Eosinophilic myocarditis: characteristics, diagnostics and outcomes of a rare condition.

Eosinophilic myocarditis is a rare and potentially fatal condition characterised by eosinophilic inflammatory infiltration of myocardium. We report seven consecutive cases of eosinophilic myocarditis at our centre and discuss the important characteristics, investigation and management of this disease.

The utility of a 'non-significant' coronary angiogram.

BACKGROUND: Coronary angiography is the gold standard for assessing coronary artery disease (CAD). In many patients with chest pain, no or mild CAD (< 50% stenosis) is found. It is uncertain whether this 'non-significant' result influences management and outcomes. We reviewed characteristics and outcomes in a contemporary cohort of chest pain referrals who had mild or absent CAD on coronary angiography. METHOD: All patients undergoing coronary angiography at Auckland City Hospital during July 2010-October 2011 were reviewed (n = 2983). Of these, 12.3% (n = 366) underwent coronary angiography for evaluation of chest pain and were found to have absent or mild CAD. These patients were followed up for 2.3 ± 0.6 years. RESULTS: Mean age was 60.0 ± 12.3 years, 56.1% were female. The ECG was abnormal in 55.0% of patients. Stress testing for inducible ischaemia was undertaken in 40.7% of patients and was abnormal in 57.7%. Following angiography, 43.2% had no changes to cardiac medications. Additional drug therapy (aspirin, statin, beta-blockers, ACE-inhibitor) was commenced in around 14.2-22.1% of cases. These drugs were discontinued in 4.1-8.2% of patients. Rates of major adverse cardiovascular events and readmissions with chest pain were 0.3% (1) and 1.9% (7) respectively at 30 days, and 1.9% (7) and 6.0% (22) at 1 year. CONCLUSION: Although even non-obstructive atheroma may justify medical therapy to limit disease progression, our findings may suggest that in these cases, invasive coronary angiography, may not lead to the patient/physician reassurance justified by historical data.

Computed tomography in the diagnosis of adult midgut rotational anomalies: a report of two cases.

Adult midgut rotational anomalies are difficult to diagnose. Any symptoms present in adults may be the result of intermittent volvulus of the midgut. Successful outcome of this clinical condition depends on prompt diagnosis and timely surgical intervention. Computed tomography (CT) is useful in early identification of these lesions in the abdomen. However, the specific CT signs, the "superior mesenteric vein rotation" sign and the "whirl" sign, are easy to overlook if not kept in mind, as occurred in one of our two patients. In the other patient, CT played the major role in preoperative diagnosis.

Colorectal perforation with barium enema in the elderly: case analysis with the POSSUM scoring system.

Colorectal perforation is a serious complication of barium-enema examination, as the resultant contamination of the intraperitoneal or extraperitoneal space may result in a severe septic course. Between 1 October 1993 and 30 September 1996, four patients had colorectal injuries after barium-enema examinations at the Far Eastern Memorial Hospital, Taipei, Taiwan. Their mean age was 80 years and three of them died, despite the implementation of early and aggressive treatment. To examine the differences between this high crude mortality rate and reports of zero mortality, we retrospectively analyzed the data with the well established predictive surgical scoring system, the Physiological and Operative Severity Score for the enUmeration of Morbidity and mortality (POSSUM), to estimate the potential risk of death in these four patients.

Anorectal leiomyosarcomas.

In adults, rectal leiomyosarcoma is uncommon, and anal leiomyosarcoma is even more rare. We report one patient with anal leiomyosarcoma and one patient with a biphasic clinical history, with three occurrences of perineal leiomyosarcomas after surgically resected rectal leiomyoma. We discuss the characteristics of these rare entities based upon a review of the literature.

[Relatedness of Shigella sonnei isolates from six outbreaks in Tao-Yuan area, Taiwan].

Between November 1995 and January 1996, one larger-scale outbreak of Shigella sonnei infection occurred in the area of Tao-Yuan, Taiwan. Subsequently, five outbreaks of S. sonnei infection occurred in the same area during the period from October 1998 to February 1999. Fifty-five isolates obtained from these six outbreaks were differentiated by antimicrobial susceptibility testing, plasmid profile analysis (PPA) and pulsed-field gel electrophoresis (PFGE). They were classified into two and three types by antimicrobial susceptibility testing and PPA, respectively. However, only one pattern was observed by PFGE. The molecular epidemiology by PFGE in this study indicated that they were closely-related. These data suggest that the clinical isolates obtained during the period of January 1998 to January 1999 were probably derived from the outbreak strain of 1995.

