamethoxazole (TMP-SMX) causes neutropenia in children with leukemia, we investigated the possibility that pharmacokinetic interaction between methotrexate (MTX) and TMP-SMX causes accumulation of the antileukemia agent. We studied the pharmacokinetics of MTX given intravenously or orally to nine children with acute lymphoblastic leukemia, once with and once without TMP-SMX. There was an increase in free MTX fraction during TMP-SMX therapy in all patients, from (mean +/- SD) 37.4 +/- 11% without TMP-SMX to 52.2 +/- 6.4% with TMP-SMX (p less than 0.01). Plasma clearance of total MTX did not change significantly, whereas clearance of free MTX decreased significantly (from 12.5 +/- 4 to 7.6 +/- 1.5 ml/kg/min; p less than 0.05). There was a consistent decrease in the renal clearance of free MTX (from 12.1 +/- 6.8 to 5.6 +/- 2.4 ml/kg/min; p less than 0.05). Elimination half-life of MTX was not affected significantly by TMP-SMX. There was a significant correlation between serum concentrations of TMP-SMX and the percentage of decrease in the renal clearance of free MTX (r = 0.91; p less than 0.05). These changes in protein binding and tubular clearance of MTX, caused by competition with TMP-SMX, result in a mean 66% increase in systemic exposure to MTX and may explain the myelotoxicity often observed with the coadministration of the two drugs.

Successful treatment of acute mountain sickness with dexamethasone.

A double blind, randomised, placebo controlled trial of treatment with dexamethasone for acute mountain sickness was performed in the Capanna "Regina Margherita" at an altitude of 4559 m in the Alps Valais. After 12-16 hours of treatment (8 mg dexamethasone initially, followed by 4 mg every six hours) the mean acute mountain sickness score decreased significantly from 5.4 to 1.3, and eight of 17 patients became totally asymptomatic. Mean arterial oxygen saturation rose from 75.5% to 82.0%, and there was a small increase in standard spirometric measurements. In the placebo group none of these variables changed significantly. It is concluded that dexamethasone may be used as emergency treatment for acute mountain sickness to facilitate safe descent to a lower altitude.

[Located hinge-axis or conventional hinge-axis?]. / Axe-charnière localisé ou axe-charnière conventionnel?

The purpose of this study is first, to evaluate the influence of locating the horizontal transverse axis of rotation of the mandible, both kinematically and conventionally, and second, to determine the influence of the thickness of the wax check-bite, as obtained in the centric relation, upon the functional analysis of the occlusion. The results show that the influence of any displacement of the horizontal transverse axis of rotation of the mandible is smaller, within a circle with a 6-mm radius, than that of the thickness of the wax check-bite obtained in the centric relation.

[Prevention in the schools of Massagno, Ticino: results after 8 years]. / Prophylaxie dans les écoles de Massagno TI: résultats après 8 ans.

The results of 8 years of combined caries prophylaxis (fluoride tablets in school, brushing with aminofluoride gel, motivation of teachers, pupils and parents) are reported from the community of Massagno TI. Caries reduction of about 60%, or from 2.72 new lesion to 1.12 new lesion per pupil and year. About 60% of pupils did not require dental treatment in the year 1977/78. Root canal treatment and fillings of anterior teeth have all but disappeared. MO and MOD fillings have receded more than occlusal fillings. The community and the canton have economized some SFr. 20000.-per annum.

Critical evaluation of the ANB angle.

It has been demonstrated, first, in an empirical manner (qualitatively) and, second, in a geometric-mathematical manner (quantitatively) that the ANB angle depends not only on the anteroposterior relationship of the jawbones (which it should measure) but also on the maxillary inclination and maxillary prognathism, and slightly on the facial dimensions. Faces having the same anteroposterior value for the jawbones can have very different ANB angles (Figs. 3 and 4) and vice versa.