A Case of Idiopathic Hypereosinophilic Syndrome Causing Mitral Valve Papillary Muscle Rupture.

Idiopathic Hypereosinophilic Syndrome (IHES) is a rare disease that can be difficult to diagnose as the differential is broad. This disease can cause significant morbidity and mortality if left untreated. Our patient is a 17-year-old adolescent female who presented with nonspecific symptoms of abdominal pain and malaise. She was incidentally found to have hypereosinophilia of 16,000 on complete blood count and nonspecific colitis and pulmonary edema on computed tomography. She went into cardiogenic shock due to papillary rupture of her mitral valve requiring extreme life support measures including intubation and extracorporal membrane oxygenation (ECMO) as well as mitral valve replacement. Pathology of the valve showed eosinophilic infiltration as the underlying etiology. The patient was diagnosed with IHES after the exclusion of infectious, rheumatologic, and oncologic causes. She was treated with steroids with improvement of her symptoms and scheduled for close follow-up. In general patients with IHES that have cardiac involvement have poorer prognoses.

Delayed clinical improvement after deep brain stimulation-related subdural hematoma. Report of 4 cases.

OBJECT: The purpose of this paper is to present 4 cases that illustrate the management and outcome of subdural hematoma (SDH) following deep brain stimulation (DBS) lead implantation. METHODS: The authors identified 4 cases of SDH following DBS lead implantation from a pool of 500 consecutive lead implantations (incidence 0.08%) performed at the University of Florida. Cases were characterized by chart review, serial Unified Parkinson's Disease Rating Scale evaluations, and changes on serial postoperative imaging studies. RESULTS: Two of the 4 patients with DBS-related SDH were clinically symptomatic. In the other 2 cases the SDH was incidentally discovered on routine postoperative lead localization imaging studies. None of the patients required craniotomy for evacuation of the SDH in the acute phase. Three of the 4 cases were managed with bur hole drainage in the chronic phase, and one was successfully managed nonoperatively. In all 4 cases, thresholds for stimulationinduced side effects were lower during initial postoperative programming than during intraoperative macrostimulation. Expected clinical improvement from DBS was achieved without lead revision in all 4 cases, but only after a significant delay. CONCLUSIONS: Subdural hematoma is a rare and potentially avoidable complication of DBS that does not typically mandate acute hematoma evacuation or hardware revision and does not preclude an excellent outcome from DBS therapy. The clinical picture and apparent lead position tend to improve with time, and it may be wise to delay repositioning of an ineffective DBS lead following a hemorrhage until the DBS lead and surrounding brain tissue have settled into their final position and the insulted brain has had sufficient time to recover.

Supervised moderate intensity resistance exercise training improves strength in Special Olympic athletes.

The purpose of this study was to examine the effects of a moderate intensity resistance training program on Special Olympic athletes (SOAs) and similarly aged typically developed volunteers (TDs) who also served as coaches. Fifteen SOAs and 17 TDs participated (age range 19-24 years). The intervention consisted of resistance training: 1 set, 8-12 reps, over 10-12 sessions, on Med-X weight equipment. Exercises tested were seated row (SR), leg curl (LC), leg extension (LE), chest press (CP), and the abdominal crunch (AC). The weight lifted, and the amount of repetitions performed at the beginning and end of training, were used to determine the predicted 1 repetition max (1RM). A 2-way (2:group x 2:time) analysis of variance was computed for each exercise. Time main effects were detected, which indicated that predicted 1RM increased significantly for all participants. Specifically, these were the SR (F(1,30) = 99.238, p < 0.001); the LC (F(1,30) = 91.578, p < 0.001); the LE (F(1,30) = 83.253, p < 0.001); the CP (F(1,30) = 53.675, p < 0.001); and the AC (F(1,30) = 57.759, p < 0.001). The predicted 1RM values increased between 25 and 50% across the exercises tested. There were no group main effects or interactions. Thus, with minimal training time, both similar and significant strength gains can be accomplished by both SOAs and TDs, respectively. Supervised moderate intensity resistance training is recommended for the populations tested and may result in vocational and athletic performance gains.