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Chen M, Wang RZ, Meng FQ, Fang QQ, Zhao DY. [Clinical characteristics of 6 children with idiopathic interstitial pneumonia]. Zhonghua Er Ke Za Zhi 2022; 60:930-934. [PMID: 36038304 DOI: 10.3760/cma.j.cn112140-20220422-00364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the clinical characteristics and prognosis of 6 children with idiopathic interstitial pneumonia (IIP). Methods: This retrospective study analyzed the clinical manifestations, examinations, treatment and prognosis of 6 children with IIP who were hospitalized in Children's Hospital of Nanjing Medical University from January 2015 to March 2020. Results: Of the 6 children, 2 were males and 4 were females, aged 4.8 to10.6 years. All children had a subacute onset, and presented with cough, shortness of breath and cyanosis. The lung high-resolution CT (HRCT) showed diffuse patchiness in bilateral lung fields in all the children and reticular pattern in 2 cases. Pulmonary function test found moderate to severe mixed defect in 5 children. Lung biopsy was performed in 4 children. All of the 6 children were treated with systemic glucocorticoids, of whom 2 cases had additional inhaled glucocorticoids. Four children were finally diagnosed as cryptogenic organizing pneumonia (COP), whose lung HRCT return to normal in 1-11 months. Two children were finally diagnosed as nonspecific interstitial pneumonia (NSIP), and had long-term residual fibrosis on lung HRCT. The 6 children were followed up for 1 year to 6 years and 5 months after discontinuation of systemic glucocorticoids, and all had no recurrence. Conclusions: The clinical characteristics of IIP in children are subacute onset presented with cough, shortness of breath, cyanosis and diffuse patchiness in bilateral lungs on HRCT. The common subtypes of IIP in children are COP and NSIP. Systemic glucocorticoid is effective for IIP in children and there is a good prognosis overall.
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Affiliation(s)
- M Chen
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - R Z Wang
- Department of Radiology, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - F Q Meng
- Department of Pathology, Nanjing Drum Tower Hospital, the Affiliated of Nanjing University Medical School, Nanjing 210008, China
| | - Q Q Fang
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - D Y Zhao
- Department of Respiratory, Children's Hospital of Nanjing Medical University, Nanjing 210008, China
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Bouatrous E, Nouira S, Ben Khaled M, Ouederni M, Abbes S, Menif S, Ouragini H. First Observation of HbM-Saskatoon at the Origin of Neonatal Cyanosis in a Tunisian Baby. J Pediatr Hematol Oncol 2021; 43:e1055-e1058. [PMID: 33625083 DOI: 10.1097/mph.0000000000002096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/08/2021] [Indexed: 11/26/2022]
Abstract
Several causes are known to be at the origin of neonatal cyanosis among them methemoglobinemia is by inheritance of an hemoglobin (Hb) M variant. This is a rare condition never been reported in Tunisia so far. Here, we report a Tunisian newborn with refractory cyanosis since birth. As cardiac and respiratory diseases were ruled out, methemoglobinemia was suspected. Hematological parameters, concentration of methemoglobin, capillary electrophoresis, and amplification sequencing of the HBB gene were performed. Computational analysis was achieved by different in silico tools to investigate the mutation effect. The diagnosis was established by a raised MetHb, confirmed by the presence HbM-Saskatoon [Beta63 (E7) His>Tyr] by capillary electrophoresis and molecular analysis. The identified mutation occurred as a de novo mutation. In silico analysis confirmed the pathogenicity of the mutation. To our knowledge, this is the first time that this mutation has been reported in the Tunisian population. In view of its low incidence rate, clinicians might misdiagnose cyanosis caused by HbM, which can lead to inappropriate treatment and clinical complications. An up-to-date literature review of HbM disease is presented in this study.
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Affiliation(s)
- Emna Bouatrous
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
| | - Sonia Nouira
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
- Molecular Biology Cell and Biotechnology Department, Higher Institute of Biotechnology of Monastir, University of Monastir, Monastir, Tunisia
| | - Monia Ben Khaled
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis
| | - Monia Ouederni
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
- Pediatric Immuno-Hematology Unit, Bone Marrow Transplantation Center, Tunis
| | - Salem Abbes
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
| | - Samia Menif
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
| | - Houyem Ouragini
- Laboratory of Molecular and Cellular Hematology, LR16IPT07, Pasteur Institute of Tunis, University of Tunis El Manar
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Pomoni A, Aggeli I, Loutsi E, Hatzimichael E, Chaliasos N, Makis A. Cyanosis Due to Methemoglobinemia as the Presenting Sign of Glucose-6-Phosphate Dehydrogenase Deficiency in a Child: Diagnostic and Clinical Implications. J Pediatr Hematol Oncol 2021; 43:e1140-e1144. [PMID: 33031164 DOI: 10.1097/mph.0000000000001967] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 09/10/2020] [Indexed: 11/27/2022]
Abstract
A previously healthy 3-year-old boy presented with pallor, jaundice, cyanosis, and a 24-hour history of vomiting and anorexia following fava bean ingestion. Clinical examination and laboratory findings were consistent with severe nonimmune hemolytic anemia with methemoglobinemia. Given the patient's history, a previously unrecognized glucose-6-phosphate dehydrogenase deficiency was suspected and diagnosed. The aim of this article is to delineate the possible coexistence of methemoglobinemia and glucose-6-phosphate dehydrogenase deficiency in children presented with acute hemolysis and discuss its management while reviewing the existing literature.
