Home About us Contact
|
Home About us Contact | ||
|
|
||
Recurrent Episodes (recurrent + episode)
Selected AbstractsSerologic and genotypic analysis of a series of herpes simplex virus type 1 isolates from two patients with genital herpesJOURNAL OF MEDICAL VIROLOGY, Issue 9 2009Kenichi Umene Abstract Herpes simplex virus type 1 (HSV-1) has been reported increasingly as a cause of genital herpes, although HSV-1 is usually associated with oro-labial herpes. In the present study, serum specimens and materials for viral isolation were obtained serially from two patients with recrudescent HSV-1 genital infections to study serology and molecular epidemiology. Recurrent episodes, during which HSV-1 was isolated, were followed by an increase in the level of anti-HSV-1 antibody, suggesting a booster effect from re-exposure to viral antigens and the possible usefulness of the variation in the level of anti-HSV-1 antibody to diagnose recurrence. While genotypes of HSV-1 isolates obtained from one patient were different from those from the other patient, genotypes of sequential HSV-1 isolates obtained from the same patient were the same, implying that the recrudescent genital lesions of the two patients could be attributed to endogenous recurrence of a latent virus. Sera from one patient neutralized HSV-1 isolates obtained from the other patient as well as HSV-1 isolates obtained from the same patient. An HSV-1 isolate obtained during a later episode in one patient was neutralized by sera taken before/during the later episode of the same patient, as effectively as an HSV-1 isolate obtained during an earlier episode in the same patient; thus, in these two cases, HSV-1 was assumed to have multiplied during recurrence despite the presence of an anti-HSV-1 antibody that could neutralize experimentally HSV-1. J. Med. Virol. 81:1605,1612, 2009. © 2009 Wiley-Liss, Inc. [source] Behçet Disease in a Child,Emphasis on Cutaneous ManifestationsPEDIATRIC DERMATOLOGY, Issue 5 2007Vânia Oliveira de Carvalho M.D. Recurrent episodes of oral and genital ulcerations, skin lesions, and ocular manifestations are seen. The disease may also involve the central nervous system, gastrointestinal tract and, less frequently, the large vessels. In general, manifestations occur in the third or fourth decade of life and are not common in children. Therefore few data concerning this age group have been found in the literature. In this study we report a child with Behçet disease beginning at 1 year of age whose cutaneous manifestations were exuberant acne-like and folliculitis-like lesions, which were crucial for diagnostic confirmation. [source] Recurrent episodes of fever and pancytopenia due to haemophagocytosis during maintenance therapy for acute myeloid leukaemiaBRITISH JOURNAL OF HAEMATOLOGY, Issue 5 2008P. Sovinz No abstract is available for this article. [source] Emergency surgery for complicated acute diverticulitisCOLORECTAL DISEASE, Issue 2 2009N. Issa Abstract Aim, Antecedent attacks of diverticulitis are thought to increase the risk of complicated diverticulitis, and unless elective surgery is performed, a high proportion of patients with recurrent symptoms will require emergency operations for complicated diverticulitis with its associated morbidity. In this multicentre study, we aim to assess impact of previous attacks of diverticulitis on patients requiring an emergency surgical intervention. Method, All patients operated on as an emergency for complicated diverticulitis were retrospectively analysed. Patients were separated into two groups: group A included patients without previous history of diverticular disease, and group B those with previous attacks of diverticulitis. Results, A total of 96 patients were included in the study. Group A included 68 (70.8%) patients, and group B 28 (29.2%) patients. Generalized peritonitis was the reason for operation in 50 (73.5%) patients in-group A and only four (14%) patients in group B. Perforated diverticulitis occurred more often in group A, whereas pericolonic abscess and phlegmon formation occurred more commonly in group B. Resection was performed in all patients in group B; 50% had a Hartmann's procedure, and the other 50% patients had primary anastomosis. Hartmann's procedure was performed in 52 patients (76.5%) in group A, and 8 patients (11.7%) had resection and primary anastomosis. No difference in postoperative complications was identified between the groups. Conclusion, Multiple attacks of diverticulitis are not associated with an increased risk of complicated diverticulitis. Recurrent episodes of diverticulitis are not associated with a less favourable outcome or an increased risk of fatality if complications ensue. [source] The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the legJOURNAL OF INTERNAL MEDICINE, Issue 5 2000P. Lindmarker Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601,606. Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. Design. An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. Setting. Sixteen hospitals in central Sweden. Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (±SD) period of 31(±29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4,1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis. [source] Clozapine in schizophrenia patients with recurrent catatonia: Report of two casesPSYCHIATRY AND CLINICAL NEUROSCIENCES, Issue 2 2006YI-YUNG HUNG md Abstract, Prolonged catatonia can be a source of extremely serious morbidity and mortality. Lorazepam is effective in rapidly relieving most cases of catatonia. Reports have also shown that second-generation antipsychotic drugs are also efficacious in relieving catatonia. This report describes two schizophrenia patients who demonstrated recurrent catatonic features mutism and stupor. Both patients were treated with lorazepam, diazepam or electroconvulsive therapy (ECT). Patient 1 responded well and rapidly to lorazepam each time catatonia happened; but catatonia recurred once a year under treatment with many antipsychotic drugs. Patient 2 had catatonia features associated with discontinuing or decreasing clozapine. With each recurrent episode, the duration of catatonia increased, requiring an increased dosage of benzodiazepine. The patient's response to lorazepam and ECT gradually decreased, until the patient had almost no response to lorazepam, diazepam or ECT. Both patients had no recurrence during a period of 2-year follow up with continuous clozapine therapy. [source] Aphasic or amnesic status epilepticus detected on PET but not EEGEPILEPSIA, Issue 2 2009Christine Dong Summary Purpose:, To describe five patients with ictal aphasia and one patient with ictal amnesia, who had focal positron emission tomography (PET) hypermetabolism but no clear ictal activity on electroencephalography (EEG). Methods:,18F-Fluorodeoxyglucose (FDG),PET scans with concomitant EEG were obtained in five patients with suspected ictal aphasia or ictal amnesia without ictal activity on EEG. We reviewed medical history, EEG, imaging data, and treatment outcome. Results:, Brain magnetic resonance imaging (MRI) showed no structural abnormalities in any of the patients. EEG showed left temporal irregular delta activity in three patients, with aphasia and nonspecific abnormalities in two other patients, all without clear ictal pattern. All patients demonstrated focal hypermetabolism on PET scan. The hypermetabolism was in the left frontotemporal region in patients with ictal aphasia and in the bilateral hippocampal region in the patient with amnesia. Three patients who received intravenous benzodiazepines during their episodes had transient clinical improvement. With antiepileptic drug (AED) treatment, symptoms gradually resolved in all patients. Concomitant resolution of PET hypermetabolism was documented in three patients who had follow up scans. One patient with ictal aphasia later developed recurrent episodes, each with recurrent PET hypermetabolism. This patient and one other patient required immune-modulating therapy in addition to AEDs. Discussion:, FDG-PET imaging should be considered as a diagnostic tool in patients with suspected ictal aphasia or amnesia, who fail to show clear evidence of ictal activity on EEG. [source] Hereditary neuropathy with liability to pressure palsies associated with central nervous system myelin lesionsEUROPEAN JOURNAL OF NEUROLOGY, Issue 6 2001J. Dac Hereditary neuropathy with liability to pressure palsies (HNPP) is an autosomal dominant disorder most commonly caused by a 1.5-Mb deletion in chromosome 17p11.2 which contains the peripheral myelin protein-22 (PMP22) gene. Mutations resulting in functional loss of one PMP22 gene copy are less frequent. We present a 51-year-old patient with a l.5-Mb deletion in chromosome 17p11.2 who exhibited signs of peripheral as well as central nervous system lesions. He gave a history of recurrent episodes of limb numbness and weakness with spontaneous but incomplete recovery since age 20. His father and two brothers had similar symptoms. Neurological examination revealed signs of multiple mononeuropathy associated with frontal lobe, corticospinal tract and cerebellar dysfunction, as well as signs of initial cognitive impairment. Electrophysiological investigations showed a demyelinating peripheral nerve disease with multiple conduction blocks and conduction disturbances in both optic nerves. Magnetic resonance imaging of the brain revealed multiple subcortical and periventricular foci of myelin lesions. The association of central and peripheral nervous system lesions in this patient indicates a possible role of PMP22 not only in peripheral but also in central nervous system myelin structure. [source] SYNTHESIS: Evolutionary history of Pacific salmon in dynamic environmentsEVOLUTIONARY APPLICATIONS (ELECTRONIC), Issue 2 2008Robin S. Waples Abstract Contemporary evolution of Pacific salmon (Oncorhynchus spp.) is best viewed in the context of the evolutionary history of the species and the dynamic ecosystems they inhabit. Speciation was complete by the late Miocene, leaving c. six million years for intraspecific diversification. Following the most recent glacial maximum, large areas became available for recolonization. Current intraspecific diversity is thus the product of recent evolution overlaid onto divergent historical lineages forged during recurrent episodes of Pleistocene glaciation. In northwestern North America, dominant habitat features have been relatively stable for the past 5000 years, but salmon ecosystems remain dynamic because of disturbance regimes (volcanic eruptions, landslides, wildfires, floods, variations in marine and freshwater productivity) that occur on a variety