Cardiac effects of granisetron in a prospective crossover randomized dose comparison trial

Cardiac side effects of granisetron have been studied mostly in adult patients that are using cardiotoxic chemotherapeutics. There is limited evidence in pediatric age group and no information in pediatric oncology patients with non-cardiotoxic chemotherapeutics. In this prospective, crossover randomized study, the cardiac side effects of granisetron are compared in pediatric oncology patients who had carboplatin based chemotherapy. They were randomized to receive either 10 or 40 mu g kg(-1) dose(-1) of granisetron before each cycle of chemotherapy. We drew blood for creatine phosphokinase (CPK), CPK-muscle band (MB) and Troponin-T before and 24 h after administering granisetron. Electrocardiography (ECG) tracings were taken at 0, 1, 2, 3, 6 and 24 h of granisetron. Twenty-four hours Holter ECG monitorisation was performed after each granisetron infusion. A total of 16 patients (median 8.7 years of age) were treated with weekly consecutive courses of carboplatin. There was bradycardia (p = 0.000) in patients that had granisetron at 40 mu g/kg and PR interval was shortened in patients that had granisetron at 10 mu g/kg dose (p = 0.021). At both doses of granisetron, QTc interval and dispersion were found to be similar. CPK, CK-MB and Troponin-T values were found to be normal before and 24 h after granisetron infusion. As the first study that has studied cardiac side effects of granisetron in patients that are not using cardiotoxic chemotherapeutics, we conclude that granisetron at 40 mu g kg(-1) dose(-1) causes bradycardia only. We have also demonstrated that granisetron does not cause any clinically cardiac side effects either at 10 or 40 mu g kg(-1) dose(-1). However, our results should be supported by prospective randomized studies with larger samples of patient groups

Increased QT dispersion in epileptic children

Aim: Epilepsy is a common paroxysmal disorder in childhood. Tachyarrhythmia, bradyarrhythmia, asystole, atrioventricular block, ventricular fibrillation or sudden death may occur during seizures. Mutations of ion-channel coding genes are found in patients with idiopathic or cryptogenic epilepsy. The ion channels also play a role in arrhythmogenesis. QT dispersion is a non-invasive method for assessment of regional repolarization differences within the myocardial tissue. This study investigated QT and QTc dispersion (QTcd) and the risk of dysrhythmia in epileptic children. Methods: The first group included 28 patients with newly diagnosed epilepsy and not taking antiepileptic treatment (range 10 mo to 15 y, mean+/-SD 6.86+/-3.92 y), the second group included 34 patients taking antiepileptic treatment (range 1-14 y, mean+/-SD 7.51+/-3.68 y) and the control group included 52 healthy children (range 4 mo to 15 y, mean+/-SD 6.94+/-3.92 y). Twelve-lead ECGs were obtained and heart rate, RR interval, P wave amplitude and duration, PR interval, QRS duration, QRS axis and QT intervals were measured, and QTc, QTd, QTcd were calculated in all subjects. The measurements were repeated in the first group under antiepileptic treatment. Results: While no significant difference in terms of heart rate, RR interval, P wave amplitude and duration, PR interval, QRS duration, QRS axis, QT intervals or QTc intervals was found, QTd and QTcd values were significantly increased in epileptic children compared with,the control group. QTd was 58.1+/-13.4 ms and 35.9+/-9.3 ms and QTcd was 91.0+/-22.9 and 68.6+/-18.0 ms in patients and controls, respectively. Antiepileptic treatment did not affect QT dispersion. Conclusion: QT dispersion is increased in epileptic children. Further investigation is needed to reveal the pathogenesis of myocardial repolarization abnormalities in epileptic patients

Effects of childhood bronchiectasis on cardiac functions

BACKGROUND: Bronchiectasis is still a widespread disease in developing countries. It is an important cause of mortality and morbidity. The information on cardiac involvement in bronchiectasis is limited. However, cor pulmonale is common in patients with chronic lung disease, such as cystic fibrosis. METHODS: We utilized echocardiography and exercise tests, along with clinical scoring, chest radiograph scoring, and pulmonary function tests in 21 patients to determine whether detectable changes in cardiac functions were present, and the nature of their relationship to the underlying disease severity. RESULTS: The ventricular systolic functions were preserved in all patients. Some of the patients had changes in left ventricular diastolic function indices, characterized by abnormal Ewave/Awave (E/A) ratios or isovolumetric relaxation time values. Isovolumetric relaxation time but not E/A ratios was found to have a significant negative correlation with the clinical score. In addition, exercise capacity was decreased in bronchiectatic children. Most of the patients stopped the exercise test due to exhaustion before reaching maximum heart rate. CONCLUSION: Left ventricular diastolic functions are affected in bronchiectasis, and the performance of patients is dependent on their pulmonary status. This is the first study demonstrating the cardiac effects of bronchiectasis according to our survey of the published literature

