IL-1-dependent electrophysiological changes and cardiac neural remodeling in a mouse model of Kawasaki disease vasculitis.

Kawasaki disease (KD) is the leading cause of acquired heart disease in children. In addition to coronary artery abnormalities, aneurysms and myocarditis, acute KD is also associated with echocardiogram (ECG) abnormalities in 40-80% of patients. Here, we show that these ECG changes are recapitulated in the Lactobacillus casei cell wall extract (LCWE)-induced KD vasculitis mouse model. LCWE-injected mice developed elevated heart rate and decreased R wave amplitude, with significant differences in prolonged ventricular repolarization. LCWE-injected mice developed cardiac ganglion inflammation, that may affect the impulse-conducting system in the myocardium. Furthermore, serum nerve growth factor (NGF) was significantly elevated in LCWE-injected mice, similar to children with KD vasculitis, associated with increased neural remodeling of the myocardium. ECG abnormalities were prevented by blocking interleukin (IL)-1 signaling with anakinra, and the increase in serum NGF and cardiac neural remodeling were similarly blocked in Il1r1-/- mice and in wild-type mice treated with anakinra. Thus, similar to clinical KD, the LCWE-induced KD vasculitis mouse model also exhibits electrophysiological abnormalities and cardiac neuronal remodeling, and these changes can be prevented by blocking IL-1 signaling. These data support the acceleration of anti-IL-1 therapy trials to benefit KD patients.

Farm level bio-economic modelling of aquatic animal disease and health interventions.

A farm level bio-economic model, for aquatic animal production, of the relationships between inputs (e.g. purchased animals), outputs (e.g. harvested animals) and gross margin (GM) was developed to assess ex-ante the economics of disease and animal health interventions. Feed costs were calculated from estimates of food conversion ratio (FCR), animals harvested and mortality. The model was applied to a typical grow-out rainbow trout (Oncorhynchus mykiss) farm on Lake Titicaca, Peru and a typical shrimp (Paenus vannamei) farm in the Mekong Delta, Vietnam. The model was used in two analyses. Firstly, an approach to assess the burden of disease developed by the Global Burden of Animal Diseases (GBADs) project was adopted. Output under conditions of 'ideal health' was estimated by reducing mortality to zero and removing health costs. GM in both systems increased by approximately 25% when production was kept constant (and stocking rates reduced) and more than doubled if production was allowed to rise (and initial stocking increased). The increase in GM under conditions of ideal compared with current production provided an estimate of the maximum possible benefit from improved health management. Secondly, break-even analysis was used to assess the economics of vaccination against infectious pancreatic necrosis (IPN) vaccine (rainbow trout - RBT) and probiotics (shrimp). If initial stocking was kept constant, and production allowed to rise, break-even points for the intervention (when GM was the same with and without the intervention) were achieved when mortality was reduced by 16% in RBT fry and juvenile and 28% in shrimp. If production was kept constant and benefit realised by reduced initial stocking, the break-even point was achieved for i) vaccination of RBT when mortality in fry and juveniles was reduced by 39%, and ii) probiotics in shrimp production when there was a 15% reduction in mortality (nursery and grow-out), 10% increase in shrimp weight at harvest and 10% improvement in FCR. The results demonstrate how relatively simple models, parameterised with basic farm production data, can assess the burden of disease and quantify ex-ante the potential benefit of interventions. In the absence of trial data, these analyses support decision-making by farmers. The models can be adapted for many aquaculture systems. Farm level results can be extrapolated to estimate disease burden, and benefits of interventions, at regional or national level and thus support informed decision-making and allocation of resources to health management.

Anatomical variation in the position of the brachiocephalic trunk (innominate artery) with respect to the trachea: a computed tomography-based study and literature review of Innominate Artery Compression Syndrome.

