Sjogren's syndrome with acute cerebellar ataxia and massive lymphadenopathy : a case report.

PURPOSE: Common etiologies of acute acquired cerebellar ataxia include cerebrovascular diseases, toxin or drugs, infections/para-infections, and autoimmune diseases. It is a rare manifestation of Sjögren's syndrome, which is a common autoimmune disease but is often missed as a differential diagnosis. CASE REPORT: This is a report of a patient with acute onset cerebellar ataxia for one month. She also had massive neck lymphadenopathy. After a series of studies and the exclusion of other common causes of acute cerebellar ataxia, she was diagnosed as having Sjögren's syndrome. Patients with Sjögren's syndrome have higher risk for lymphoma, which leads to poorer prognosis. After lymph node biopsy, the patient was proven to have sinus histiocytosis, which is another rare finding in Sjögren's syndrome. DISCUSSION: For patients with acute acquired cerebellar ataxia, immune-mediated cerebellar ataxia should be an important differential diagnosis aside from the more common causes like stroke or drugs.

Near-infrared light device can improve intravenous cannulation in critically ill children.

BACKGROUND: Vascular access in critically ill children can be a real challenge for medical staff. METHODS: To evaluate the effectiveness of a near-infrared light vein-viewing device for critically ill children, 60 pediatric inpatients were enrolled in a randomized prospective observation trial for intravenous cannulation. The patients' demographic data, mean time required to find the first available vessel, first-attempt success rate, mean number of attempts per patient, and the total time taken on the attempts per patient were compared. RESULTS: Less time was required to find the first available vessel in the near-infrared light device group compared with the control group (126.37 vs. 383.61 seconds; p = 0.027). In addition, the near-infrared light device group had a fewer number of attempts compared with the control group (median 1 vs. 2; p = 0.004), and also a shorter total time of attempts per patient compared with the control group (186.16 vs. 497.23 seconds; p = 0.014). CONCLUSION: The use of a near-infrared light vein-viewing device for vascular access in critically ill children can decrease the total medical time and cost.

Simultaneous laparoscopy for endometriotic women undergoing in vitro fertilization.

OBJECTIVE: The aim of this study was to investigate simultaneous laparoscopy in endometriotic women with infertility undergoing in vitro fertilization (IVF). MATERIALS AND METHODS: Forty-seven infertile patients with endometriosis were enrolled in this retrospective study and underwent IVF cycles in a university affiliated hospital. RESULTS: The chemical pregnancy, clinical pregnancy and live birth rates were statistically significantly different between patients with minimal or mild stage endometriosis and patients with moderate or severe stage endometriosis, who received simultaneous laparoscopy and modified IVF with a GnRH antagonist protocol. A higher live birth rate was achieved in IVF patients with minimal or mild stage endometriosis combined with laparoscopic treatment, than in patients who received traditional IVF with prior laparoscopic surgery for endometrioma. CONCLUSION: Simultaneous laparoscopy combined with a modified IVF (GnRH antagonist) protocol may benefit patients with minimal and mild endometriosis. Traditional GnRH agonist IVF cycles may improve the fecundity rates in women with moderate and severe endometriosis after laparoscopic treatment.

Propofol exerts protective effects on the acute lung injury induced by endotoxin in rats.

Acute lung injury (ALI) is a major culprit of mortality in endotoxemia. Propofol has been commonly used in critical ill patients for sedation. This experiment attempted to elucidate the effects and possible mechanisms of propofol on the ALI induced by endotoxin. Experimentations were carried out using anesthetized, ventilated rats and isolated perfused rat lungs. Endotoxemia was induced by intravenous lipopolysaccharide (LPS, 10 mg kg(-1)). Various groups of rats received infusion of physiological saline solution (PSS) and LPS. Five min after LPS, propofol at low dose (5 mg kg(-1)h(-1)) or high dose (10 mg kg(-1)h(-1)) was infused for 6h. In isolated perfused rat lungs, PSS, LPS, and propofol (30 or 60 mg kg(-1)) were added into the perfusion circuit. During or after 6h observation, we determined the lung weight (LW)/body weight ratio, LW gain, exhaled nitric oxide (NO) and protein concentration in broncheoalveolar lavage. Lung pathology was evaluated to quantify the lung injury score. Plasma nitrate/nitrite, methyl guanidine (MG), tumor necrosis factor(alpha), and interleukin-1(beta) were examined. Blood leukocytes were counted. Capillary filtration coefficient (K(fc)) was obtained in isolated perfused lungs. Posttreatment of propofol at low or high dose attenuated or prevented the extent of ALI. It also reduced the plasma nitrate/nitrite, MG, and pro-inflammatory cytokines including tumor necrosis factor(alpha) (TNF(alpha)) and interleukin-1(beta) (IL-1(beta)). In the isolated perfused rat lungs, propofol significantly reduced the LPS-induced increase in K(fc). This agent did not affect the leukocytopenia caused by LPS. Accordingly, the effects of propofol on the ALI were not related to leukocyte activation or sequestration. Our results suggest that propofol exerts protective effect on the endotoxin-induced ALI. The mechanisms of actions may be mediated through inhibition on the release of pro-inflammatory cytokines, free radicals and NO. In addition, propofol abrogates the microvascular leakage of water and protein in the lungs. The results imply that the use of propofol in critically ill is not only for sedation, but also useful for the prevention of inflammatory progression and lung damage.