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The objective of this study was to present the use of retrograde colon enema in myelodysplasic patients with fecal incontinence.Thirty-three patients, 16 males and 19 females, 5 to 22 years old (average age 11.9 years) with spina bifida and fecal incontinence which obliged them to use a diaper. Retrograde colon enema procedures were performed in all of them.With the use of the retrograde enema the best rectal emptying was achieved and kept 32 children (97%) diaper free after a follow-up period of more than two years. Only one girl (3%) needed pads because she was not able to defecate in an appropriate place after administering the enema.The retrograde enema is the best conservative treatment for children with neurogenic fecal incontinence. This method achieves good rectal emptying allowing the children to be diaper free, resulting in better social adaptation and integration.

The C-reactive protein, leukocytes count and erythrocyte sedimentation rate, were determined in 32 hydrocephalus children treated with shunt, on the 1st day, 5th day and 10th day postintervention. C-reactive protein was positive on the 5th day postintervention in the 66.6% of the patients with infection and the 100% of these patients on the 10th day. In three patients C-reactive protein was the first sign of infection. In 33.3% of the patients with infectious complications, C-reactive protein positive was earlier than leukocytes and erythrocyte sedimentation rate abnormalities. From these findings, authors suggest C-reactive protein as valuable test in the postoperative control of the hydrocephalus children and should alert to the possibility of a infectious complication.

We present extrapyramidal syndrome in 22 children (5 en 1984 and 17 during 1985) who received clebopride (15), metoclopramide (6) and haloperidol (1), almost all at the level of therapeutic doses, which fact seems to indicated a idiosyncratic factor. Symptoms occurred after 2.36 +/- 1.49 doses (mean+/- SD), and the most frequent was: dyskinetic movements (45.5%), oculogyric crisis (40.9%), uneasiness (40.9%) and hypertonic reaction (36.4%). The symptoms disappeared in all patients after drug administration was stopped and therapy with diphenhydramine or biperiden intravenously.

In a patient with congenital chloride diarrhea, the hyperreninemia, hyperaldosteronism, hypokaliemia and hypokaliuria diminished during treatment with prostaglandin synthetase inhibitor. These findings suggest that probably prostaglandins stimulate renin-aldosterone system in congenital chloride diarrhea.

Authors make a report concerning a male patient who presents microcephaly, oculocutaneus albinism, hypoplasia of the distal phalanx of the 1st, 3rd and 4th finger of the right hand, 1st, 3rd, 4th and 5th finger of the left hand and agenesia of the distal end of the big toe of the right foot. They think it is a new dysmorphic syndrome. Because of patient's sister presented a similar picture they suggest that it may be an autosomal recessive inheritance pattern.

Authors report clinical and laboratory findings, treatment and evolution of six girls and three boys aged between 20 months and 13 years, diagnosed of juvenile polymyositis-dermatomyositis in the last seven years. Presenting symptoms were asthenia and proximal muscle weakness; in 3 cases characteristic skin lesions were associated. All were treated initially with prednisone p.o. (1-2 mg/kg/day) response being favourable in seven. Two patients with chronic evolution were treated with methotrexate and IV bolus of methylprednisolone.

Authors present two cases of children with abnormal movements. One of them described slow and dystonic movements of neck and head due to an important gastroesophageal reflux. These movements were useful to decrease annoyances that reflux causes in the child. Appearance of these movements and reflux is what is named "Sandifer syndrome". The other case presented stereotyped movements of head, like a negation, continuous and produced by a long intake of neuroleptics, which had caused a blockade of central dopaminergic receivers. Suppression neuroleptics of cured the child.

Authors review 70 consecutive cases of intussusception treated from 1969 to 1984. Most patients (87.5%) were under one year, and male/female ratio was 2/1. Nutritional status was good as 75.7% were above 50 percentiles for age. There was a higher seasonal incidence in spring and summer. Most frequent presenting symptom were weeping/pain (87.1%), rectal bleeding (82.8%) and vomiting (78.5%). Typical symptomatology was present in only 48.5%. Plain X-ray of abdomen and ultrasonography are the best diagnostic aid (91.4% and 90%). Hydrostatic reduction was successful in 30.1% whereas 51 cases had to be operated with a resection rate of 27.5%. Half of the patients over two years had an organic leading point. Complications, 8.6% were related with age, clinical course and need for bowel resection.

Authors have treated with allopurinol ten children with progressive muscular dystrophy, whose ages were between 15 months to eleven years. An initial and monthly clinical evaluation of muscular strength, Gowers's sign and pseudohypertrophy was performed. Monthly determinations of CPK, LDH, aldolase, GOT and serum urate; every two months electromyography was also made. In three patients a complete recovery of strength, Gowers's sign was found and at the same time pseudohypertrophy diminished; the age average was three years and four months. In four patients a partial recovery was found; the age average was nine years and four months. In three patients there was no answer to treatment, they were contracted and had deformities, being age average ten years. No variations on monthly controls of CPK, LDH, aldolase and GOT were observed. On these facts their opinion is that allopurinol is an effective drug in the treatment of progressive muscular dystrophy and that its' effectivity is better when treatment is initiated early and, of course, before patients present deformities and contractures.

