1/166. The first case report of the use of a zoom videoendoscope for the evaluation of small bowel graft mucosa in a human after intestinal transplantation.BACKGROUND: Control of allograft rejection remains the most difficult dilemma in intestinal transplantation. Standard endoscopic surveillance to date has not been always accurate in the diagnosis of rejection. We describe the first application of a zoom video endoscope in monitoring graft mucosa in humans after intestinal transplantation. METHOD: A zoom video endoscope, which can magnify the image up to 100-fold, was used in this study. The patient was a 31-year-old man who received an isolated intestinal transplant. Surveillance endoscopy with the zoom video endoscope was performed through the ileostomy. Endoscopic biopsies were done at the same time. RESULTS: The zoom video endoscope showed the microscopic architecture of the graft mucosa such as villi and crypts with outstanding quality. We found that an enlargement of the crypt areas appeared to correlate with morphologic changes of early rejection. This finding was reversed with the treatment of rejection. CONCLUSIONS: The zoom video endoscope successfully showed the detailed information of intestinal mucosa. The ability to visualize a more representative view of the graft mucosa could lead to better detection of early rejection. A greater experience with this unique method will provide more accurate assessment of the intestinal allograft.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
2/166. Elevated plantar pressure and ulceration in diabetic patients after panmetatarsal head resection: two case reports.Panmetatarsal head resection (variously called forefoot arthroplasty, forefoot resection arthroplasty, the Hoffman procedure, and the Fowler procedure) was developed for the relief of pain and deformity in rheumatoid arthritis. Although there are successful retrospective series reported in the literature, such an approach is not supported by carefully designed controlled trials. This procedure has also been advocated by some for the relief of plantar pressure in diabetic patients who are at risk for plantar ulceration. The efficacy of the procedure in this context is not supported by existing pressure measurements on rheumatoid arthritis patients in the literature, which has tended to show that although pain relief is obtained, the procedure results in elevation of forefoot pressure. case reports are described of two patients (three feet) with sensory neuropathy who presented to our clinic 1 to 2 years after panmetatarsal head resections had been performed. Peak plantar pressures in these feet during first step gait were above the 99th percentile and outside the measuring range of the device used (EMED SF platform; NOVEL electronics Inc., St. Paul, MN). Both patients had also experienced plantar ulcers subsequent to the surgery. Combining the information on patients with rheumatoid arthritis (RA) with that from our two case studies, we conclude that panmetatarsal head resection does not necessarily eliminate focal regions of elevated plantar pressure.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
3/166. Recurrent Epstein-Barr virus-associated post-transplant lymphoproliferative disorder: report of a patient with histologically similar but clonally distinct metachronous abdominal and brain lesions.A liver transplant patient developed a single central nervous system (CNS) intraparenchymal lesion 5 months after the diagnosis of an intraabdominal diffuse large B-cell post-transplant lymphoproliferative disorder (PTLD). biopsy of the new CNS lesion showed a diffuse large B-cell PTLD morphologically and immunohistochemically indistinguishable from the abdominal lesion. In addition, both lesions were positive for Epstein-Barr virus (EBV) dna by polymerase chain reaction (PCR) and for EBV-encoded rna by in situ hybridization. Although these results were consistent with a metastatic origin for the CNS lesion, the finding of an intraparenchymal lesion without leptomeningeal or dural spread was suggestive of a new primary CNS lymphoma. Proof that the brain lesion was a second primary and not a metastasis was obtained by immunoglobulin gene rearrangement studies and assessment of EBV clonality. Multiple primary lymphoid neoplasms arise at higher frequency in the setting of immunosuppression, and molecular investigations of tumor clonality can provide clinically relevant staging and prognostic information.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
4/166. Neurophysiological and ultrasound findings in sural nerve lesions following stripping of the small saphenous vein.We describe the neurophysiological and ultrasound (US) findings in two patients with right sural nerve lesions following stripping of the small saphenous vein for varicose vein treatment. In the first case, US showed a tear of the nerve proximal to the lateral malleolus and a hypoechoic swelling of the proximal stump, likely related to a terminal bulb neuroma. A sural conduction study performed distally and proximally to the lesion through a near-nerve needle technique showed absent responses. In the second case, US showed a deep subcutaneous extension of a postsurgical scar placed behind the lateral malleolus close to the sural nerve, but no nerve discontinuity. Sural conduction study showed absent responses distal to the scar. Sural stimulation immediately above the scar yielded a small response at the sciatic nerve. A subsequent investigation performed 15 months after the operation showed absent proximal and distal responses. The combination of US and sural conduction study, including recording at the sciatic nerve, to our knowledge has not been described previously, and may yield important complementary information in the diagnosis of sural nerve lesions.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
