Allopurinol-induced Sweet's syndrome.

Sweet's syndrome, or acute febrile neutrophilic dermatosis, is an uncommon severe cutaneous condition, not previously associated with allopurinol therapy. We describe the case of an 87-year-old woman with hyperuricemia who developed classic Sweet's syndrome manifestations 8 days after being treated with allopurinol. Patient's symptoms included fever, painful edema in the hands and lower limbs with non-pruritic erythematous plaques topped by pus-filled skin blisters, right eye conjunctivitis, splenomegaly and joint pain. At the emergency department, blood tests showed neutrophilic leukocytosis, inflammatory state and altered liver function. During hospitalization, she received unsuccessful treatments with two different antibiotics (namely ceftriaxone and levofloxacin), while treatment with intravenous methylprednisolone produced a rapid clinical remission of symptoms, cutaneous lesion pain improvement, normalization of her body temperature and her blood values returned to normal. Use of the Naranjo adverse drug reaction probability scale indicated a probable relationship between the patient's development of Sweet's syndrome and allopurinol therapy. Because the signs and symptoms of Sweet's syndrome resemble an infectious process, the correct diagnosis may be delayed and inappropriate treatment regimen with antibiotics may often precede glucocorticoid therapy.

Bioethics consultation practices and procedures: a survey of a large Canadian community of practice.

The literature fails to reflect general agreement over the nature of the services and procedures provided by bioethicists, and the training and core competencies this work requires. If bioethicists are to define their activities in a consistent way, it makes sense to look for common ground in shared communities of practice. We report results of a survey of the services and procedures among bioethicists affiliated with the University of Toronto Joint Centre for Bioethics (JCB). This is the largest group of bioethicists working in healthcare organizations in Canada. The results suggest there are many common services and procedures of JCB bioethicists. This survey can serve as a baseline for further exploration of the work of JCB bioethicists. Common practices exist with respect to the domains of practice, individual reporting relationships, service availability within business hours and the education and training of the bioethicist.

Immunoglobulin concentrations in nasal lavage fluids in dogs with non-specific rhinitis.

The pathophysiology of non-specific chronic rhinitis(NSCR) in dogs is still unknown. In this study the possible role of immunological mechanisms in NSCR is examined, by comparing immunoglobulin concentrations in nasal lavage fluids of dogs with NSCR with those of healthy dogs. The immunoglobulin IgA was detected in nasal lavage fluids of both groups of dogs and the differences in relative levels of IgA in dogs with NSCR were not significant. IgM, IgG(a,b), and IgG(d) were detected more frequently in dogs with NSCR (P<0.05), and the relative levels were higher. The presence of IgG(a,b) may indicate the chronic character of rhinitis, and the presence of IgG(d) the possibility of an allergic component in its pathophysiology. The role of IgM is not completely clear.

Successful repair of post-infarction heart rupture. Case report and review of the literature.

Left ventricular rupture secondary to acute myocardial infarction (AMI) if untreated, is invariably fatal. Successful surgical correction reported in the reviewed literature amounts to twenty cases. This is the case presentation of a 53 year old Caucasian woman admitted urgently to our Institution 6 hours after acute chest pain with a presumptive diagnosis of intrapericardial aortic rupture secondary to acute ascending aortic dissection. A cross-sectional echocardiogram demonstrated a posterior left ventricular rupture secondary to myocardial infarction. Emergency repair was carried out with the aid of cardiopulmonary bypass (CPB) and the patient was discharged after an uneventful recovery. However, five months later she was reoperated on for resection of a large pseudoaneurysm presumably secondary to incomplete resection of nonviable myocardium at the first operation. The patient made an uneventful recovery and remains asymptomatic and well. On the basis of this experience and review of the literature the authors propose a more aggressive approach in an attempt to improve the salvage rate of this not so rare complication of AMI.

[Isolated straddling tricuspid valve. Presentation of 2 cases operated on successfully]. / Valvola tricuspide a cavaliere isolata. Presentazione di due casi operati con successo.

During the period May 1977-September 1983 in the Department of Cardiac Surgery of Massa Hospital two patients with isolated straddling tricuspid valve were studied with cardiac catheterization and selective angiocardiography and subsequently underwent surgical correction. The first patient, a 38-month-old white boy presented with "complete straddling" according to Bharati and Lev classification; the second, a 39-month-old white boy presented with "peripheral straddling". In both cases at surgery the ventricular septal defect was closed with a Teflon patch, sparing the chordae tendinae and the "straddling" papillary muscle. Both patients survived operation. The first one developed a complete atrioventricular (A-V) block with a ventricular rate which never was below 80 beats/min, during the 30 days of in-hospital observation. No permanent pacemaker was therefore inserted. The follow-up controls (39 and 79 months respectively) shows both patients to be hemodynamically and functionally well.

The syndrome of congenital absence of the pulmonary valve: pathological, clinical and surgical considerations.

Four cases of congenital absence of the pulmonary valve are described. Three of them underwent successful operation. The fourth case, operated on in the first days of life, died because of severe respiratory distress. After examining the embryological aspects of this malformation, its treatment is discussed in relation to particular respiratory problems in infants and to the possibility of inserting prosthetic valves in children undergoing elective surgical treatment.

Congenital coronary artery fistula: report of five patients, diagnostic problems and principles of management.

The detection of a coronary artery fistula (CAF) is usually by chance and, because of the to-and-fro characters of the murmur, a misdiagnosis of a patent ductus arteriosus is frequently made. Correct diagnosis can only be reached after hemodynamic investigation completed by angiography. This lesion is often accompanied by few or no symptoms in infancy, but may become symptomatic with aging even if the shunt is small: complications such as endocarditis, rhythm disturbances, aneurysmatic dilation and rupture have been reported. Five cases of CAF have been studied in our institution: 3 of them have been operated upon in extracorporeal circulation with good results. Principles of management are controversial: many authors advocate delay of treatment until symptoms appear: in our opinion, based on the natural history of the disease and on our experience, closure of the fistula in pediatric age, even in asymptomatic patients, is the treatment of choice.

[Permanent pacemaker implantation in children after open heart cardiac surgery (author's transl)]. / Impianto di pacemaker definitivo in eta' pediatrica, successivo ad interventi chirurgici a cuore aperto.

Between 1972 and 1977, a permanent pacemaker has been implanted in 9 children for complete heart block, after repair of a congenital heart disease. Children's age ranged between 2 1/2 years and 13 years (mean age 8 years). The block had been caused by the operation in 8 children and was pre-existent in the last one. A permanent pacemaker was not implanted in another four children with postoperative complete heart block. In seven cases the pacemaker was implanted in the subclavear zone and connected to a transvenous electrode; in the remaining two cases the pacemaker was positioned subcutaneously in the abdomen and connected to an epicardial electrode. VVI-type pacemaker have always been used. Three children died after implantation because of chronic cardiac failure complicated, in one case, by surrhenalic insufficiency. In two cases the pacemaker was replaced because of battery exhaustion, as suggested by routine controls; in five cases, wire breakage occurred and it was replaced together with the pacemaker. In another case transvenous electrode displacement occurred; skin infection at pacemaker site occurred only once. No skin breakdown at pacemaker site has ever occurred, or any problem due to excessive pacemaker dimensions. Reappearance of normal synus rhythm was noted in one patient. No complication has been reported so far for the cases with postoperative complete heart block not treated with cardiac pacing.