Generalized pustular psoriasis is a rare form of psoriasis, seldom seen in children. Three patients with generalized pustular psoriasis are presented, two of whom were a sister and brother and whose grandfather also had pustular psoriasis. Lesions consisted of pustular, erythematous, scaly, follicular papules located on the trunk, scalp, and extremities. The pustules in some areas coalesced to form lakes. Histologic examination of several biopsy specimens revealed the changes of pustular psoriasis, which were parakeratosis, elongation of the rete ridges, and deep spongioform pustules and Munro abscesses. All patients were treated with cyclosporin A for periods of 2-12 months. The doses ranged from 1 to 2 mg/kg/day. Clearance of psoriatic lesions occurred after 2-4 weeks of therapy.

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Tuberculosis is an important health problem in developing countries and the BCG vaccine plays an important part in preventing the disease. There are different reports about the preventive value of BCG. Some of them claim that it is satisfactory while others suggest that it provides little protection. There are also varying ideas about the optimum time to vaccinate babies, some studies suggesting that late vaccination confers a high degree of protection. This prospective controlied study has been undertaken to evaluate the value of BCG vaccine given to babies during their first three days of life versus its value when given in their third month of life. Evaluation was measured by the results of tests with purified protein derivative (PPD), by vaccine scars, and by the complications of the vaccine. It was found that BCG given at the end of the third month provides a higher rate of response and fewer complications than when given during the first three days of life.BCG plays a significant part in protection against tuberculosis, which is one of the most important problems in developing countries. Nevertheless, the protective effect of vaccine remains a highly controversial subject, and has been reported to range from 80% to less than 5%. '4 In many countries the first BCG vaccine is received at birth, but it has been suggested that this requires further evaluation.' 7 8 A controlled prospective study has been recommended' 7 to compare BCG results from vaccination at birth and those at the third month of life. This prospective controlled study was planned to compare tuberculin response, BCG scar, and the complications of the vaccine given in the first three days compared with the third month of life. Subjects and methods The subjects selected for the study were healthy, full term babies of over 2500 g born either in the Uludag University Medical School Hospital or City Maternity Hospital in Bursa between October 1989 and January 1990. All the babies were followed up to 12 months. Babies who had a history of tuberculosis among their family or close contacts were excluded from the study.Babies were randomly divided into two groups. Four hundred babies in the first group (group I) were vaccinated with BCG intradermally in the left shoulder in the first three days of life, and the second group of 400 babies (group II) was vaccinated in the same manner at the end of the third month (90±3 days) of life. Vaccines were given to both groups by the same trained personnel. At the beginning of the study the mothers of the babies under study were carefully examined and their BCG scars and induration of purified protein derivative (PPD) were recorded. For the babies in group II, a PPD test was carried out before the BCG vaccination. The babies in both groups were examined every three months until they were 12 months old, PPD tests were performed three months after BCG vaccination and at the end of the first year. A full examination was performed in the follow up and BCG complications were recorded. Lymphadenopathies of mo...

The effectiveness of fibrinolytic treatment has been shown in cases of thoracic empyema in adults. In pediatric patients experience is, however, very limited. The aim of this study was to determine the success and complication rates of fibrinolytic treatment in thoracic empyema in children. A series of 25 consecutive children who had loculated pleural empyemas that did not respond to tube thoracostomy and antibiotics is presented. Their ages ranged from 1 to 12 years (mean 4.2). There were 19 boys and 6 girls, and all epyemas were postpneumonic. The fibrinolytic agent used was urokinase in 17 and streptokinase in 8. The mean duration of fibrinolytic treatment was 4.3 days (range 2 to 8) and the mean duration of chest-tube drainage was 8.9 days (range 7 to 13). In 20 patients the fluid output from the chest tube increased significantly after instillation of the fibrinolytic agent, and these patients showed almost complete resolution of the effusion on chest radiograph and ultrasound examinations (80%). Only 5 patients developed complications: bronchopleural fistula and pleural thickening in 3, and recurrent effusion, multiloculation, and pleural thickening in other 2 which were managed by surgical intervention (20%). Our study suggests that intrapleural fibrinolytic treatment is an effective and safe adjunctive therapy in children with thoracic empyema and can obviate a thoracotomy in most cases.