Native valve endocarditis due to Pseudomonas mendocina in a patient with mental retardation and a review of literature

Pseudomonas mendocina, a Gram-negative non-fermentative rod, occurs in water and soil but is rarely recovered as a human pathogen. We report a native valve endocarditis due to Pseudomonas mendocina in a patient with mental retardation.     

Erythema nodosum: an evaluation of 100 cases

OBJECTIVES: In this study, we investigated the clinical features, etiology, and also predictive factors of secondary erythema nodosum (EN) in patients with EN. METHODS: A total of 100 patients (mean age: 37 years) diagnosed with EN between 1993 and 2004 in our clinic were included in the study prospectively. A skin biopsy was performed in 46 of the patients. Patients were considered to have secondary EN when an underlying condition was found, and to have primary EN when no such condition was found. For the diagnosis of the underlying diseases, the pertinent diagnostic criteria and/or diagnostic methods were used. Categorical and continuous variables were compared by using chi-square and Mann-Whitney U tests respectively. Multiple regression analysis was applied to the significantly different variables. RESULTS: The majority of the patients were female (female/male: 6/1) and nearly half (47%) of the cases had a determined etiology. The leading etiology was poststreptococcal (11%), followed in decreasing order by primary tuberculosis (10%), sarcoidosis (10%), Beh?et's syndrome (BS) (6%), drugs (5%), inflammatory bowel diseases (IBD) (3%), and pregnancy (2%). Fifteen (15%) patients complained of cough; the diagnosis was primary tuberculosis in eight cases and sarcoidosis in seven. Four patients with arthritis were diagnosed as having BS (in 3) and Crohn's disease (in 1). All the patients were followed for a mean duration of 4.5 years. The nodosities relapsed annually in 62% (33/53) of idiopathic EN patients but in only one (BS) in the secondary EN group. The histology was consistent with EN in all biopsied patients. Our study revealed that fever, leukocytosis, elevated CRP level, accelerated ESR, presence of cough, sore throat, diarrhea, arthritis, and pulmonary pathology were predictors of secondary EN. Recurrence in EN significantly predicted primary EN. All of the patients had bed rest and the majority was given an anti-inflammatory agent (naproxen sodium). The outcomes were usually favorable within 7 days. The patients with an underlying disease were given the specific treatment. CONCLUSION: EN has been associated with numerous diseases. In order to reduce cost and duration of diagnosis, every centre should determine its own most frequent etiologic factors. Predictive variables for secondary EN should also be determined and an optimum management for such patients should be clarified. Our study revealed streptococcal pharyngitis, primary tuberculosis, sarcoidosis, IBD, and BS as the main etiologies of EN.     

Hyperventilation in a motion sickness desensitization program

INTRODUCTION: In motion sickness desensitization programs, the motion sickness provocative stimulus is often a forward bending of the trunk on a rotating chair, inducing Coriolis effects. Since respiratory relaxation techniques are applied successfully in these courses, we investigated whether these repetitive trunk movements by themselves may induce hyperventilation and consequently add to the motion sickness. METHODS: There were 12 healthy subjects who participated in our study. In the Baseline condition, subjects sat relaxed on the stationary chair. In the Hypervent condition, subjects performed voluntary hyperventilation (the level was prescribed). In two other conditions subjects rhythmically bent their trunk on a stationary chair (Tilt-Stat condition) and on a rotating chair (Tilt-Rot condition). In all conditions we measured respiratory and cardiovascular activity (heart frequency, tidal volume, end-tidal CO2, and respiration frequency). RESULTS: Of the 12 subjects, 9 had to stop prematurely in the Tilt-Rot condition because of moderate nausea. Except for heart rate in the Tilt-Rot condition, the measured physiological parameters in these subjects in the Tilt-Stat and Tilt-Rot conditions were not statistically different from the Baseline condition. Only in the Hypervent condition were significant differences observed, but no nausea. DISCUSSION: The findings show that hyperventilation is not the main cause of nausea during the Coriolis effects. We conclude that during the pilot desensitization program with Coriolis stimuli, measurement of cardiovascular and respiratory parameters is not necessary; however, in those cases that do not respond to the intervention, we recommend paying attention to respiratory parameters because hyperventilation does occur on an individual basis.     

Diffusion tensor MR imaging in pediatric head trauma

PURPOSE: We propose to investigate the fractional anisotropy (FA) values in pediatric patients with closed head trauma and correlate them with the initial Glasgow Coma Scale (GCS). MATERIALS AND METHODS: A retrospective evaluation of 24 pediatric patients (15 men, 9 women; mean age, 13 years; range, 2-18 years) who underwent both unenhanced head computed tomography and cerebral magnetic resonance imaging (MRI), including the tensor diffusion sequence, within 30 days of the incident. Twenty-two atraumatic control patients (9 men, 13 women; mean age, 9 years; range, 4-17 years) were randomly selected from the records of the radiology department within the same period. Fractional anisotropy measurements were taken from each of 6 major white matter volumes. Data extracted from the record of each subject included GCS, initial head computed tomographic results, and length of hospital stay. Kruskal-Wallis and t tests were used for statistical evaluation. RESULTS: The mean acute score on the GCS was 9.7 +/- 5. Mean duration of hospitalization days was 8.7 +/- 10. Statistically significant differences in mean FA values between trauma and control subjects were noted in corpus callosum. Trauma patients with positive findings on MRI and with GCS less than 10 also had lower FA values than patients with GCS greater than 10 and patients who had normal MRI findings. There was a negative correlation between time to discharge and FA values. CONCLUSIONS: In pediatric head trauma, MRI diffusion FA measurements can show abnormalities despite normal-appearing brain MRI findings. Larger investigations are required to verify the stability of correlations.