Rectal peptic ulceration—A rare cause of rectal bleeding

Analysis of the 27 cases of heterotopic gastric mucosa reported in the literature and a new case described here elucidates the main features of this disease: 1) all but one asymptomatic case were diagnosed in infants or in adults under 26 years old; 2) although rectal bleeding occurred in 24 patients, rectal peptic ulceration was found in only 13; 3) six of the patients also had rectal duplication; and 4) 19 times the limited extension of the heterotopic gastric mucosa was compatible with a complete excision by a transanal approach.     

Dapsone for thrombocytopenic purpura related to human immunodeficiency virus infection

PURPOSE: The purpose of this study was to determine the effect of dapsone on platelet count in patients with human immunodeficiency virus (HIV)-related autoimmune thrombocytopenia. PATIENTS AND METHODS: Eleven patients with HIV-related thrombocytopenia received dapsone (50 to 125 mg/day) for 2 to 43 months. Patients with the acquired immunodeficiency syndrome were not enrolled. RESULTS: Of the 11 patients, six developed platelet counts above 50 X 10(9)/L and did not require any other specific therapy. No significant side effects were observed. CONCLUSION: We conclude that dapsone may be effective in some patients with HIV-related thrombocytopenia.     

Burkholderia pseudomallei Isolates in 2 Pet Iguanas,California, USA

Burkholderia pseudomallei, the causative agent of melioidosis, was isolated from abscesses of 2 pet green iguanas in California, USA. The international trade in iguanas may contribute to importation of this pathogen into countries where it is not endemic and put persons exposed to these animals at risk for infection.Key words: Burkholderia pseudomallei, iguana, zoonoses, abscess, melioidosis, bacteriaBurkholderia pseudomallei, a gram-negative bacterium, is the causative agent of melioidosis. Melioidosis is endemic in countries in Southeast Asia and in northern Australia, and has been sporadically reported from Central and South America (1). In the United States, most case-patients have traveled to disease-endemic areas (2).B. pseudomallei infection occurs through direct cutaneous inoculation with soil or water containing B. pseudomallei and through ingestion or inhalation of aerosolized bacteria. In humans, the incubation period is typically 1–21 days, but some patients demonstrate clinical signs years after exposure (1). Acute melioidosis can manifest as a severe pneumonia and septicemia, with death rates >40% in countries where access to medical care is limited. In chronic melioidosis, abscesses occur in various organs, including the lungs, liver, spleen, and cutaneous sites (1,3). In animals, abscesses and acute illness are common (4).B. pseudomallei is classified by US federal agencies as a tier 1 select agent. Tier 1 agents are believed to pose the greatest threat for deliberate misuse and potential harm to public health. Multiple regulations restrict access to these agents and reduce the risk of their release from secure settings (5). Infection is generally diagnosed by culture. Commercially available bacterial identification systems may provide initial identification; however, B. pseudomallei may be misidentified by some systems (6). Other identification tests are available, including PCR and antigen detection; these are not commonly used outside disease-endemic regions (3,7,8).     

Adolescence as a Critical Stage in the MCH Life Course Model: Commentary for the Leadership Education in Adolescent Health (LEAH) Interdisciplinary Training Program Projects

The Life Course Perspective (LCP), or Model, is now a guiding framework in Maternal and Child Health (MCH) activities, including training, supported by the Health Resources and Services Administration’s Maternal and Child Health Bureau. As generally applied, the LCP tends to focus on pre- through post-natal stages, infancy and early childhood, with less attention paid to adolescents as either the “maternal” or “child” elements of MCH discourse. Adolescence is a distinct developmental period with unique opportunities for the development of health, competence and capacity and not merely a transitional phase between childhood and adulthood. Adequately addressing adolescents’ emergent and ongoing health needs requires well-trained and specialized professionals who recognize the unique role of this developmental period in the LCP.     

Pancreaticoduodenectomy for malignancies in children

Purpose

Malignant tumors of the common bile duct or of the pancreas head are uncommon in childhood [Perez EA, Gutierrez JC, Koniaris LG, Neville HL, Thompson WR, Sola JE. Malignant pancreatic tumors: incidence and outcome in 58 pediatric patients. J Pediatr Surg. 2009; Jan; 44 (1): 197–203]. With radical surgery being the standard cure for nonmetastatic diseases, pancreaticoduodenectomy (PD) is the best choice when the tumor is localized in the head of the pancreas, or in the lower portion of the common bile duct. The purpose of the present study is to describe five consecutive children managed by PD, and reviewing the particular aspects and results of this rare procedure in children.

Methods

Between 2007 and 2010, five patients (median age: 7 years) underwent PD for nonmetastatic malignant tumors. In two cases, PD was performed en bloc with a right hepatectomy in order to achieve the radical resection of a recurrent biliary sarcoma. Four patients benefited from a “pylorus-preserving” PD procedure. In two patients, resection of the portal vein and vascular reconstruction was performed, and in one case, an extended resection of the biliary ductal system was necessary.

Results

All resection margins were clear. The postoperative course was uneventful, with no pancreatic or biliary leakage in all of the patients. Oral refeeding was achieved by the eighth postoperative day. In two cases, a late revision of pancreatic–jejunal anastomosis was performed because of mild steatorrea and a suspected anastomotic stricture. Two of the patients, who were subsequently operated on second hand, for biliary sarcoma, died from the recurrence; while three of the others, with pancreatic malignancies, are alive and well, with a good functional outcome.

Conclusions

Surgical resection is the treatment of choice for tumors of the pancreatic head area. In the absence of regional or metastatic extension, the radicality of primary intervention is associated with favorable outcomes. Good functionality results were observed after the PD was limited to the head of the pancreas and subject to pylorus-preserving techniques.     

Prevalence of headache in patients with Parkinson’s disease and its association with the side of motor symptom onset

We compared the lifetime prevalence and the prevalence of headache during the previous year in patients with Parkinson’s disease (PD) and control subjects. We also investigated the association between the side of PD symptom onset and the side of the headache. We interviewed 98 consecutive patients with an established diagnosis of PD between December 2010 and January 2012. The control group consisted of the 98 oldest sex-matched individuals from the nationwide Brazilian headache database. PD patients showed a significantly lower prevalence (40.8 %) of headache in the previous year than controls (69.4 %) (adjusted OR 0.5, CI 95 % 0.2–0.9, p = 0.03). PD patients also showed a lower prevalence of headache throughout life (74.5 %) than controls (93.9 %) (adjusted OR 0.2, CI 95 % 0.1–0.6, p = 0.01). Considering only patients who presented headache during the previous year, PD patients showed a higher association with occurrence of migraine than tension-type headache compared with controls (adjusted OR 3.3, CI 95 % 1.2–8.9, p = 0.02). The headache side was ipsilateral to the side of PD onset in 21 patients (84 %), with a concordance of 85.7 % on the left side and 81.8 % on the right side (p < 0.01). The prevalence of primary headache was significantly lower in patients with PD than controls. The predominant side of headache was ipsilateral to the side of initial motor signs of PD.