A molecular approach (multiplex polymerase chain reaction) for diagnosis of rhinosporidiosis

A New multiplex PCR have been developed in our laboratory using primer sets, aiming amplification of both D.N.A target fragments obtained in 18S RNA of commonly encountered fungi in human being and in Rhinosporidium seeberi using F1-fw/F2-rev (500 bp target) and Rhino-fw/ Rhino-rev (.177 bp target). This multiplex PCR has been found to be able to delect R. seeberi from clinical samples and differentiate it from other fungi. Furthermore, by this multiplex PCR, R. seeberi, phylogenitically appears to belong to a member of so called DRIPs clade of fish parasite not a cyanobacterium as claimed previously, by some workers.     

Vagally mediated sympathoexcitation and central depression by desflurane in rabbits

The effects of desflurane on renal sympathetic nerve activity(RSNA) were studied in intact or vagotomized anaesthetized rabbitswith initial concentrations of 4.5–18%, subsequently equilibratedto end-tidal concentrations from 3%, 6%, 9% and 12% each for20 min allowing sympathetic activity to stabilize. In intactanimals, immediate transient increases in mean sympathetic activityfrom 27% to 63% were closely related to initial concentrationsfrom 4.5% to 18%. During subsequent equilibration this remainedelevated by 25–30% up to 6%, returned to control at 9%and fell by 33% at 12%. Bilateral vagotomy abolished sympathoexcitationapart from small increases in sympathetic activity, for example14% at 4.5% (P<0.05). We conclude that increases in inspireddesflurane concentrations evoked rapid transient vagally mediatedreflex sympathoexcitation with a small extra-vagal contribution.Central depression of sympathetic activity started at 6% andwas 33% below baseline at 12%. Footnotes ² Present address: Department of Anaesthetics, Wycombe Hospital,Queen Alexandra Road, Buckinghamshire HP11 2TT, UK     

Alveolar capillary dysplasia. Report of a case of prolonged life without extracorporeal membrane oxygenation (ECMO) and review of the literature

We describe an unusual infant with the diagnosis of alveolar capillary dysplasia who had a relatively prolonged life without extracorporeal membrane oxygenation (ECMO). We have used this case as a springboard for a thorough review of the literature. This was a full-term female infant who presented with a picture of persistent pulmonary hypertension of the newborn. She was treated as such, with various ventilatory modes, alkalinizing agents, surfactant therapy, tolazoline, prostacyclin and nitric oxide. Because of the prolonged clinical course the possibility of alveolar capillary dysplasia was raised. The parents refused ECMO. Despite all efforts she progressively deteriorated and died at 22 days of age. Macro- and microscopic examination of the lung at autopsy were diagnostic of alveolar capillary dysplasia. A detailed review of 39 cases published in the literature with comments regarding incidence, etiology, pathophysiology, clinical picture, diagnosis and treatment is presented.     

Intermittent high frequency ventilation: a new mode to measure changes in lung volume and alveolar gas concentration, enhance CO2 elimination and reduce intrapulmonary pressures

A new method of artificial ventilation, intermittent high frequency ventilation (IHFV), is described in which high frequency ventilation (HFV) is intermittently interrupted so that short periods of ventilation and pauses in ventilation occur in sequence several times a minute. During the pauses in ventilation the increase in lung volume, which occurs during the short periods of HFV, is either exhaled completely or to a predetermined level which prevents sustained hyperinflation of the lungs but allows the maintenance of PEEP if required. The volume of gas expired during the ventilation pauses, i.e. gas retained during the periods of HFV, is measured. When this trapped gas is exhaled completely, the mean airway and compliance pressures are reduced by up to 50% compared to continuous HFV at the same frequency, inspiration:expiration (I:E) ratio and low tidal volume (VT). The alveolar CO2 concentration was measured in gas expired towards the end of the pauses in ventilation. CO2 elimination was improved, especially at high frequencies of ventilation, which allowed a further reduction in inflation pressures while maintaining a constant PaCO2.     

Cardiac tamponade as a terminal event in the hemolytic uremic syndrome in childhood

The case of a 6-year-old Inuit female with the epidemic form of hemolytic uremic syndrome (HUS) with myocardial involvement and probable cardiac tamponade is presented. This case illustrates the multisystemic nature of the syndrome, and to our knowledge, cardiac tamponate as a probable terminal event in HUS has not been reported previously.     

Efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting

Objectives : To determine the efficacy of antimicrobial treatment in non-dysenteric persistent diarrhoea in a community setting. Methods : In this double-blind field trial, 156 children aged 4 36 months with persistent diarrhoea not associated with Giardia lamblia infestation seeking treatment in a community outpatient clinic, were randomized to receive a combination of nalidixic acid and metronidazole, metronidazole alone, or placebo for 7 days. Results : In comparison with placebo, metronidazole treatment did not result in a significant reduction in the mean post-enrolment diarrhoeal duration and stool frequency, increase in the proportion of patients recovered by days 3, 5 and 7 of treatment, and increase in weight gain at days 7 and 14. Comparing the combination of nalidixic acid and metronidazole with metronidazole alone, 17.5% more children treated with the combination recovered by day 3 of treatment ( p = 0.08) and the mean stool frequency ascertained on day 7 for the previous 24 h was 26.8% less in them ( p = 0.05). The weight gains at days 7 and 14 were similar in the two groups. Conclusions : These findings indicate that metronidazole offers no therapeutic benefit in persistent diarrhoea not associated with Giardia lamblia and nalidixic acid has only a modest clinical benefit, which is not substantial enough to warrant its routine use.     

Determination of 8-methoxypsoralen in plasma by scanning fluorometry after thin-layer chromatography

A rapid and sensitive method is described for determining 8-methoxypsoralen in plasma. Plasma samples are acidified with 6 mol/liter and heated in a boiling water bath to release the plasma-bound drug nondestructively. It then is extracted into a solvent mixture consisting of benzene/ethyl acetate (9/1 by vol). The solvent phase is separated, evaporated, and an aliquot of the dissolved residue is thin-layer chromatographed, with benzene/ethyl acetete (9/1) as developing solvent. The plate is dried and the spots, made visible under ultraviolet light (320-400 nm), are scanned. The smallest amount detectable is 20 ng; the overall analytical recovery from plasma is 84%. We used the method to determine the drug in the plasma of rabbits after intravenous and oral administration of 10 mg, and in one patient after an oral dose of 30 mg.     

Fractures of the proximal tibial epiphysis

Fractures of the upper tibial epiphysis are rare. We report on three cases classified according to the Salter and Harris method. Case one, a Type III injury, was associated with a neurovascular lesion. Case two, a Type II injury, was associated with rupture of the medial collateral ligament of the knee, which was treated by internal fixation of the fracture and repair of the ligament. Case three was an unusual fracture, which has not previously been reported in the literature, a Type II injury with an accompanying fracture of the tibial tubercle.     

Mucormycosis in immunocompetent individuals: an increasing trend

OBJECTIVE: Mucormycosis is a fatal infection of the immunocompromised individual. It is unusual to affect healthy individuals. We report eight such cases of infection caused by this emerging fungal pathogen in healthy patients. Of the eight cases, three were infected with Apophysomyces elegans, again an unusual pathogen causing mucormycosis. STUDY DESIGN: Retrospective case review conducted at a tertiary referral center. METHODS: From 1999 to 2003, eight cases of mucormycosis were managed in otherwise healthy patients. Seven of them were treated with surgery. Clinical presentation, imaging studies, mycologic findings, operative findings at surgery, and postoperative results were evaluated. A review of the literature pertaining to mucormycosis infecting otherwise healthy patients and A. elegans infecting otherwise healthy patients in the nose and paranasal sinuses also was done. RESULTS: Of the eight cases, three were infected with A. elegans, with no history of trauma or any invasive procedure. Seven patients underwent surgical treatment. Histopathologic examination showed broad, sparsely aseptate, thin-walled hyphae and angioinvasion with thrombosis. CONCLUSION: Mucormycosis must be considered in the differential diagnosis of any severe acute headache, sinusitis, or orbital cellulites, not only in immunocompromised patients but also in the absence of any underlying disease. Successful treatment requires tissue débridement and injection of amphotericin B.     

Understanding cardiac arrhythmias

This review highlights the applied science intrinsic to the interpretation of the electrocardiogram and cardiac arrhythmias in children.