Artritis crónica juvenil: a propósito de un caso post-enteritis por Campylobacter jejuni / Juvenile chronic arthritis developed after a Campylobacter jejuni enteritis. A case report

La artritis crónica juvenil es la enfermedad reumática más frecuente en niños. El diagnóstico precoz y el tratamiento energético de los pacientes con mal pronóstico sirven para mejorar la calidad de vida y la evolución. Presentamos un caso de artritis crónica juvenil que se presentó después de una enteritis por Campylobacter jejuni. (AU)

Fallo de medro: a propósito de un caso de causa no orgánica / Failure to thrive in relation with a case of non organic cause

El niño que no gana peso es un problema frecuente e importante en la práctica pediátrica. Las causas de éste pueden ser múltiples y el pediatra debe de tenerlas presentes –principalmente las no orgánicas–, ya que únicamente una historia clínica correctamente dirigida nos conducirá a su diagnóstico. Presentamos un caso de fallo de medro debido al uso de caminadores a la edad de 4 meses, lo que comportó un ejercicio excesivo con el consiguiente aplanamiento de la curva ponderal (AU)

Hyperinsulinemia in pre- and post-pubertal children born small for gestational age.

BACKGROUND: Reduced fetal growth is a potential risk factor for development of metabolic abnormalities in later life. The relationship between low birthweight and impaired glucose tolerance, type 2 diabetes and insulin resistance in adulthood has been well documented. PURPOSE: Assuming that fetal undernutrition is associated with insulin resistance in middle age, we elected to study whether this process may already be present in young adults and adolescents born small for gestational age (SGA). SUBJECTS AND METHODS: Children born in Vall d'Hebron Hospital Infantil, Barcelona, between 1986 and 1989 and between 1978 and 1983 with birthweights below the third centile for the local standard values, were invited to participate in the present study. Of those, 51 (22 girls and 29 boys) were pre-pubertal with 9.4 +/- 0.2 years of age and 49 (29 girls and 20 boys ) were post-pubertal, with 17.3 +/- 0.3 years of age. All patients underwent a standard, 2-hour oral glucose tolerance test. Insulin and glucose responses were compared with our previously published data in control children with normal birthweight. RESULTS: The insulin response at 30 min after glucose load was significantly higher (p < 0.001) in pre- and post-pubertal girls and boys formerly SGA than in controls. In addition, the girls also had a higher insulin response at 60 and 120 min. Mean serum insulin (MSI), the area under the insulin curve during the glucose challenge, was statistically increased in pre- and post-pubertal boys and girls born SGA when compared to controls. CONCLUSION: The presence of high insulin levels after an oral glucose challenge in children and adolescents born SGA might be considered as an early marker of subsequent insulin resistance in adulthood. Furthermore, our population offers the opportunity to study the natural course of hyperinsulinemia and its outcome. Follow-up of this cohort may be helpful in distinguishing a subset of young children and adolescents in whom therapeutic intervention could be done.

Pronounced adrenarche and precocious pubarche in boys.

In girls, pronounced adrenarche with precocious pubarche (PP) has been related to reduced fetal growth and to a cluster of endocrine-metabolic abnormalities. We examined whether these associations are also evident in boys with PP. The study population consisted of matched groups of boys (n = 58; age range 5-15 years) without or with a history of PP. After stratification for pubertal development, non-PP and PP boys displayed comparable results for the studied variables, including serum insulin-like growth factor I, sex hormone binding globulin, insulin-like growth factor binding proteins 1 and 3, indices of circulating glucose and insulin responsiveness to an oral glucose load, and birth weight SD score. In conclusion, the present results indicate that adrenarche-driven PP in boys is, in contrast to PP in girls, not associated with a cluster of endocrine-metabolic abnormalities and is not related to reduced fetal growth. These observations support the view that adrenarche-driven PP in boys may be regarded as a variant of normal development. Copyrightz1999S.KargerAG,Basel

[Cardiac tamponade in children as a complication of central venous catheterization. Report of four cases]. / Taponamiento cardiaco en niños como complicación de la cateterización venosa céntral. Presentación de cuatro casos.

Very few cases of children with cardiac tamponade from central venous catheterization have been reported. Four cases are described. In 3 patients the diagnosis was suspected, a pericardiocentesis was performed and they survived. The other patient died and, at autopsy, diagnosis was made. The available literature on cardiac tamponade from central venous catheters in children is reviewed, preventive measures are considered in detail and the need for a high index of suspicion is highlighted.

[Cardiac complications in Kawasaki disease]. / Complicaciones cardiacas en la enfermedad de Kawasaki.

We present 3 patients, aged 7 and 12 months. and 5 years, who meet the diagnostic criteria for Kawasaki's disease. In these, there was coronary artery involvement. which was identified by two dimensional echocardiography. In two of these, a coronary artery involvement which was identified by two dimensional echocardiography. In two of these, a coronary artery aneurysm was demonstrated within the 3rd week. The aneurysm resolved after 4 months in one patient, and still persist after 15 months in the other. The third patient had a left coronary artery aneurysm, confirmed by angiocardiography, which also showed small aneurysms in the right coronary artery. The electrocardiographic study of this patient, performed 3 months after onset, showed a patterns of necrosis (anterolateral infarction), confirmed by mean of a thallium scintigraphy. We have performed a study about the management of this kind of patients, and can conclude: 1. Coronary angiocardiography may permit the detection of right coronary artery aneurysms, not visualized by echocardiography. 2. Patients with coronary artery aneurysms, with no stenotic lesions 1 the coronary angiocardiography, may evolve into myocardia infarction. 3. We expose our doubts about the indication and right time to perform the angiocardiographic study.