Recurrent respiratory papillomatosis complicated by aspergillosis: a case report with review of literature.

Pulmonary extension of recurrent invasive papillomatosis often poses a diagnostic challenge to the examining bronchoscopist, pathologist, radiologist and surgeon, in distinguishing it as a benign lesion that is confined to the mucosa and extending along the branches of the tracheobronchial tree from true invasion of a malignant tumor. We document here a case of recurrent invasive respiratory papillomatosis which initially presented as a laryngeal papilloma. After multiple recurrences, the patient presented with bronchopulmonary involvement, complicated by invasive aspergillosis in a non-immunocompromised setting.

An outbreak of extended spectrum beta-lactamase producing Klebsiella pneumoniae in a neonatal intensive care unit.

Klebsiella pneumoniae has long been a prominent cause of nosocomial infections and outbreaks have been observed in the intensive care units and in high risk groups. We present here a brief report on an outbreak of Klebsiella pneumoniae which occurred in a neonatal intensive care unit in our teaching hospital. As neonates are at highest risk for acquisition of Klebsiella pneumoniae producing extended spectrum beta-lactamase, infection control policies and procedures should be strictly followed to prevent such outbreaks.

Cardiac tumors.

Primary cardiac tumours of the heart are rare. Primary cardiac neoplasms are benign in 75% cases. Among the benign lesions about 40% are myxomas. Approximately 25% of primary cardiac neoplasms are malignant and almost all are sarcomas and lymphomas of varying types. Clinical evaluation has been augmented by echocardiography, angiography, radionuclide studies, computed tomography and magnetic resonance imaging. Benign tumours are amenable to resection and in selected patients with malignant cardiac disease surgical intervention may be feasible.

Surgical experience with congenital heart disease in Down's syndrome.

Children with Down's syndrome and congenital heart defects have multiple problems. The role of cardiac surgery in the management of these patients was investigated by reviewing the clinical data, hospital course and follow-up of 21 patients (9 males and 12 females, age range 1 month to 14 years) with Down's syndrome and congenital heart defects operated in our institute. Twelve (57%) of these were infants and nine (43%), older children. Five were in congestive cardiac failure, four were hypothyroid. The heart lesions ranked in incidence as follows: atrioventricular septal defect 7 (33.3%), tetralogy of Fallot 3 (14.3%), tetralogy of Fallot & atrioventricular septal defect both 2 (9.5%), double outlet right ventricle with pulmonary stenosis 1 (4.8%), patent ductus arteriosus 2 (9.5%), patent ductus arteriosus plus coarctation 1 (4.8%), ventricular septal defect 2 (9.5%), atrial septal defect plus ventricular septal defect 1 (4.8%), atrial septal defect plus patent ductus arteriosus plus right pulmonary artery stenosis 1 (4.8%) and transposition of great arteries with multiple ventricular septal defect 1 (4.8%). Four (19%) patients had palliative procedures while the rest (81%) underwent primary repair. All survived the operation. The post-operative period was complicated in 6 (28.5%), with respiratory infections in 3, pulmonary hypertensive crisis in 2 and complete heart block in 1. The early mortality was 0, while there were 2 (9.5%) late deaths. The number of hospitalisations was markedly reduced according to the parents. Follow-up showed near normal pulmonary artery pressure in 50 percent children with large shunts and a good developmental spurt was seen in 60 percent. From a purely surgical viewpoint, the prognosis for children with Down's syndrome and congenital heart disease is good.

Prazosin na hipertensão arterial essencial moderada e severa, não controlada com clortalidona. Estudo multicentrico / Prazosin in moderate or severe essential arterial hypertension, non-controlled with chlorthalidone. A multicentric study

Estudo multicentrico abrangendo 19 centros de cardiologia e incluindo 398 casos de hipertensao essenciais (hipertensao moderada ou grave), foi desenvolvido em tres etapas (fases I, II e III). Na 1a. utilizou-se a clortalidona; na 2a., clortalidona 50 mg + prazosin em doses crescentes ate 15 mg/24h e, na 3a., clortalidona 50 mg +prazosin 15mg + propranolol em doses progressivas ate 240mg/24h, enquanto nao se obtivesse a normalizacao tensional. 306 pacientes foram tratados na fase II e,destes 76,5% normalizaram a PA. Quarenta hipertensos cumpriram a fase III, obtendo-se normalizacao tensional em 60% dos mesmos.A frequencia cardiaca nao apresentou variacoes significativas nas fases I e II, nao ocorrendo o mesmo na fase III. Ocorreram reacoes adversas na fase I, responsaveis por 5 casos de exclusao; na fase II foram excluidas 24 pacientes, 14 por "tontura" que constituiu a manifestacao adversa mais importante. Nesta fase, predominaram reacoes de leve intensidade e sua ocorrencia verificou-se na primeira e segunda semanas de prazosin. Controles laboratoriais revelaram variacoes discretas da potassemia, uremia, creatinemia e uricemia nas fases I e II proprias do emprego da clortalidona. Nao houve modificacao significativa da colesterolemia e trigliceridemia em nenhumas das fases