RESUMO
Lymphedema praecox, a type of primary lymphedema, becomes evident at puberty, occurs mostly in girls, and is usually confined to the lower extremities. Arms tend to be involved in either congenital or secondary lymphedema. We describe a unique localization in an 11-year-old girl who had primary lymphedema of the right hand and arm. The pertinent literature is reviewed.
Assuntos
Braço , Linfedema/diagnóstico , Criança , Feminino , Humanos , Linfedema/epidemiologia , PuberdadeRESUMO
Administration of ceftriaxone for 5 days has been shown to be highly efficient in the treatment of severe shigellosis in children. Our study, involving 40 children, demonstrated that a 2-day course of ceftriaxone was as beneficial as a 5-day course and constituted effective therapy for children with severe shigellosis.
Assuntos
Ceftriaxona/administração & dosagem , Disenteria Bacilar/tratamento farmacológico , Shigella sonnei , Adolescente , Ceftriaxona/uso terapêutico , Criança , Pré-Escolar , Diarreia Infantil/tratamento farmacológico , Diarreia Infantil/microbiologia , Relação Dose-Resposta a Droga , Humanos , Lactente , Shigella flexneri , Resultado do TratamentoRESUMO
We compared the clinical and bacteriologic response of 5-day treatment with cefixime, 8 mg/kg per day, with the response to trimethoprim-sulfamethoxazole (TMP-SMX), 10-50 mg/kg per day, the currently recommended therapy. Of the assessable children with acute, culture-proven shigellosis, 38 received cefixime and 39 received TMP-SMX. Pretreatment data on the two study groups were similar. In the first group, all isolates were susceptible to cefixime; in the TMP-SMX group, 32 isolates were resistant and 7 were susceptible to TMP-SMX. Clinical response (day 5) showed cure, improvement, and failure in 89%, 8%, and 3%, respectively, of the cefixime group, and in 25%, 44%, and 31%, respectively, of the TMP-SMX-resistant group (p < 0.001). Bacteriologic cure (day 3) occurred in 78% and 23% of the cefixime and TMP-SMX-resistant groups, respectively (p < 0.001). Clinical or bacteriologic relapse (day 12) was infrequent in both groups. The response to treatment of the cefixime and the TMP-SMX-susceptible groups was similar. No significant side effects were noted. We conclude that cefixime is superior to TMP-SMX in the treatment of suspected shigellosis in areas with a high rate of resistance to TMP-SMX.
Assuntos
Cefotaxima/análogos & derivados , Disenteria Bacilar/tratamento farmacológico , Shigella/efeitos dos fármacos , Combinação Trimetoprima e Sulfametoxazol/uso terapêutico , Adolescente , Cefixima , Cefotaxima/uso terapêutico , Criança , Pré-Escolar , Diarreia Infantil/tratamento farmacológico , Diarreia Infantil/microbiologia , Método Duplo-Cego , Feminino , Humanos , Lactente , Masculino , Estudos Prospectivos , Shigella boydii/efeitos dos fármacos , Shigella flexneri/efeitos dos fármacos , Shigella sonnei/efeitos dos fármacos , Resistência a TrimetoprimaRESUMO
In three young children a newly acquired clinical sign--the knee-chest position--was associated with increased intracranial pressure. This sign may serve as an additional marker to suggest increased intracranial pressure in young children.
Assuntos
Postura/fisiologia , Pseudotumor Cerebral/fisiopatologia , Astrocitoma/complicações , Neoplasias Encefálicas/complicações , Neoplasias Cerebelares/complicações , Pré-Escolar , Feminino , Humanos , Hidrocefalia/complicações , Lactente , Joelho , Glândula Pineal , Pseudotumor Cerebral/etiologia , TóraxRESUMO
In a prospective randomized open study, ceftriaxone, 50 mg/kg per day, was compared with ampicillin, 100 mg/kg per day, both given for a period of 5 days, for the treatment of 40 children whose mean (+/- SD) age was 4.5 +/- 3.2 years and who had severe dysentery caused by Shigella organisms. Twenty patients were treated with ceftriaxone and 20 with ampicillin. Both drugs were initially given intravenously for a period of 1 to 2 days and were continued intramuscularly, in the case of ceftriaxone, or orally, in the patients receiving ampicillin. All Shigella organisms isolated were susceptible to ceftriaxone; 28% were resistant to ampicillin. The diarrhea persisted for a mean (+/- SD) period of 2.5 +/- 1.0 days in the ceftriaxone-treated patients versus 6.8 +/- 6.3 days in the ampicillin-treated patients (p less than 0.005). At the end of the 5 days of therapy, stool cultures for Shigella organisms were negative in 12 (60%) of the 20 patients from the ampicillin group and in all the children (100%) from the ceftriaxone group (p less than 0.001). Bacteriologic relapses were observed in eight (40%) of the patients treated with ampicillin but in none of the children treated with ceftriaxone (p less than 0.001). In instances of clinical or bacteriologic failure in the ampicillin group, retreatment was instituted in most of the cases with ceftriaxone; persistent clearing of the Shigella organisms from the stool was finally achieved after a mean (+/- SD) period of 11.75 +/- 9.4 days after therapy was started, as compared with 1.85 +/- 0.6 days in the ceftriaxone-treated patients (p less than 0.001). We conclude that in children with severe shigellosis, treatment with ceftriaxone for 5 days is effective and better than use of ampicillin for clinical cure and eradication of the Shigella organisms from the stool.