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Affiliation(s)
| | - Ioanna Aggeli
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
| | - Eleni Loutsi
- Department of Pediatrics, University Hospital of Ioannina, Ioannina, Greece
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4
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Affiliation(s)
- K Horiuchi
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashi Ueno, Taito-ku, Tokyo, Japan
| | - T Asakura
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashi Ueno, Taito-ku, Tokyo, Japan
| | - F Saito
- Department of Pulmonary Medicine, Eiju General Hospital, 2-23-16 Higashi Ueno, Taito-ku, Tokyo, Japan
| | - T Asakura
- Division of Pulmonary Medicine, Department of Medicine, Keio University School of Medicine, Tokyo, Japan
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5
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Shi VJ, Leventhal JS, Mensah KA, Galan A, Choate KA. Cyanosis of the foot. Cutis 2017; 100:206-210. [PMID: 29136053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Veronica J Shi
- Department of Dermatology, Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Kofi A Mensah
- Department of Internal Medicine, Section of Rheumatology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Anjela Galan
- Department of Dermatology, Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
| | - Keith A Choate
- Department of Dermatology, Department of Genetics, Department of Pathology, Yale School of Medicine, New Haven, Connecticut, USA
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Celmeli F, Kocabas A, Isik IA, Parlak M, Kisand K, Ceylaner S, Turkkahraman D. Unexplained cyanosis caused by hepatopulmonary syndrome in a girl with APECED syndrome. J Pediatr Endocrinol Metab 2017; 30:365-369. [PMID: 28222032 DOI: 10.1515/jpem-2016-0276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/19/2016] [Indexed: 01/08/2023]
Abstract
Autoimmune polyendocrinopathy, candidiasis and ectodermal dystrophy (APECED) is a rare but devastating primary immunodeficiency disease caused by loss-of-function mutations in autoimmune regulator (AIRE) gene on chromosome 21q22.3. The clinical spectrum of the disease is characterized by a wide heterogeneity because of autoimmune reactions toward different endocrine and non-endocrine organs. Here, we report a 17-year-old Turkish girl diagnosed with APECED at 9 years in whom a novel homozygote mutation in AIRE gene p.R15H (c.44G>A) was found. In the clinical course of the patient, chronic liver disease due to autoimmune hepatitis has evolved resulting in hepatopulmonary syndrome (HPS) which has not been reported before in patients with APECED.
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7
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El Amraoui W, El Koraichi A, Bentalha A, El Kettani SE. [Perthes syndrome secondary to an asthma attack: A case report in a 15-year-old child]. Rev Pneumol Clin 2016; 72:359-362. [PMID: 27789160 DOI: 10.1016/j.pneumo.2016.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 08/18/2016] [Accepted: 08/27/2016] [Indexed: 06/06/2023]
Abstract
Perthes syndrome, or traumatic asphyxia syndrome, is a rare clinical entity, associating cyanosis, cervicofacial petechiae and subconjunctival hemorrhage. It is usually secondary to chest trauma, but can occur in any situation of abrupt rise in intrathoracic pressure with closed glottis. In this paper, we present a case of Perthes syndrome that triggered an asthma attack for a child during surgery.
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Affiliation(s)
- W El Amraoui
- Service de réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc.
| | - A El Koraichi
- Service de réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc; Faculté de médecine et de pharmacie, université Mohammed V, Rabat, Maroc.
| | - A Bentalha
- Département d'anesthésie réanimation, centre hospitalier Ibn Sina, Rabat, Maroc.
| | - S E El Kettani
- Service de réanimation pédiatrique polyvalente, hôpital d'enfants de Rabat, Rabat, Maroc; Département d'anesthésie réanimation, centre hospitalier Ibn Sina, Rabat, Maroc.
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8
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Osovsky M, Yacobovich J, Sirota L, Tamary H. [BLUE BABY, PINK FUTURE]. Harefuah 2016; 155:24-68. [PMID: 27012070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Neonatal cyanosis is relatively common. It is usually a consequence of cyanotic heart disease or a pulmonary disorder, and warrants a thorough and quick investigation. Mutations causing decreased affinity of hemoglobin to oxygen may change α1 to β2 binding. We describe a new mutation (asp 102 serine), in the γ chain of hemoglobin, causing neonatal cyanosis which resolves as the baby matures. In this case we would like to emphasize the importance of early diagnosis in order to avoid unnecessary disease workup.
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9
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Ceyran AB, Şenol S, Güzelmeriç F, Tunçer E, Tongut A, Özbek B, Şavluk Ö, Aydın A, Ceyran H. Effects of hypoxia and its relationship with apoptosis, stem cells, and angiogenesis on the thymus of children with congenital heart defects: a morphological and immunohistochemical study. Int J Clin Exp Pathol 2015; 8:8038-8047. [PMID: 26339370 PMCID: PMC4555698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 06/28/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The thymus slowly involutes with age after puberty. Various stress conditions accelerate the involution of the thymus and cause changes in the histologic structure of the gland. OBJECTIVE The present study performed histomorphological and immunohistochemical (IHC) evaluations of the thymus glands removed during surgical repair in patients with cyanotic or acyanotic congenital heart disease (CHD). The thymus glands in the hypoxic group were compared to those in the non-hypoxic group. This study suggested that the activation of HIF-1 alpha promotes tumor progression and impair prognosis due to the inhibition of apoptosis, increased population of stem cells, and induction of angiogenesis also suggested that inactivation of HIF-1 alpha in tumor-infiltrated tissues could halt tumor progression and improve prognosis. MATERIALS AND METHODS The study included 76 thymus glands removed from patients who underwent an operation due to CHD. Of these cases, 38 had cyanotic CHD, and constituted the hypoxic group. The remaining 38 patients had acyanotic CHD, and constituted the non-hypoxic group. IHC procedures were performed for HIF-1 alpha, FoxP3, CD44, Bcl-2, and CD34. RESULTS There were statistically significant differences between the hypoxic and non-hypoxic groups only in terms of medullary enlargement toward the cortex and effacement of the corticomedullary junction. In the immunohistochemical examination for five markers, staining intensity and staining rates increased with decreasing oxygen saturation. CONCLUSION It can be concluded that the activation of HIF-1 alpha promotes tumor progression and impair prognosis due to the inhibition of apoptosis, increased population of stem cells, and induction of angiogenesis.
