A case of Henoch-Schönlein purpura and rheumatic carditis with complete atrioventricular block

Henoch-Schönlein purpura is the most common systemic vasculitis during childhood. Many antigenic stimuli and infectious agents have been proposed as a trigger of the disease. Group A beta-hemolytic streptococcus is the most common proposed infectious agent as a trigger for Henoch-Schönlein purpura. We report a 9-year-old boy who has Henoch-Schönlein purpura and acute rheumatic fever with complete atrioventricular block.     

Engraftment syndrome and survival after respiratory failure post-bone marrow transplantation

Respiratory failure (RF) requiring mechanical ventilation (MV) is a frequent, critical complication of bone marrow transplantation. RF has a global survival rate at 6 months of between 2 and 5 %, depending on the patient group. Recently, a type of RF associated with hemoperipheric recovery has been described. This is known as engraftment syndrome. We have documented two cases of RF that follow the engraftment syndrome criteria and needed MV. Both patients had all the features identified for a bad prognosis described in the literature. Both are alive after being discharged from the hospital 20 months ago. Received: 8 August 1997 Accepted: 1 April 1998     

Diagnostic delay and outcome in immunocompetent patients with primary central nervous system lymphoma in Spain: a multicentric study

Journal of Neuro-Oncology - To assess the management of immunocompetent patients with primary central nervous system lymphomas (PCNSL) in Spain. Retrospective analysis of 327 immunocompetent...     

Exposure of Infants to Aflatoxin M1 from Mother's Breast Milk in Ilam,Western Iran

Objectives

Aflatoxins as a highly toxic group of mycotoxins are present in the environment and foodstuff. These have been reported to cause serious health problems in humans. Since aflatoxin M1 (AFM1) is excreted into breast milk, investigating the exposure of infants to AFM1 is of special concern.

Methods

In the present study, breast milk samples were collected from 85 lactating mothers in Ilam province, Iran, and the levels of AFM1 were analyzed using the enzyme-linked immunosorbent assay-based technique. AFM1 was detected in breast milk of all lactating women. The mean contamination level was 5.91 ± 2.031 ng/L, ranging from 2 ng/L to 10 ng/L.

Results

Multiple regression analysis indicated no significant associations of consumption of milk and dairy products, meat, fish, legumes, grain products, fruits, and nuts with the concentration of AFM1 in breast milk. Furthermore, no significant association was observed between AFM1 concentration and anthropometric data of infants.

Conclusion

In western parts of Iran, lactating mothers and their infants could be at risk of aflatoxin B1 and AFM1 exposure, respectively. Therefore, in Iran, the evaluation of AFM1 in human breast milk as a biomarker for postnatal exposure of infants to this carcinogen requires more attention in different regions and various seasons.     

Pseudoaneurysm - a rare complication after insertion of a distal locking bolt of an intramedullary femur nail

A pseudoaneurysm is caused by an extravasal hematoma after vessel injury. Persistent blood supply via the afferent artery can lead to aneurysm growth with potential rupture of the lesion. We present a case of a 27-year-old man who developed three independent pseudoaneurysms after insertion of percutaneous distal locking bolts for static locking of an intramedullary femur nail. Color-coded Doppler sonography and intraarterial subtraction angiography were used to detect the lesion. Successful treatment consisted of endovascular embolization (coiling) with injection of a platinum coil into the aneurysm's supplying vessel. Pseudoaneurysm after fracture or fracture fixation represents a rare complication, but the risk of acute bleeding by pseudoaneurysm rupture should not be neglected.     

The need for improved neutropenia risk assessment in DLBCL patients receiving R-CHOP-21: findings from clinical practice

Febrile neutropenia (FN) risk-assessment and granulocyte-colony stimulating factor (G-CSF) prophylaxis use in clinical practice was evaluated in patients with diffuse large B-cell lymphoma receiving R-CHOP-21. More G-CSF primary prophylaxis was used in patients assessed as high FN risk, but R-CHOP-21 was associated with substantial myelotoxicity in both high- and low-risk groups. In a multivariate analysis, older age, poor performance status, lower baseline hemoglobin, and lack of G-CSF prophylaxis were significantly associated with occurrence of FN in any cycle. Results highlight the need for improved FN risk-assessment and thorough guideline adherence to further reduce FN and better support chemotherapy delivery.     

Closed Tibial Fracture Associated with Laceration of Tibialis Anterior Tendon

Traumatic laceration of the tibialis anterior tendon is a rare finding. To the best of our knowledge, 4 such cases have been reported in the surgical literature, and 3 of these were missed upon initial clinical examination. We present the case of a 26-year-old male motorcyclist who sustained an acute laceration of the tibialis anterior tendon in association with closed fractures of the tibia and fibula. The laceration was initially not included in the diagnosis, because weak ankle dorsiflexion was attributed to antalgic guarding. The primary aim of this report is to emphasize the possibility of tibialis anterior tendon laceration in association with closed fracture of the tibia, and to encourage surgeons to maintain a high index of suspicion for this particular defect. Furthermore, we encourage surgeons to undertake a meticulous physical examination and, if warranted, obtain ancillary diagnostic images, such as magnetic resonance images, in order to accurately diagnose and determine the optimal course of treatment.     

Ovarian ependymoma

A 76-year-old woman presented with a large calcifying mass behind the bladder. The tumor contained solid areas of a yellowish white color. Microscopic examination revealed highly cellular solid areas with many typical ependymal perivascular pseudorosettes. The cells contained uniform round-to-oval nuclei, some of which had irregular contours, clumped chromatin and occasional prominent nucleoli. There was widespread geographic necrosis and there were 5 atypical mitotic figures per 10 high power fields. Glial fibrillary acidic protein (GFAP) immunopositivity was observed in the cytoplasm of the tumor cells. Based on the histopathologic and immunohistochemical features, the tumor was diagnosed as an anaplastic ependymoma. This is to the best of our knowledge only the second case of anaplastic ependymoma in the medical literature.