Protocol for Clozapine Rechallenge in a Case of Clozapine-Induced Myocarditis.

OBJECTIVE: Protocol for clozapine rechallenge in patients with a history of clozapine-induced myocarditis. METHOD: Clozapine-related cardiovascular adverse effects including myocarditis and cardiomyopathy have limited its widespread use in treatment-resistant schizophrenia. Here, we present a case of clozapine-induced myocarditis and successful cautious rechallenge. Ms. AA, a young female patient with severe psychosis developed myocarditis during her initial clozapine titration phase, which was thus discontinued. Subsequent response to other medications was poor, and she remained significantly disabled. We reviewed blood-based biomarkers identified during the emergence of her index episode of myocarditis and developed a successful clozapine rechallenge protocol, based on careful monitoring of changes in these indices and a very slow clozapine re-titration. RESULTS AND CONCLUSIONS: This protocol may have utility in the management of patients with a history of clozapine-induced myocarditis.

Liver and lung hydatid cysts with transdiaphragmatic rupture treated by radical surgery.

Hydatidosis is a parasitic disease caused by Echinococcus granulosus, a tapeworm that is endemic in certain parts of the world. We present a case of hepatopulmonary hydatidosis with diaphragm involvement and close contact with the suprahepatic inferior vena cava treated with radical surgery. We discuss therapeutical surgical options (approach and type of surgery).

Intrauterine growth retardation, body size, body composition and physical performance in adolescence.

Studies about effects of IUGR on growth in childhood as well as on body size, body composition and physical performance in adolescence and adulthood are reviewed. The review is based on 12 studies that distinguished IUGR from other types of low birthweight and compared outcomes of IUGR cases with those of non-IUGR controls. This information is complemented by results of a follow-up study of IUGR cases and controls carried out in Guatemalan adolescents and young adults. In Guatemala as well as in other countries, IUGR newborns showed partial catch-up growth during the first one or two years of life, and then maintained their achieved place in the growth distribution. Guatemalan IUGR cases were shorter, lighter and weaker than non-IUGR controls as adolescents and young adults. The differences in adult body size observed in Guatemala between cases and controls are similar to those found in more affluent countries (i.e. about 5 cm in height and 5 kg in weight).