of temporal and spatial scales. These disturbances both create selective pressures for adaptive responses by salmon and inhibit long-term divergence by periodically extirpating local populations and creating episodic dispersal events that erode emerging differences. Recent anthropogenic changes are replicated pervasively across the landscape and interrupt processes that allow natural habitat recovery. If anthropogenic changes can be shaped to produce disturbance regimes that more closely mimic (in both space and time) those under which the species evolved, Pacific salmon should be well-equipped to deal with future challenges, just as they have throughout their evolutionary history. [source] Paroxysmal Hemicrania With Visual Aura in a 17-Year-Old BoyHEADACHE, Issue 4 2009Stefan Seidel MD We report the case of a 17-year-old boy presenting with a history of recurrent episodes of isolated visual aura later followed infrequently by indomethacin-responsive headache attacks resembling paroxysmal hemicrania. [source] Liver transplantation for the sequelae of intra-operative bile duct injuryHPB, Issue 3 2002E De Santibañes Background Intra-operative bile duct injuries (IBDI) are potentially severe complications of the treatment of benign conditions, with unpredictable long-term results. Multiple procedures are frequently needed to correct these complications. In spite of the application of these procedures, patients with severe injuries can develop irreversible liver disease. Liver transplantation (LT) is currently the only treatment available for such patients, but little information has been published concerning the results of LT. Methods Eight patients with LT for end-stage liver disease for IBDI were studied retrospectively. They had failure of multiple previous treatments and experienced recurrent episodes of cholangitis, oesophageal variceal bleeding, severe pruritus, refractory ascites and spontaneous peritonitis. Results Mean recipient hepatectomy time was of 243 minutes (range 140,295 min), the complete procedure averages 545 minutes (260,720) and intraoperative red-blood-cells consumption was 6.5 units (1,7). One patient required reoperation due to perforation of a Roux-en-Y loop, and three developed minor complications (2 wound infections, 1 inguinal lymphocele). One patient died due to nosocomial pneumonia (mortality rate 12.5%). One patient required retransplantation due to delayed hepatic artery thrombosis. At follow-up 75% of patients are alive with normal graft function and an excellent quality of life. Conclusions LT represents a safe curative treatment for end-stage liver disease after IBDI, albeit a major undertaking in the context of a surgical complication in the treatment of benign disease. The complications of the surgical procedure and the long-standing immunosupression impart a high cost for resolutions of these sequelae but LT represents the only long-term effective treatment for these selected patients. [source] Cutaneous cryptococcosis associated with lepromatous leprosyINTERNATIONAL JOURNAL OF DERMATOLOGY, Issue 6 2001Rubem David Azulay MD A 65-year-old Brazilian man presented with an erythematous nodular lesion on the left forearm (Fig. 1). The patient had been treated with multidrug therapy for 8 months for lepromatous leprosy. During therapy, he developed recurrent episodes of reactions which were treated with high doses of prednisone and thalidomide. The histopathology of the cutaneous nodular lesion showed a granulomatous inflammatory infiltrate; some histiocytes contained vacuolations and others demonstrated oval-like or coma-like structures (Fig. 2). The specimen was cultivated in Sabouraud agar at room temperature. The colonies were transferred to Petri dishes containing Niger Seed Agar (NSA) (Fig. 3). The confirmed diagnosis was Cryptococcus neoformans var. neoformans based on microscopy and physiology, including the canavanine,glycine,bromothymol blue (CGB) medium (Lazéra MS, Pires FDA, Camillo-Coura L et al. Natural habitat of Cryptococcus neoformans var. neoformans in decaying wood forming hollows in living trees. J Med Vet Mycol 1996; 34: 127,131). The liquor culture was negative. Hemoculture and urine culture were also negative. Latex agglutination test was blood positive and liquor negative. Figure 1. Erythematous nodular lesion on the left forearm measuring 9 cm in diameter Figure 2. Granulomatous infiltrate presenting oval-like or coma-like structures inside the histiocytes (mucicarmine stain, ×,100) Figure 3. Petri dishes with Niger Seed Agar containing numerous colonies of Cryptococcus neoformans var. neoformans The patient's hemogram revealed normocytic anemia and normal total and differential white blood count. The CD4 count was 189/m3 and the CD8 count was 141/m3. Serology for anti-human immunodeficiency virus-I (anti-HIV-I) antibodies was negative. The X-ray of the lungs showed an areolar image in the superior lobe of the right lung. Therapy with prednisone was suspended and fluconazole (300 mg/day) was prescribed. The nodular cutaneous lesion regressed completely after 90 days. The patient was submitted to a second skin biopsy for treatment control. The culture of the specimen taken was still positive and the histopathology showed the same picture as before treatment. After 5 months of continued therapy with fluconazole, another biopsy