Aspergillus infection and extracorporeal membrane oxygenation support.

BACKGROUND: The clinical characteristics of patients with Aspergillus isolation while supported on extracorporeal membrane oxygenator (ECMO) remain unclear. OBJECTIVES: We present a case report of angioinvasive Aspergillus infection on an infant supported on ECMO and also investigate outcomes among patients with Aspergillus infection reported to the Extracorporeal Life Support Organization (ELSO) registry. DESIGN: Case report and retrospective analysis of ELSO registry data set from 1985 to 2009. SETTING: One hundred and seventy ECMO centers contributing data to the ELSO registry. PATIENTS: Single case report and patients 0 to 90 years of age with Aspergillus infection requiring ECMO support as reported to the ELSO registry. METHODS: Besides presenting details of our institutional case, we compared clinical characteristics and outcomes between pediatric and adult patients with Aspergillus isolation. Risk factors for in-hospital mortality were investigated. Kaplan-Meier estimates for freedom from death on ECMO for pediatric and adult patients were investigated. MEASUREMENTS AND MAIN RESULTS: (a) we report a case with Aspergillus supported on ECMO, (b) the ELSO registry yielded 46 patients with 59% (n = 27) in the pediatric data set (≤20 years of age) and 41% (n = 19) in the adult data set (>20 years of age) with Aspergillus infection requiring ECMO support. Overall survival to hospital discharge was 30% (14/46) with 22% (6/27) in children as compared to 42% (8/18) in adults (P = .19). Table 1 shows a comparison of clinical characteristics between children and adults. The comparison between adults and pediatric groups differed significantly in age (P = .0001), more use of venoarterial ECMO in children (P = .028). The median age of pediatric group was 1.95 years (range 0-17.3 years) versus 30.2 years (range 22-60 years) among adults. CONCLUSIONS: Aspergillus infection/colonization is associated with a 70% overall mortality among patients supported on ECMO. The ELSO registry data confirms that Aspergillus infection among ECMO supported patients occurs often in hosts who do not have known immunodeficiencies. The case stresses the need for a high level of suspicion for Aspergillus infection in nonimproving lung disease in patients on ECMO support.

Enucleation of the solitary epithelial cyst of pancreatic head in an adult: a case report and review of the literature.

Solitary true pancreatic cyst is a rare entity, and only a few cases are reported in the literature. We report a case of a 35-year-old woman who had a cyst in the head of the pancreas and gall stones and presented with complaints of pain in the epigastric region. The patient underwent open cholecystectomy with aspiration of the pancreatic cyst at some other private hospital. After 4 months, she presented to us with no relief in pain. Repeat contrast-enhanced computed tomography of the abdomen showed recurrence of the cyst. The patient underwent enucleation of the cyst at our hospital. During a 2-year follow-up after the enucleation, she remained asymptomatic.

Trends in percutaneous endoscopic gastrostomy placement in the elderly from 1993 to 2003.

OBJECTIVES: To investigate national trends in percutaneous endoscopic gastrostomy (PEG) tube placement for hospitalized elderly patients from 1993 to 2003. METHODS: Retrospective analysis of patients ≥ 65 years of age with PEG tube placement from 1993 to 2003 from the Nationwide Inpatient Sample (NIS) database was utilized to calculate PEG placement rates per 1000 people. RESULTS: Placement of PEG tube increased by 38% in elderly patients during the study period, from 2.71 procedures during hospitalization per 1000 people to 3.75 procedures during hospitalization per 1,000 people. Placement of PEG tube in patients with Alzheimer's dementia doubled (5%-10%) over the study period. CONCLUSION: Over a 10-year period, PEG tube use in hospitalized elderly patients increased significantly. More importantly, approximately 1 in 10 PEG tube placements occurred in patients with dementia.

Cupric ions and DOPA oxidase activity in melanocytes.

The inhibition of DOPA oxidase activity by cupric ions has been quantitated in cases of vitiligo showing dendritic and non-dendritic melanocytes at the margins. Cupric sulphate was added to the substrate solution, containing a reacting quantity of 12.12 micrograms of DOPA, to give 42.8 micrograms, 85.6 micrograms, 128.4 micrograms and 171.2 micrograms of cupric ions. Control slides were incubated with DOPA alone as substrate. On cytospectrophotometric analysis it was seen that the initial level of enzyme activity determines the type of inhibition curve. Thus, there is a gradual fall in activity with dendritic melanocytes which have a very high enzyme content, whereas the non-dendritic melanocytes show complete inhibition with one dose. It was observed that 15.75 micrograms of cupric ions were reduced by 12.12 micrograms of DOPA. The enzyme activation by cupreous ions is countered by the enzyme inhibition by cupric ions, the rate of inhibition being determined by the level of cupric ions.