Atypical hemolytic uremic syndrome in human immunodeficiency virus-1-infected children

We describe the clinical and pathological findings of the hemolytic uremic syndrome (HUS) in two children with human immunodeficiency virus (HIV) infection. Both patients presented with microangiopathic hemolytic anemia, thrombocytopenia, and subsequently developed renal failure. The diagnosis of HUS was confirmed by renal histopathology in both patients. None of these children presented with bloody diarrhea, evidence of circulating antibody response to Escherichia coli O157 lipopolysaccharide, or other known risk factors for HUS, except for the presence of HIV infection. Each patient was treated with intravenous plasma infusion and renal replacement therapy. Their clinical course was characterized by non-oliguria and lack of significant hypertension throughout the acute phase of the disease. Despite these favorable clinical parameters, both patients developed end-stage renal failure. The etiology of this atypical HUS characterized by poor renal survival remains unknown and the role of HIV infection in its pathogenesis, although possible, is unclear. Received March 5, 1996; received in revised form and accepted October 15, 1996     

Postpartum acute myocardial infarction

We report a postpartum acute myocardial infarction that occurred during the first week after cesarean section delivery. We also calculated the rate of postpartum myocardial infarction as related to all women with myocardial infarctions seen in our hospital.(Am J Obstet Gynecol 1997;177:1553-5.)     

Neurologic injury and recovery patterns in burst fractures at the T12 or L1 motion segment

Fourteen consecutive patients with burst fractures at T12 or L1, partial paralysis, and more than 30% canal compromise were prospectively evaluated pretreatment and posttreatment with roentgenograms to determine the initial fracture pattern, CT scans to determine the percent canal compromise and subsequent improvement, and a quantitative motor trauma index scale and bladder sphincter evaluation to determine neurologic recovery. The follow-up period averaged 32 months (range, 12-50 months). Treatment was as follows: nonoperative (three patients), Harrington rods and fusion (seven patients), and Harrington rods and fusion followed by anterior decompression and fusion (four patients). The initial severity of paralysis did not correlate with the initial fracture roentgenographic pattern or the amount of initial CT canal compromise. Neurologic recovery did not correlate with the treatment method or amount of canal decompression. Subsequent recovery did correlate with the initial fracture pattern. If the patient had a Type I or Type II fracture (both greater than 15 degrees kyphosis), greater than 90% neurologic recovery occurred, regardless of treatment. If the patient had a Type III fracture (less than 15 degrees kyphosis and the maximal canal compromise where bone encircles the canal) less than 50% neurologic recovery occurred. If the patient had a Type IV fracture (less than or equal to 15 degrees kyphosis and the maximal canal compromise at the level of the ligamentum flavum), the neurologic recovery was variable. Prognosis for neurologic recovery can be made based on initial roentgenograms. If greater than 15 degrees kyphosis is present, there is a good prognosis.(ABSTRACT TRUNCATED AT 250 WORDS)     

Studies of the reproductive toxicity of Rumalaya

The reproductive toxicity of the complex plant preparation Rumalaya was studied in experiments on white mongrel rats. Rumalaya at doses of 400 and 2000 mg/kg given via the intragastric route with simultaneous application of cream to the skin was found to have no embryotoxic or teratogenic actions and had no significant effect on the postnatal development of offspring or the generative functions of female or male rats. Thus, these data identified no contraindications to the clinical use of this agent in pregnant women. __________ Translated from Khimiko-Farmatsevticheskii Zhurnal, Vol. 41, No. 8, pp. 3–6, August, 2007.     

How four and twelve weeks of implantation affect the strength and stiffness of a tendon graft securely fixed in a bone tunnel: a study of Evolgate fixation in an extra-articular model ovine model

Healing of a tendon graft to a bone tunnel is slower than the healing of a bone plug. Therefore, the device chosen for hamstring fixation may need to maintain its strength and stiffness longer than the device chosen for bone-tendon-bone fixation. We evaluated, in an extraarticular ovine model, how 4 and 12 weeks of implantation affect the strength of a tendon graft fixed to bone with the Evolgate. The long digital extensor tendon was transplanted and fixed with the Evolgate into a 30-mm long, 8 mm diameter bone tunnel drilled in the tibial metaphysis of both posterior limbs of 15 skeletally mature Suffolk sheep. Immediately after implantation, and 4 and 12 weeks later, biomechanical cyclic load tests in 50 N increments were performed until failure to evaluate the ultimate failure load (UFL). Histological analysis was also performed at 4 and 12 weeks. Biomechanical tests revealed a UFL of 339±120 N at time 0, and increases to 635±19 N (4 weeks) and to 867±80 N (12 weeks). The differences between all 3 groups were significant (p<0.001, paired t test). The histological evaluation showed a layer of cellular, fibrous tissue between the tendon and the bone, along the length of the bone tunnel; this layer progressively matured and reorganized during the healing process. The collagen fibers that attached the tendon to the bone resembled Sharpey’s fibers. The strength of the interface significantly and progressively increased between weeks 4 and 12 after transplantation, and was associated with a degree of bone ingrowth noted histologically. The use of the Evolgate seems not to interfere with the bone ingrowth after implantation, allowing an improvement in strength of the bonetendon- device complex.