was performed but no fungus was recovered from the specimen. [source] A case report of systemic capillary leak syndrome (Clarkson's disease)ACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2010J. HOLLENBERG Systemic capillary leak syndrome (SCLS) is a very rare disorder also known as Clarkson's disease. The condition is characterized by recurrent episodes of severe capillary hyperpermeability resulting in severe hemoconcentration, hypoalbuminemia, hypovolemia and shock. We describe a 41-year-old previously healthy man who was admitted to hospital on several occasions with rapidly developing hypovolemic shock accompanied by extreme hemoconcentration and hypoalbuminemia. Our case is similar to other reports describing patients with SCLS where the initial suspicions have been pointing towards septic shock. He received a combination of prophylactic treatment with theophylline, ,-agonists, immunoglobulins and statins but eventually died after a severe episode of SCLS that ended with recurrent cardiac arrest. Clinical autopsy revealed pulmonary edema and acute and chronical organic fluid overload. SCLS should be kept in mind when treating patients suffering from attacks of severe idiopathic edema and mimics recurrent septic shock where no pathogen is found. The pathogenesis is unknown and the attacks may be lethal. [source] Diagnostic and treatment delays in recurrent clostridium difficile,associated diseaseJOURNAL OF HOSPITAL MEDICINE, Issue 2 2008Danielle Scheurer MD Abstract BACKGROUND: Because Clostridium difficile,associated disease (CDAD) is primarily an inpatient issue, hospitalists are at the forefront of the timely diagnosis and treatment of patients with this disease. DESIGN: The study was a retrospective cohort of all inpatients with CDAD at Brigham and Women's Hospital from 1997 to 2004 in order to determine the time to diagnosis and treatment in initial and recurrent episodes of disease. RESULTS: The mean time to sampling, between 2.09 and 2.24 days, was not significantly different between initial and recurrent CDAD hospital episodes. The mean time to treatment (from symptoms and sampling) was shorter in recurrent episodes but was still 2.5 days. CONCLUSIONS: Patients with recurrent disease were more likely to be treated earlier but not diagnosed earlier than those with initial disease. Because both groups had significant diagnostic and treatment delays, this is an area in which hospitalists can have a major impact on patient care. Journal of Hospital Medicine 2008;3:156,159. © 2008 Society of Hospital Medicine. [source] Effect of inflammatory attacks in the classical type hyper-IgD syndrome on immunoglobulin D, cholesterol and parameters of the acute phase responseJOURNAL OF INTERNAL MEDICINE, Issue 3 2004A. Simon Abstract. Background., Classical type hyper-immunoglobulin D (IgD) syndrome (HIDS) is an hereditary auto-inflammatory disorder, characterized by recurrent episodes of fever, lymphadenopathy, abdominal distress and a high serum concentration of IgD. It is caused by mevalonate kinase deficiency. Objective., To further characterize the acute phase response during fever attacks in HIDS in order to improve diagnosis. Subjects., Twenty-two mevalonate kinase-deficient HIDS patients. Methods., Blood samples were drawn during and in between febrile attacks, and concentrations ofC-reactive protein (CRP), ferritin, procalcitonin, pentraxin 3, IgD and cholesterol in several lipoprotein fractions were determined. Results., The marked acute phase response at the time of a fever attack in classical type HIDS is reflected by a rise in CRP accompanied by a moderate but statistically significant rise in procalcitonin and pentraxin 3. In only two of 22 patients, procalcitonin concentration rose above 2 ng mL,1 during fever attack, compatible with the noninfectious nature of these attacks. Ferritin does not reach the high concentrations found in adult-onset Still's disease. Despite the defect in mevalonate kinase, a component of cholesterol metabolism, serum cholesterol did not change during attacks. IgD concentration is elevated regardless of disease activity, although there is appreciable variation during life. Its role in HIDS remains unclear. Conclusion., The combination of high CRP concentration plus procalcitonin concentration <2 ng mL,1 in a symptomatic HIDS patient might indicate a febrile attack without (bacterial) infection; this observation warrants further investigation for its usefulness as a marker in clinical practice. [source] The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the legJOURNAL OF INTERNAL MEDICINE, Issue 5 2000P. Lindmarker Abstract. Lindmarker P, Schulman S, the DURAC Trial Study Group (Karolinska Hospital, Karolinska Institute, Stockholm, Sweden) The risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. J Intern Med 2000; 247: 601,606. Objectives. To investigate the risk of ipsilateral versus contralateral recurrent deep vein thrombosis in the leg. Design. An open prospective long term follow-up multicentre trial. Patients were followed by frequent outpatient visits at each centre during the first 12 months after inclusion and thereafter annually. Setting. Sixteen hospitals in central Sweden. Subjects. A total of 790 consecutive patients with objectively verified first episode of acute deep vein thrombosis and without diagnosed