Heart Transplantation as a Result of Pediatric Inflammatory Multisystem Syndrome in an Adolescent.

Several reviews have shown that COVID-19 in children is a relatively mild disease. However, a rare complication affecting children and adolescents after COVID-19 has been identified. Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS), which in some cases manifests itself as a hyperinflammatory syndrome with a multiorgan failure, may lead to death. We report a case of a 17-year-old patient who was admitted to the hospital with cardiogenic shock of unknown etiology. The disease was life-threatening, thus necessitating mechanical ventilation, circulatory support, and extracorporeal therapy due to renal and liver dysfunction. The patient tested negative for SARS-CoV-2 Reverse Transcription Polymerase Chain Reaction. Other infectious causes of illness were excluded. However, the patient had a positive IgG antibody test result and high levels of interleukin-6, which helped to diagnose PIMS-TS. Intravenous immunoglobulin and steroid therapies were initiated, unfortunately, with poor outcome. The patient's critical condition, particularly end-stage heart failure, led to mechanical circulatory support implantation and finally orthotopic heart transplantation. After the surgery, the patient's condition improved gradually. PIMS-TS manifests itself with different clinical images and as a state of varying severity, ultimately causing multiorgan dysfunction with shock resembling toxic shock syndrome. Ultimately, myocardial complications of PIMS-TS necessitated heart transplantation in the described patient.

Successful Orthotopic Heart Transplantation With Positive Crossmatch in a Hyperimmunized Child on Mechanical Circulatory Support-Case Report.

In the pediatric population there is a shortage in the number of hearts available for transplantation. However, sometimes a heart transplant is urgently required to save lives. The problem arises when the patient is hyperimmunized and there is a positive crossmatch with the only available donor. We present such a case of a 9-year-old patient with dilated cardiomyopathy on ventricular assist device, in whom it was possible to perform a successful HT and also apply a successive prevention against graft rejection.

[Impact of an educational video on the representations of electroconvulsive therapy among psychiatrists in Hauts-de-France and Occitanie]. / Impact d'une vidéo pédagogique sur les croyances et représentations relatives à l'électro-convulsivothérapie chez les psychiatres des Hauts-de-France et d'Occitanie.

INTRODUCTION: Despite its effectiveness and good tolerance, electro-convulsive therapy (ECT) is under-used in current clinical practice probably because of stigma and the negative image of this treatment. The main objective of this study was to evaluate the impact of an educational video on the representations of ECT among psychiatrists and psychiatric residents in the North and in Occitanie districts of France. METHOD: We evaluated the representations of ECT through the Questionnaire on Attitudes and Knowledge of ECT (QuAKE) before (T0) and after (T1) viewing a short educational video. Scores at T0 and T1 were compared with a paired t-test. Factors associated with the improvement of the representations were investigated using a logistic regression model. RESULTS: In all, 195 responses were obtained. The QuAKE score at T1 was significantly better than at T0 (29.4 at T1 vs. 31.5 at T0, P<0.001). The more negative the representations were at T0, the higher the probability of a decrease in the score at T1 (OR=1.07 [1.02-1.13], P=0.003). DISCUSSION: Our study showed a beneficial effect of a short educational video on psychiatrists' representations of ECT. The wide use of this type of media, allowing information and destigmatization, could considerably optimize access to ECT for patients.

Utilizing Solanum glaucophyllum alone or with phytase to improve phosphorus utilization in broilers.

