Simultaneous aortic and renal artery reconstruction for acute arterial occlusion in solitary kidney

A case is described of the onset of acute renal failure due to renal artery occlusion in a solitary kidney of a sixty-six-year-old woman. She had been treated for severe hypertension due to renal artery stenosis. An aortorenal bypass to revascularized the kidney was combined with repair of an abdominal aortic aneurysm. There was early and full recovery of renal function in the single kidney, and the patient was completely rehabilitated. Review of the literature shows that an aggressive surgical approach to the management of renal artery occlusion is usually followed by excellent results. The pre-existence of renal artery stenosis encourages the formation of a collateral arterial supply which maintains the nutrition of the kidney almost indefinitely, after renal artery occlusion. Revascularization will result in prompt recovery of renal function.     

Fever in pregnancy and offspring head circumference

Purpose

To examine whether maternal fever during pregnancy is associated with reduced head circumference and risk of microcephaly at birth.

Outcomes associated with delirium in acutely hospitalized acquired immune deficiency syndrome patients

The study demonstrates that delirium in acquired immune deficiency syndrome (AIDS) patients is associated with mortality, the need for long-term care, and an increased length of hospitalization. Data were collected prospectively on human immunodeficiency virus (HIV)/AIDS patients admitted to a teaching hospital from January 1996 through December 1996. The data included demographic characteristics of the participants, medical diagnoses, CD4 cell count, Karnofsky functional assessment, mortality during admission, length of stay, and discharge placement. Participants were evaluated throughout their hospital stay for evidence of delirium. The presence of delirium was determined using DSM-IV diagnostic criteria. There were no significant differences between delirious and nondelirious patients with respect to demographic characteristics or markers of medical morbidity. Patients with delirium were more likely to die during admission (chi-square [chi2] = 39.1, df = 1, P<.0010), to stay longer in hospital (t = 3.50, df = 12.9, P<.0041), or to need long-term care if discharged alive (chi2 = 12.8, df = 2, P<.0021). Delirium is associated with adverse outcomes in hospitalized AIDS patients. More research is needed to characterize the nature of this association.     

Tiagabine adjunctive therapy in children with refractory epilepsy: a single-blind dose escalating study

Tiagabine, a specific gamma-aminobutyric acid-uptake inhibitor, has been shown to be reasonably well tolerated and efficacious as adjunctive treatment for partial seizures in adults and is now being investigated in children. This 4-month, single-blind study evaluated the tolerability, safety and preliminary efficacy of ascending doses (0.25-1.5 mg/kg/day) of tiagabine add-on therapy in 52 children over the age of 2 years with different syndromes of refractory epilepsy. Adverse events, mostly mild to moderate, were reported by 39% of children during the single-blind placebo period and by 83% of children during tiagabine treatment. The events predominantly affected the nervous system with asthenia (19%), nervousness (19%), dizziness (17%) and somnolence (17%) being the most common. Only three children (6%) withdrew because of adverse events. Tiagabine appeared to reduce seizures more in localisation-related epilepsy syndromes than in generalised epilepsy syndromes. Twenty-three patients with localisation-related epilepsy syndromes were included and 17 of these patients entered the fourth dosing period. The 17 patients had a median reduction of seizure rate in the fourth month of treatment of 33% compared with baseline. In comparison, 13 of 22 children with seven different generalised epilepsy syndromes entered the fourth dosing period with a median change of seizure rate of 0%. Two patients experienced single episodes of status epilepticus during treatment; both cases resolved. Tiagabine showed efficacy mainly in localisation-related syndromes and was well tolerated by most children in a group of very refractory patients and warrants further study in children with epilepsy.     

Hemodynamic Changes During Acetate and Bicarbonate Hemodialysis

In a crossover, double-blind comparison, circulatory changes induced by hemodialysis with bicarbonate versus acetate dialysate were evaluated at the first exposure as well as after 2 weeks of acclimatization to each dialysate. Hemodialysis with bicarbonate dialysate resulted in only minor changes in blood pressure and left ventricular (LV) function as assessed by M-mode echocardiography. In contrast, the first exposure to acetate resulted in significant decreases in systolic (30 mm Hg) and diastolic (17 mm Hg) blood pressure as well as in LV end-diastolic and end-systolic dimensions (5-6 mm) and a rise in ejection fraction. After acclimatization, tolerance developed for the arterial vasodilatory effects of acetate, but not for the venous vasodilatory effect (persistent decrease in LV end-diastolic dimension). These results indicate that some of the circulatory changes induced by hemodialysis may be related more to the acetate infused than to fluid losses or relative autonomic insufficiency.     

Scoliosis: a rare manifestation of intrinsic tumours of the spinal cord in children

Three cases are described of apparent idiopathic scoliosis in childhood which were shown subsequently to be due to intramedullary spinal cord tumour. The possibility of this underlying lesion should be considered in any child who develops scoliosis without an obvious cause.     

Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature

Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.