Moderate acute rejection detected during annual catheterization in pediatric heart transplant recipients.

BACKGROUND: Acute rejection commonly occurs within the first year after heart transplantation, and then decreases in frequency with time. Recently, the long-term utility of endomyocardial biopsy during routine annual catheterization has been questioned. The purpose of this study was to retrospectively review the prevalence of biopsy-proven rejection during routine annual catheterization in our patient population, determine whether biopsies late after transplant are useful, and identify factors that correlate with late unsuspected rejection. METHODS: Biopsy results from the annual catheterization were evaluated from 1986 to August 2000. The prevalence of moderate rejection was evaluated and compared with the patient's immunosuppressive regimen; the prevalence of late rejection; and how late rejection correlated with recipient age, number of first-year rejections and presence of sub-therapeutic cyclosporine. RESULTS: A total of 1108 biopsies were performed in 269 children with a mean follow-up of 5 +/- 3 years (median 5 years, range 1 to 11 years). Three-drug immunosuppressive therapy, including steroids, was used in 93 patients. There was a persistent 8% to 10% prevalence of moderate rejection at up to 10 years post-transplantation. Moderate rejection was more likely in patients: (1). on 3-drug immunosuppressive therapy; (2). with a recipient age >1 year; and (3). with a relatively lower cyclosporine level. CONCLUSIONS: These data suggest that continued surveillance of pediatric transplant patients for acute rejection is indicated for long-term follow-up.     

Characteristics of Multifocal and Multicentric Breast Cancers

Annals of Surgical Oncology - Multifocality and multicentricity are increasingly recognized in breast cancer. However, little is known about the characteristics and biology of these cancers and the...     

Gibbus deformity: Lessons from incompletely treated osteomyelitis

Gibbus deformity is defined by the collapse of one or more vertebral bodies, which results in kyphosis and is often the consequence of infection, metabolic, or congenital irregularities in the vertebrae. In this report we present a unique case of a young male with inadequately treated MRSA bacteremia complicated by lumbar osteomyelitis with progression to severe joint destruction and a marked Gibbus deformity.     

Cryptococcal meningitis in steroid-treated systemic lupus erythematosus

A case of cryptococcal meningitis complicating steroid-treated systemic lupus erythematosus (SLE) which was successfully treated with amphotericin B is described.