malignant disease were recruited from a randomized study comparing 6 weeks with 6 months of oral antivitamin K therapy as secondary thromboprophylaxis. Main outcome measures. Deep vein thrombosis in the contralateral leg was confirmed by venography or ultrasound. With regard to the ipsilateral leg, venography was required. Results. A recurrent episode of venous thromboembolism was documented in 192 patients after a mean (±SD) period of 31(±29) months. In 26 additional patients with ipsilateral symptoms the diagnostic critera were not fulfilled. One hundred and eleven patients have deceased and 69 patients withdrew from the study. The 392 patients without recurrent episodes were followed for a median of 96 months with 90% for at least 48 months. An objectively verified recurrent contralateral and ipsilateral deep vein thrombosis occurred in 95 and 54 cases, respectively, and in 41 patients pulmonary embolism was documented. In two patients thromboses with unusual locations were registered. The risk of contralateral versus ipsilateral recurrence was significantly increased with a risk ratio of 1.6 (95% confidence interval 1.4,1.9) in a time to event model. In a multivariate analysis none of the investigated variables were significantly associated with the side of recurrent thrombosis. Conclusions. The risk of a recurrent deep vein thrombosis is increased in the contralateral leg. This brings into question the importance of an impaired venous flow for recurrent episodes of thrombosis. [source] Variable small protein (Vsp)-dependent and Vsp-independent pathways for glycosaminoglycan recognition by relapsing fever spirochaetesMOLECULAR MICROBIOLOGY, Issue 4 2000Loranne Magoun Tick-borne relapsing fever, caused by pathogenic Borrelia such as B. hermsii and B. turicatae, features recurrent episodes of bacteraemia, each of which is caused by a population of spirochaetes that expresses a different variable major protein. Relapsing fever is also associated with the infection of a variety of tissues, such as the central nervous system. In this study, we show that glycosaminoglycans (GAGs) mediate the attachment of relapsing fever spirochaetes to mammalian cells. B. hermsii strain DAH bound to immobilized heparin, and heparin and dermatan sulphate blocked bacterial binding to host cells. Bacterial binding was diminished by inhibition of host cell GAG synthesis or sulphation, or by the enzymatic removal of GAGs. GAGs mediated the attachment of relapsing fever spirochaetes to potentially relevant target cells, such as endothelial and glial cells. B. hermsii was able to attach to GAGs independently of variable major proteins, because strains expressing the variable major proteins Vsp33, Vlp7 or no variable major protein at all each recognized GAGs. Nevertheless, we found that a variable major protein of B. turicatae directly promoted GAG binding by this relapsing fever spirochaete. B. turicatae strain Oz1 serotype B, which expresses the variable major protein VspB, bound to GAGs more efficiently than did B. turicatae Oz1 serotype A, which expresses VspA. Recombinant VspB, but not VspA, bound to heparin and dermatan sulphate. Previous studies have shown that strain Oz1 serotype B grows to higher concentrations in the blood than does Oz1 serotype A. Thus, relapsing fever spirochaetes have the potential to express Vsp-dependent and Vsp-independent GAG-binding activities and, for one pair of highly related B. turicatae strains, differences in GAG binding correlate with differences in tissue tropism. [source] Association of interleukin-1, polymorphism with recurrent aphthous stomatitis in Brazilian individualsORAL DISEASES, Issue 6 2006ALS Guimarães Background:, Recurrent aphthous stomatitis (RAS) is characterized by recurrent episodes of oral ulceration in an otherwise healthy individual. Some reports in the literature indicate that RAS may have immunological, psychological, genetic and microbiological bases. The purpose of the present study was to investigate the possible association between interleukin-1, (IL-1,) +3954 (C/T) genetic polymorphism and RAS in a sample of Brazilian patients. Subjects and methods:, Sixty-two consecutive subjects affected by minor and major forms of RAS and 62 healthy volunteers were genotyped at IL-1, (+3954). The chi-squared test was used for statistical analysis. Results:, A significant increase in the high production of IL-1, genotype CT was observed in the group with RAS (P = 0.01). After stratifying RAS patients according to the mean number of lesions per episode, a significant difference was only observed between patients with ,3 lesions in each episode and control. Conclusion:, There is an increased frequency of polymorphism associated with high IL-1, production in RAS patients. [source] Atrioventricular Nodal Tachycardia in a Patient with Anomalous Inferior Vena Cava with Azygos Continuation and Persistent Left Superior Vena CavaPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 10 2009MIGUEL A. ARIAS M.D., Ph.D. A 39-year-old female patient was referred for ablation of recurrent episodes of atrioventricular nodal reentrant tachycardia. A combination of an anomalous inferior vena cava with azygos continuation and a persistent left superior vena cava was discovered. A nonfluoroscopic navigation system was very useful for catheter ablation of the tachycardia