Minerva pediatrica
-
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.
-
Intracranial tuberculoma is a possible complication of meningeal, miliary or pulmonary tuberculosis. In developing countries it represents 30% of space-occupying intracranial lesions, in industrialised countries only 0.1-0.2%. ⋯ Here we report the clinical case of an immunocompetent Italian baby girl who presented an intracranial tuberculoma during tuberculous meningitis. We underline how such an event is possible, the need for early neuroradiological evaluation and its favourable course, maintaining adequate antitubercular therapy associated with steroid therapy.
-
Case Reports
[Transient right ventricular hypertrophy in a newborn infant exposed in utero to nimesulide].
The use of non-steroidal anti-inflammatory drugs (NSAIDs) during pregnancy has been sometimes related to harmful cardiac effects secondary to the precocious closure in uterus of ductus arteriosus. This closure is linked to the inhibition of the cyclo-oxygenase (COX) enzyme that plays a key-role in the prostaglandin synthesis. ⋯ The case reported in this paper describes a remarkable right ventricle hypertrophy observed in a newborn whose mother, during the whole period of pregnancy, frequently used nimesulide as analgesic. Probably, in spite of its selective action on COX-2, the prolonged use of nimesulide has determined a closure of the ductus, inducing a functional fetal pulmonary hypertension that resolved after birth with the consequent regression of the right ventricular hypertrophy.