Minerva pediatrica
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Newer immunosuppressive agents have dramatically reduced the rates of acute graft rejection over the last decade but may have exacerbated the problem of post-transplant infections. Causes of early mortality include graft dysfunction and sepsis. Late mortality occurs mainly due to sepsis. ⋯ Moreover, potentially promising immunomodulatory approaches, i.e. human activated protein C, immunomodulatory diets containing L-arginine and fish oil, selective cytokine blockade, platelet-activating factor receptor antagonist, LPS receptor CD14 blockade and G-CSF, for the treatment of immunodysfunction in septic patients will be outlined in this review article. Most of them, however, have not been tested in the clinical arena in transplanted patients. Thus, the main part of the article, immunomodulation during sepsis in organ transplanted children is quite speculative and based on immunomodulatory strategies in other non-transplanted septic patients.
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The aim of this paper was to compare the efficacy of adjunctive intrapleural fibrinolygic agents (streptokinase, urokinase) on fibrinopurulent stage empyema and chronic stage empyema. ⋯ Our study suggests that intrapleural fibrinolytic treatment is an effective and safe therapy in children with fibrinopurulent phase thoracic empyema.
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Growth hormone (GH) has been suggested to increase the growth of melanocytic nevi and the risk for melanoma in short children treated with substitutive therapy. On the contrary, in GH deficient patients the influence of GH treatment on the appearance and the long-term evolution of Sutton's nevus, a pigmented melanocytic lesion surrounded by a ring (halo) of depigmentation, that usually and progressively involves the nevus, is debated. The aim of this study was to investigate whether GH therapy causes an accelerated growth of Sutton's nevus. ⋯ Moreover, Sutton's nevus is present in case 2, who is prepuberal and not yet treated with hGH. In case 3 Sutton's nevi occurred during GH treatment and after the onset of puberty, but didn't show any long-term change in both the number and size. No clear influence of both GH therapy and sexual steroids on Sutton's nevi was observed.
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Endoscopic third-ventriculostomy (ETV) became the treatment of choice for non-communicating hydrocephalus and its effectiveness is largely reported. On the contrary, specific articles on complications and failures of this technique are very rare and this review aims at supplying further information about it. Therefore, an analysis of the main and up-to-date series is made and exhaustive data about complications and failures of ETV and about their incidence are obtained. ⋯ Moreover, this study showed both the risk that the endoscopic procedure must be suspended (intra-operative failure) and the risk of an early (before 1 month) or delayed (even some years after the intervention) narrowing of the ventriculostomy. The rate of and the reasons for failure have been analysed and the success of a second ETV has been estimated. The results of this analysis suggest that the children proposed for ETV are carefully selected and meticulously studied during the follow-up.