Experiments were conducted to determine if Solanum glaucophyllum (SG), a plant containing a glycoside of 1,25-dihydroxyvitamin D, could be used as a feed additive to improve P utilization of broilers. SG leaves (1, 2.5, or 5 g/kg), 1,25-dihydroxyvitamin D (15 microg/kg), or Ca and P (to achieve a 0.92% Ca:0.65% P:0.41% nonphytate P control diet) were added to a 0.56% Ca/0.45% P/0.28% nonphytate P basal diet and fed to broilers from 7 to 28 d of age. Birds fed basal ration alone exhibited reduced weight gain, bone density, and bone mineral content when compared with birds fed the 0.92% Ca:0.65% P diet. Adding 5 g SG leaves or 15 microg of 1,25-dihydroxyvitamin D/kg to the basal diet increased body weight gain, plasma Ca and P, bone ash, and bone density above basal diet levels. Plasma P and weight gain of birds fed 5 g SG or 15 microg of 1,25-dihydroxyvitamin D/kg basal diet were equivalent to those observed in birds fed the 0.92% Ca:0.65% P diet. In experiment 2, the effect of higher doses of SG, as well as the additive effect of SG with 1,200 phytase units/kg diet, were examined in chicks fed a 0.59% Ca and 0.42% P basal diet. Two levels of SG leaves (7.5 g and 10 g), phytase, or both SG (7.5 g) and phytase were added per kilogram of basal diet. Adding SG or phytase to the basal diet increased weight gain, plasma Ca, plasma P, and bone mineral content over that observed in birds fed basal diet alone. Combining SG with phytase provided no significant gains in growth or bone parameters over treatment with phytase alone.

Cardiac surgical treatment of the patients with renal insufficiency.

Cardiac surgical treatment of the patients with renal insufficiency became more frequent necessity. Also postoperative renal insufficiency occurs pretty often after cardiac surgery. That is in part a result of broadening of operative indications, which might concern patients with multiple diseases. Patients with renal insufficiency and coexistent heart diseases, patients with endocarditis and patients with renal insufficiency after cardiac surgery require the treatment of cardiac surgeons and nephrologists. Heart diseases are the main cause of the mortality in the dialysis patients. Among the patients with renal diseases the cardiac surgeon most often receive long-term dialysis patients with coexistent heart diseases, who needs cardiac surgery (coronary artery by-pass grafting, valve operations). The amount of these operations increases, however it does not exceed 1% of overall number of cardiac operations. This group however, is very exacting and carries a high operative risk. Dialysis patients are exposed to increased risk of infection. 75% of them reveal infections in the form of sepsis. The presence of bacteria in the bloodstream increase the risk of infectious endocarditis. 6% of dialysis patients with IE require surgery. The prevention of renal failure after cardiac surgery is also very important. Renal insufficiency occurs in 12% of patients after cardiac surgery with the use of extracorporeal circulation. Renal failure complicates postoperative course and is of high risk for the patient. The mortality due to acute postoperative renal failure, which requires hemofiltration, reaches 70%. The proper cardiac surgical and nephrological management of renal insufficiency in patients selected for cardiac surgery as well as in patients with postoperative renal insufficiency is necessary to obtain good operative results.

Surgical treatment of hemorrhoids: prospective, randomized trial comparing closed excisional hemorrhoidectomy and the Harmonic Scalpel technique of excisional hemorrhoidectomy.

PURPOSE: The object of this study was to evaluate technique using the ultrasonically activated scalpel as an alternative to closed hemorrhoidectomy in an unbiased evaluation of this new technology. METHODS: Thirty patients with Grade 2 or 3 symptomatic hemorrhoids were prospectively randomized to undergo closed hemorrhoidectomy assisted by electrocautery or hemorrhoidectomy with the ultrasonically activated scalpel, i.e., the Harmonic Scalpel. We evaluated the difference between techniques in operative time, postoperative pain, incontinence, and quality of life (using the Short Form-36 survey), as well as complications. RESULTS: Mean operative time for closed hemorrhoidectomy with electrocautery was 35.7 +/- 3 minutes; for Harmonic Scalpel patients, it was 31.7 +/- 2 minutes (P < 0.37). There was no statistical difference in operative time for two- or three-column hemorrhoidectomy. There was no significant difference in pain measurements reported on Day 1 (5.8 +/- 0.4 for electrocautery and 5.6 +/- 0.6 for Harmonic Scalpel, P < 0.82). On postoperative Day 7, the difference in pain between groups approached significance, with pain reported as 3.7 +/- 0.3 for electrocautery and 5.1 +/- 0.7 for Harmonic Scalpel(R) (P < 0.06). At six weeks, both groups were pain free. There was a significant decrease in pain between postoperative Days 1 and 7 in the electrocautery patients that was not seen in the Harmonic Scalpel patients. Incontinence measured preoperatively, at postoperative Day 7, and at postoperative Week 6 was similar for both groups and reflected occasional incontinence of gas. When the various items of the Short Form-36 survey were compared, there was no significant difference between posttreatment and preoperative values. There was no difference in the number of complications between patient groups. CONCLUSION: Although the Harmonic Scalpel is an effective tool in the treatment of hemorrhoidal disease, we found no specific advantage in postoperative pain, fecal incontinence, operative time, quality of life, or complications compared with traditional closed hemorrhoidectomy.

