Role of heart transplantation in pediatric heart surgery. The first successful pediatric heart transplantation in Hungary

7-year-old boy, who underwent aortic valve replacement two years previously, suffered from idiopathic dilated cardiomyopathy. Because of poor condition (NYHA-IV), heart transplantation was performed on 18th October 2007. It was the first pediatric heart transplantation in Hungary. It was an uneventful early postoperative period, 6 months after the operation he is doing well, no biopsy-proven and tissue Doppler echocardiography (TDI-derived velocities measurement) rejection was detected. The immunosuppression was based on triple-drug therapy (tacrolimus+mycophenolate mofetil+corticosteroid) with use of induction therapy with interleukin-2 receptor blocker (basiliximab).     

Maturation of pelvic ossification centers on computed tomography in normal children

Background

The pelvis is composed of three paired primary ossification centers: the pubis, the ischium and the ilium. During maturation, multiple secondary ossification centers can be seen in the synchondroses between these bones and in the pelvic apophyses. The fragmented appearance of these centers can be confused with pathology.

Objective

To examine development of pelvic ossification centers by CT and determine normal appearance throughout childhood.

Materials and methods

Three pediatric radiologists reviewed 325 pelvic CT scans in children and young adults 5–18 years old and graded 6 pelvic ossification centers to evaluate maturational changes in critical structures.

Results

Rate and progression of ossification and age at complete fusion vary with gender at the different ossification centers in the growing pelvis.

Conclusion

Knowledge of the normal CT appearance of ossification centers throughout childhood is important to differentiate the normal appearance from pathology.

     

Mouthwash in the etiology of oral cancer in Puerto Rico

Objectives: To determine if the risk of cancers of the mouth and pharynx is associated with mouthwash use in Puerto Rico, an area of relatively high risk. Methods: Interviews were conducted with 342 cases of oral and pharyngeal cancer registered in Puerto Rico and diagnosed between 1992 and 1995 and with 521 population-based controls regarding mouthwash use and other factors. Mouthwash-related risks were estimated using unconditional logistic regression controlling for potential confounders. Results: The adjusted odds ratio associated with using mouthwash with an alcohol content of 25% or greater was 1.0. Risks were not higher with greater frequency, years of use, or lifetime mouthwash exposure. Among tobacco and alcohol abstainers the odds ratio associated with mouthwash use was 2.8 (CI = 0.8–9.9), in contrast to 0.8 (CI = 0.4–1.7) and 0.9 (CI = 0.6–1.3) among those with light and heavy cigarette smoking/alcohol drinking behaviors, respectively. Conclusions: There was no overall increased risk of oral cancer associated with mouthwash use. An elevated, but not statistically significant, risk was observed among the small number of subjects who neither smoked cigarettes nor drank alcohol, among whom an effect of alcohol-containing mouthwash would be most likely evident. Our findings indicate the need to clarify the mechanisms of oral carcinogenesis, including the possible role of alcohol-containing mouthwash.     

Complications of whole bladder dihematoporphyrin ether photodynamic therapy

Photodynamic therapy with dihematoporphyrin ether was used to treat superficial bladder tumors in 7 patients with a followup of at least 1 year. Each patient received treatment to the whole bladder and those with papillary lesions received additional focal treatment. At 3 months 4 of the 5 patients with papillary tumors (stages Ta and T1) and 1 of the 2 with diffuse carcinoma in situ (Tis) were free of disease. However, at 1 year only 3 patients remained free of disease. Of 5 patients with an increase in irritative bladder symptoms 4 had a contracted bladder, hydroureteronephrosis and vesicoureteral reflux. Deep bladder biopsies showed replacement of smooth muscle by fibrous tissue. Six patients had mild to moderate skin phototoxicity. We conclude that although photodynamic therapy is an attractive and exciting method to treat cancer, its use with dihematoporphyrin ether in cases of bladder carcinoma can be associated with significant complications. The correct treatment parameters for safe, effective therapy are not known to date.     

Minnesota plan for nonsmoking and health: multidisciplinary approach to risk factor control

In 1981, the Minnesota Department of Health began a long-term program to control risk factors for the major health problems of the State as determined by an expert committee. The methods chosen to initiate programs were social, economic, and epidemiologic background research and a multidisciplinary statewide planning process. Smoking was considered the most important problem. During 1983-84, department staff members analyzed the epidemiology and economics of smoking in Minnesota and reviewed the literature on methods of smoking control. They and a multidisciplinary technical committee prepared a coordinated plan to increase the prevalence of nonsmoking in Minnesota. The 39 recommendations address mass communication and marketing, educational programs in schools, public and private regulation, economic disincentives through taxation, and funding of programs and evaluation of results. The Minnesota Plan for Nonsmoking and Health was released in September 1984. During the first half year, the plan provided material for formation of a coalition of health organizations to promote nonsmoking. In June 1985, the Minnesota Legislature passed the Omnibus Nonsmoking and Disease Prevention Act, which provides $4 million over 2 years for promotion of nonsmoking through education, regulation, and public communications. These intervention activities will be funded by a portion of a 5-cent increase in cigarette excise tax. The foundations have been laid for what may be the most comprehensive statewide nonsmoking program in the United States.     

Cocaine: Effects on acoustic startle and startle elicited electrically from the cochlear nucleus

Startle-like responses can be elicited by single pulse electrical stimulation of nuclei within the acoustic startle pathway. Compared with acoustically-elicited startle, this technique provides a method for localizing the ultimate sites of action of a drug that affects the acoustic startle response. Strychnine (1 mg/kg) increased both acoustically-elicited startle and startle elicited from the ventral cochlear nucleus (VCN), the first central nucleus in the acoustic startle pathway. In contrast, cocaine (10 mg/kg) increased acoustically-elicited startle but depressed VCN-elicited startle. These results suggest that cocaine increases startle by acting on sensory rather than final motor systems and are discussed in relation to the putative effect of cocaine on dopamine neurotransmission and the involvement of dopamine in sensorimotor reactivity.     

Heart surgery in infants and children based on echocardiographic diagnosis

The authors report on 134 heart operations performed with infants and children on the basis of echocardiography (2-dimensional and Doppler's). Correction was made in 77 cases and palliation in 57 cases. The majority of the operations was performed with infants suffering from left heart obstruction and being in critical state. Diagnostic error or pseudo-negative cases influencing unfavourably the course of the illness did not occur. It is stated that a 2-dimensional echocardiography furnishing detailed anatomical diagnosis concerning each intracardiac segment is the condition of heart operations. Hemodynamic information given by Doppler's echocardiography are of importance firstly in the indication for operation in complex cardiac failures.