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Affiliation(s)
- A Bahar Ceyran
- Department of Pathology, Medeniyet University, Göztepe Training and Research Hospitalİstanbul, Turkey
| | - Serkan Şenol
- Department of Pathology, Medeniyet University, Göztepe Training and Research Hospitalİstanbul, Turkey
| | - Füsun Güzelmeriç
- Department of Anesthesiology, Koşuyolu Training and Research Hospitalİstanbul, Turkey
| | - Eylem Tunçer
- Department of Pediatric Cardiac Surgery, Koşuyolu Training and Research Hospitalİstanbul, Turkey
| | - Aybala Tongut
- Department of Pediatric Cardiac Surgery, Koşuyolu Training and Research Hospitalİstanbul, Turkey
| | - Babürhan Özbek
- Department of Pediatric Cardiac Surgery, Koşuyolu Training and Research Hospitalİstanbul, Turkey
| | - Ömer Şavluk
- Department of Anesthesiology, Koşuyolu Training and Research Hospitalİstanbul, Turkey
| | - Abdullah Aydın
- Department of Pathology, Medeniyet University, Göztepe Training and Research Hospitalİstanbul, Turkey
| | - Hakan Ceyran
- Department of Pediatric Cardiac Surgery, Koşuyolu Training and Research Hospitalİstanbul, Turkey
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10
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Duman N, Sahin S. Lesson of the month 1: sudden onset postural livedo reticularis, cyanotic toes and multiorgan failure. Clin Med (Lond) 2014; 14:314-5. [PMID: 24889582 PMCID: PMC4952550 DOI: 10.7861/clinmedicine.14-3-314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Cholesterol embolisation syndrome (CES) is a rare but serious disease with high mortality caused by the formation of an embolus made up of cholesterol crystals from atherosclerotic plaques. Its clinical presentation is usually initially insidious and it often remains unrecognised because of its non-specific clinical presentation, which can cause delays in treatment and high mortality. The most common physical symptoms are cutaneous. We present a lethal case of CES to increase the awareness about this serious condition.
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Affiliation(s)
- Nilay Duman
- Department of Dermatology, Afyonkarahisar Government Hospital, Afyonkarahisar, Turkey
| | - Sedef Sahin
- Department of Dermatology, School of Medicine, Acibadem University, Istanbul, Turkey
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11
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Sakelliadis EI, Vlachodimitropoulos DG, Goutas ND, Panousi PI, Logiopoulou API, Delicha EM, Spiliopoulou CA. Forensic investigation of suicide cases in major Greek correctional facilities. J Forensic Leg Med 2013; 20:953-8. [PMID: 24237797 DOI: 10.1016/j.jflm.2013.08.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 08/20/2013] [Indexed: 11/18/2022]
Abstract
INTRODUCTION According to Greek legislation the medico-legal investigation of deaths occurring in prisons is mandatory. Furthermore, in cases of suicide or of suspected suicide the contribution of medico-legal investigation is of grave importance. The current paper addresses the medico-legal investigation of suicide cases in Greek correctional facilities and aims to describe the current situation. MATERIALS & METHODS Our study consists of the meticulous research in the data records of major Greek correctional facilities, for the time period 1999-2010. Official permission was obtained by the Hellenic Ministry of Justice, which provided us the access to the records. Data was also collected from the Piraeus Forensic Service, from the Department of Pathological Anatomy of the University of Athens and finally from our own records. Measures were taken to respect the anonymity of the cases. Data was collected for the social, penal, medical history as well as for the medico-legal investigation. RESULTS-CONCLUSIONS It appears that 85.7% of suicide cases were transferred to the Prisoner's Hospital (p < 0.0001), the forensic pathologist who conducted the PME did not perform scene investigation in none of the 70 suicide cases. In a total of 70 cases, histopathological examination, was requested only in 30 cases (42.9%). Hanging was the preferred method for those who committed suicide, followed by the poisoning due to psychoactive substances. Understanding the mistakes made during the forensic investigation of suicide cases inside correctional facilities is necessary, in order to prevent them from occurring again in the future, by implementing appropriate new policies and guidelines.
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Affiliation(s)
- E I Sakelliadis
- Department of Forensic Medicine & Toxicology, Medical Faculty, National & Kapodistrian University of Athens, Mikras Asias 75, Goudi, 11527 Athens, Greece.
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12
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Wendling AL, Seller A, Peterson E. Case report of a parturient with cyanotic congenital heart disease palliated with a Glenn procedure. J Clin Anesth 2012; 24:586-9. [PMID: 23101775 DOI: 10.1016/j.jclinane.2012.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2011] [Revised: 02/03/2012] [Accepted: 03/16/2012] [Indexed: 11/18/2022]
Abstract
As the prevalence of adults with palliated congenital heart disease continues to increase, so, too, does the number of these patients who will become pregnant. Practicing physicians need to be familiar with the impact that normal physiologic changes associated with pregnancy and delivery has on patients with palliated congenital heart disease. The physiologic impact of pregnancy on a patient with palliated cyanotic congenital heart disease and the management of her delivery are presented.
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Affiliation(s)
- Adam L Wendling
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL 32610-0254, USA.
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13
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Affiliation(s)
- T M Anoop
- Kottayam Medical College, Kottayam, Kerala, India.
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14
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Lee S, Ozeki T. Photo quiz. Cyanosis in an older woman. Diffuse acute limb ischemia. Am Fam Physician 2010; 81:1491-1492. [PMID: 20540487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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15
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Eren B, Turkmen N, Fedakar R, Senel B, Cetin V. Single ventricle cardiac defect. J PAK MED ASSOC 2010; 60:390-391. [PMID: 20527615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Single ventricle heart is defined as a rare cardiac abnormality with a single ventricle chamber involving diverse functional and physiological defects. Our case is of a ten month-old baby boy who died shortly after admission to the hospital due to vomiting and diarrhoea. Autopsy findings revealed cyanosis of finger nails and ears. Internal examination revealed; large heart, weighing 60 grams, single ventricle, without a septum and upper membranous part. Single ventricle is a rare pathology, hence, this paper aims to discuss this case from a medico-legal point of view.
