La peritonitis es un problema grave en los niños que reciben diálisis peritoneal. La bacteria Campylobacter jejuni es una causa infrecuente de peritonitis. Un niño de 10 años de edad con ...insuficiencia renal terminal causada por síndrome urémico hemolítico atípico ingresó a nuestro hospital con dolor abdominal y fiebre. El líquido de la diálisis peritoneal era turbio; en el examen microscópico se observaron leucocitos abundantes. Se inició tratamiento con cefepime intraperitoneal. En el cultivo del líquido peritoneal se aisló Campylobacter jejuni, por lo que se agregó claritromicina oral al tratamiento. Al finalizar el tratamiento, el resultado del cultivo del líquido peritoneal era negativo. Hasta donde sabemos, no se había informado previamente peritonitis por C. jejuni en niños. Conclusión. Si bien la peritonitis por C. jejuni es rara en los niños, debe considerarse como factor etiológico de la peritonitis.
We investigated whether spontaneous normalization of negative T waves (TWN) on infarct-related ECG leads (IRLs) in the chronic phase of Q wave anterior myocardial infarction (MI) could be a predictor ...of residual viability in infarct areas. We prospectively studied 35 patients (age 60 +/- 8.6 years) in the chronic phase of Q wave anterior MI. Spontaneous TWN (group A, n = 23) were defined as negative T waves that became upright (> or =0.15 mV) in > or =2 IRLs. The presence of negative T waves (group B, n = 12) was defined as symmetric or biphasic negative T wave of > or =0.15 mV. All patients underwent same-day rest 201Tl-stress (99m)Tc sestamibi dual-isotope myocardial perfusion SPECT and 24-hour 201Tl reinjection imaging for ischemia and viability analysis. On scintigraphic examination, ischemic or viable myocardial segments were found in 18 patients (78%) with TWN and 4 patients (33%) of group B (p = 0.013). The use of TWN as a parameter had a marked influence on the sensitivity (82%), specificity (62%), positive (78%) and negative (67%) predictive values and accuracy (74%) of the diagnosis of viable myocardium. If we add the criterion of positive T waves in aVR with negative T waves to our criteria, we found that sensitivity (90%), positive (80%) and negative (80%) predictive values and accuracy (80%) increased. The results of our study suggest that analysis of TWN on IRLs is an accurate marker of residual viability and/or persistent peri-infarct ischemia in patients in the chronic stage of Q wave anterior MI, and therefore optimizes the diagnostic and therapeutic strategies after MI.
The purpose of this study was to compare coronary collateral circulation and with other risk factors in patients with coronary artery disease and different body mass index. Between January 1999 and ...December 2001, of 867 patients who underwent angiography for the first time, 90 patients (24 women and 66 men), with occlusion in only 1 coronary artery participated in the study. Information regarding age, body mass index, sex, smoking, hypertension, diabetes mellitus, hyperlipidemia, preinfarction angina, and use of oral beta blockers and nitrates were recorded for all patients. The patients were separated into 2 groups in accordance with development of their coronary collateral circulation; those with insufficient (Rentrop 0, 1, and 2) and those with sufficient coronary collateral circulation. They were also divided into 3 groups on the basis of body mass index as follows: (I) 18.0-24.9 kg/m2, (II) 25.0-29.9 kg/m2, and (III) more than 30 kg/m2. In the obesity and overweight groups, hyperlipidemia, diabetes mellitus, and nitrate use were identified more frequently than in the other groups (p<0.05). Use of oral nitrates more than 6 months before the myocardial infarction and existence of preinfarction angina affected collateral coronary vessel development in the positive direction (p=0.01, p=0.03, respectively). There was no correlation between coronary artery disease and coronary collateral vessel development in the obese patients (p=0.6). Although it has been shown that coronary collateral vessel development was affected negatively in obese patients with coronary artery disease, no statistical significance was identified.
We investigated the ventricular repolarization changes during thyrotropin-releasing hormone (TRH) test in 20 euthyroid healthy subjects. TSH elevation was observed in 14 subjects (age: 29±5 years). ...TSH increased at 20 min (baseline: 1.91±1.18 μU/ml vs. 20 min: 13.7±7.2 μU/ml,
P<0.0001) and slightly decreased at 40 min (baseline vs. 40 min: 11.6±6.7 μU/ml
P<0.0001). Many dispersions prolonged at 20 and 40 min (
P<0.05). At baseline, 20 and 40 min, positive linear correlations were observed between TSH levels and TTd and TTcd. These data shows that ventricular repolarization and regional inhomogeneity of ventricular repolarization increase during the TRH test. Neural and receptor-mediated mechanisms on repolarization kinetics of myocardial cells may act on this effect.
Background:
Bradyasystolic episodes are frequently observed in patients who present with presyncope, syncope, or sudden cardiac death to emergency departments. Current therapeutic modalities in ...treating patients with bradyasystolic episodes include pharmacotherapeutic agents (eg, atropine, epinephrine, and dopamine) and cardiac pacing.
Objective:
The aim of this open-label, crossover, prospective, sequential, pilot study was to compare the effects of 3 agents—atropine, dopamine, and aminophylline—on ventricular escape rate in Turkish patients.
Methods:
Eligible patients were stable and had chronic, symptomatic, second-degree 2:1 or third-degree atrioventricular (AV) block with a narrow complex escape rhythm. Patients who were receiving a pharmacotherapeutic regimen or who presented with a wide QRS complex escape rhythm, severely disturbed hemodynamic status, an electrolyte disturbance, previous heart surgery, myocarditis, or a reversible underlying cause (eg, acute ischemia) were excluded from the study. Study drugs were given in the same sequential order to all patients, without a washout period, until the ventricular escape rate returned to the initial level. Atropine (1 mg), dopamine (7.5 and 15 μg/kg/min), and aminophylline (240 mg, twice) were sequentially given to each patient.
Results:
Twelve consecutive patients (5 women, 7 men; mean age, 69 ± 14 years) were enrolled. Compared with the baseline rate, a significantly improved ventricular escape rate was found after the beta-mimetic dose of dopamine (44 ± 6 beats/min vs 49 ± 10 beats/min;
P = 0.005). Improvement in ventricular escape rate was also shown after the alpha-mimetic dose of dopamine, but it was not as dramatic as with the beta-mimetic dose (49 ± 10 beats/min vs 52 ± 13 beats/min;
P = NS). Compared with the baseline rate, the ventricular escape rate was significantly increased after the second dose of aminophylline (45 ± 10 beats/min vs 50 ± 8 beats/min;
P = 0.04).
Conclusions:
This study revealed that, in this patient population, significant acceleration of the ventricular escape rate was found after both the beta-mimetic dose of dopamine and high-dose aminophylline. This study may have been limited by its small sample size and short duration. Additional studies with larger sample sizes and of longer duration are needed to prove that dopamine and high-dose aminophylline can be used as therapy for patients with high-grade AV block and a slow escape rate.
With these findings the patient was diagnosed to have homozygous protein C deficiency and disseminated intravascular coagulation and was treated with fresh frozen plasma, sodium warfarin, and low ...molecular weight heparin. To our knowledge earliest leucocoria due to protein C deficiency was reported in a 2 months old infant.4 However, in our patient leucocoria was present at birth and the skin lesions appeared on the second day of life showing that the infant actually suffered from protein C deficiency in utero. ...we conclude that leucocoria by itself can be the first manifestation of homozygous protein C deficiency; this should alert the physician to the problem since these infants can also have severe cerebral complications which are preventable if treated on time.
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