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21/251. Postmyocardial infarction (Dressler's) syndrome: report of a case with immunological and viral studies.

    A case of PMIX with immunologic and viral studies obtained prior, during, and after a typical exacerbation are reported. Immunologic studies indicated the presence of humoral antiheart autoantibodies, and an increase in the number and proportion of lymphocytes containing surface IgG immunoglobulin during acute activity. Viral studies were negative. Previously reported immunologic and viral data, as well as etiology and pathogenesis of PMIS are discussed. ( info)

22/251. Acute meningococcemia without meningitis in association with influenza-like illness.

    An outbreak of meningococcal disease in a family of six resulted in four simultaneous cases of meningococcemia without meningitis. Although no definite explanation for this unusual collection of meningococcemia cases could be identified, a preceding influenza-like illness in the family may have increased their susceptibility to meningococcemia. ( info)

23/251. Impaired response to interferon-alpha/beta and lethal viral disease in human STAT1 deficiency.

    The receptors for interferon-alpha/beta (IFN-alpha/beta) and IFN-gamma activate components of the Janus kinase-signal transducer and activator of transcription (JAK-STAT) signaling pathway, leading to the formation of at least two transcription factor complexes. STAT1 interacts with STAT2 and p48/IRF-9 to form the transcription factor IFN-stimulated gene factor 3 (ISGF3). STAT1 dimers form gamma-activated factor (GAF). ISGF3 is induced mainly by IFN-alpha/beta, and GAF by IFN-gamma, although both factors can be activated by both types of IFN. Individuals with mutations in either chain of the IFN-gamma receptor (IFN-gammaR) are susceptible to infection with mycobacteria. A heterozygous STAT1 mutation that impairs GAF but not ISGF3 activation has been found in other individuals with mycobacterial disease. No individuals with deleterious mutations in the IFN-alpha/beta signaling pathway have been described. We report here two unrelated infants homozygous with respect to mutated STAT1 alleles. Neither IFN-alpha/beta nor IFN-gamma activated STAT1-containing transcription factors. Like individuals with IFN-gammaR deficiency, both infants suffered from mycobacterial disease, but unlike individuals with IFN-gammaR deficiency, both died of viral disease. Viral multiplication was not inhibited by recombinant IFN-alpha/beta in cell lines from the two individuals. Inherited impairment of the STAT1-dependent response to human IFN-alpha/beta thus results in susceptibility to viral disease. ( info)

24/251. Infections in the heart transplant recipient.

    The overall incidence of infection after transplantation has decreased with improved immunosuppressive agents, increased knowledge and use of prophylaxis, and better detection and treatment of infection. Nevertheless, infection continues to be a major cause of morbidity and mortality in heart transplant recipients. The knowledgeable nurse in any setting who cares for a transplant recipient must be aware of the lifelong susceptibility to common and opportunistic infections. The transplant recipient and his or her family must also be aware of the risks of early opportunistic infection. Infection is a lifelong concern for all persons on immunosuppressant medications, and the individual must learn appropriate precautions to reduce this risk. hand washing and avoidance of infected individuals are the most important self-care actions that the transplant patient should adopt. Recipients must also learn to monitor for subtle signs of infection. The nurse is responsible for teaching self-care to patients and family members. Ultimately, a team effort by the patient, family, nurses, and physicians can reduce the risk of infection in this vulnerable population. ( info)

25/251. Transient elevation of platelet count in patients with chronic idiopathic thrombocytopenic purpura: association with infection.

    platelet count occasionally increases after infection in patients with chronic idiopathic thrombocytopenic purpura (ITP). We report 5 such patients. Three of them were males. Between November 1992 and December 2001, increased platelet counts were observed 9 times in 5 patients with chronic ITP. Corticosteroids were administered during 7 episodes; splenectomy was performed to treat 3 episodes. Antibiotics were administered in the course of 6 episodes to treat complicating infection. Platelet counts showing 1.4- to 24-fold increases have been observed. Median duration from the onset of infection until peak platelet count was 14 days. However, platelet count finally decreased to the initial level in all episodes. These findings suggest that infection is associated with the elevation of platelet count in some patients with chronic ITP, although this phenomenon is transient. ( info)

26/251. Condyloma acuminatum of the bladder.

    Condyloma acuminatum in the bladder of 2 patients on immunosuppressive therapy after kidney transplantation is described. The successful treatment was transurethral electroresection and coagulation. We do not recommend radical operations in cases of condyloma acuminatum. Resected specimens should be examined pathologically to exclude papillary epithelial tumors. ( info)

27/251. Early-onset acute transverse myelitis following hepatitis b vaccination and respiratory infection: case report.

    Acute transverse myelitis is an acute inflammatory process of the spinal cord and it is a rare clinical syndrome in childhood. In this paper, we report a case of 3 years-old boy who developed acute onset tetraparesia following a viral respiratory infecction and hepatitis b vaccination. magnetic resonance imaging of the spinal cord disclosed signal-intensity abnormalities from C4 to C3. A diagnosis of acute transverse myelitis was made and the patient was treated with IV methylprednisolone and IV immunoglobulin. The child had a fair outcome despite of the very acute course of the disease and the presence of a cervical sensory level which usually harbor a poor prognosis. ( info)

28/251. Cytophagic histiocytic panniculitis with atypical lymphocytes in peripheral blood.

    A 26-year-old female patient developed high fever, hepatosplenomegaly and subcutaneous nodules. Atypical lymphocytes were present in the peripheral blood. skin biopsy revealed lobular panniculitis. bone marrow examination showed prominent phagocytosis by benign histiocytes. The diagnosis of cytophagic histiocytic panniculitis was made, and the disease has been well controlled with oral prednisolone. This is the first report of cytophagic histiocytic panniculitis with atypical lymphocytes in the peripheral blood, which are frequently seen in virus-associated hemophagocytic syndrome. This observation suggests that underlying viral infection may be one factor in the development of cytophagic histiocytic panniculitis. ( info)

29/251. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.

    We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion. ( info)

30/251. cardiac tamponade complicating postpericardiotomy syndrome.

    We present 2 children who developed postpericardiotomy syndrome (PPS) and the rare complication of cardiac tamponade after cardiac surgery, each requiring life-saving pericardiocentesis in the emergency department (ED). Each child presented with vomiting as a chief complaint, an initial sign that has not been reported previously. As the frequency of orthotopic heart transplants and other cardiac surgeries among children increases, it is likely that ED physicians will encounter PPS and cardiac tamponade with greater frequency, and it is imperative that it be recognized promptly and treated appropriately. We review PPS, cardiac tamponade, and the proper performance of a pericardiocentesis. ( info)
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