Transient Myocarditis Associated with Fulminant Colitis

Case Summary. An 18-year old man presented with a three-week history of abdominal pain, weight loss and bloody diarrhoea. He was profoundly septic, with generalised abdominal tenderness. CT and flexible sigmoidosopy confirmed colitis of the colon with rectal sparing. Laparotomy was performed when conservative management failed to improve his condition. Subtotal colectomy, with end ileostomy and mucus fistula formation, was performed in light of active colitis. Despite successful operative intervention the patient acute left ventricular failure, raising the possibility of giant cell myocarditis, which fully resolved before a definitive diagnosis could be reached. Discussion. It is possible that the transient cardiac failure in this case may represent an overwhelming inflammatory response or myocarditis. Inflammatory bowel disease is rarely associated with giant cell myocarditis (GCM). GCM usually affects a young population and its prognosis is variable, ranging from complete recovery, remission with recurrence and fatality. The management of this group of patients is still relatively experimental. Conclusion. Fulminant colitis can be associated with a rapid deterioration in cardiac function. Causes include sepsis, systemic inflammatory response syndrome or myocarditis. GCM should be considered in patients with new onset of left ventricular failure that decline rapidly

Administration of Anesthesia in a Patient with Allgrove Syndrome

The aim of the present paper is to report the anesthesia administration to a patient who was planned to undergo Heller myotomy for achalasia. There wasnot property in the patient whom allgrove syndrome was excepted any steroid treatment in preoperative period. The night before the operation 18 mg of prednisolone was administered intravenously. Induction of anesthesia was performed with thiopental sodium, vecuronium and fentanyl and the patient received endotracheal intubation. Eyes were taped closed and protected with ointment during surgery. Maintenance of anesthesia was achieved with 2% sevoflurane concentration in 50% O2-50% N2O. 25 mg of prednisolone was infused preoperatively, and intervention with insulin treatment was initiated when blood glucose level rose to 18 mmol/L at 2 hours. Safe anesthesia can be achieved by observing the preoperative development of tracheal aspiration, adrenal insufficiency and, autonomic dysfunction carefully and maintaining eye protection

Metastatic Crohn's Disease of the Ear

Objective. We reported a very rare case of metastatic Crohn's disease involving the retro-auricular region. Method. A case report and a review of literature concerning metastatic Crohn's disease. Results. Metastatic Crohn's disease is an uncommon extraintestinal cutaneous manifestation of Crohn's disease and a very rare case involving the retro-auricular region is reported here. Given the limited existing literature little is known about this condition. The skin lesions appear to have a predilection for the lower trunk and genitalia regions. There is no clear association with the severity of Crohn's disease and in some cases, the cutaneous lesions predate the onset of gastrointestinal Crohn's disease. Treatment with immune-modulating medications together with the antitumour necrosis factor monoclonal antibody therapy appears to offer the best chance of remission. Conclusion. By reporting this interesting and rare condition we also hope to highlight the importance of considering underlying chronic systemic disorders, such as Crohn's disease, when presented with skin lesions resistant to simple local treatments

IMMUNOCAT—A Data Management System for Epitope Mapping Studies

To enable rationale vaccine design, studies of molecular and cellular mechanisms of immune recognition need to be linked with clinical studies in humans. A major challenge in conducting such translational research studies lies in the management and integration of large amounts and various types of data collected from multiple sources. For this purpose, we have established “IMMUNOCAT”, an interactive data management system for the epitope discovery research projects conducted by our group. The system provides functions to store, query, and analyze clinical and experimental data, enabling efficient, systematic, and integrative data management. We demonstrate how IMMUNOCAT is utilized in a large-scale research contract that aims to identify epitopes in common allergens recognized by T cells from human donors, in order to facilitate the rational design of allergy vaccines. At clinical sites, demographic information and disease history of each enrolled donor are captured, followed by results of an allergen skin test and blood draw. At the laboratory site, T cells derived from blood samples are tested for reactivity against a panel of peptides derived from common human allergens. IMMUNOCAT stores results from these T cell assays along with MHC:peptide binding data, results from RAST tests for antibody titers in donor serum, and the respective donor HLA typing results. Through this system, we are able to perform queries and integrated analyses of the various types of data. This provides a case study for the use of bioinformatics and information management techniques to track and analyze data produced in a translational research study aimed at epitope identification

Diabetic Mastopathy as a Radiographically Occult Palpable Breast Mass

Diabetic mastopathy is an uncommon, benign disease of the breast that can occur in women with diabetes and clinically mimic breast cancer. We describe a patient with long-standing type 1 diabetes who presented with a palpable breast mass with negative imaging findings on mammography, ultrasonography, and breast MRI. Surgical biopsy and histopathology confirmed diabetic mastopathy. We use this case to highlight the recognition, radiographic features, pathology, and management of this benign breast condition and emphasize that, in diabetic patients, the differential diagnosis of a new breast mass should include diabetic mastopathy

