No abstract

Acute pancreatitis is an inflammatory condition which typically presents with abdominal pain, and is one of the most complex and challenging of all acute abdominal disorders. Its clinical manifestations are as numerous and diverse as its etiology. Rare complications of measles virus infection include acute appendicitis with perforation and peritonitis, mesenteric lymphadenitis, hepatitis, ileocolitis, cervicitis and acuteglomerulonephritis. 1,2 Only two cases have been reported in the literature that were caused by the measles virus, while another case was caused by the measles, mumps and rubella vaccine. Case Report A 16-year-old female was admitted to Whammed General Hospital in August 1997, with fever of five days' duration, which was associated with dry cough, a burning sensation in the eyes, and running nose. A reddish skin rash appeared on the fourth day of her illness, starting on the face, and then spreading to the trunk and extremities. On the day of admission, the patient started to complain of severe epigastric pain radiating to the back, and associated with repeated vomiting. The patient gave no history of any recent drug intake. According to the parents, the patient had not received the measles vaccination during her childhood, and had had a recent contact with a patient who had measles. On examination, the patient looked ill and flushed in the face, with a temperature of 38.6°C, pulse rate of 130/minute regular, and blood pressure of 145/75 mm Hg. She had red conjunctiva, Koplik's spots on the buccal mucosa, and a congested throat. Maculopapular rashes covered the face, around the ears, the trunk and the extremities. There was epigastric tenderness on abdominal examination, but no palpable mass. Laboratory investigations showed hemoglobin of 145 g/L, WBC 4.5X10 9 /L, platelets 159X10 9 /L, all of which were within normal limits. As well, kidney function tests, liver function tests, arterial blood gases, serum cholesterol, triglycerides and serum calcium were all normal. Chest x-ray, abdominal CT scan and sonography were normal. Hepatitis viral serology for A, B, and C, and human immunodeficiency virus (HIV) were negative, as well as blood cultures. Virology studies showed Epstein-Barr virus-Caspid IgG antibodies as positive, EBV-Caspid IgM antibodies as negative,EBVnuclearantigenas-ABpositive,andEBV early antigen as negative. These results were suggestive of previous EBV exposure. Enterovirus (IgM ELISA) total antibodies by CFT16 were negative, mumps IgM and IgG were negative, but measles (EIA) IgM was positive.

No abstract

Erysipelas most commonly affects infants and young children but sepsis in erysipelas is uncommon accounting for less than 1% [1]. Few authors have reported hypertriglyceridemia (HTGA) secondary to sepsis in children [2]. Moreover, HTGA is one cause of acute pancreatitis (AP): Bai et al. [3] have shown the metabolic causes of AP in approximately 2-7% of children. It is well known that sepsis and HTGA are independent risk factors for AP and this study will try to establish an association with HTGA secondary to sepsis and AP.A 40-day-old girl born full-term by means of C-section with uneventful pregnancy, normal for gestational age, breast-fed, was admitted to the pediatric operative unit with fever [39.81C (103.71F)]. On arrival, her physical examination was unremarkable except for the presence of facial and thoracic fiery-red plaques with raised, welldemarcated borders, local signs of inflammation and skin discomfort; vital signs, and hemogasanalysis were normal. The complete blood count showed high white blood cell count with marked neutrophilia (white blood cell 23.44 Â 10 9 /l, 18.752 neutrophils) and mild thrombocytosis (platelet count 637 Â 10 9 /l); erythrocyte sedimentation rate was 87 mm/h, C-reactive protein was 410 mg/l, and procalcitonin was 5.21 ng/ml. Blood culture was positive for Streptococcus pyogenes. Hydration, intravenous third generation cephalosporin, and antipyretic medications were effective at lowering the temperature and reducing plaques. During sixth hospital day, the laboratory work showed a fasting lactescent (milky) blood sample with HTGA (1565 mg/dl), extremely elevated low-density lipoprotein (LDL) levels (254 mg/dl), and very low high-density lipoprotein (HDL) levels (13 mg/ dl). Moreover lipase was 554 U/l and amylase was 134 U/l, whereas total cholesterol and liver functions were normal. The girl presented only with abdominal pain and tenderness and abdominal ultrasound shows a normal pancreas.Family history of lipid abnormalities was negative; lipase and amylase levels rapidly fell within 5 days of presentation whereas triglyceride (TG), LDL, HDL, levels were normalized about 5 months after pediatric operative unit admission.In erysipelas, the blood culture is positive in only 5% of cases and less common complication is septicemia [1,4]. Few studies have explored the metabolic response to sepsis in children: Henter et al.[2] reported TG and LDL levels markedly elevated and HDL decreased; Vermont et al.[5] noted extremely low levels of total cholesterol, HDL, and LDL in the initial phase of sepsis inversely associated with disease severity. Our findings are the same described by Henter et al. and emphasize the usefulness of TG levels as indicators of inflammatory activity. Both hereditary and secondary disorders of lipoprotein metabolism may be associated with hypertriglyceridemic pancreatitis (HTGP) but the mechanism by which HTGA causes AP is unknown. Because no official pediatric recommendations exist, the purpose of this letter is to bring to attention the importance of manage...

BACKGROUND Meconium stained amniotic fluid (MSAF) occurs in around 14 % of all pregnancies, but only a minority of these children will develop meconium aspiration syndrome (MAS). In the Netherlands, infants born through MSAF, are often admitted for a 24-hour observation period. We questioned the usefulness of postnatal hospital observation in vigorously born infants. OBJECTIVE The aim of this study was to evaluate the usefulness of a 24-hour hospital observation period of newborn infants born through MSAF. DESIGN/METHOD Newborn infants, born through MSAF, from two local hospitals (total 3200 deliveries) were included for whom a pediatrician was consulted. Infants were divided based on Apgar score, i.e. a 5-minute Apgar score of 9 or 10 (vigorous infants) (group 1) or below 9 (group 2). Gestational age, maternal fever, antenatal fetal monitoring (CTG), duration of rupture of membranes, mode of delivery, arterial umbilical pH, 1 and 5-minute Apgar scores, and postnatal course were recorded. Chest X-rays were not routinely performed. RESULTS 171 patients were enrolled: 113 in group 1 and 58 in group 2. None of the group 1 infants developed MAS or had a chest X-ray performed. Four patients from group 2 developed MAS (5-minute Apgar scores respectively 6,7,7 and 8). These infants, all first born and full term, had an arterial umbilical pHϽ7,20. In 3 mothers CTG abnormalities were observed; 1 mother had fever. From the 54 infants (group 2) without MAS, 1 child died of asphyxia. CONCLUSION This study shows that a 24-hour hospital observation period of newborn infants born through MSAF with a 5-minute Apgar score of 9 or 10 has no added value. Even in the group with 5-minute Apgar scores below 9 only 4 (6,9%) children developed MAS. Using the 5-minute Apgar score vigorous infants can safely be discharged.