Evaluation of autonomic nervous system functions by using tilt table test and heart rate variability in epileptic children

Objective: The value of head-up tilt test (HUTT) for differential diagnosis of epilepsy and the autonomic nervous system functions in epileptic children using heart rate variability (HRV) are studied. Patients and Methods: The study group consisted of 16 children with idiopatic/criptogenic epilepsy and 12 controls. Heart rate, PR interval, corrected QT (QTc) interval, QT and QTc dispersion were calculated using 12-lead electrocardiogram (ECG), HRV analysis was performed using the Holter recordings obtained both during HUTT and throughout the day. Time domain parameters, standard deviation of all RR intervals (SDNN), the standard deviation of mean NN intervals in five-minutes recording (SDANN), mean standard deviation of NN intervals in five-minutes recordings (SDNNi), root mean square of successive differences (RMSSD), count divided by the total number of all NN intervals (pNN50) and frequency domain parameters low frequency (LF), high frequency (HF), low-frequency/high-frequency ratio (LF/HF) were calculated in both and compared between the two groups.Results: Head-up tilt test was positive in 4 epileptic children (25%), none of controls were positive. The heart rate of the patients were higher than the controls (p=0.015). LF/HF ratio in 24-hour Holter recordings, were significantly lower (1.13 +/- 0.6, 1.83 +/- 0.7 respectively, p=0.002); the SDANN during HUTT (28.7 +/- 20.2, 18.2 +/- 19.9 respectively, p=0.024) were significantly higher in the patients than the controls.Conclusion: Head-up tilt test positivity is frequent in epileptic children, and cannot be used in differential diagnosis. HRV calculated both from 24 hour Holter recordings and Holter recordings under orthostatic stress were impaired in favour of parasympathetic system in epileptic children

Coronary Arteriovenous Fistula Causing Hydrops Fetalis

Fetal heart failure and hydrops fetalis may occur due to systemic arteriovenous fistula because of increased cardiac output. Arteriovenous fistula of the central nervous system, liver, bone or vascular tumors such as sacrococcygeal teratoma were previously reported to be causes of intrauterine heart failure. However, coronary arteriovenous fistula was not reported as a cause of fetal heart failure previously. It is a rare pathology comprising 0.2-0.4% of all congenital heart diseases even during postnatal life. Some may remain asymptomatic for many years and diagnosed by auscultation of a continuous murmur during a routine examination, while a larger fistulous coronary artery opening to a low pressure cardiac chamber may cause ischemia of the affected myocardial region due to steal phenomenon and may present with cardiomyopathy or congestive heart failure during childhood. We herein report a neonate with coronary arteriovenous fistula between the left main coronary artery and the right ventricular apex, who presented with hydrops fetalis during the third trimester of pregnancy

Chronic granulomatous disease: is it always associated with infections?

Chronic granulomatous disease (CGD) is a rare disease of the phagocytic system characterized by mutation in nicotinamide adenine dinucleotide phosphate oxidase enzyme system. The heredity of disease is heterogeneous and X-linked genotype accounts for the most common type (65-70%). In patients with CGD reduction of reactive oxygen intermediates in phagocytes have result in susceptibility to catalase positive bacterial and fungal infections and abscess formation. Pericardial effusion and CGD coexistence is very rare condition and may occur during invasive fungal infections or secondary to enhanced inflammation. Twenty-month-old boy presented with fever and palpitation. On physical examination tachycardia and pericardial effusion was revealed (width: 11 mm) and his history was notable for perianal abscess in newborn period. Therefore, CGD was included in the differential diagnosis which was confirmed by nitroblue tetrazolium and dihidrorhodamin test. Despite negativity of microbiological culture for bacterial and fungal microorganisms the patient was placed on broad-spectrum antibacterial, antifungal and anti-inflammatory treatment. His condition improved without any complication. In this report, we emphasize that in patient with CGD pericardial effusion may be occurred secondary to increased inflammation without any microbial causes and can be resolved during clinical follow-up