5/166. Gorham syndrome: anaesthetic management.Gorham syndrome is a rare chronic disease of children and young adults, featuring massive osteolysis with pathological fractures and complicated by respiratory and neurological deficits. To date, 175 cases have been reported in the literature but information on anaesthetic management is sparse. We present a child with Gorham syndrome who underwent urgent surgical medullary decompression and who subsequently developed bilateral pleural effusions.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
6/166. hypokalemia and metabolic alkalosis: algorithms for combined clinical problem solving.This article reviews an approach to patients with hypokalemia and metabolic alkalosis using the information obtained from spot urine chloride values, blood pressure determinations, and renin and aldosterone measurements in order to simplify clinical problem solving.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
7/166. Medial temporal lobe amnesia: a case study for nursing.Maintaining and enhancing cognitive function is a crucial but challenging intervention for patients with memory problems. research on the medial temporal lobe (MTL) memory system has yielded much information that can guide nurses in planning, evaluating, and performing effective interventions. A patient, Mrs. N, with a diagnosis of anaplastic astrocytoma of the left medial temporal lobe provides an example. Information from research guides assessment of Mrs. N and affords development of specific patient-centered interventions to maintain function, cope, and compensate. Data have been gathered from the patient, relatives, and caregivers to compare with and augment existing research, because few nursing case studies of amnesia involving patients with left medial temporal lobe tumors are available for analysis.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
8/166. Mismatch negativity and N100 monitoring: potential clinical value and methodological advances.Continuous long-term recording of brainstem (BAEPs), middle-latency (MLAEPs) and long-latency auditory evoked potentials, including the mismatch negativity (MMN), brings additional information on the immediate functional state and the outcome of patients in coma or recovering after surgery, in relation with clinical observations and therapeutics. A recently designed monitoring system is introduced, aimed at the continuous recording of late auditory potentials (N100 and MMN) as well as BAEPs and MLAEPs. Specific methodological aspects are emphasized. Long-term monitoring data from one patient recorded in the recovery room after surgery are displayed, allowing an illustration of the techniques used and of the problems raised.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
9/166. magnetic resonance imaging of growth plate injuries: the efficacy and indications for surgical procedures.In 23 patients with growth plate injuries, magnetic resonance imaging (MRI) studies were performed a total of 31 times to evaluate the physis which showed plain radiographic evidence of possible damage. Fourteen patients clinically showed growth arrest, and 10 patients required a Langenskiold operation. In 3 patients who underwent this operation, subsequent premature total fusion of the physis adversely affected the postoperative results. We propose that the merging shape of the arrest line with calcification of the provisional zone of the metaphysis shown by MRI indicates poor viability of the physis. MRI provided useful information on the appearance of the growth plate and changes in the metaphysis, both of which affected the prognosis and the results of the surgical procedures.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
10/166. Alatrofloxacin-induced seizures during slow intravenous infusion.OBJECTIVE: To report a case of seizures associated with slow infusion (1-2 h) of alatrofloxacin, the prodrug of trovafloxacin. CASE SUMMARY: A 37-year-old Asian man was admitted to the hospital for a distal pancreatectomy and drainage of a pseudocyst. postoperative complications developed, which included peritonitis and pneumonia, requiring intensive care admission. Cultures from peritoneal drainage fluid and sputum isolated klebsiella pneumoniae and pseudomonas aeruginosa, respectively. He was treated with multiple courses of antibiotics, including intravenous gentamicin, metronidazole, vancomycin, meropenem, and ceftazidime. After three weeks, the patient still had sepsis and began therapy with alatrofloxacin in addition to ceftazidime and vancomycin. Alatrofloxacin infusion was administered according to product information instructions. Fifteen minutes after the first dose was started, the patient developed generalized clonus. On rechallenge, infusing at half the initial rate, the seizure recurred; consequently, the infusion was discontinued and replaced with intravenous ciprofloxacin and metronidazole. The patient remained seizure free thereafter. DISCUSSION: fluoroquinolones have been implicated in central nervous system adverse effects, including seizures, which have been reported with other fluoroquinolones but not with alatrofloxacin or trovafloxacin. In these reports, the patients often had preexisting risk factors such as increased age and electrolyte imbalances. The only apparent predisposition in this patient was mild hyponatremia. CONCLUSIONS: Alatrofloxacin may cause seizures even during slow infusion. This case highlights the need for caution when commencing parenteral fluoroquinolone therapy, particularly with a new agent.- - - - - - - - - - ranking = 1keywords = information (Clic here for more details about this article) |
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