Right atrial thrombosis complicating renal transplantation in a child

Abstract:  Nephrotic syndrome represents a form of acquired thrombophilia thereby causing increased risk of thrombosis. In patients with nephrotic syndrome both venous and arterial thrombosis can occur; however, intracardiac thrombus is among the rarest reported in the literature. In this case report, we present a 10.5-yr-old boy with right atrial thrombosis and an acute rejection episode after renal transplantation due to end stage renal disease caused by focal segmental glomerulosclerosis manifested by nephrotic syndrome. The clinical course was successfully managed with surgical removal of thrombus, institution of anticoagulant as well as antirejection therapy. This report draws attention to the risks that could be associated with thrombosis in renal recipients with congenital or acquired thrombophilias and emphasizes the importance of identifying risk factors for thrombosis in these patients.     

Changes in intraocular pressure during cardiopulmonary bypass

Purpose

The aim of the present study was to investigate the changes in intraocular pressures (IOP) in patients who underwent pulsatile and non-pulsatile cardiopulmonary bypass (CPB).

Methods

A total of 42 patients operated for elective coronary bypass surgery (CABG) on CPB were randomly allocated to pulsatile (Group P) and non-pulsatile (Group N) groups. Pulsatile flow was applied to Group P patients during crops-clamp period. The IOP measurements were made before and after the induction of anesthesia, before the onset of CPB, on the 5th, 15th, 30th, 45th, and 60th min of CPB, after CPB and at the end of the operation. The results of repetitive measurements were analyzed at different intervals and in two groups.

Results

The second IOP measurements of right and left eyes displayed statistically significant decreases from the baseline level [11.9 ± 2.9 (p = 0.0001) and 12.5 ± 3.2 (p = 0.0001), respectively]. The significant decrease in the IOP values persisted in the repeated measurements except for the 5th min of CPB values [17.0 ± 3.5 (p = 0.346) and 16.7 ± 3.6 (p = 0.399)]. Comparison of two groups demonstrated significant differences at pre-CPB (right 12.8 ± 2.3 vs. 10.8 ± 2.4; p = 0.013 and left 13.3 ± 2.4 vs. 11.5 ± 2.5; p = 0.023), and 5th min of CPB measurements (right 18.5 ± 3.1 vs. 15.9 ± 3.4; p = 0.015; left 18.2 ± 3.0 vs. 15.7 ± 3.6; p = 0.019).

Conclusion

We noted a steady decrease in repeated IOP measurements except for the transient increase in CPB values on 5th min. The IOP values were higher in pulsatile CPB group in pre-CPB and 5th min of CPB measurements; however, the difference was not significant in the repeated measurements.

     

Evaluation of the correlation between preoperative airway assessment tests,anthropometric measurements,and endotracheal intubation difficulty in obesity class III patients undergoing bariatric surgery

In this study, we investigated the correlation between airway assessment tests, anthropometric measurements, and the Modified Cormack– Lehane Classification (MCLC) assessed by videolaryngoscopy in patients undergoing bariatric surgery.This study included 121 morbidly obese patients undergoing bariatric surgery. The body mass index, Modified Mallampati Score (MMS), thyromental distance, sternomental distance, interincisor distance, and neck, waist, and chest circumferences were recorded. The correlation between the airway assessment tests, anthropometric parameters, and the MCLC were analyzed. The time required for endotracheal intubation (EI) and the attempt required for EI were also recorded.Thirty-three patients were found to be at risk of a difficult EI. The MMS, neck circumference, waist circumference, chest circumference, the time required for EI, and the number of attempts for EI were positively correlated with MCLC (all P < .05). As the MMS increased, the risk of a difficult EI increased (P < .001). The cutoff values of neck, waist, and chest circumference for the risk of a difficult EI were 41.5, 153.5, and 147.5 cm, respectively (P < .05).This study indicates that the high MMS, as well as increased neck, waist, and chest circumference, should be considered EI difficulty in obese patients, even if a videolaryngoscopy is used.     

Giant chondroblastoma of the scapula with pulmonary metastases

A 53-year-old man presented with a 12-year history of a progressively growing solid mass at his left shoulder. A 39×30×18-cm and 14.440-kg mass including the scapula was resected. Pathologic features were specific for chondroblastoma. During the 36-month follow-up, he had multiple inoperable metastatic lesions in his lungs. Histology of the transthoracic needle biopsy showed the metastatic nodules had features specific for chondroblastoma; however, the microscopic features additionally had hyperchromasia and increased mitotic activity in some areas. In the English literature, there are a few cases of chondroblastoma located in the scapula. It is exceptional to see this lesion in the sixth decade of life and with pulmonary metastases.     