Molecular subtyping of Shigella flexneri 3a isolates by plasmid profile analysis and pulsed-field gel electrophoresis.

Twenty-two clinical isolates of Shigella flexneri 3a that were obtained from stool specimens from seven outbreaks of infection in northern Taiwan were subtyped and compared using plasmid profile analysis and pulsed-field gel electrophoresis (PFGE). Among 32 isolates, three distinct patterns were found by plasmid profile analysis and six by PFGE, with three different restriction enzymes, XbaI, SfiI, or NotI. Seven PFGE patterns were observed in a comparative analysis using a combination of these three enzymes. Isolates collected from the same outbreaks had the same PFGE combination patterns and were distinguishable from those obtained during other outbreaks. These findings suggest that PFGE may be the most powerful method of genotyping S. flexneri 3a in epidemiological studies.

Disseminated ochroconis gallopavum infection in a renal transplant recipient: the first reported case and a review of the literature.

Ochroconis gallopavum is a potentially fatal dematiaceous fungus causing opportunistic infections in immunocompromised hosts. We report the first case of disseminated O. gallopavum infection in a 13-year-old renal transplant recipient, which involved the brain, lung and spleen. He was treated with amphotericin B, itraconazole and voriconazole, a new antifungal agent first used to treat such an infection. Besides antifungal treatment, all immunosuppressive agents were stopped and automated peritoneal dialysis was resumed. The initial infection was under control with both clinical and radiological improvements after treatment. However, the patient later acquired Acremonium spp. peritonitis; he failed to respond to high-dose amphotericin B, and finally succumbed. A total of 13 reported O. gallopavum human infections, including the one described here, are reviewed. The most common site of involvement is the brain and the crude mortality rate is up to 46%. As the disease is potentially lethal in immunocompromised hosts, empirical antifungal coverage should be considered in post-renal transplant recipients with suspected brain abscess. Early biopsy of lesion for histopathological and microbiological diagnosis would be essential in managing such cases.

Characterization of Vibrio parahaemolyticus isolates obtained from foodborne illness outbreaks during 1992 through 1995 in Taiwan.

Vibrio parahaemolyticus is an important foodborne pathogen in Taiwan and many other Asian countries. A total of 371 isolates of V. parahaemolyticus collected from patients involved in foodborne illness outbreaks in Taiwan from 1992 to 1995 were characterized. These isolates had typical biochemical characteristics and only 4% were urease positive. The most frequently isolated serovars were O5:K15 (18.5%), O4:K8 (16.2%), O3:K29 (12.5%), O1:K56 (8.3%), O2:K3 (6.5%), and O4:K12 (6.0%). Most of the isolates were susceptible to nalidixic acid, tetracycline, tobramycin, cephalothin, and gentamicin. About 10% of the isolates were resistant to seven or more antibiotics. Approximately 92.4% of these V. parahaemolyticus showed beta-hemolysis on Wagatsuma blood agar plate and approximately 62.1% of these isolates exhibited detectable amounts of thermostable direct hemolysin. Most of the isolates examined exhibited two copies of tdh genes on the 1.3- and 2.5-kb HindIII-digested chromosome fragments with several variations on other fragments. A pulsed-field gel electrophoresis (PFGE) subspecies typing scheme was used to analyze these domestic isolates and the O3:K6 strains from Japan, Korea, and Taiwan. Fifty seven patterns were differentiated with A, B, C, E, and H being the major domestic types (cumulatively 76% of isolates), while O3:K6 strains (PFGE type I), abruptly occurring since 1996, were genetically distant from the major domestic types.

Perianal abscess caused by Propionibacterium avidum in a cirrhotic patient.

We describe the first case of community-acquired Propionibacterium avidum subcutaneous tissue infection in a cirrhotic patient. A 70-year-old Chinese male with a 2-year history of hepatitis B virus-induced chronic liver failure and hemorrhoidectomy 17 months previously presented with a painful left buttock abscess, which was culture positive for P. avidum. Being a normal flora of skin with low pathogenicity, there have been only 3 case reports on P. avidum infection, all associated with surgical intervention within 2 to 6 weeks before the onset of P. avidum infection. We hereby review the literature on P. avidum summarizing

Junctional ectopic tachycardia in infancy: report of two cases.