in this unusual case of anomalous venous system of the heart. [source] How Revealing Are Insertable Loop Recorders in Pediatrics?PACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 3 2008PATRICIA A. FRANGINI M.D. Introduction: An insertable loop recorder (ILR) in patients with infrequent syncope or palpitations may be useful to decide management strategies, including clinical observation, medical therapy, pacemaker, or implantable cardioverter defibrillator (ICD). We sought to determine the diagnostic utility of the Reveal® ILR (Medtronic, Inc., Minneapolis, MN, USA) in pediatric patients. Methods: Retrospective review of clinical data, indications, findings, and therapeutic decision in 27 consecutive patients who underwent ILR implantation from 1998,2007. Results: The median age was 14.8 years (2,25 years). Indications were syncope in 24 patients and recurrent palpitations in three. Overall, eight patients had structural heart disease (six congenital heart disease, one hypertrophic cardiomyopathy, one Kawasaki), five had previous documented ventricular arrhythmias with negative evaluation including electrophysiology study, and three patients had QT prolongation. Tilt testing was performed in 10 patients, of which five had neurocardiogenic syncope but recurrent episodes despite medical therapy. After median three months (1,20 months), 17 patients presented with symptoms and the ILR memory was analyzed in 16 (no episode stored in one due to full device memory), showing asystole or transient atrioventricular (AV) block (2), sinus bradycardia (6), or normal sinus rhythm (8). Among asymptomatic patients, 3/10 had intermittent AV block or long pauses, automatically detected and stored by the ILR. In 19 of 20 patients, ILR was diagnostic (95%) and five subsequently underwent pacemaker implantation, while seven patients remained asymptomatic without ILR events. Notably, no life-threatening events were detected. The ILR was explanted in 22 patients after a median of 22 months, two due to pocket infection, 12 for battery depletion and eight after clear documentation of nonmalignant arrhythmia. Conclusions: The ILR in pediatrics is a useful adjunct to other diagnostic studies. Patient selection is critical as the ILR should not be utilized for malignant arrhythmias. A diagnosis is attained in the majority of symptomatic patients, predominantly bradyarrhythmias including pauses and intermittent AV block. [source] Capture of Atrial Fibrillation Reduces the Atrial Defibrillation ThresholdPACING AND CLINICAL ELECTROPHYSIOLOGY, Issue 8 2002GIOVANNI Q. VILLANI VILLANI, G.Q., et al.: Capture of Atrial Fibrillation Reduces the Atrial Defibrillation Threshold. The effect of the atrial activity synchronization by single site right atrial pacing on atrial defibrillation threshold (ADFT) was investigated in patients with AF. Two series of randomized incremental cardioversion tests, with increasing energy levels from 0.5 to 10 J, were performed in 15 patients with recurrent episodes of idiopathic paroxysmal AF using two 7 Fr "single coil" catheters for internal cardioversion. After induction of sustained AF (> 10 minutes), shocks were delivered, preceded or not by 10 seconds of overdrive local atrial pacing, according to the randomization, using an external cardioverter defibrillator. A total of 187 shocks was delivered to the study population. ADFT was reduced when overdrive atrial stimulation preceded the cardioversion (3.6 ± 1.6 vs 2.9 ± 1.7 J, P = 0.02). Local atrial capture was considered on the basis of 1:1 phase locking between stimulus and atrial activation wave, and constant morphology of atrial wave criteria. Effective atrial capture was obtained in 8 of 15 patients. There was not significant difference in the mean of FF intervals of patients in which atrial capture was or was not stable (209 ± 22 vs 208 ± 28 ms). Patients were then considered according to the outcome of atrial pacing before direct current shock. A marked ADFT reduction was observed in patients with stable capture (3.8 ± 1.7 vs 2.5 ± 1.7 J, P = 0.0003), while no significant difference in ADFT was found when capture was not achieved (3.4 ± 1.6 vs 3.6 ± 1.5 J, P = NS). In conclusion, regularization of atrial electrical activity by atrial capture reduces the ADFT. A constant pacing entrainment seems to lower the energy required for electrical cardioversion by reducing the amount of fibrillating tissue. [source] The anaesthetic management of patients with congenital insensitivity to pain with anhidrosisPEDIATRIC ANESTHESIA, Issue 4 2004V. Rozentsveig MD Summary Background :,Congenital insensitivity to pain with anhidrosis (CIPA, or hereditary sensory and autonomic neuropathy type IV) is a rare, autosomal recessive disease, related to a mutation in the TrkA gene, characterized by inability to sweat, insensitivity to pain and recurrent episodes of hyperpyrexia. There are two Bedouin tribes in Israel with different mutations of the TrkA gene: one in the southern region and the other in the northern region. The Soroka University Medical Center is the referral centre for the entire southern region of Israel. One in 4500 anaesthesia cases involves a patient with CIPA. Methods :,We reviewed 40 anaesthesia records of 20 patients with CIPA for anaesthetic technique and incidence of side-effects. Results :,Sixteen patients developed