Vertical transmission of dengue: first case report from Bangladesh

We report a case of vertical transmission of dengue infection in a new born from Bangladesh. The mother was primigravida with an uneventful antenatal period except the fever she developed at 37 weeks of gestation. She underwent cesarean section for decreased fetal movement. The fever lasted for 7 days and was associated with intense bodyache, and a positive tourniquet test. She did not experience any hemorrhages including from the surgical wound. Her platelet count fell at its lowest to 100,000/mm3. She had bilateral mild pleural effusions and positive anti-dengue antibodies (both IgG and IgM). She received symptomatic treatment. The baby was deeply meconium stained and was resuscitated by a pediatrician. His postnatal period went well until day-3 of life when he developed fever and respiratory distress. There were no signs of meconiun aspiration syndrome (MAS) and the septic work up was negative. The platelets count fell to its lowest of 40,000/mm3 on day-3 and day-5 of his illness. Anti-dengue antibodies (both IgG and IgM) were positive with a nearly four-fold rise of IgM antibodies in the convalescent sera. The boy was treated with platelet transfusions and was discharged on day-6 after becoming ill. This report emphasizes that in a dengue epidemic or when dengue is endemic (which Bangladesh has experienced recently), a pregnant woman with fever, myalgia and/or bleeding manifestations should raise a high suspicion that the baby may develop the disease, and both the mother and baby should be closely followed-up. Viral isolation could not be done due to the unavailability of the test.     

Paclitaxel-containing high-dose chemotherapy in high-risk breast cancer patients

Despite standard-dose adjuvant chemotherapy, the prognosis for patients with breast cancer and extensive axillary lymph node involvement at diagnosis is poor. The efficacy of a paclitaxel-containing, high-dose chemotherapy protocol in 21 high-risk breast cancer patients is assessed. After standard-dose chemotherapy followed by peripheral blood stem cell (PBSC) mobilization, high-dose therapy with paclitaxel, carboplatin, and cyclophosphamide and CD34-selected PBSC rescue was given. Hematologic reconstitution after high-dose therapy was rapid. Main toxicity included diarrhea grade I or II in about half of the patients and infections were observed in 19%. Five-year probabilities for relapse and failure-free survival were 32% and 62%, respectively. High-dose consolidation with paclitaxel, carboplatin, and cyclophosphamide achieves a high failure-free survival in patients with high-risk breast cancer with acceptable toxicities and stable, long-term hematopoietic reconstitution. Evaluation of the benefit of high-dose therapy in these patients in larger prospective, randomized trials is warranted and currently under way.     

Neoaortic aneurysm after stage I Norwood reconstruction

Treatment of hypoplastic left heart syndrome through staged repairs has resulted in patients surviving into adulthood. Use of either aortic or pulmonary homografts in performing the neoaortic reconstruction has become the standard of practice with relatively few problems. We report the case of an asymptomatic adolescent boy who had an enlarging neoaortic aneurysm and mild neoaortic regurgitation develop after undergoing a stage I Norwood procedure using a pulmonary homograft. Given the risk for rupture and a concern for further functional deterioration of the neoaortic valve, the patient underwent repair. Histologic examination showed a striking accumulation of myxoid material as well as abnormal vasculature in both the native and engrafted portions of the neoaorta.     

Recalcitrant chest wall Aspergillus fumigatus osteomyelitis after coronary artery bypass grafting: successful radical surgical and medical management

This report describes a 62-year-old male diabetic patient with persistent chest wall osteomyelitis that developed after repeat coronary artery bypass grafting. The chronic infection was localized to the right anterior chest wall and refractory to medical and surgical treatment including long-term antiobiotics, five separate intraoperative debridements, and reconstruction with vascularized omentum over a two-year period at outside institutions. Aggressive surgical debridement with flap reconstruction resulted in definitive management. The organism isolated from multiple intraoperative bone, cartilage, and tissue cultures yielded Aspergillus fumigatus; therapy with itraconazole was utilized for 6 months. Surgical management of osteomyelitis and costochondritis is reviewed accompanied by a literature review on this uncommon cause of chronic chest wall infection.     

Acute renal failure in patients with ischemic heart disease: causes and novel approaches in breaking the cycle of self-perpetuating insults abrogated by surgery

At present, there seems to be diametrically opposing views on the causes of acute renal insufficiency in patients with ischemic heart disease (IHD) elective for cardiac revascularization. In this review, we examined recent advances in the understanding of the pathophysiology of acute renal failure in patients with IHD and surgery-induced acute phase reaction. Emphasis is given to the cellular and molecular mechanisms that contribute to the initiation and progression of inflammation. We evaluated the different pharmacological, technical, and surgical strategies used to improve the outcome of patients with IHD with impaired renal dysfunction and analyzed the influence of renal insufficiency on long-term results after surgery.     

Essential thrombocythemia in a child: diagnostic and therapeutic dilemma

We report an 11-year-old child with essential thrombocythemia ET, a very rare myeloproliferative disorder among children. Essential thrombocythemia can be complicated by life-threatening thrombosis with a risk of converting into acute leukemia. Cytoreductive therapy may reduce the risk of thromboembolic complications. We usually recommend cytoreductive treatment for asymptomatic adult patients with platelet counts of more than 1.5 million/micro liter, but treatment remains obscure in children. Herein, we report the results of child with ET, treated successfully with hydroxuea.