Junctional ectopic tachycardia (JET) in infancy is one of the serious arrhythmias which can be fatal. Typical features of JET include rapid and irregular heart beats with atrioventricular dissociation. Two cases of JET are reported: Case 1 was a 35-week-gestational age newborn who was found to have hydropsy and fetal tachycardia at the 21st week of gestational age. Antiarrhythmic agents including digoxin, propranolol and verapamil were administered to his mother to treat the fetal arrhythmia without success. JET was recognized at birth which was spontaneously converted into a sinus rhythm at 1 month of age. The maternal history revealed that two previous pregnancies ended in hydrops fetalis, and one of these was documented to have fetal tachycardia. Case 2 was a 6-month-old male infant with JET and congestive heart failure. After failure of various antiarrhythmic agents, amiodarone finally slowed down his heart rate and controlled his congestive heart failure.

Endotracheal tube size selection guidelines for Chinese children: prospective study of 533 cases.

Appropriate selection of the size of an endotracheal tube (ETT) for use in children is important both in general anesthesia and critical care practice. Past published data on guidelines for selecting ETT size in children are based on Caucasian measurements. As body build is generally different in Chinese children compared with Caucasians of the same age group, guidelines for Chinese children are needed. The aim of this study was to determine guidelines for ETT size selection by recording and comparing age, body weight, length, head girth and circumference of the right fifth finger of the child. Correlations between internal diameter (ID) of the chosen ETT and the child's data were calculated and compared. In this study, 533 Chinese children. American Society of Anesthesiolgists class I or II, aged from 3 months to 6 years, undergoing oral intubation for general anesthesia for minor pediatric surgery were enrolled. Our results showed that body length (height) had the best correlation to the size of an uncuffed oral ETT. Through stepwise regression, a formula. ETT ID = 2 + (body length (cm)/30), was obtained.

Food-borne disease outbreaks in Taiwan, 1994.

In 1994, 102 outbreaks of food-borne disease involving 4,726 cases were reported to the Taiwan Department of Health. This is the highest number of outbreaks and cases in recent years in Taiwan. Of these outbreaks, 72.5% (74/102) were caused by bacterial pathogens, with Vibrio parahaemolyticus responsible for 56.7% (42/74), Staphylococcus aureus 20.3% (15/74), Bacillus cereus 14.9% (11/74) and Salmonella spp other than S. typhi and S. paratyphi 8.1% (6/74). V. parahaemolyticus has been a leading cause of problems in Taiwan for many years. Contamination of seafood with this organism has been reported frequently, particularly in the warmer months. In 1994, small outbreaks (fewer than 5 cases) and large outbreaks (more than 50 cases) represented 31.4% (32/102) and 12.7% (13/102), respectively, of the total. The median outbreak size was 10 cases. A high proportion (54%, 7/13) of the large outbreaks was associated with commercial lunch-boxes supplied to elementary and junior high schools. Health education to improve food sanitation and supervision of food sanitation practices need to be strengthened.

Universal antenatal human immunodeficiency virus testing in Hong Kong: consensus statement.

Following the recommendations of the Advisory Council on AIDS, Hong Kong, the Hospital Authority announced plans to introduce universal antenatal screening for human immunodeficiency virus infection and hence, a consensus conference was held to discuss strategies for implementing such screening in Hong Kong. This paper reports the discussions of the consensus conference. The consensus meeting group consisted of 15 clinicians and scientists from Hong Kong, Macau, and Thailand. Seven commonly asked questions concerning mother-to-child transmission of human immunodeficiency virus were selected for discussion by the participating panellists. Information on the laboratory diagnosis of human immunodeficiency virus infection and the efficacy of preventive measures in reducing mother-to-child transmission of human immunodeficiency virus were reviewed. Data from local studies was also presented and discussed. The timing, potential problems, and cost issues involved in testing all pregnant women in Hong Kong for human immunodeficiency virus were then considered.

An iterative approach for TRIGA fuel burn-up determination using nondestructive gamma-ray spectrometry.

The purpose of this work is to establish a method for evaluating the burn-up values of the rod-type TRIGA spent fuel by using gamma-ray spectrometry of the short-lived fission products 97Zr/97Nb, 132I, and 140La. Fuel irradiation history is not needed in this method. Short-lived fission-product activities were established by reirradiating the spent fuels in a nuclear reactor. Based on the measured activities, 235U burn-up values can be deduced by iterative calculations. The complication caused by 239Pu production and fission is also discussed in detail. The burn-up values obtained by this method are in good agreement with those deduced from the conventional method based on long-lived fission products 137Cs, 134Cs/137Cs ratio and 106Ru/137Cs ratio.