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Affiliation(s)
- Bulent Eren
- Uludag University Medical Faculty, Forensic Medicine Department, Council of Forensic Medicine of Turkey Bursa Morgue Department, 16059, Bursa, Turkey
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Paden NE, Smith EE, Kendall RJ. Acute toxicity of 2,4,6-trinitrotoluene, 2,4-dinitrotoluene, and 2,6-dinitrotoluene in the adult bullfrog (Lithobates catesbeiana). Bull Environ Contam Toxicol 2008; 80:487-491. [PMID: 18551238 DOI: 10.1007/s00128-008-9467-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Accepted: 05/12/2008] [Indexed: 05/26/2023]
Abstract
2,4,6-Trinitrotoluene (TNT) is one of the most prevalent high explosives in the environment. 2,4-Dinitrotoluene (2,4-DNT) and 2,6-dinitrotoluene (2,6-DNT) are the most common isoforms of dinitrotoluene. The goal of this study was to determine the acute toxic effects of TNT, 2,4-DNT, and 2,6-DNT in adult male bullfrogs. The LD(50) for TNT was 1,060 mg/kg BW while the LD(50 )for 2,4-DNT and 2,6-DNT was 1,098 mg/kg BW. All three compounds elicited similar symptoms of toxicity including changes of skin color, body weight, development of seizures, liver and kidney necrosis, and lung cyanosis. Relative organ weights did not show significant change.
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Affiliation(s)
- Norka E Paden
- The Institute of Environmental and Human Health, Texas Tech University, Lubbock, Texas 79409, USA.
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17
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Krishnakumar N, Krishna MR, Tharakan JA. Right pulmonary artery-to-left atrial fistula: a differential diagnosis of cyanosis without structural heart disease. J Invasive Cardiol 2007; 19:401-2. [PMID: 17827511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
We present the case of a 19-year-old male who presented with late-onset cyanosis and a normal cardiovascular system examination. Contrast echocardiography revealed a right-to-left shunt. A right pulmonary artery-to-left atrial fistula was seen on the angiogram, which was surgically corrected. Early intervention is indicated to prevent complications in patients with this condition.
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Affiliation(s)
- Nair Krishnakumar
- Department of Cardiology, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
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18
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Affiliation(s)
- H A Martens
- University Medical Center Groningen, Groningen, The Netherlands
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19
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Inatomi J, Matsuoka K, Fujimaru R, Nakagawa A, Iijima K. Mechanisms of development and progression of cyanotic nephropathy. Pediatr Nephrol 2006; 21:1440-5. [PMID: 16902784 DOI: 10.1007/s00467-006-0220-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 05/09/2006] [Accepted: 05/09/2006] [Indexed: 10/24/2022]
Abstract
Cyanotic nephropathy (CN) is often accompanied by congenital cyanotic heart diseases (CCHD). The purpose of this study was to clarify the risk factors and the mechanisms of involved in the development and progression of CN. Thirty patients with CCHD were examined. We analyzed the risk factors for the development of CN on the basis of the clinical and laboratory findings. We also examined ten renal biopsy specimens obtained from patients with CN. Patients with CN showed significantly higher hematocrit levels than those without CN (P=0.025), although there was no difference between the two groups in terms of oxygen saturation. The renal plasma flow (RPF) in patients both with and without CN was low. However, the filtration fraction (FF) was significantly lower in patients with CN than in those without CN (P=0.001). The glomeruli of biopsy specimens with significant proteinuria (n=7) were larger than those of biopsy specimens without significant proteinuria, and there were more capillaries per glomerulus in the former than in the latter (n=3) and the control specimens (n=6) (glomerular size: P<0.01; number of glomerular capillaries: P<0.01). In conclusion, hyperviscosity by polycythemia may be responsible for the development of CN. This pathological condition may induce an angiogenic increase in the glomerular capillary beds, in turn leading to glomerulomegaly. In addition, the failure of a compensatory mechanism to respond to reduced RPF by hyperfiltration may be accompanied by the development and progression of CN.
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Affiliation(s)
- Jun Inatomi
- Department of Nephrology, National Children's Medical Center, National Center for Child Health and Development, 10-1, Okura 2-chome, Setagaya-ku, Tokyo 157-8535, Japan
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21
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Mohammad Alizadeh AH, Fatemi SR, Mirzaee V, Khoshbaten M, Talebipour B, Sharifian A, Khoram Z, Haj-sheikh-oleslami F, Gholamreza-shirazi M, Zali MR. Clinical features of hepatopulmonary syndrome in cirrhotic patients. World J Gastroenterol 2006; 12:1954-6. [PMID: 16610006 PMCID: PMC4087525 DOI: 10.3748/wjg.v12.i12.1954] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the frequency, clinical and paraclinical features of hepatopulmonary syndrome (HPS) and to determine their predictive values in diagnosis of this syndrome in patients in Iran.
METHODS: Fifty four cirrhotic patients underwent contrast enhanced echocardiography to detect intrapulmonary and intracardiac shunts by two cardiologists. Arterial blood oxygen, O2 gradient (A-a) and orthodoxy were measured by arterial blood gas (ABG) test. The patients positive for diagnostic criteria of HPS were defined as clinical HPS cases and those manifesting the intrapulmonary arterial dilation but no other criteria (arterial blood hypoxemia) were defined as lHPS cases. HPS frequency, sensitivity, positive and negative predictive values of clinical and paraclinical features were studied.
RESULTS: Ten (18.5%) and seven (13%) cases had clinical and subclinical HPS, respectively. The most common etiology was hepatitis B. Dyspnea (100%) and cyanosis (90%) were the most prevalent clinical features. Dyspnea and clubbing were the most sensitive and specific clinical features respectively. No significant relationship was found between HPS and splenomegaly, ascites, edema, jaundice, oliguria, and collateral veins. HPS was more prevalent in hepatitis B. PaO2 < 70 and arterial-alveolar gradient had the highest sensitivity in HPS patients. Orthodoxy specificity was 100%.
