Kawasaki disease in Greek children: a retrospective study

Background The studies of series of children with Kawasaki disease (KD) in Greek children are limited. Objectives To evaluate the epidemiology, clinical manifestations, laboratory findings, course and outcome of complete KD in Greek children. Methods Patients with complete KD who were discharged from our hospital and followed up routinely between 2004 and 2011 were included in the study. The relevant data were collected using a standardized form. Results There were 49 children (27 boys, 22 girls), mean age: 2.14 years. A seasonal peak of the disease during spring and summer months was detected. Changes of the extremities and cervical adenopathy were the least commonly met criteria for the complete KD diagnosis. The mean time of starting treatment was 6.5 days from the disease onset. The majority of patients, 42/49, responded well to a single infusion of intravenous immunoglobulin (IVIG), while 7/49 patients who had persistent fever despite initial therapy with IVIG needed additional treatment with either a second dose of IVIG(5), intravenous pulse of methyl prednisolone(1) or infliximab(1). Coronary artery abnormalities were detected echocardiographically in 17/49 patients. Most of them (15/17) developed transient dilatations which resolved by the 8^th week of disease onset while only 2 patients, despite early onset of treatment, developed coronary artery aneurysms which required coronary artery bypass grafts at a later stage. Conclusions Major epidemiologic features of KD detected among Greek children are similar to those reported in other populations. This study also demonstrates that significant cardiac complications may still occur following the disease even if it is diagnosed and treated early.     

A contemporary systematic review on liver transplantation for unresectable liver metastases of colorectal cancer

The 5-year overall survival rate of a patient with unresectable metastatic colorectal cancer is poor at approximately 14%. Similarly, historical data on liver transplantation (LT) in those with colorectal liver metastases (CRLM) showed poor outcomes, with 5-year survival rates between 12% and 21%. More recently, limited data have shown improved outcomes in select patients with 5-year overall survival rates of approximately 60%. Despite these reported survival improvements, there is no significant improvement in disease-free survival. Given the uncertain benefit with this therapeutic approach and a renewed investigational interest, we aimed to conduct a contemporary systematic review on LT for CRLM. A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis statement. English articles reporting on data regarding LT for CRLM were identified through the MEDLINE (via PubMed), Cochrane Library, and ClinicalTrials.gov databases (last search date: December 16th, 2021) by 2 researchers independently. A total of 58 studies (45 published and 13 ongoing) were included. Although early retrospective studies suggest the possibility that some carefully selected patients may benefit from LT, there is minimal prospective data on the topic and LT remains exploratory in the setting of CRLM. Additionally, several other challenges, such as the limited availability of deceased donor organs and defining appropriate selection criteria, remain when considering the implementation of LT for these patients. Further evidence from ongoing prospective trials is needed to determine if and to what extent there is a role for LT in patients with surgically unresectable CRLM.     

Anoxia–ischemia: A mechanism of seizure termination in ictal asystole

Cerebral anoxia–ischemia (CAI) is a potent inhibitor of cerebral hyperactivity and a potential mechanism of seizure self-termination. Prolonged ictal asystole (IA) invariably leads to CAI and has been implicated as a potential cause of sudden unexplained death in epilepsy (SUDEP). IA was seen in eight consecutive patients (0.12% of all patients monitored). Ten of their seizures with IA had evidence of CAI on electroencephalography (EEG), manifested by bilateral hypersynchronous slowing (BHS), and were compared to 18 seizures without signs of CAI. The ictal EEG pattern resolved in all 10 CAI events with onset of the BHS. The period from IA onset to seizure end was reduced in events with BHS compared to events without BHS (10.5 s vs. 28.3 s, respectively; p = 0.005), and the total seizure duration tended to be shorter. Anoxia–ischemia as a result of IA may represent an effective endogenous mechanism for seizure termination and may explain why the hearts of patients with ictal asystole reported to date in the literature resumed beating spontaneously.     

A phase III randomised trial comparing sequential chemotherapy using cisplatin-based regimen and paclitaxel to cisplatin-based chemotherapy alone in advanced non-small-cell lung cancer.

BACKGROUND: The purpose of this study is to determine whether in advanced non-small-cell lung cancer (NSCLC), the sequential administration of cisplatin-based chemotherapy and paclitaxel (Taxol) is superior to a cisplatin-based chemotherapy, followed by paclitaxel as salvage treatment. PATIENTS AND METHODS: A total of 485 chemotherapy naive patients with advanced NSCLC were treated with three courses of GIP (gemcitibine + ifosfamide + cisplatin), consisting of cisplatin 50 mg/m(2) on day 1, ifosfamide 3 g/m(2) on day 1 and gemcitabine 1 g/m(2) on days 1 and 8. Patients with nonprogressive disease were then randomised to further similar courses of GIP or courses of paclitaxel (225 mg/m(2) over 3 h every 3 weeks). RESULTS: Objective response or nonprogression after induction GIP occurred in 174 and 115 patients, respectively. After randomisation, there were 140 patients in the GIP arm and 141 in the paclitaxel arm. In terms of postrandomisation survival, there was no statistically significant difference (P = 0.17) between the two arms. Median times were 9.7 [95% confidence interval (CI) 7.8-11.6] and 11.9 (95% CI 9.4-14.3) months for paclitaxel and GIP, respectively. Multivariate analysis demonstrated that sex and haemoglobin were independent prognostic factors. After adjustment for these factors, the observed hazard ratio was 0.81 (95% CI 0.63-1.04) in favour of GIP (P = 0.10). Toxicity was tolerable; there was a significantly higher rate of grades III/IV thrombocytopenia with GIP and more alopecia with paclitaxel. CONCLUSION: Sequential chemotherapy using cisplatin-based regimen followed by paclitaxel does not result in better outcome than cisplatin-based chemotherapy using taxane as salvage treatment.     

