Primary leptomeningeal melanoma in a child.

Primary malignant melanoma of the leptomeninges is a rare and aggressive tumor in children and accounts for less than 1% of all pediatric malignancies. Usually its symptoms include raised intracraneal pressure resulting from hydrocephalus secondary to tumoral obliteration of basal cisterns, but the passage of time from the initial symptomatology to diagnosis is frequently delayed. A 7-year-old male with primary leptomeningeal melanoma is reported. At the beginning, he presented ataxia and dysarthria followed by symptoms of raised intracranial pressure, complex partial seizures, progressive loss of consciousness, and coma. Cerebrospinal fluid analysis demonstrated raised opening pressure, normal glucose, and increased protein concentration, but malignant melanoma cells were not found. Magnetic resonance imaging scans depicted bright signals in the subarachnoid spaces on T(1) images and gadolinium-enhanced focal lesions. Cerebral biopsy was proposed, but it was not authorized. Definitive diagnosis was thus made by pathologic postmortem examination.

Uso de imipenem/ cilastatina en niños con infecciones bacterianas graves / Use of imipenem/cilastatin in children with severe bacterial infections

Objetivo: Determinar la eficacia y seguridad de imipenem/cilastatina (I/C) en niños con infecciones bacterianas graves. Material y métodos: Realizamos un estudio retrospectivo de 44 niños con infecciones bacterianas graves, ingresados en la Unidad de Cuidados Intensivos Pediátricos del Hospital Infantil Universitario 'Virgen del Rocío' entre enero de 1989 y diciembre de 1995. Ningún paciente padeció infección del siste-ma nervioso central. Se administró I/C en dosis media de 83 mg/kg de peso y día por vía intravenosa. Resultados: Se obtuvo una respuesta clínica favorable en 31 de los 44 pacientes (70,5 por ciento), y una sensibilidad del 87 por ciento. Imipenem/cilastatina fue efectivo en infecciones causadas por un espectro amplio de patógenos en pacientes con patología muy diversa, incluyendo sepsis, infecciones respiratorias, mediastinitis y peritonitis. La mayoría de los pacientes había recibido otros antibióticos e I/C se pautó como terapia de segunda elección. Este fármaco fue bien tolerado y no causó efectos secundarios graves o irreversibles. Dos pacientes padecieron convulsiones por causas diferentes a su administración. Conclusión: Nuestra experiencia confirma que I/C es una buena alternativa como terapia de segunda elección en pacientes pediátricos con infecciones bacterianas graves (AU)

Primary idiopathic chylopericardium in a 2 month old successfully treated without surgery.

The authors report a case of primary idiopathic chylopericardium in a previously healthy 2-month-old infant. He was treated with continuous pericardial drainage and low-fat total parenteral nutrition. He remains asymptomatic after 14 months of follow-up. This is the first report of primary idiopathic chylopericardium successfully treated nonoperatively.

[Multicenter prospective study on severe bacterial meningitis in children]. / Estudio prospectivo multicéntrico de la meningitis bacteriana grave pediátrica.

UNLABELLED: We prospectively studied the epidemiologic, clinic signs and outcome of bacterial meningitis in 125 children who were admitted into a PICU (Pediatric Intensive Care Unit) of 11 hospitals of Spain and whose meningitis was diagnosed between May 1994 and April 1995. RESULTS: The median age of the children was 3.55 +/- 3.32 years (range 1 month to 16.5 yrs). Eighty-eight were bacterial meningitis, probably bacterial 30 and aseptic 7. The most frequently isolated organisms were N. meningitidis (52), H. influenza type b (17) and S. pneumoniae (8). Twenty-five percent of N. meningitidis had C serotype. Incidence rate of each germen was depending of age. All patients diagnosed of H. influenza type b meningitis were less than 3 years old. H. influenza type b and meningococcus had similar incidence rate during the first year of life (27% versus 31%). During the first three years of life H. influenza type b produced one third of bacterial meningitis. A mortality rate of 5.6% (seven patients: 3 S. pneumoniae, 1 N. meningitidis, 1 H. influenza type b and 2 unknown germen) was observed. Patients who die had lower Glasgow coma score (p = 0.034) and seizures (p = 0.001) at admission. At discharge of PICU, 9 survivors (7.2%) had sequelae: mental retardation in 7 patients and hearing loss in two. One third of patients needed hemodynamic support and a 15% of them ventilatory support. CONCLUSIONS: Age is an important epidemiological factor in the etiology of pediatric acute meningitis. H. influenza type b and N. meningitidis had similar incidence rate during the first year of life. S. pneumoniae had the highest mortality rate (37.5%). The presence of coma and seizures at admission were associated with mortality.

Appearance of resistance to beta-lactam antibiotics during therapy for Streptococcus pneumoniae meningitis.

A young boy had meningitis caused by Streptococcus pneumoniae that was relatively resistant to penicillin and susceptible to cefotaxime. After 10 days of therapy with penicillin and cefotaxime, fever recurred and a second lumbar puncture revealed a pneumococcus that was resistant to all beta-lactam antibiotics. We now add vancomycin to empiric third-generation cephalosporin therapy for meningitis in children when gram-positive cocci are seen on the cerebrospinal fluid smear.

Efficacy and safety of intravenous amiodarone for short-term treatment of paroxysmal supraventricular tachycardia in children.

The use of intravenous amiodarone was assessed during 23 episodes of paroxysmal supraventricular tachycardia in 15 children aged 9 days to 11 years. Five of the fifteen patients had congenital structural heart disease, and three had Wolf-Parkinson-White syndrome. Tachyarrhythmias were returned to sinus rhythm during 20 of the 23 episodes (87%). No major adverse effects occurred. Recurrence of tachycardia was not observed during short-term follow-up. In conclusion, intravenous amiodarone is an effective, safe antiarrhythmic drug for short-term treatment of supraventricular tachycardia in children.