CONCLUSION: Clubbing with positive predictive value (PPV) of 75% and dyspnea with negative predictive value (NPV) of 75% are the best clinical factors in diagnosis of HPS syndrome. PaO2 < 70 and P (A-a) O2 > 30 and their sum, are the most valuable negative and positive predictive values in HPS patients.
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Affiliation(s)
- Amir Houshang Mohammad Alizadeh
- Research Center for Gastroenterology and Liver Disease, Shaheed Beheshti University of Medical Sciences, 7th floor, Taleghani Hospital, Yaman Str., Evin, 19857 Tehran, Iran.
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22
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Modi P, Suleiman MS, Reeves BC, Pawade A, Parry AJ, Angelini GD, Caputo M. Free Amino Acids in Hearts of Pediatric Patients With Congenital Heart Disease: The Effects of Cyanosis, Age, and Pathology. Ann Thorac Surg 2006; 81:943-9. [PMID: 16488699 DOI: 10.1016/j.athoracsur.2005.08.071] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2005] [Revised: 08/22/2005] [Accepted: 08/25/2005] [Indexed: 10/25/2022]
Abstract
BACKGROUND The immature heart has a much greater dependence than the adult heart on amino acid transamination in determining its ischemic tolerance. Compared with adult hearts, experimental models of the immature heart have quantified higher resting concentrations of free amino acids (AA) which are depleted by acute hypoxia. However, we have found no clinical studies that have looked at the free AA profile of the immature human heart or the effects of cyanosis, age, and pathology upon this. METHODS One hundred eighty-one pediatric patients (37 cyanotic, 144 acyanotic) undergoing open-heart surgery were recruited. Myocardial biopsies were collected prior to ischemia and analyzed for free AAs (eg, glutamate, aspartate) using high-performance liquid chromatography. The effects of cyanosis, age, and pathology on amino acid concentrations were estimated by multiple regression modeling with and without controlling for diagnosis; the effects of age and pathology were estimated only in acyanotic children. RESULTS Alanine concentrations were about 20% higher in cyanotic than acyanotic patients (p = 0.04). Cyanosis was not associated with any other amino acid levels. In acyanotic patients, after controlling for diagnosis, concentrations of glutamate, aspartate, and alanine decreased from birth to about 8 to 10 years, then started to increase again (p < 0.05 for both linear and quadratic terms); concentrations of taurine and the branched chain AAs decreased steadily with increasing age (p < 0.05). There were significant effects of pathology on glutamate (p = 0.006), glutamine (p = 0.003), and branched chain AA (p = 0.004) levels. CONCLUSIONS There is no evidence that chronic hypoxia depletes endogenous AAs. Young age is associated with higher resting AA levels.
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Affiliation(s)
- Paul Modi
- Bristol Heart Institute, University of Bristol, Bristol Royal Infirmary, Bristol, United Kingdom
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23
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Goodfellow RJ, Schwartz J, Leya F. BlackAorta: a rare finding at aortic valve replacement. J Invasive Cardiol 2005; 17:165-7. [PMID: 15867448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Ross J Goodfellow
- Department of Cardiology, Loyola University Medical Center, EMS Building, 6th Floor, 2160 S. First Avenue, Maywood, IL, 60153, USA.
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24
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Abstract
We report a case of thoracopagus twins undergoing magnetic resonance imaging (MRI) studies under general anesthesia. The twins had a complex shared cardiac anatomy that posed additional challenges to an already-difficult anesthesia care area. This report emphasizes the approach to anesthetic management of conjoined twins in the MRI environment.
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Affiliation(s)
- Erik Shank
- Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston, Massachusetts
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25
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Affiliation(s)
- Susan F McAllister
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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26
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Affiliation(s)
- Marilyn J Siegel
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, 510 S Kingshighway Blvd., St. Louis, MO 63110, USA
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27
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Amital H, Applbaum YH, Vasiliev L, Rubinow A. Hypertrophic pulmonary osteoarthropathy: control of pain and symptoms with pamidronate. Clin Rheumatol 2004; 23:330-2. [PMID: 15293094 DOI: 10.1007/s10067-004-0941-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2004] [Accepted: 04/06/2004] [Indexed: 02/06/2023]
Abstract
This case presents a patient with hypertrophic osteoarthropathy of the lower extremities that developed secondary to congenital cyanotic heart disease. The major clinical manifestation was severe bilateral leg pain. The pain that was debilitating in nature completely resolved following a single administration of 60 mg pamidronate. Hypertrophic osteoarthropathy (HOA) is an acquired, uncommon disorder of obscure etiology. It has been described mainly in association with chronic suppurative pulmonary diseases, bronchogenic carcinoma and lung metastases, cystic fibrosis, and cyanotic congenital malformations of the heart.
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Affiliation(s)
- Howard Amital
- Rheumatology Unit, Department of Radiology and Division of Internal Medicine, Hadassah-Hebrew University School of Medicine, Ein-Karem, POB 12000, 91120 Jerusalem, Israel.
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28
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Kothari SS, Goyal NK. Anomalous origin of the pulmonary artery from the left coronary artery. Heart 2003; 89:1436. [PMID: 14617556 PMCID: PMC1767967 DOI: 10.1136/heart.89.12.1436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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29
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Medical image. Disabling acrocyanosis. N Z Med J 2003; 116:3 p following U520. [PMID: 12901363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
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30
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Abstract
We report a male newborn infant of Chinese descent with the Smith-Magenis (SMS) syndrome who presented with a severe cyanotic congenital heart disease. This report adds pulmonary atresia and ventricular septal defect to the spectrum of cardiac defects seen in SMS.
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Affiliation(s)
- Janice Tzen-Yuen Wong
- Department of Paediatric Medicine, KK Women's and Children's Hospital, 100 Bukit Timah Road, Singapore 229899
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31
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Abstract
Acrocyanosis is an uncommon condition characterized by symmetric coolness and violaceous discoloration of the hands and feet. The nose, ears, lips, and nipples are also often affected. The disease is temperature dependent and generally worsens with cold exposure. Acrocyanosis is often secondary to a variety of underlying causes. We present a very interesting case of a 44-year-old woman with almost lifelong idiopathic acrocyanosis. Differential diagnoses are discussed in this article.
