Infantile Henoch-Schönlein purpura

We present an infant with generalized palpable purpura, arthritis and fever, whose findings were atypical for classic childhood Henoch‐Schönlein purpura (HSP). By describing the clinical symptoms and prognostic differences seen in infants versus school age children, we encourage physicians to be aware of infantile HSP in their differential diagnosis when they encounter a non‐toxic infant with generalized purpura.     

Development and preliminary validation of the Meta-cognitions Questionnaire-Adolescent Version

This study describes the development of the Meta-cognitions Questionnaire for Adolescents (MCQ-A). The adult version of this questionnaire has been widely used, and the meta-cognitive theory of emotional disorders has become influential in the adult literature. This study sought to examine the prevalence and emotional correlates of meta-cognition in adolescents. The MCQ-A was administered to 177 schoolchildren aged 13 through 17 years, together with measures of emotional well-being. Factor analysis suggested a five-factor solution similar to that reported for the adult version. Internal consistency of the scale was high. Scores ranged from low to high across the age range, suggesting that meta-cognitive beliefs are well-established by adolescence. Scores on the MCQ-A were highly correlated with a number of measures of emotional symptoms. The MCQ-A is a reliable and valid instrument for measuring meta-cognitive beliefs in adolescents. Young people aged between 13 and 17 years report a range of types and levels of meta-cognitive beliefs and these are positively associated with emotional symptoms.     

Nonneurologic morbidity and profound hypothermia in aortic surgery

Background

Use of profoundly hypothermic cardiopulmonary bypass may increase the risk of postoperative bleeding and lung and renal dysfunction. The aim of this study was to analyze postoperative blood loss and indices of pulmonary and renal dysfunction in patients undergoing proximal aortic surgery with and without the use of profound hypothermia to determine risk factors for nonneurologic morbidity.

Methods

Risk factors for blood loss, transfusion requirement, and pulmonary and renal dysfunction were studied in 116 patients undergoing thoracic aortic surgery with profoundly or moderately hypothermic cardiopulmonary bypass.

Results

Overall mortality was 8.6%. Mean (± standard deviation) cardiopulmonary bypass times were 191 ± 53 minutes (profoundly hypothermic group) and 131 ± 48 minutes (moderately hypothermic group; p < 0.0001). The incidence of blood loss more than 1 L or resternotomy for bleeding was 25% (29 patients). Fifteen patients (12.9%) experienced postoperative pulmonary dysfunction, and 25 patients (21.6%) had postoperative renal dysfunction. Forty-one patients (35.3%) had a prolonged intensive therapy unit length of stay. Multivariate analysis demonstrated that prolonged cardiopulmonary bypass time was the only predictor of postoperative hemorrhage and resternotomy for bleeding (p = 0.03). Increased intensive therapy unit length of stay was predicted by total arch replacement (p = 0.01) and low 6-hour ratio of partial pressure of arterial oxygen to inspired fraction of oxygen (p = 0.05). Increased preoperative creatinine (p = 0.002) and emergency status (p = 0.015) predicted postoperative renal dysfunction. Low 6-hour ratio of partial pressure of arterial oxygen to inspired fraction of oxygen was predicted by increased preoperative creatinine (p = 0.03) and prolonged cardiopulmonary bypass time (p = 0.03).

Conclusions

Profound hypothermia may cause a coagulopathy, but procedure extent is the primary determinant of postoperative bleeding. Profoundly hypothermic cardiopulmonary bypass does not appear to be a risk factor for renal or early pulmonary dysfunction or intensive therapy unit length of stay.     

Managing hypertension in patients with stroke. Are you prepared for labetalol infusion?

As community hospitals adopt comprehensive stroke pathways, nurses in critical care areas must prepare for each possible complication. Although the thrombolytic component of a new stroke protocol may receive the most attention, the various details of the pathway--in this case, management of blood pressure--should not be overlooked. Critical care nurses who appreciate the considerations for treatment of hypertension and who can correctly and efficiently administer intravenous labetalol may save precious time and enhance outcomes for patients with stroke who have hypertension.     

Acute hemodynamic effects of abdominal exercise with and without breath holding

OBJECTIVES: To compare the magnitudes of change in heart rate, systolic blood pressure (SBP), diastolic blood pressure (DBP), mean blood pressure, and rate-pressure product (RPP) during 3 abdominal exercises: straight partial sit-up (SPSU), oblique partial sit-up (OPSU), and the AbSculptor(R) sit-up; and to examine the effect of breath holding on these parameters. DESIGN: Prospective, repeated measures. SETTING: Autonomic research laboratory in a major medical center. PARTICIPANTS: Fourteen normal male and female volunteers (age range, 24-37y; mean, 30.4y). INTERVENTIONS: Hemodynamic parameters were recorded during each abdominal exercise performed with and without breath holding. Mean peak values were calculated for 1 minute before exercise, during exercise, and for 10 minutes after exercise.Main Outcome Measures: Statistical analysis examined for differences in the hemodynamic changes among the 3 exercises under both conditions (with and without breath holding). RESULTS: Heart rate, SBP, DBP, mean blood pressure, and RPP increased during all 3 exercises. The mean peak heart rate and RPP increases were greater for the OPSU than the AbSculptor (heart-rate increase, 21.1+/-6.6bpm vs 17.6+/-5.7bpm, P=.03; RPP increase, 36.9+/-15.5bpm.mmHg vs 29.4+/-10.1bpm.mmHg, P=.05). For all 3 exercises, breath holding significantly increased the hemodynamic parameter elevations during exercise, with the exception of heart rate (SBP, P<.001; DBP, P<.001; mean blood pressure, P<.001; RPP, P=.02). Quantitatively, breath holding during the OPSU resulted in the largest exercise-associated increases in heart rate (21.0+/-8.1bpm), mean blood pressure (22.2+/-16.4mmHg), and RPP (44.9+/-22.3bpm.mmHg). Postexercise, all hemodynamic parameters generally returned to baseline within several minutes. CONCLUSION: When performing the OPSU, SPSU, or the AbSculptor exercises as used in this investigation, normal individuals exercising at low intensities may experience peak heart rate and mean blood pressure increases of 30bpm and 50mmHg, respectively. Voluntary breath holding significantly increased the peak blood pressure elevations and RPP for all 3 exercises, but particularly for the OPSU.     

Primary non-Hodgkin’s lymphoma of the transverse colon presenting as dermatomyositis

Primary extranodal non-Hodgkin’s lymphoma of the transverse colon is a rare presentation of non-Hodgkin’s lymphoma or colonic neoplasm. Dermatomyositis is an autoimmune condition of the skin, muscle, and blood vessels that when associated with malignancy is a true paraneoplastic syndrome but is rarely associated with non-Hodgkin’s lymphoma. We present a case of primary non-Hodgkin’s lymphoma of the transverse colon diagnosed after the presentation of dermatomyositis and review the literature on dermatomyositis and hematologic neoplasm.