No abstract

GnRH analogues (GnRHa) represent the treatment of choice in central precocious puberty (CPP), because arresting pubertal development and reducing either growth velocity (GV) or bone maturation (BA) should improve adult height. However, in some patients, GV decrease is so remarkable that it impairs predicted adult height (PAH); and therefore, the addition of GH is suggested. Out of twenty subjects with idiopathic CPP (treated with GnRHa depot-triptorelin, at a dose of 100 microg/kg im every 21 days, for at least 2-3 yr), whose GV fall below the 25th percentile for chronological age, 10 received, in addition to GnRHa, GH at a dose of 0.3 mg/kg x week s.c., 6 days weekly, for 2-4 yr; and 10 matched for BA, chronological age, and duration of GnRHa treatment, who showed the same growth pattern but refused GH treatment, served to evaluate the efficacy of GH addition. No patient showed classical GH deficiency. Both groups discontinued treatment at a comparable BA (mean +/- SEM): 13.2 +/- 0.2 in GnRHa plus GH vs. 13.0 +/- 0.1 yr in the control group. At the conclusion of the study, all the patients had achieved adult height. Adult height was considered to be attained when the growth during the preceding year was less than 1 cm, with a BA of over 15 yr. Patients of the group treated with GH plus GnRHa showed an adult height significantly higher (P < 0.001) than pretreatment PAH (160.6 +/- 1.3 vs. 152.7 +/- 1.7 cm). Target height (TH) was significantly exceeded. The group treated with GnRH alone reached an adult height not significantly higher than pretreatment PAH (157.1 +/- 2.5 vs. 155.5 +/- 1.9 cm). TH was just reached but not significantly exceeded. The gain in centimeters obtained, calculated between pretreatment PAH and final height, was 7.9 +/- 1.1 cm in patients treated with GH combined with GnRHa; whereas in patients treated with GnRHa alone, the gain was just 1.6 +/- 1.2 cm (P = 0.001). Furthermore, no side effects have been observed either on bone age progression or ovarian cyst appearance and the gynecological follow-up in the GH-treated patients (in comparison with those treated with GnRHa alone). In conclusion, a gain of 7.9 cm in adult height represents a significant improvement, which justifies the addition of GH for 2-3 yr during the conventional treatment with GnRHa, especially in patients with CPP, and a decrease in GV so marked as to impair PAH, not allowing it to reach even the third centile.

We report two premature neonates with Candida albicans septic thrombosis of the portal vein who developed, in very early childhood, the sonographic appearance of cavernous transformation of the vessel and/or clinical signs of extrahepatic portal hypertension. CASE REPORTS Case 1. A 1,980-g male infant, who was the second infant delivered, was born by emergency cesarean section for fetal distress after a 34-week-triplet gestation to a 35-year-old primigravida mother. Except for premature labor, her pregnancy had been otherwise normal, without prolonged rupture of membranes or maternal fever. The infant had respiratory distress immediately after birth and was therefore admitted to the neonatal intensive care unit (NICU), where he was treated for 2 days with nasal continuous positive airway pressure (CPAP) and for 5 days with oxygen therapy. On admission to the NICU, a polyvinyl chloride 5 French catheter was inserted into the umbilical vein, and intravenous ampicillin and netilmicin were started for suspected sepsis. The catheter tip was noted to be in the inferior vena cava. Blood culture obtained on admission gave negative test results, and antibiotics were discontinued after 3 days. On postnatal day 8, he developed apnea and bradycardia, irritability, feeding difficulties, and abdominal distension. The same day, the catheter was removed, the cathetertip, blood from peripheral veins, and urine cultures were taken, and the infant was started on teicoplanin therapy. While the infant continued to be symptomatic, on postnatal day 10, the laboratory report for the positive cultures of the catheter tip indicated a pure growth of Candida albicans and treatment was changed to oral fluconazole. On postnatal day 11, the blood culture performed 3 days earlier was reported to have yielded a heavy (defined as Ն50 CFU/ml) (24) growth of C. albicans (sensitive to fluconazole and amphotericin B). He continued treatment with fluconazole for 6 weeks and on day 11 started a 6-week intravenous amphotericin B treatment. Soon after the positive blood culture result, a disseminated fungal workup including abdominal and cranial ultrasound, echocardiogram, and ophthalmologic evaluation was performed. The echocardiogram, cranial ultrasound, and ophthalmologic evaluation were negative. Abdominal gray-scale ultrasound showed that both right and main portal veins were completely filled with hyperechoic thrombus. The spleen was of normal size, but the liver appeared slightly enlarged without sonographic abnormalities of the hepatic parenchyma or of the biliary structures. A second cranial ultrasound revealed, in the parietal and temporal lobes, multiple, bilateral, round hypoechoic lesions with echogenic rims, which were consistent with intracranial abscesses (18). A peripheral venipuncture blood culture obtained 1 week after initiation of antifungal therapy was still positive for C. albicans. However, it became sterile 11 days after antifungal treatment was started. At 35 days of age, the cranial ultrasound became normal, but the abdominal ...

Measurement of PCT concentrations may be useful for early diagnosis and monitoring of infectious complications in neonates during their stay in the neonatal intensive care unit.

VT was visualized by echo-color-Doppler ultrasonography in 12% of the patients; it was asymptomatic in 7%. In our small series, VT was related to neuroblastoma disease and a longer duration of catheter insertion. Prospective and multicentric studies are required to select risk factors for VT in children with solid tumors.