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Affiliation(s)
- H C Nousari
- Department of Dermatology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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32
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Starnes SL, Duncan BW, Kneebone JM, Rosenthal GL, Patterson K, Fraga CH, Kilian KM, Mathur SK, Lupinetti FM. Angiogenic proteins in the lungs of children after cavopulmonary anastomosis. J Thorac Cardiovasc Surg 2001; 122:518-23. [PMID: 11547304 DOI: 10.1067/mtc.2001.115423] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Pulmonary arteriovenous malformations may cause progressive cyanosis after cavopulmonary anastomosis and may develop as a result of abnormal angiogenesis. We used immunohistochemistry to determine whether angiogenic proteins are increased in the lungs of children after cavopulmonary anastomosis. METHODS Lung specimens were obtained from 13 children after cavopulmonary anastomosis and from 6 control subjects. Specimens were stained with antibodies against vascular endothelial growth factor and its receptor (flk-1/KDR), basic fibroblast growth factor, alpha-smooth muscle actin, CD31, collagen IV, fibronectin, and proliferating cell nuclear antigen. Staining was graded on a scale of 0 to 3. Vessels positive for proliferating cell nuclear antigen were counted in 10 fields per specimen, and the results were averaged. RESULTS After cavopulmonary anastomosis, patients demonstrated increased staining for vascular endothelial growth factor (P =.03) and its receptor (P =.03) and decreased staining for CD31 (P =.004). Proliferating cell nuclear antigen staining in patients was equivalent to that for control subjects (P =.9). CONCLUSIONS Lung biopsy specimens from children after cavopulmonary anastomosis demonstrate increased expression of vascular endothelial growth factor and its receptor. These data confirm earlier findings that blood vessels forming after cavopulmonary anastomosis may have reduced intercellular junctions (decreased CD31 staining). Despite the increased numbers of pulmonary vessels that are present in these patients, these vessels are not highly proliferative (proliferating cell nuclear antigen staining equivalent to that of control subjects). These results suggest that vascular endothelial growth factor may be a mediator of angiogenesis in the lungs of children after cavopulmonary anastomosis; however, other factors, such as vascular dilation and remodeling, may also be important.
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Affiliation(s)
- S L Starnes
- Division of Cardiac Surgery, Children's Hospital and Regional Medical Center, Seattle, Wash, USA
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33
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Ligeron C, Stoebner P, Ribeyre C, Meynadier J, Meunier L. [Erythrocyanosis]. Ann Dermatol Venereol 2001; 128:925-6. [PMID: 11590346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Affiliation(s)
- C Ligeron
- Service de Dermatologie, Centre Hospitalier Carémeau, 30900 Nîmes
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34
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Abstract
We present evidence of 2 distinct glomerular abnormalities in cyanotic congenital heart disease--vascular and nonvascular--each believed to reflect a distinct pathogenesis. Glomeruli from both kidneys were studied with light microscopy in 13 necropsied cyanotic patients and in 8 controls. The vascular study characterized hilar arteriolar dilatation, capillary diameter, glomerular diameter, and capillary engorgement with red blood cells. The nonvascular study characterized juxtaglomerular cellularity, mesangeal cellularity, mesangeal matrix, focal interstitial fibrosis, and megakaryocytic nuclei per cm2 of renal cortex. There was a significant increase in each of the above vascular and nonvascular items of interest relative to controls. Electron microscopy identified whole megakaryocytes with their cytoplasm in glomeruli. The vascular abnormality is believed to result from intraglomerular release of nitric oxide. The nonvascular abnormality is believed to result from platelet-derived growth factor and transforming growth factor-beta.
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Affiliation(s)
- J K Perloff
- Department of Medicine, and the Ahmanson Adult Congenital Heart Disease Center, University of California at Los Angeles, USA.
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35
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Mallia JG, Hunter B, Vaillancourt JP, Irwin R, Muckle CA, Martin SW, McEwen SA. Bacteriological and histological profile of turkeys condemned for cyanosis. Poult Sci 2000; 79:1194-9. [PMID: 10947191 DOI: 10.1093/ps/79.8.1194] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Canadian Food Inspection Agency (CFIA) has adopted the term cyanosis to describe a category of condemnation for poultry that is dark but has no other condemnable lesions. Two case-control studies (n = 30 pairs; n = 65 pairs) of 18-wk-old tom turkeys were conducted. A case was defined as a carcass condemned by the veterinary inspector for cyanosis, and a control carcass was one that passed inspection. Microbiological tests were conducted on samples of Pectoralis major and Gastrocnemius lacteralis. A modified Rappaport Vassiliadis medium was used for Salmonella, and a Petrifilm method was used to assess aerobic counts, coliform counts, and Escherichia coli. The Salmonella (qualitative) test was negative for all cases and controls, and there were no significant differences between the aerobic counts, coliform counts, and E. coli counts of case and control carcasses. Two pathologists conducted a blind histopathological study: there were no lesions compatible with those of septicemia-toxemia, as defined by CFIA and the USDA, nor any significant histopathological differences between the skin, P. major, G. lateralis, kidney, liver, spleen, small intestine, pancreas, lung, and heart of cases and controls. The inter-rater agreement between pathologists ranged from good to excellent (Kappa = 0.7 to 1.0). In the absence of important lesions and microbial contamination, carcasses with this color change alone should be suitable for human consumption.