Respiratory compromise due to tracheal compression by the brachiocephalic trunk (BT), a condition first labeled as Innominate Artery Compression Syndrome (IACS), has been controversially attributed to an anomalous origin of this vessel to the left of, and hence crossing, the trachea. The aim of this study was to establish the normal relationship between the BT and trachea in infants, children, and young adults without obstructive respiratory symptoms. One hundred and eighty-one computed tomography (CT) examinations of the thorax, in three age groups, were reviewed. In axial cross section, the origin of the BT from the aortic arch was identified. The BT origin, with respect to the trachea, was recorded as for a clock face, approximated to the nearest half hour. There were 62 CTs in Group 1 (1 day to 3 years of age), 48 CTs in Group 2 (10-15 years), and 71 examinations in Group 3 (20-40 years). In 96.8% of Group 1, 91.7% of Group 2, and 74.6% of Group 3 the BT origin was to the left of the trachea, between the half past twelve and 3 o'clock positions. The BT origin occurred more the left in Group 1 when compared with the other two groups (P < 0.001). An origin of the BT to the left of the trachea is a normal finding in children and young adults without obstructive respiratory symptoms. There is a tendency for the origin to become progressively more rightward with age.

The toddler refusing to weight-bear: a revised imaging guide from a case series.

BACKGROUND: The previously mobile child who refuses to walk or weight-bear is a common presentation to the accident and emergency department, for which there are a number of causes. One uncommon cause is discitis, an inflammatory process of the intervertebral disc, which is easily diagnosed with spinal magnetic resonance imaging (MRI). A case series of three patients is presented of non-weight-bearing children in whom there was a delay in making the diagnosis of lumbosacral discitis. None presented with back pain, spinal symptoms or abnormal neurological findings, and a full range of movement of both hips was found. METHODS: All patients underwent conventional radiography and ultrasound, but diagnoses were made on spinal MRI, with two patients undergoing bone scintigraphy before this. RESULTS: The mean delay was 15.6 days (range 13-20) from presentation at the hospital to MRI. All three patients made a good clinical recovery with intravenous antibiotics. CONCLUSION: These cases are presented in order to heighten the awareness of this disease entity and its imaging findings, and suggest new guidelines for the appropriate radiological investigations in this clinical setting.

Plasmacytoma arising in a pacemaker pocket.

A 48-year-old man developed a plasmacytoma in the subcutaneous pocket of a titanium covered pulse generator that had been inserted sixteen months previously. The tumor represented a cutaneous manifestation of myelomatosis. The presence of a pacemaker may affect the detection and treatment of tumors arising in the region of pulse generator pockets. Possible cause-and-effect relationships are explored.

Changes in the manufacture of expanded microporous polytetrafluoroethylene: effects on patency and histological behavior when used to replace the superior vena cava.

Polytetrafluoroethylene (PTFE) has been used clinically and experimentally as a vein substitute. Since its introduction, changes have been made in the manufacture of the material. This study was designed to evaluate the effects of pore size (fibril length), PTFE cover, and spiral tube support on long-term patency and histological behavior when this material is used as a replacement for the precava in the dog. A graft of 30-mu pore size has adequate fibroblastic ingrowth, a neointima of 200 mu or less, and the best long-term patency. The PTFE cover results in less fibroblastic involvement of the prosthetic graft and prevents late occlusion caused by transmural fibrosis in the 90-mu graft. The spiral support does not affect patency and may be indicated when external pressure on the tube must be avoided.

Preferred surgical treatment for alveolar cell carcinoma.

An analysis of our experience with 48 patients having bronchiolar or alveolar cell carcinoma is reported. The remarkable biological variability of this peripheral tumor has important surgical implications. Basically, two dominant clinical presentations occur. In the less common diffuse or multinodular form, prolonged survival is infrequent regardless of the therapeutic approach. Often these patients die from respiratory compromise due to the tumor itself. In the more common localized or solitary form the prognosis for cure is good, approximating 47% or higher. Based on the material presented, lobectomy is the preferred method of surgical treatment. In patients manifesting multinodular disease, surgical resection rarely seems warranted. The concept of preserving pulmonary tissue is stressed.

