560 research outputs found

    Acute urinary retention as a complication of primary varicella-zoster infection of childhood – a second reported case

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    We present the case of an 8 year old male child with acute urinary retention and constipation following primary varicella-zoster infection (chicken pox). To our knowledge, this unusual complication has only been reported once before in the modern English-language medical literature. Our patient’s presentation is congruent with the hypothesis that towards the end of primary varicella-zoster infection, virus infecting a specific ganglion (prior to becoming latent) may cause transient neurological effects

    Natural Law Institute Proceedings Vol. 2

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    https://scholarship.law.nd.edu/naturallaw_proceedings/1002/thumbnail.jp

    Pulmonary-to-Systemic Arterial Shunt to Treat Children With Severe Pulmonary Hypertension

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    BACKGROUND: The placement of a pulmonary-to-systemic arterial shunt in children with severe pulmonary hypertension (PH) has been demonstrated, in relatively small studies, to be an effective palliation for their disease. OBJECTIVES: The aim of this study was to expand upon these earlier findings using an international registry for children with PH who have undergone a shunt procedure. METHODS: Retrospective data were obtained from 110 children with PH who underwent a shunt procedure collected from 13 institutions in Europe and the United States. RESULTS: Seventeen children died in-hospital postprocedure (15%). Of the 93 children successfully discharged home, 18 subsequently died or underwent lung transplantation (20%); the mean follow-up was 3.1 years (range: 25 days to 17 years). The overall 1- and 5-year freedom from death or transplant rates were 77% and 58%, respectively, and 92% and 68% for those discharged home, respectively. Children discharged home had significantly improved World Health Organization functional class (P < 0.001), 6-minute walk distances (P = 0.047) and lower brain natriuretic peptide levels (P < 0.001). Postprocedure, 59% of children were weaned completely from their prostacyclin infusion (P < 0.001). Preprocedural risk factors for dying in-hospital postprocedure included intensive care unit admission (hazard ratio [HR]: 3.2; P = 0.02), mechanical ventilation (HR: 8.3; P < 0.001) and extracorporeal membrane oxygenation (HR: 10.7; P < 0.001). CONCLUSIONS: A pulmonary-to-systemic arterial shunt can provide a child with severe PH significant clinical improvement that is both durable and potentially free from continuous prostacyclin infusion. Five-year survival is comparable to children undergoing lung transplantation for PH. Children with severely decompensated disease requiring aggressive intensive care are not good candidates for the shunt procedure
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