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Affiliation(s)
- J G Mallia
- Department of Population Medicine, University of Guelph, Canada
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36
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Abstract
Although fetal breathing movements are required for normal lung development, there is uncertainty concerning the specific effect of absent fetal breathing movements on pulmonary cell maturation. We set out to evaluate pulmonary development in a genetically defined mouse model, the myogenin null mouse, in which there is a lack of normal skeletal muscle fibers and thus skeletal muscle movements are absent in utero. Significant decreases were observed in lung:body weight ratio and lung total DNA at embryonic days (E)14, E17, and E20. Reverse transcriptase/polymerase chain reaction, in situ immunofluorescence, and electron microscopy revealed early lung cell differentiation in both null and wild-type lungs as early as E14. However at E14, myogenin null lungs had decreased 5'-bromo-2-deoxyuridine incorporation compared with that of wild-type littermates, whereas at E17 and E20, increased Bax immunolabeling and terminal deoxyribonucleotidyl transferase-mediated dUTP-biotin nick-end labeling staining were detected in the myogenin null mice but not in the wild-type littermates. These observations highlight the importance of skeletal muscle contractile activity in utero for normal lung organogenesis. Null mice lacking the muscle-specific transcription factor myogenin exhibit a secondary effect on lung development such that decreased lung cell proliferation and increased programmed cell death are associated with lung hypoplasia.
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Affiliation(s)
- B S Tseng
- Department of Neurology, University of Texas at Houston Medical School, USA
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37
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Kobayasi T, Ullman S. Twisted collagen fibrils in acrocyanosis. Eur J Dermatol 1999; 9:285-8. [PMID: 10356406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Essential acrocyanosis (EA) present as a dusky discoloration of the hands as the sole symptom without any other abnormal results from laboratory investigation. Previously, the authors have found twisted collagen fibrils (TCF) in the normal skin of an EA patient. This study was intended to evaluate the significance of TCF in EA. Thirteen patients showing dusky discoloration were randomly selected and studied for TCF in normal skin by routine electron microscopy. TCF were found in 10 of 13 patients; 3 patients with only the discoloration (EA), 3 with the mild symptoms which were supposed to be Ehlers-Danlos syndrome (EDS), 1 with definite symptoms of EDS, 1 with Raynaud's disease and 2 with hyperglobulinemia. TCF were the ultrastructural sign for inherited malformation of collagen fibrils. EA was probably elucidated as a vascular disorder in TCF-carrying people. EA could be included in the disease category of EDS but it seems unreasonable to force EA patients into one of the subtypes of EDS. For pathogenesis, the inherited dysfunction in the hypertrophic pericytes of the subpapillary vascular plexus was presumed.
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Affiliation(s)
- T Kobayasi
- Departement. of Dermatology, University of Copenhagen, Bispebjerg Hospital, Bispebjerg Bakke 23, Copenhagen NV. 2400 Denmark
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38
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39
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Cluroe AD. Test and teach. Number eighty eight: alveolar capillary dysplasia. Pathology 1998; 30:155, 205-6. [PMID: 9643494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- A D Cluroe
- Department of Pathology, Auckland University School of Medicine, New Zealand
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40
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Abstract
Previous work has demonstrated that vitamin A-deficient, retinoic acid-supplemented pregnant rats cannot complete gestation without the administration of retinol. As little as 2 micrograms administered on day 10 of gestation is sufficient to prevent the characteristic fetal resorption that begins at day 15 of gestation. This single dose of retinol supports continued development through day 20 of gestation. However, if gestation is allowed to proceed to parturition, the newborn pups die within a few minutes of being severed from the umbilical cord. The pups are born with a pink and healthy skin tone, but within seconds of umbilical separation, they begin to gasp for air, become cyanotic in appearance, and die within several minutes from an apparent inability to obtain oxygen. Histological examination of these neonates demonstrates delayed pulmonary development. Branching and scalloping of ducts and saccule and subsaccule formation are decreased. This phenotype is consistent with that observed in respiratory distress syndrome seen in some premature human infants.
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Affiliation(s)
- D M Wellik
- Department of Biochemistry, University of Wisconsin-Madison 53706, USA
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41
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Vayssairat M, Abuaf N, Deschamps A, Baudot N, Gaitz JP, Chakkour K, Nussaume O. Nailfold capillary microscopy in patients with anticardiolipin antibodies: a case-control study. Dermatology 1997; 194:36-40. [PMID: 9031789 DOI: 10.1159/000246054] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND AND DESIGN This case-control study was undertaken to determine whether anticardiolipin antibodies (ACA) are responsible for particular abnormalities in nailfold capillary microscopy (NCM). Cases comprised 33 consecutive patients positive for ACA (24 women and 7 men). Controls comprised the same number of ACA-negative patients, with the same sex ratio, the same diagnosis and the most similar duration of disease possible. Clinical data, serum samples and NCM recordings were obtained from all patients and controls. RESULTS In each group, 22 patients had connective-tissue-related disorders and 11 various other diseases. In ACA-positive patients, the mean IgG ACA titre was 39 +/- 58 IgG phospholipid units. Cases and controls displayed various cutaneous manifestations. In ACA-positive patients, there were Raynaud's phenomenon (54%), cutaneous vasculitis (24%), scleroderma changes (18%), photosensitivity (9%), a history of digital gangrene (6%), malar rash (6%), acrocyanosis (6%), chilblains (3%), livedo reticularis (3%) and purpura (3%). Cases and controls exhibited numerous NCM abnormalities. In ACA-positive patients, they included haemorrhages (54%), oedema (24%), bushy capillaries (21%), disordered capillaries (18%), capillary bed disorganization (12%), capillary rarefaction (9%), giant capillaries (6%) and 'desert areas' (3%). There were no correlations between the ACA titres on the one hand and the number of cutaneous manifestations or NCM abnormalities on the other. CONCLUSIONS ACA-positive patients frequently exhibit clinical skin lesions and abnormal NCM. In this study, these lesions and NCM abnormalities resembled those of the matched ACA-negative controls.
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Affiliation(s)
- M Vayssairat
- Laboratory for Research in Microcirculation, Tenon Hospital, Paris, France
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42
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Wilmshurst P, Da Costa P. Probable right ventricular dysplasia and patent foramen ovale presenting with cyanosis and clubbing in a patient with characteristics of Noonan syndrome. Heart 1995; 74:471-5. [PMID: 7488469 PMCID: PMC484061 DOI: 10.1136/hrt.74.4.471] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Probable right ventricular dysplasia and a patent foramen ovale resulted in cyanotic heart disease in a patient with some characteristics of Noonan syndrome.