Moyamoya Disease in Pregnancy: Management after Intracranial Bypass Grafting

Moyamoya disease (MD) is a chronic, progressive cerebrovascular disease distinguished by bilateral stenosis or occlusion of the arteries around the circle of Willis with resulting prominent arterial collateral circulation. We describe a pregnant woman in whom this diagnosis was confirmed by cerebral angiogram and treated with bilateral superficial temporal artery-middle cerebral artery (STA-MCA) bypass grafting prior to conception. The patient was managed with strict blood pressure monitoring and low-dose aspirin antepartum, intrapartum, and postpartum. The patient presented in spontaneous labor at term and underwent a spontaneous vaginal delivery without complications

Synchronous Laparoscopic Radical Nephrectomy Left and Contralateral Right Hemicolectomy during the Same Endoscopic Procedure

Synchronous renal cell carcinoma in patients with colorectal carcinoma is reported in various percentages ranging from 0.03 up to 4.85% (Halak et al. (2000), Capra et al. (2003)). When surgical treatment is indicated usually two separate operations are planned for resection. In open surgery, in such cases simultaneous resection is recommended if possible. Few reports have described the resection of colorectal and renal cell carcinoma in a single laparoscopic procedure. We have shown that combining left radical nephrectomy and right hemicolectomy is technically feasible, safe and that overall operative time can be limited. In our case operative time was 210 minutes, blood loss 100 milliliters, and duration of hospital stay was 8 days. Adequate port placement, preoperative scheduling, and surgical experience are essential to achieve this goal

Blastomyces Antigen Detection for Monitoring Progression of Blastomycosis in a Pregnant Adolescent

Although disseminated blastomycosis is a rare complication in pregnancy, delay in diagnosis and treatment can be fatal. We investigate the use of the Blastomyces urine antigen in diagnosis following disease progression in the intrapartum, postpartum, and neonatal periods. We describe a case of disseminated blastomycosis in a pregnant adolescent and review the pertinent literature regarding treatment and monitoring blastomycosis in pregnancy and the neonatal periods. This is the first reported case in which the Blastomyces urine antigen is utilized as a method of following disease activity during pregnancy confirming absence of clinically evident disease in a neonate. Urine antigen detection for blastomycosis can be useful for following progression of disease in patients with disseminated blastomycosis in both the intrapartum and postpartum periods

Development of Cutaneous Leishmaniasis after Leishmania Skin Test

Thirty-year-old female with a previous history of a cutaneous ulcer suspicious of leishmaniasis 20 years ago presented with a new complaint of a depressed papular lesion 8 × 7 mm in the right lower extremity. The lesion was of 10-day duration. Because early cutaneous leishmaniasis (CL) lesions may have a non-ulcerated appearance, a Leishmania skin test (LST) was performed on the forearm with a strong positive result (38 × 32 mm). After 8 days, the lesion in the leg, which was diagnosed as folliculitis, completely healed. However, a typical CL ulcer (26 × 24 mm) developed at the LST site. Histopathology of the new lesion did not identifiy parasites, but the findings were consistent with a diagnosis of CL. Further analysis identified amastigotes by immunohistochemical stain. Mononuclear cells harvested from the patient were stimulated with Leishmania antigen and showed high levels of production of both tumor necrosis factor-alpha (TNF-α) and interferon-gamma (IFN-γ): 2,943 pg/mL and 2,313 pg/mL, respectively. After 40 days of treatment with antimony and pentoxifylline, the ulcer resolved. The development of CL at the LST site suggests a strong Th1 immune response, and it is an in vivo documentation of the role of the host immune response in the pathology of CL. It teaches us that LST should be cautiously, if at all, used in patients with self-healing CL ulcers

Oxandrolone Improves Height Velocity and BMI in Patients with Cystic Fibrosis

Objective. To evaluate the effectiveness of oxandrolone in improving the nutritional status and linear growth of pediatric patients with cystic fibrosis (CF). Methods. Medical records of patients with CF treated with oxandrolone were reviewed for height z score, height velocity (HV), BMI z score, weight velocity (WV), Tanner stage, pulmonary function, liver enzyme levels, and any reported adverse events. Data were compared before (pre-Ox) and after (Ox) oxandrolone using a paired t-test. Results. 5 subjects (ages 8.5–14.5 years) were treated with oxandrolone 2.5 mg daily for 8–38 months. After 8–12 months of treatment, there was a statistically significant improvement in HV (pre-Ox = 5.3 ± 1.4 cm/yr, Ox = 8.3 ± 1.2 cm/yr, P < .01) and BMI z score (pre-Ox = −0.61 ± 1.04, Ox = −0.30 ± 0.86, P = .02). Both height z score (pre-Ox = −1.64 ± 0.63, Ox = −1.30 ± 0.49, P = .057) and WV (pre-Ox = 4.2 ± 3.7 kg/yr, Ox = 6.8 ± 1.0 kg/yr, P = .072) showed beneficial trends that did not reach statistical significance. No adverse events were reported. Conclusions. In this brief clinical report, oxandrolone improved the HV and BMI z score in patients with CF. Larger studies are needed to determine if oxandrolone is an effective, safe, and affordable option to stimulate appetite, improve weight gain, and promote linear growth in patients with CF