Characterization and modeling of the metal diffusion from deep ultraviolet photoresist and silicon-based substrate.

The radioactive tracer technique was applied to investigate the out-diffusion of the transition metals (Cu, Fe and Co) from deep ultraviolet (DUV) photoresist into underlying substrate. Two important process parameters, viz., baking temperatures and substrate types (i.e., bare silicon, polysilicon, silicon oxide and silicon nitride), were evaluated. Results indicate that the out-diffusion of Co is insignificant, irrespective of the substrate type and baking temperature. The out-diffusion of Cu is significant for substrates of bare silicon and polysilicon but not for silicon oxide and nitride; for Fe, the story is reversed. The substrate type appears to strongly affect the diffusion, while the baking temperature does not. Also, the effect of solvent evaporation was found to play an important role in impurity diffusion. Using the method of numerical analysis, a diffusion profile was depicted in this work to describe the out-diffusion of metallic impurities from photoresist layer under various baking conditions. In addition, the effectiveness of various wet-cleaning recipes in removing metallic impurities such as Cu, Fe and Co was also studied using the radioactive tracer technique. Among the six cleaning solutions studied, SC2 and SPM are the most effective in impurity removal. An out-diffusion cleaning model was first proposed to describe the cleaning process. A new cleaning coefficient, h(T), was suggested to explain the cleaning effect. The cleaning model could explain the tracer results.

Bone density in heart or lung transplant recipients--a longitudinal study.

BACKGROUND: Osteoporosis is prevalent among heart or lung transplant (HLT) candidates. Bone loss is common posttransplant, with an associated increase in fracture risk. There is a lack of consensus regarding optimal management of bone health in HLT recipients. We report bone health data in a cohort of HLT recipients before and after transplantation and make recommendations for management. METHODS: Patients over the age of 20 who had a heart or lung transplant between 2000 and 2011 were identified from the New Zealand HLT Service database, and demographic data, immunosuppressive regimens, bisphosphonate use, and serial bone mineral density (BMD) data were extracted. RESULTS: Pretransplant BMD was available in 52 heart and 72 lung transplant recipients; 30 and 42, respectively, also had posttransplant BMD data. Pretransplant osteopenia or osteoporosis prevalence were 23% and 8% for heart candidates and 36% and 31% for lung candidates. Posttransplant, BMD decreased significantly at the femoral neck but not at the lumbar spine in the first year, with subsequent stabilization particularly in the presence of bisphosphonate use. Pretransplant BMD was the major predictor for developing osteopenia or osteoporosis after transplantation. CONCLUSION: A significant proportion of HLT recipients have osteopenia or osteoporosis pretransplant, and this persists posttransplant. Pretransplant BMD is an important predictor of subsequent osteopenia or osteoporosis development, allowing risk stratification and targeted intervention.

Characterization of new O3:K6 strains and phylogenetically related strains of Vibrio parahaemolyticus isolated in Taiwan and other countries.

AIMS: We analysed the genetic divergence in the pandemic new O3:K6 and phylogenetically related (new O3:K6-like) strains and compare these two groups in terms of virulence and other biological traits. METHODS AND RESULTS: A total of 160 new O3:K6, new O3:K6-like and other strains of Vibrio parahaemolyticus isolated in Taiwan and other countries were collected and their clonal relationships analysed using SfiI-pulsed-field gel electrophoresis. All of the new O3:K6 and new O3:K6-like strains were grouped in cluster I with five new patterns identified. A O6:K18 strain was identified as a new member of the new O3:K6-like strains in addition to O4:K68, O1:KUT and O1:K25 strains. All of the lipopolysaccharide preparations of the selected strains exhibited closely spaced quadruplet banding patterns with similar mobility. The two groups of strains exhibited 100% sequence identity in the internal sequences of the toxR and laf genes, and also displayed similar virulence properties as determined with a suckling mouse model. CONCLUSIONS: The new O3:K6 and new O3:K6-like strains were highly similar in virulence and in several other phenotypical and genotypical traits. SIGNIFICANCE AND IMPACT OF THE STUDY: This work demonstrated the spread and divergence of the pandemic and related clone of V. parahaemolyticus with similar virulence.

Adult descending colocolic intussusception caused by a large lipoma.

Adult intussusception is uncommon and varies considerably from the more common occurrence of this disorder in infants and children. Although lipoma represents the most common benign tumor of the colon, it is a relatively rare cause of gastrointestinal symptoms. A rare case of adult intussusception of the descending colon caused by a giant lipoma is presented and discussed.