Absence of both stapedius tendon and muscle

During surgery for otosclerosis, it is common for the surgeon to cut the stapedius tendon. The absence of the stapedius muscle with its tendon is uncommon. In this study, we present a case of the absence of the unilateral stapedius tendon and muscle. During dissections of adult temporal bones, the absence of the stapedius tendon and muscle was found in one case. The tympanic cavity was explored with the help of a surgical microscope. The pyramidal process was not developed. A possible ontogenetic explanation was provided. In the presented case, the cause of the anomaly may be failure of the embryological development of the muscle. Awareness of the variations or anomalies of the stapedius muscle and tendon are important for surgeons who operate upon the tympanic cavity, especially during surgery for otosclerosis.     

Bullous erythema ab igne

Erythema ab igne is a localized, cutaneous condition, consisting of reticulate hyperpigmentation, dusky erythema, epidermal atrophy, and telangiectasia, all the result of repeated exposures to heat. We describe a patient with a bullous form of erythema ab igne: bullae and crusts within a localized area of reticular, brown, macular pigmentation on the lateral side of the left leg, an area that had repeated close exposure to an electrical heater over the previous 3 months. We believe that bullous erythema ab igne, something rarely reported in the literature, should be considered a well-defined variant of erythema ab igne; it may be more common than the literature suggests.     

Peritonitis rates and common microorganisms in continuous ambulatory peritoneal dialysis and automated peritoneal dialysis

Background:  The aim of the present study was to perform a multicenter investigation in Turkish children on chronic peritoneal dialysis by examining the rates of peritonitis as well as causative organisms according to year.
Methods:  Twelve pediatric renal units participated in this study and data were obtained by review of the medical records.
Results:  One hundred and thirty-two patients were on continuous ambulatory peritoneal dialysis (CAPD), 21 were on automated peritoneal dialysis (APD) and 59 were on CAPD and APD at different times. Mean durations of CAPD and APD were 24.2 ± 21.1 months and 22.9 ± 12.8 months, respectively. Seventy-one (33%) out of 212 patients had no peritonitis episode. Overall peritonitis rate was one episode per 15.5 patient-months. The peritonitis rate was one episode per 15.4 patient-months for APD and one episode per 15.6 patient-months for CAPD. Coagulase-negative staphylococcus was the most common cause of peritonitis among patients with positive culture (20.6%). While the incidence of Gram-negative infection remained unchanged according to year in patients on CAPD ( P  = 0.68), the rate of Gram-negative peritonitis in children on APD was significantly higher ( P  = 0.03).
Conclusions:  Peritonitis rate was similar in CAPD and APD, but the risk of Gram-negative peritonitis in APD was higher than that of CAPD.     

The significance of antineutrophil cytoplasmic antibody in microscopic polyangitis and classic polyarteritis nodosa.

AIMS: To describe the distribution and features of classic polyarteritis nodosa (PAN) and microscopic polyarteritis (MPA) and the importance of antineutrophil cytoplasmic antibody (ANCA) in childhood PAN. METHODS: Classic PAN was diagnosed in 15 patients based on the presence of aneurysms on angiography in 10 patients and of necrotising vasculitis in medium sized arteries in five. MPA was diagnosed in 10 patients, based on characteristic findings at renal biopsy in six and by the presence of small sized necrotising arteritis in four. Serum ANCA was detected initially by indirect immunofluorescence (IIF) followed by an immunoassay for myeloperoxidase (MPO) in each case. RESULTS: The median age of the patients with classic PAN and MPA was 12 (range 8-17) and 9.5 (range 5-14) respectively. None of the patients with classic PAN had renal failure. Six of the patients with MPA presented with renal failure; four progressed to chronic renal failure. Clinically evident pulmonary-renal syndrome was present in three of the 10 patients with MPA. IIF for ANCA in classic PAN was negative in nine, showed mild staining patterns in six, and in one MPO-ELISA was mildly increased. IIF for ANCA in MPA revealed very strong perinuclear ANCA staining in nine and atypical staining in one. In MPA, median MPO-ELISA level was 42.5 EU/ml (range 20-250). Treatment of childhood PAN was satisfactory with effective treatment; however relapses did occur. CONCLUSION: ANCA is useful in the diagnosis and follow up of MPA.     

Benign familial hematuria associated with a novel COL4A4 mutation

We describe a father and three offspring with hematuria. The father and one girl also complained of flank pain. Renal function tests and ophthalmological examinations were normal in all. The father had very mild neural deafness. The renal biopsy samples of two affected siblings showed changes compatible with thin basement membrane disease. Genetic analysis revealed a novel missense mutation in exon 32 of COL4A4 to be responsible for the phenotype in this family. We suggest that thin basement membrane disease may have overlapping clinical features with other causes of hematuria; genetic analysis may help in the differential diagnosis and help us further understand the disease processes. Received: 29 January 2001 / Revised: 5 June 2001 / Accepted: 6 June 2001