Congenital tuberculosis in an extremely preterm infant conceived after in vitro fertilization: case report.

BACKGROUND: Congenital tuberculosis is a rare manifestation of tuberculosis. The diagnosis is often delayed, especially in preterm neonates because of the non-specific clinical presentation and the lack of awareness of maternal disease prior to pregnancy. CASE PRESENTATION: We report a case of congenital tuberculosis in an infant born at 24 weeks of gestation to a mother who presented with uncontrolled seizures during preterm labor. Maternal diagnosis was initially made by placental pathology, and later confirmed by isolation of Mycobacterium tuberculosis in urine, gastric aspirates and sputum. Full screening was performed on the newborn infant, and both mother and infant were successfully treated for tuberculosis with a four drug regimen. CONCLUSION: Pregnancy can exacerbate latent tuberculosis and women originating from endemic areas are especially susceptible. The best way to prevent congenital tuberculosis is to have a high index of suspicion and identify and treat tuberculosis in pregnant women.

Detection and localization of bile duct leaks after cholecystectomy using Gd-EOB-DTPA-enhanced MR cholangiography: retrospective study of 16 patients.

OBJECTIVE: To determine if gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance (MR) cholangiography can detect and localize bile duct leaks in postcholecystectomy patients. MATERIAL AND METHODS: Four blinded independent radiologists performed a retrospective review of 16 consecutive patients who underwent MR cholangiography with intravenous Gd-EOB-DTPA for the evaluation of possible biliary leak. Image quality, ductal opacification, and presence and location of any bile leak were evaluated. An independent observer determined the criterion standard using a consensus of all chart, clinical, and imaging findings. RESULTS: All 6 bile leaks confirmed at endoscopic retrograde cholangiopancreatography were diagnosed by all reviewers (sensitivity, 100%). Of the 10 patients with no leak, only one reader incorrectly diagnosed a bile leak in a single case (specificity, 98%). The accuracy for detection of the site of leak with Gd-EOB-DTPA-enhanced MR cholangiography was 80%. CONCLUSION: Gadolinium-EOB-DTPA-enhanced MR can detect bile leaks with a high sensitivity and specificity.

Stanford type A aortic dissection with pulmonary arterial intramural hematoma and pulmonary hemorrhage.

A rare complication of a Stanford type A aortic dissection is extension along the pulmonary arteries. We present a case that shows main and right pulmonary artery intramural hematoma and pulmonary hemorrhage in an 80-year-old woman who presented with a type A Stanford aortic dissection. The 11-month follow-up multidetector CT angiogram for this patient showed that the right pulmonary artery had become aneurysmal.

The relationship between migraine and mental disorders in a population-based sample.

OBJECTIVE: There is emerging evidence from clinical and community samples to suggest that migraines are associated with mental disorders. The present study utilized a large population-based sample to investigate the association between physician-diagnosed migraine and mental disorders. METHOD: Data were from the German Health Survey conducted between 1997 and 1999 (N=4181, response rate 61.4%, age 18-65 years). Lifetime and 12-month history of migraines were assessed by self-report and by a physician. Past 12-month DSM-IV mental disorders were assessed using the Composite International Diagnostic Interview. RESULTS: After adjusting for sociodemographic factors, past-year migraine was significantly and positively associated with depression, dysthymia, bipolar disorder, panic attacks, panic disorder, agoraphobia and simple phobia [adjusted odds ratios (AOR) ranging from 1.74 to 3.21]. After additionally adjusting for other mental disorders, any anxiety disorder (AOR=1.82) and any mood disorder (AOR=1.61) remained significantly associated with past-year migraine. CONCLUSION: Although causal inferences cannot be made due to the cross-sectional nature of the data, the present study adds to a growing body of literature that suggests a strong association between migraines and mood and anxiety disorders.

Chronic pain conditions and suicidal ideation and suicide attempts: an epidemiologic perspective.

OBJECTIVES: Investigations of the association between chronic pain conditions and suicidal ideation (SI) and suicide attempts (SA) have rarely taken the effect of mental disorders into account and have been limited by nonrepresentative samples. The present study used a large population-based sample to investigate the association between chronic pain conditions and SI and SA. METHODS: Data were from the Canadian Community Health Survey Cycle 1.2 public use file conducted by Statistics Canada from 2001 to 2002 (N=36,984; response rate 77%). Respondents were asked if they had been diagnosed with the following painful conditions: migraine, back problems, arthritis, and fibromyalgia. Respondents were assessed for past 12-month SI and SA. The Composite International Diagnostic Interview was used to assess Diagnostic and Statistical Manual of Mental Disorders-IV. RESULTS: After adjusting for sociodemographics, Axis I mental disorders and comorbidity (3 or more mental disorders), the presence of 1 or more chronic pain conditions was associated with both SI and SA. Among respondents with a mental disorder, comorbidity with 1 or more chronic pain conditions was also associated with SI and SA. In models adjusting for other painful conditions, migraine had the strongest link with SI and SA. DISCUSSION: This is the first study to demonstrate the association between several chronic pain conditions and SI and SA while adjusting for mental disorders in a nationally representative sample. Moreover, this study demonstrates that among individuals with a mental disorder, having a chronic pain condition significantly increased the association with SI and SA.