Gangrenous cutaneous mucormycosis in a child with a solid organ transplant: a case report and review of the literature

Infections by members of the Phycomycetes class of fungi typically arise in patients with substantial underlying immunosuppression. Several clinical presentations, including that of gangrenous cellulitis, have been described. In the pediatric population, critically ill premature newborns and older children with underlying hematopoietic malignancies and/or bone marrow transplantation are affected. Presentation in children with solid organ transplants is rare. Successful therapy for this condition includes aggressive debridement of infected tissue and systemic administration of amphotericin B.     

Complications of umbilical vein catheterization: neonatal total parenteral nutrition ascites after surgical repair of congenital diaphragmatic hernia

A 2-day-old girl was admitted to surgery for repair of a left-sided diaphragmatic hernia (CDH). Preoperatively, an umbilical vein catheter (UVC) was inserted with the tip in the left hypochondrium. The UVC tip position was unchanged radiographically peroperatively. At the fifth postopertive day abdominal distension and signs of gastric outlet obstruction appeared. Explorative laparotomy found liver necrosis at the site of the catheter tip and parenteral nutrition ascites. J Pediatr Surg 37:E21.     

Plasma cholecystokinin is associated with subjective measures of satiety in women

BACKGROUND: Cholecystokinin is associated with satiety. Fat stimulates cholecystokinin release, and fiber appears to prolong cholecystokinin elevation during the alimentary period. OBJECTIVE: We tested whether adding fiber or fat to a low-fat, low-fiber meal increases cholecystokinin release and enhances subjective measures of satiety and whether the cholecystokinin response correlates with subjective measures of satiety. DESIGN: Three isoenergetic breakfast meals were tested in a randomized crossover design: low fiber, low fat; high fiber, low fat; and low fiber, high fat. Blood samples were drawn from fasted subjects (7 men and 8 women) before and at different time points after test meal consumption for 6 h. Plasma was analyzed for cholecystokinin, insulin, glucose, and triacylglycerols. Visual analogue scales were used to assess subjects' hunger, desire to eat, fullness, and prospective consumption. RESULTS: In the women, the meals higher in fiber or in fat resulted in greater feelings of satiety and in significantly higher cholecystokinin responses than did the low-fat, low-fiber meal. In the men, the increase in cholecystokinin concentration did not differ between meals, but the 2 low-fat meals elicited a greater feeling of satiety than did the high-fat meal. The insulin response was significantly higher for the low-fiber, low-fat meal than for the other 2 meals, and the triacylglycerol response was greatest for the high-fat, low-fiber meal. CONCLUSION: In women, the feeling of satiety caused by cholecystokinin release is enhanced by increasing either the fiber or fat content of a low-fat, low-fiber meal.     

Human cytomegalovirus infection and expression in human malignant glioma

Malignant gliomas are the most common primary brain tumors in adults, have no known etiology, and are generally rapidly fatal despite current therapies. Human cytomegalovirus (HCMV) is beta-herpesvirus trophic for glial cells that persistently infects 50-90% of the adult human population. HCMV can be reactivated under conditions of inflammation and immunosuppression, and HCMV gene products can dysregulate multiple cellular pathways involved in oncogenesis. Here we show that a high percentage of malignant gliomas are infected by HCMV and multiple HCMV gene products are expressed in these tumors. These data are the first to show an association between HCMV and malignant gliomas and suggest that HCMV may play an active role in glioma pathogenesis.     

Levodopa dependency in Parkinson's disease: case report and review

Only a few patients with Parkinson's disease and levodopa dependency or abuse have been reported. We present a 35-year-old patient with young-onset Parkinson's disease who developed motor complications, levodopa dependency, and drug-induced psychosis after primary treatment with levodopa. Diagnostic criteria and treatment guidelines for this neuropsychiatric disorder are presented as well as a tentative neurobiological answer to the question of why levodopa dependency is observed only in a minority of patients with Parkinson's disease.     

The trigonometric responder approach: a new method for detecting responders to pharmacological or experimental challenges

The paper presents a newly developed response measure that is particularly suitable for the evaluation of pharmacokinetic data. This method is based on trigonometric considerations, defining a hormone response as the difference between the angle of the slope of the curve before and after drug intake. In addition, the size of this difference is compared to the difference obtained in placebo conditions. In this way, the trigonometric response measure overcomes one of the most problematic shortcomings of the 'area under the curve' (AUC) approach, the problem of the initial value. We will present the mathematical background of the trigonometric method and demonstrate its usefulness by evaluating empirical data (a pharmacological challenge test using the dopamine agonist lisuride) and comparing it to classical AUC measures. This has been achieved by contrasting both approaches with responder definitions according to binary time series analysis and the peak value of the curve.     

Improved pediatric multidetector body CT using a size-based color-coded format

OBJECTIVE: CT technique should be adjusted while scanning infants and children. One format that has proven successful in simplifying pediatric care and reducing medical error is the size-based, color-coded Broselow-Luten pediatric system. This color-coded system can serve as a format for CT protocols. The purpose of this investigation was to compare variation (or error) occurrence and technologist preference for conventional and color-coded formats for pediatric multidetector body CT protocols. MATERIALS AND METHODS: Multidetector CT examinations were set up using either a conventional or a color-coded format for a period of 6 weeks each. Variations (errors) from protocol parameters (including tube current, detector configuration, table speed, and IV contrast media dose) were tabulated. Qualitative assessment consisted of a survey of CT technologists (n = 20) for preference in six areas related to ease of use and clarity of the formats. RESULTS: There were 44 CT examinations (n = 30 infants and children) in the conventional group and 55 CT examinations (n = 31 infants and children) in the color-coded protocol format group. Overall, the number of errors was significantly less in the color-coded group (p < 0.01), with a significantly lower error percentage in individual parameters affecting radiation dose, including tube current, detector configuration, and table speed (p < 0.05). In all areas, the color-coded format was preferred over the conventional format (p < 0.0003). CONCLUSION: Color-coded CT formatting is an extension of a clinical color-coded system. This system provides an easy, expeditious, consistent, and preferable format for general pediatric body CT protocols. Most importantly, the color-coded system can reduce variations (errors) in the radiology department.     

Mid-term results of patients undergoing endovascular aortic aneurysm repair

BACKGROUND: The utilization of endovascular aneurysm repair (EAR) is increasing significantly; however, few papers have outlined mid-term outcomes. METHODS: Patients undergoing EAR with an AneuRx endograft between September 1997 and May 2001 were evaluated. Mean follow-up was 20.7 +/- 11.9 (SD) months. RESULTS: In all, 101 EAR devices were successfully deployed in 105 attempts. Four open conversions (2 acute, 2 delayed) were performed for complications of EAR. Technical, clinical, and 1 to 3 year continuing success rates were 75%, 73%, and 78% to 83%. When divided by the median date, significantly fewer patients in the later group required secondary procedures compared with the early group. Vascular insufficiency occurred in 12 patients; 11 were treated with a secondary procedure. For 9 type I and 9 type II persistent endoleaks, secondary procedures were attempted and successful in 10 patients. Of successful EAR deployments, including secondary interventions, 85% demonstrated no persistent leak, rupture, increase in aneurysm size, or migration at most recent follow-up. CONCLUSIONS: EAR is successful in selected individuals; however, continuing follow-up is of paramount importance.