A preliminary study of left frontal region error negativity and symptom improvement in geriatric depression

OBJECTIVE: This study tested the hypothesis that frontal error negative wave amplitude on EEG during Stroop test activation predict change in depressive symptoms in depressed elders. METHOD: Twenty-two older patients with major depression received controlled treatment with citalopram at a target dose of 40 mg/day for 6 weeks. Paramedian error negative waves were recorded during Stroop activation before treatment. RESULTS: Nine subjects who remained symptomatic had larger left frontal error negative waves than the subjects who achieved remission. Left frontal error negative waves were correlated with percent change of depressive symptoms from baseline. Other paramedian error negative waves did not distinguish remitted from unremitted subjects. Left frontal error negative waves were negatively correlated with Mattis Dementia Rating Scale scores for initiation/perseveration; these scores were lower in unremitted than remitted patients. CONCLUSIONS: Increased left frontal error negative waves are associated with limited or slow change in depressive symptoms in elders receiving citalopram.     

Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device

BACKGROUND: The hand-carried cardiac ultrasound (HCU) device is a recently introduced imaging device, which may be potentially useful in the primary care setting. AIM: To test the screening potential of a HCU for the detection of left ventricular (LV) dysfunction by evaluating LV ejection fraction (LVEF) and inferior vena cava (IVC) collapse. Standard echocardiographic system (SE) and plasma brain natriuretic peptide (BNP) measurements were used as a reference. METHODS: Eighty-eight consecutive patients (56 male, aged 59+/-12 years) with suspected LV dysfunction were enrolled in the study. The HCU-LVEF was visually estimated and the SE-LVEF was derived by the Simpson's biplane method. A LVEF <40% represented LV dysfunction. An IVC collapse of <50% and BNP levels > or =15 pmol/l were considered abnormal. The correlation of HCU-LVEF, HCU-IVC and BNP to the SE-LVEF and SE-IVC was analysed independently using 2x2 tables. RESULTS: Six patients were excluded because of poor echo images. 19/82 patients had LV dysfunction. The HCU and BNP could identify 17 and 18 out of these 19 patients, respectively. The agreement for LVEF and IVC collapse between SE and HCU was 96% for both parameters. The sensitivity of IVC collapse, HCU-LVEF and BNP in identifying patients with LV dysfunction was 26, 89 and 94%, respectively. CONCLUSION: A HCU device can reliably be used as a screening tool for LV dysfunction.     

Assessment of patient effective radiation dose and associated radiogenic risk from extracorporeal shock-wave lithotripsy

The aim of the present study was to calculate patient effective dose and associated radiogenic risk from fluoroscopy guided extracorporeal shock-wave lithotripsy procedures. Fluoroscopy required during extracorporeal shock-wave lithotripsy was classified in two types identified by beam orientation: antero-posterior and 30 degrees anterior-oblique projected exposures. Duration of each exposure was monitored in 124 patients undergoing extracorporeal shock-wave lithotripsy treatment for ureteral stones. The dose from a kidney-ureter-bladder radiograph and the dose per min of fluoroscopy along antero-posterior and anterior-oblique projections were measured at 13 organs/tissues using an anthropomorphic phantom and thermoluminescence dosimetry. A radio-opaque object was placed in the phantom to simulate an ureteral stone at the proximal and distal ureter. The total effective dose in male and female patients with proximal ureteral stones was 1.71 mSv and 1.82 mSv, respectively. The corresponding values for male and female patients with distal ureteral stones was 0.76 mSv and 1.62 mSv, respectively. In the United States, the theoretical sex-averaged radiogenic excess of fatal cancers was estimated to be 140 per million and 85 per million of patients treated for proximal and distal ureteral stone, respectively. The average radiogenic risk for genetic defect associated to treatments of proximal and distal ureteral stones was found to be 2.5 and 24.4 per million of births, respectively. The radiation risk from a typical fluoroscopy guided extracorporeal shock-wave lithotripsy treatment of ureteral stones is low. Presented data may be used to determine patient effective dose from extracorporeal shock-wave lithotripsy procedures performed in any laboratory.     

Clinical presentation of the "depression-executive dysfunction syndrome" of late life.

It has been proposed that a "depression-executive dysfunction (DED) syndrome" occurs in late life. This assertion was based on clinical, neuropathological, and neuroimaging findings suggesting that frontostriatal dysfunctions contribute to the development of both depression and executive dysfunction and influence the course of depression. The authors describe the clinical presentation of DED and its relationship to disability, studying 126 elderly subjects with major depression and evaluating depressive symptoms, cognitive functioning, disability, and personality dimensions. Patients with the DED syndrome had reduced fluency, impaired visual naming, paranoia, loss of interest in activities, and psychomotor retardation, but showed a rather mild vegetative syndrome. Depressive symptomatology, and especially psychomotor retardation and loss of interest in activities, contributed to disability in DED patients, whereas paranoia was associated with disability independently of executive dysfunction. These findings may aid clinicians in identifying patients needing vigilant follow-up, because depression with executive dysfunction was found to be associated with disability, poor treatment response, relapse, and recurrence.