Oropharyngeal candidiasis in immunocompromised children: a randomized, multicenter study of orally administered fluconazole suspension versus nystatin. The Multicenter Fluconazole Study Group.

OBJECTIVE: To compare the efficacy, safety, and tolerance of fluconazole suspension versus nystatin in the treatment of oropharyngeal thrush in immunocompromised children. DESIGN: Multicenter, randomized, observer-masked trial. SETTING: Thirty-two centers participated, including hospitals and ambulatory care clinics. PATIENTS: We enrolled 182 immunocompromised infants and children, ages 5 months to 14 years, with signs of oral thrush and presence of yeasts on potassium hydroxide- or gram-stained preparations. Subjects were randomly assigned to receive a single daily dose of fluconazole suspension, 2 to 3 mg/kg per day, or nystatin, 400,000 units four times daily for 14 days; 159 patients, who had culture confirmation of thrush and received at least 7 days of study drug, were evaluated for efficacy; all patients were evaluated for safety. RESULTS: Clinical cure was demonstrated in 91% of the subjects in the fluconazole group and 51% of the subjects in the nystatin group (p < 0.001), and eradication of the organism cultured at entry occurred in 76% and 11% (p < 0.001), respectively. Gastrointestinal conditions developed in six patients who received fluconazole and in three who received nystatin; two fluconazole recipients were subsequently withdrawn from the study. Laboratory abnormalities occurred with equal frequency in both groups. Clinical relapse rates were similar in both groups at 2 weeks (18% and 24% for fluconazole and nystatin, respectively) and 1 month (28% and 27%, respectively) after the completion of study drug. CONCLUSIONS: Fluconazole suspension is more effective than nystatin in the treatment of thrush in immunocompromised children. Both regimens were well tolerated.

Acute poststreptococcal glomerulonephritis and sickle cell disease.

In this paper, we describe a case of acute poststreptococcal glomerulonephritis in a patient with sickle cell disease and review four other cases in the literature. Acute glomerulonephritis in patients with sickle disease frequently presents with anasarca, severe proteinuria, hypoproteinemia and normal complement. This presentation makes it difficult to differentiate acute glomerulonephritis from nephrotic syndrome associated with sickle cell disease. The prognosis of the two entities is extremely different; a renal biopsy may be needed to confirm the diagnosis.

The in vitro culture studies of eosinophils.

Techniques for the in vitro culture of eosinophils from marrow and peripheral blood have been available since the early 1970's. Concepts of hematopoiesis and techniques for in vitro culture are reviewed. Insights into eosinophilpoiesis from the relatively few studies reported are discussed. Areas for future study are outlined.

Parent consultants in pediatric oncology.

A Parent Consultant position has been included in the pediatric oncology unit at Rhode Island Hospital since 1975. The history and functioning of the position is discussed. Data from questionnaires of parents and hospital staff and a time study of the parent consultants are reviewed. This unique position has been very successful in filling many psychosocial needs of the families under our care.

Occult ganglioneuroma with diarrhea: localization by venous catecholamines.

Neural crest tumors can be complicated by secretory diarrhea mediated by vasoactive intestinal peptide (VIP). An eight-month-old male with a several-month history of secretory diarrhea is described. Elevated urine vanillylmandelic acid (VMA), total urine catecholamines, and plasma VIP indicated that a neural crest tumor was responsible for his protracted diarrhea. An extensive search for the tumor including CT scans of his head, neck, thorax, abdomen, and pelvis was unrevealing. A selective vena caval catheterization showed elevated catecholamines in a sample obtained above the renal veins. Subsequent laparotomy disclosed a benign ganglioneuroma arising from the left adrenal; the diarrhea resolved after its removal. Selective venous sampling proved useful in establishing the tumor's location where other techniques had been unsuccessful.