complications in the immediate perioperative period: mild hypothermia in one patient and cardiovascular events in 15 others with one case of cardiac arrest. These complications were unrelated to the anaesthetic drug administered. There were no events of hyperthermia or postoperative nausea. Conclusions :,Cardiovascular complications following anaesthesia are common in patients with the southern Israel variant of CIPA. Hyperthermia, previously recognized as a major concern in patients with congenital insensitivity to pain with anhydrous, was not seen in our patients. We conclude that cardiovascular involvement is frequently encountered in CIPA patients following anaesthesia and is the major concern in their anaesthetic management. [source] CD19 negative precursor B acute lymphoblastic leukemia presenting with hypercalcemiaPEDIATRIC BLOOD & CANCER, Issue 1 2004Iyad Sultan MD Abstract A 9-month-old infant presented with hypercalcemia and lytic bone lesions. Suspicion for malignancy led to a bone marrow examination, which showed replacement of the marrow by a small round blue cell infiltrate. Flow cytometric analysis of these cells showed an unusual immunophenotype in that these cells were dim CD45, HLA-DR, and CD10 positive, but CD19, CD20, CD79a, and CD34 negative. Southern blotting showed clonal rearrangement of immunoglobulin heavy chain (IgH) which confirmed a diagnosis of precursor B acute lymphoblastic leukemia (ALL). He received supportive treatment with hydration and pamidronate, but had recurrent episodes of hypercalcemia. Once the correct diagnosis of ALL was established, the patient was treated with an infantile ALL chemotherapeutic regimen and the hypercalcemia resolved. This case highlights the usefulness of immunoglobulin gene rearrangement studies in atypical cases of ALL. © 2004 Wiley-Liss, Inc. [source] Inflammatory myofibroblastic tumor of the tracheaPEDIATRIC PULMONOLOGY, Issue 9 2007Sindhu Sivanandan MBBS Abstract Inflammatory myofibroblastic tumor of the trachea is a rare benign tumor in children. We describe a 9-year-old girl who presented with recurrent episodes of wheeze and severe respiratory distress requiring mechanical ventilation. She had recurrent collapses of the right lung and a chest CT and bronchoscopy confirmed the presence of an obstructing mass lesion at the carina. The lesion, 1.5 cm,×,1.5 cm in size, was debulked by rigid bronchoscopy and histopathology revealed features of inflammatory myofibroblastic tumor. A repeat bronchoscopy at 1 month of follow up did not reveal any residual lesion. Pediatr Pulmonol. 2007; 42:847,850. © 2007 Wiley-Liss, Inc. [source] Successful liver transplantation in a child with Caroli's diseasePEDIATRIC TRANSPLANTATION, Issue 4 2008Constance Meier Abstract:, CD is a rare autosomal recessive disease, characterized by multifocal cystic dilatation of intrahepatic bile ducts. The course of the disease is characterized by intrahepatic cholelithiasis, recurrent episodes of cholangitis, because of cholelithiasis, hepatic abscesses often ending in death caused by uncontrolled infection. Other conditions such as choledochal cyst and renal cystic disease are frequently associated, and patients have a higher risk for the development of cholangiocarcinoma. Endoscopic drainage of the bile duct is palliative and ineffective. OLT appears to be the treatment of choice. In monolobar cases partial liver resection has been shown to be a curative therapeutic option. We report on the course of disease in a Turkish girl who was diagnosed with CD in the neonatal period. At the age of 8.2 yr, she received OLT and is in good health 57 months post-transplantation. [source] Exercises and education as secondary prevention for recurrent low back painPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 1 2001Margret Grotle Soukup Abstract Background and Purpose Exercise and education is a common physiotherapy approach in the prevention of low back pain. A Mensendieck exercise programme consisting of exercises and ergonomical education has, in a previous study, been shown to be effective in preventing recurrent low back pain during one-year follow-up. The purpose of the present study was to evaluate the long-term effect of the Mensendieck exercise programme on people with recurrent episodes of low back pain who, when entering the study, had finished treatment for their last episode of low back pain. Method A randomized controlled clinical trial in which 41 women and 36 men were allocated to either a Mensendieck or control group. The Mensendieck subjects received 20 group sessions of exercises and ergonomical education over 13 weeks. The control subjects were not offered any prophylactic therapy, but were free to receive treatment or exercises. Outcome measures were the number of recurrences of low back pain, sick leave, low back function and general functional status. Results At three-year follow-up, 11 subjects had been lost to the study. Survival analysis showed a significant reduction (p=0.02) in subjects experiencing recurrent low back pain in the Mensendieck group compared to the control group. Significant improvements in pain and function scores were reported in both groups. There was no significant difference between the groups in pain, function or sick leave. Conclusion A Mensendieck exercise programme seems efficient in reducing recurrent