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43
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Abstract
The morphological findings of the carotid bodies of two cases with cyanotic heart disease are presented. The first case, a 14-year-old girl with atrial and ventricular septal defect accompanied with atresia of the tricuspidal valve showed a life-long history of pulmonary hypertension and hypoxaemia. The carotid bodies were not enlarged, but the diameters of the glomic lobules were increased and its margins were sometimes blurred. There was a marked increase of glomic tissue within the carotid bodies. The ratio of chief to sustentacular cells remained unchanged. The second case, a 59-year-old man with a double inlet left ventricle, had a history of pulmonary hypertension and hypoxaemia of more than 23 years. The carotid bodies as well as the diameters of the glomic lobules were much more enlarged than in case one. There was an increase of glomic tissue within the carotid bodies, too. The histological examination showed a marked increase of sustentacular and Schwann cells. These results show that the findings of carotid bodies in cyanotic heart diseases may be different depending on the duration of hypoxaemia.
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Affiliation(s)
- J O Habeck
- Institute of Pathology, Klinikum Chemnitz gGmbH, FRG
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44
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Habeck JO, Pallot DJ, Abramovici A. The effects of chronic hypoxaemia upon the structure of the human carotid body. Adv Exp Med Biol 1993; 337:37-41. [PMID: 8109424 DOI: 10.1007/978-1-4615-2966-8_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- J O Habeck
- Inst. Pathology, Städtische Kliniken, Chemnitz, Germany
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45
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46
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Abstract
We describe three persons in one family with diffuse lung infiltrates, digital clubbing, and chronic hypoxia. Elevated immunoglobulin levels and antinuclear antibodies were found in all patients; pathologic findings included hyperplastic lymphoid follicles infiltrating the epithelium of the small airways. These cases may represent a familial systemic autoimmune disorder seen primarily with pulmonary compromise.
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Affiliation(s)
- L M Franchi
- Pediatric Pulmonary and Critical Care Division, Memorial Miller Children's Hospital, Long Beach, CA 90801
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47
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Abstract
The mechanism of recurrent cyanotic episodes in infants and children is not known, but a deficiency of surfactant is a possible cause. We have measured the amount of surfactant collected by bronchoalveolar lavage from two children with recurrent cyanotic episodes and from two controls with anatomical airway obstructions. We also assessed the physical properties of the surfactant by changing the surface area (A) of a monolayer and measuring its surface tension (gamma). The cases had lower amounts of surfactant extracted, which could explain some of the abnormalities of the gamma/A loops. However, the finding that the cases had reversed loops (ie, the surface tension is higher during monolayer compression than during expansion) shows that there is also a qualitative abnormality. These features suggest a possible diagnostic test if not a mechanism for this disorder.
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Affiliation(s)
- B A Hills
- Mater Children's Hospital, South Brisbane, Queensland, Australia
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48
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Zhou ZY, Rickard TA, Nichter LS, Zemel NP, Ashworth CR, Kassabian G. Restoration of venous outflow by simultaneous creation of an arteriovenous shunt and pedicle flap using a rat model of foot replantation. Microsurgery 1992; 13:48-55. [PMID: 1588810 DOI: 10.1002/micr.1920130112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Replantation of amputated rat feet utilizing an efferent arteriovenous shunt constructed between the distal posterior tibial artery and the proximal posterior tibial vein, in the absence of all other venous drainage, provides an alternative pathway to the normal venous drainage in a replanted rat foot. However, this substitute venous drainage was insufficient to prevent progressive ischemia and necrosis of some or all of a replanted rat foot. When a cutaneous pedicle flap supplemented the arteriovenous shunt, venous drainage was much improved, tissue hypoxia and edema began to subside on the third day, severe tissue necrosis was prevented, and seven of eight feet replanted by this technique survived. These observations may be useful in replantation in humans when veins in the amputated part are too small to be used or so damaged that they cannot be repaired or reconstructed by a vein graft, but arteries can still provide a means of returning blood from the amputated part. Constructing an alternative pathway to the normal venous drainage pattern may allow severely damaged parts to survive after replantation.
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Affiliation(s)
- Z Y Zhou
- Division of Plastic Surgery, University of Southern California, School of Medicine, Childrens Hospital Los Angeles
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49
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Affiliation(s)
- M Bigby
- Beth Israel Hospital, Boston, Mass
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50
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Lee YS, Chen YC. Alterations of ultrastructures and anionic sites in basement membranes of myocardial cells and capillaries in patients with cyanotic congenital heart disease due to tetralogy of Fallot. Jpn Heart J 1987; 28:333-47. [PMID: 3626020 DOI: 10.1536/ihj.28.333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Electron microscopic cytochemical studies of the basement membranes of myocardial cells and capillaries were performed in 13 patients with tetralogy of Fallot who were divided into 2 groups. Group 1 included 7 patients in the early stage of the disease, ranging in age from 7 months to 5 years. Group 2 consisted of 6 patients in the far advanced stage of the disease, ranging in age from 30 to 46 years. The operatively excised infundibular muscles of the right ventricle were prepared for conventional electron microscopy and electron microscopic cytochemistry. The anionic sites in the basement membranes were characterized by cationic polyethyleneimine. The basement membrane ultrastructures of the myocardial cells and capillaries in the early stage of tetralogy of Fallot showed no apparent alterations with regular distribution of anionic sites, particularly in the external lamina of the basement membranes. In contrast, irregular thickening, wide splitting and lamination of the basement membranes of myocardial cells and capillaries, always associated with derangement and focal loss of anionic sites in the membranes were consistently observed in the far advanced stage of tetralogy of Fallot. The aforementioned results suggest that altered surface membrane integrity of myocardial cells and capillaries resulting from pathologic changes of the basement membranes are an important pathogenetic mechanism responsible for progressive degeneration of infundibular muscle cells and myocardial dysfunction in the course of tetralogy of Fallot.
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