Percutaneous transhepatic stenting of a restrictive atrial septal communication in hypoplastic left heart syndrome

The postnatal survival of patients with congenital cardiac defects such as hypoplastic left heart syndrome (HLHS) is dependent on the patency of the ductus arteriosus and the presence of an unrestrictive atrial septal defect (ASD). We report a six week old infant with HLHS and tricuspid valve regurgitation with restrictive ASD. Transfemoral balloon atrial septostomy provided temporary relief but further attempts were not possible. A transhepatic venous approach to stent the atrial communication was technically successful. This approach may be the only access for certain infant cardiac catheterization interventions, permitting the use of a large delivery system (≥ 8 Fr). © 2014 Wiley Periodicals, Inc.     

Early postoperative nutritional enhancement utilizing enteral branched-chain amino acids by way of a needle catheter jejunostomy

Twenty patients who underwent extensive intraabdominal surgical procedures and placement of a needle catheter jejunostomy were prospectively studied to evaluate gastrointestinal tolerance and nutritional enhancement when fed an enteral branched-chain amino acid-enriched diet. At a mean caloric intake of 1,325.75 kcal/day (20.6 kcal/kg per day) and a mean nitrogen intake of 7.64 g/day (0.12 g/kg per day), positive nitrogen balance was achieved 2 to 3 days postoperatively. Total lymphocyte count and levels of transferrin and prealbumin increased significantly (p less than 0.05) during the study. Gastrointestinal tolerance was excellent. Plasma levels of leucine, isoleucine, and valine increased significantly during the study period but remained within the normal range.     

Neuroblastoma Causing Acute Urinary Retention: A Rare Presentation

Background: Neuroblastoma is the most common extracranial solid tumor in children under the age of 5 years and, after acute lymphoblastic leukemia, is the second most prevalent malignancy in childhood. Acute urinary retention is rare in children, especially due to a neuroblastoma. Objectives: To present the potential complications of a pelvic neuroblastoma. Case report: A 9-month-old infant presented with urinary retention that had been attributed in the past to the infant's chronic constipation. She was catheterized and a large residual of urine was obtained; she was discharged home. She returned the following day with the same complaint. Plain radiographs suggested a soft tissue density in the pelvic region with no evidence of constipation. Rectal examination revealed a mass, and a computed tomography scan showed a large, solid mass. Pathological examination confirmed a pelvic neuroblastoma, which was resected. Conclusions: The most common causes of acute urinary retention are urinary tract infections, lower urinary stones, neurologic processes, trauma, and constipation. A detailed and focused history and physical examination can be very helpful in diagnosing a pathological cause of urinary retention, such as a pelvic neuroblastoma.     

Recent advances in diagnosis and treatment of cat scratch disease

The cause of cat scratch disease (CSD), first described in France in 1950 and in the United States in 1951, was unknown until 1983 when the bacterium in lymph nodes was detected using a Warthin-Starry silver stain. Afipia felis has been an infrequent cause of CSD since1988, when this gram-negative bacterium was first isolated from 10 patients with CSD. In 1992 Bartonella organisms were isolated from immunocompetent and immunocompromised patients. An indirect fluorescent antibody test to detect bartonella-specific serum immunoglobulins was developed in 1992. Since then multiple studies have shown that three Bartonella species may produce either CSD in humans, usually Bartonella henselae or Bartonella clarridgeiae, or bacteremia in healthy cats. Also, these two bacteria and Bartonella quintana cause bacillary angiomatosis, bacillary peliosis, or relapsing bacteremia in humans. Cats are healthy carriers of Bartonella organisms and may be bacteremic for months to years. Cat-to-cat transmission of Bartonella organisms involves the cat flea in absence of direct contact transmission. CSD is the most common cause of regional lymphadenitis in children and adolescents. Present knowledge on the etiology, clinical features, epidemiology, pathogenesis, diagnosis, and management of CSD are presented. Also, brief comments about the etiology, clinical presentation, and treatment of bacillary angiomatosis and bacillary peliosis are provided.     

Transhepatic Approach for Extracardiac Inferior Cavopulmonary Connection Stent Fenestration

We report on a 3‐year‐old male who underwent transcatheter stent fenestration of the inferior portion of an extracardiac total cavopulmonary connection in the setting of hypoplastic left heart syndrome. Transhepatic approach, following an unsuccessful attempt from the femoral vein facilitated delivery of a diabolo‐shaped stent.     

A rapid review of rapid HIV antibody tests

Rapid HIV antibody tests recently approved by the Food and Drug Administration can help reduce unrecognized infections by improving access to testing in both clinical and nonclinical settings and increase the proportion of those tested who learn their results. Four rapid HIV antibody tests are now available in the United States; two are approved for use at point-of-care sites outside a traditional laboratory. All four tests are interpreted visually. Sites offering rapid HIV testing must periodically run external controls (known HIV-positive and HIV-negative specimens) and provide persons who undergo rapid testing a subject information sheet. This paper reviews the operating and performance characteristics, quality assurance and laboratory requirements, and HIV counseling implications of the currently available rapid HIV tests.