Nerve-entrapment syndromes from lower abdominal surgery.

Patients with a complaint of lower abdominal pain and a history of lower abdominal surgery, particularly inguinal herniorrhaphy, appendectomy, and procedures incorporating a Pfannenstiel incision, should have nerve entrapment considered in the differential diagnosis. Careful history and physical examination in conjunction with selected use of the ilioinguinal-iliohypogastric nerve block can confirm the diagnosis of nerve entrapment and preclude an unnecessary workup of these patients. Of the patients with nerve entrapment, most will experience complete relief of symptoms following serial injections and require no further treatment. The remainder will experience only temporary relief and require surgical interruption of the nerve involved. In those patients who obtain no relief from the nerve block, further workup for a source of their pain is warranted. Most of these patients were found to have a subclinical recurrence of an inguinal hernia.

[Pigment dispersion syndrome in a patient with megalocornea]. / Slndrome de dispersión pigmentaria en paciente con megalocórnea.

CASE REPORT: A case of a patient of 12 years old with megalocornea and bilateral pigment dispersion syndrome is reported. An ultrasound biomicroscopic study was performed with the UBM 840 (Zeiss-Humphrey, 50 MHz) and an iris concavity with an iridolenticular and iridozonular contact was observed. A new exam after pilocarpine instillation drops showed the resolution of the iris concavity, zonular and lenticular contact. DISCUSSION: The anterior chamber configuration of this patient analyzed with ultrasound biomicroscopy allowed us to understand the mechanism of the pigment dispersion syndrome.

More harm than good? The anatomy of misguided shielding of the ovaries.

OBJECTIVE: Popular gonad shield designs aim to provide coverage of the true pelvis, which is presumed to be the probable location of the ovaries. Shields are frequently placed inaccurately, especially in children, obscuring important orthopaedic landmarks on pelvic radiographs. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. We aimed to identify the position of the ovaries and asses how this may vary with age and the degree of bladder filling. METHODS: Using MRI examinations of the pelvis in women and children, we located 594 ovaries in 306 female patients aged from birth to 59 years. RESULTS: This study provides new evidence that bladder filling affects ovary position. A lower than expected number of patients had both ovaries within the pelvis if the bladder contained more than a moderate volume of urine. Bladder emptying should be achieved wherever practical if a shield is used. In children under the age of 7 years, more than half (19/37) had at least one ovary outside the true pelvis. There was a significant association between age and ovary position, with the percentage of patients with one or both ovaries outside the true pelvis decreasing with age (χ(2), p<0.0001). CONCLUSION: The embryological descent of the ovaries into the pelvis would appear to continue after birth, well into childhood. Current popular shield designs are therefore inappropriate for use in young children. Given the high risk of obscuring critical landmarks, coupled with the new evidence that even accurate placement will not necessarily protect the ovaries, the use of pelvic shields in girls should be reconsidered.

Nerve entrapment after Pfannenstiel incision.

In a 16-month period, nine cases of iliohypogastric nerve entrapment were diagnosed in patients who had undergone a Pfannenstiel incision. Three patients experienced total relief with nerve blocks alone; four patients required surgical interruption of the iliohypogastric nerve to attain total relief; two patients received significant symptomatic relief with injection and desired no further treatment. The presentation, diagnosis, treatment, and prevention of entrapment of the iliohypogastric nerve as a complication of the Pfannenstiel incision are presented and discussed.

Self-entwinement of an active fixation pacemaker electrode.

We report a case in which an active fixation atrial lead tip became entwined on the proximal lead body during implantation. It was not possible to disengage the tip or to remove the resultant lead loop atraumatically through the insertion site. Removal of the lead was accomplished using a Dotter intravascular snare inserted via a femoral vein, with subsequent successful implantation of a new lead. This unusual technique-related complication emphasizes the need for meticulous fluoroscopic visualization during lead manipulation.