A prospective study was made in a selected group of premature newborns who had presented bacteriuria in bag collected urine. Authors have analysed the real inside of urinary tract infection evidenced by suprapubic bladder aspiration in these children. These study includes the separation in two groups, with or without symptomatology, and therapy used in both cases. A high incidence of false bacteriurias was observed in bag collected urines, early in the asymptomatic group, where females were greater part. They have observed also a small correlation between clinic manifestations and urinocultive results and urinary sediment. The possible clinical, biological and bacteriological parameters were considered in order to see the better to suspect a urinary tract infection. Clinical symptomatology, and suprapubic bladder aspiration were the best to confirm it. Authors don't recommend neither aspiration nor urinocultive as routine techniques in prematures.

Authors report a four month old patient, admitted to hospital because of blood in stools. Diagnosis of congenital deficiency of factor VII was established because such factor was practically absent; on the contrary, other coagulation factors were normal. His parents and sister presented a mild deficit of factor VII without clinical manifestations. An up-to date review of the problem is presented.

Authors describe the clinical, pathological and cytogenetic data of a polymalformed premature with a complete a triploidy 69,XXY). This rare condition (30 cases in the literature) may be suspected in a premature with broad posterior fontanella, eye and ear anomalies, syndactily between IV and III fingers/toes, intersexual status and mielomeningocele. Frequently the placenta presents a molar or micromolar degeneration.

The oral dosage of theophylline was adjusted in order to maintain a serum level between 10 and 20 micrograms/ml. in a group of 53 children whose ages were less tha nine years. A plan of regular increments with a maximal dosage reduced to 18.5 mg./kg./day was followed, with advantageous results. The necessary medium dosage was 18.4 +/- 2.7 mg./kg./day. This dosage didn't have statistically significant difference with that obtained previously by us (18.4 +/- 4.0) in a group of 46 children of comparable age but, by contrast, it had a statistically significant difference when compared with the dosage (24.1 +/- 5.5) obtained by another medical teams working with american children of similar age. After a fruitless search of known causes that could explain these differences, we think in the possibility of genetical and/or unknown environmental influences.

A case of a one month old girl admitted in hospital because of cardiac failure who died at three months of age is described. Her necropsy demonstrated a ventricular septal defect and showed a blood cyst in the tricuspid valve. It might be possible that the "precordial honk" or "whoop" heard during life, the cottony, shaggy pictures recorded in the echocardiogram behind the anterior tricuspid leaflet in diastole, the tricuspid regurgitation appreciated in the angiocardiography, and the failure of the pulmonary artery banding were related to the blood cyst 4 mm. in diameter attached to the atrial surface of the anterior tricuspid leaflet near the free margin. The microscopic findings of haemosiderin loaded macrophages and calcified deposits in the haemorrhagic cyst speak in favour of its relatively ancient nature, not associated with an asphyxial mode of death.

The follow-up of 36 children with neurogenic urinary bladder, aged from 3.5 months to 12 years is reported. The were serially evaluated with tonometry of detrusor muscle and urethral sphincter. Management consisted in drugs (anticholinergics, alpha-adrenergic agonists and antagonists) associated with intermittent vesical catheterization in different combinations determined by starting urodynamic measurements. With this treatment control of micturition or frank improvement was reached in 91.6% of patients, urodynamic explorations normalized or improved in 94.3% and recurrent urinary infections persisted only in 13.8%. At the view of these results authors believe that treatment of neurogenic bladder secondary to myelodysplasia must be closely dependent on previous urodynamic evaluation.

Authors have adjusted oral theophylline requirements in 55 asthmatic children, whose ages ranged from 19 months to 14 years, following a preconceived plan. The procedure is practical and useful. It's easily understood by parents and realizable in an ambulatory way. The average necessities of oral theophylline in children under nine years in their group have been lower than those signaled by other authors. This and the fact that oral requirements of theophylline in two pair of univitelin twins were identical, make the authors think that it is necessary probably to modificate protocols previously proposed for the different groups of population.

C reactive protein lactate and LDH isoenzymes were quantified in CSF of 32 children with meningitis (27 bacterial and 5 viral). Results in cases with bacterial meningitis were as follows. C reactive protein sensitivity was 11.1% and specificity was 100%. Lactate sensitivity was 33.3% and its specificity was 80%. LDH1 and LDH5 had a sensitivity of 44.4%, and specificities of 100 and 60% respectively. Considering these results an has believe that none of these tests is definitive in diagnosis of bacterial meningitis in children.