Acute colonic perforation associated with colorectal cancer.

Our purpose was to evaluate long-term outcome in patients presenting with acute colonic perforation in the setting of colorectal cancer. We conducted a retrospective review of 48 consecutive patients presenting with acute colonic perforation associated with colorectal cancer at a single institution. Patients presented either with free air or acute peritonitis. No patients with colonic obstruction were included. Forty-eight patients presented with colon perforation. Thirty-six had perforation at the tumor, 11 proximal to the tumor, and one distal to the primary tumor. Patients who perforated proximal to the tumor were older (74.5 +/- 2 vs 64.7 +/- 3; P < 0.04) and had a longer length of stay (46.8 +/- 17 vs 11.6 +/- 1 P < 0.001). Fourteen patients had stage II disease, 19 stage III, and 15 stage IV. Thirty-day mortality was 14 per cent (n = 7) with nine in-hospital deaths. Of 30-day survivors 29 (60%) had curative resection (21 with local perforation and nine with proximal perforation). Of these 14 received adjuvant chemotherapy. Eleven patients (33%) had either unresectable or metastatic disease on exploration. Mean follow-up was 21.5 months. Ten patients developed metastatic disease after potentially curative resections. Of these nine patients had perforations of the primary tumor. Three patients developed local recurrence and all had local tumor perforations. One-year survival was 55 per cent (n = 16). Five-year disease-free survival was 14 per cent (n = 4). There were no long-term survivors after perforation proximal to the tumor, although disease stage was comparable in both groups. We conclude that perforation proximal to a cancer is associated with a higher perioperative mortality and worse long-term outcome when compared with acute perforations at the site of the tumor. Long-term survival requires both aggressive management of the concomitant sepsis and definitive oncologic surgery.

[Collagen metabolism disturbances with experimentally increased pulmonary flow--experimental model of left to right shunt with congenital heart defects in children]. / Zaburzenia metabolizmu kolagenu w doswiadczalnie wywolanym zwiekszonym przeplywie plucnym--model eksperymentalny przeciekowych wad wrodzonych serca u dzieci.

The studies carried out on young piglets were to demonstrate that experimentally increased pulmonary flow resulted in collagen hyperproduction in the pulmonary tissue. In 14 piglets a modified Blalock-Taussig anastomosis was performed, 9 animals constituted the controls. The survivors included 9 experimental and 8 control piglets. In direct lung biopsies the biochemical collagen content was assessed, whereas histopathology confirmed the development of vascular lesions characteristic for pulmonary hypertension. A significant increase of collagen level in the pulmonary tissue was demonstrated in experimental animals. Determinations were also made of serum and urine hydroxyproline values. A significant increase was observed in serum and urine hydroxyproline values in experimental animals in comparison to the controls when determinations were made 7 days to 3 months after the anastomosis had been performed (p < 0.01). The authors showed that an increase of pulmonary flow in piglets results in collagen metabolism disturbances which are seen both in an increased collagen level in the tissue and in increased serum and hydroxyproline levels.