episodes of low back pain at three-year follow-up, but it did not influence sick leave, pain or function scores. Copyright © 2001 Whurr Publishers Ltd. [source] Autoerythrocyte sensitization syndrome associated with grief complicationsTHE JOURNAL OF DERMATOLOGY, Issue 3 2006Duru GUNDOGAR ABSTRACT The clinical presentation of a patient with autoerythrocyte sensitization syndrome associated with a complicated grief reaction is reported. A 50-year-old female patient presented with recurrent episodes of painful ecchymotic bruising on the lower extremities which started in 1995 after the sudden death of her son and exacerbated almost every year at approximately the same time her son died as an anniversary reaction. No pathological findings were detected in the laboratory examinations. The diagnosis was confirmed by induction of similar lesions by i.d. injection of the patient's own washed erythrocytes and whole blood. Psychiatric assessment revealed that the patient was depressed, socially introverted, overly defensive and avoidant in interpersonal relationships. Antidepressant treatment and psychotherapy for major depression and grief complications were started with the patient. Having an awareness of this rare condition will assist in the prevention of unnecessary investigations in such cases and will allow early referral for appropriate psychological counseling. [source] Brief Communication: Successful Isolated Liver Transplantation in a Child with Atypical Hemolytic Uremic Syndrome and a Mutation in Complement Factor HAMERICAN JOURNAL OF TRANSPLANTATION, Issue 9 2010W. Haller A male infant was diagnosed with atypical hemolytic uremic syndrome (aHUS) at the age of 5.5 months. Sequencing of the gene (CFH) encoding complement factor H revealed a heterozygous mutation (c.3644G>A, p.Arg1215Gln). Despite maintenance plasmapheresis he developed recurrent episodes of aHUS and vascular access complications while maintaining stable renal function. At the age of 5 years he received an isolated split liver graft following a previously established protocol using pretransplant plasma exchange (PE) and intratransplant plasma infusion. Graft function, renal function and disease remission are preserved 2 years after transplantation. Preemptive liver transplantation prior to the development of end stage renal disease is a valuable option in the management of aHUS associated with CFH mutations. [source] Total Duodenectomy with Enteric Duct Drainage: A Rescue Operation for Duodenal Complications Occurring after Pancreas TransplantationAMERICAN JOURNAL OF TRANSPLANTATION, Issue 3 2010U. Boggi Duodenal graft complications (DGC) occur frequently after pancreas transplantation but rarely cause graft loss. Graft pancreatectomy, however, may be required when DGC compromise recipient's safety. We herein report on two patients with otherwise untreatable DGC in whom the entire pancreas was salvaged by means of total duodenectomy with enteric drainage of both pancreatic ducts. The first patient developed recurrent episodes of enteric bleeding, requiring hospitalization and blood transfusions, starting 21 months after transplantation. The disease causing hemorrhage could not be defined, despite extensive investigations, but the donor duodenum was eventually identified as the site of bleeding. The second patient was referred to us with a duodenal stump leak, 5 months after transplantation. Two previous surgeries had failed to seal the leak, despite opening a diverting stoma above the duodenal graft. Thirty-nine and 16 months after total duodenectomy with dual duct drainage, respectively, both patients are insulin-independent and free from abdominal complaints. Magnetic resonance pancreatography shows normal ducts both basal and after intravenous injection of secretin. The two cases presented herein show that when DGC jeopardize pancreas function or recipient safety, total duodenectomy with enteric duct drainage may become an option. [source] Extreme Subcutaneous, Intramuscular and Inhaled Insulin Resistance Treated by Pancreas Transplantation AloneAMERICAN JOURNAL OF TRANSPLANTATION, Issue 1 2010J. R. Sa Diabetes mellitus with resistance to insulin administered subcutaneously or intramuscularly (DRIASM) is a rare syndrome and is usually treated with continuous intravenous insulin infusion. We present here two cases of DRIASM in 16 and 18 years female patients that were submitted to pancreas transplantation alone (PTA). Both were diagnosed with type 1 diabetes as young children and had labile glycemic control with recurrent episodes of diabetic ketoacidosis. They had prolonged periods of hospitalization and complications related to their central venous access. Exocrine and endocrine drainages were in the bladder and systemic, respectively. Both presented immediate graft function. In patient 1, enteric conversion was necessary due to reflux pancreatitis. Patient 2 developed mild postoperative hyperglycemia in spite of having normal pancreas allograft biopsy and that was attributed to her immunosuppressive regimen. Patient 1 died 9 months after PTA from septic shock related to pneumonia. In 8 months of follow-up, Patient 2 presented optimal glycemic control without the use of antidiabetic agents. In conclusion, PTA may be an alternative treatment for DRIASM patients. [source] | ||||||||||||||||||||||||||||||||||