Ovarian teratoma-associated anti-NMDAR encephalitis in a 12-year-old girl

@#The association of ovarian teratoma and anti-N-Methyl-Daspartate receptor (anti-NMDAR) is one of the most common autoimmune encephalitis syndromes and it is a serious and potentially fatal pathology that occurs in young women. This case report describes of a pediatric patient with anti-NMDAR encephalitis. A-12-year-old girl presented with abnormal behavior for one week came to Emergency Department of Sarawak General Hospital, Malaysia. She had psychotic spectrum symptoms including suicidal tendency. She was diagnosed with anti-NMDAR encephalitis as positive antibody was seen in her cerebrospinal fluid. She was treated with Injection Immunoglobulin. She turned out to have teratoma which was successfully removed later. Her progress was remarkable after the surgery with the Immunoglobulin. A multi-disciplinary team involving a psychiatrist, neurologist and gynaecologist liaised with intensivist to successfully manage the case and achieve the good outcome.

Uterine artery pseudoaneurysm: A case of late intraabdominal haemorrhage after caesarean section

@#Uterine artery pseudoaneurysm (UAP) is a rare acquired vascular malformation associated with vaginal bleeding or intraabdominal haemorrhage occurring after pelvic surgery. Pseudoaneurysm may present with delayed, severe haemorrhage after a seemingly uncomplicated initial postoperative period. Treatment is therefore necessary to prevent further complications. We describe here a case of a 32-year-old mother, who presented with abdominal pain and intraabdominal bleeding, 20 days after Caesarean Section. Computerised Tomography (CT) scan showed the presence of haemoperitoneum, suggestive of pseudoaneurysm at the right cervical artery which was successfully managed with emergency angiographic embolisation.

Inhibitory effects of endocannabinoid on the action potential of pacemaker cells in sinoatrial nodes of rabbits / 生理学报

Endocannabinoid anandamide (AEA) has protective effect on the heart against ischemia/reperfusion injury and arrhythmia, but the electrophysiological mechanism is unclear yet. In this study, the sinoatrial node (SAN) samples from New Zealand rabbits were prepared, and intracellular recording technique was used to elucidate the effect of AEA on the action potential (AP) of SAN pacemaker cells of rabbits and the mechanism. Different concentrations of AEA (1, 10, 100, 200, 500 nmol/L) were applied cumulatively. For some SAN samples, cannabinoid type 1 (CB1) receptor antagonist AM251, cannabinoid type 2 (CB2) receptor antagonist AM630, potassium channel blocker tetraethylammonium (TEA) and nitric oxide (NO) synthase inhibitor L-nitro-arginine methylester (L-NAME) were used before AEA treatment, respectively. We found that: (1) AEA (100, 200 and 500 nmol/L) not only shortened AP duration (APD), but also decreased AP amplitude (APA) (P < 0.05). (2) AM251, but not AM630, abolished the effect of AEA on APD shortening. (3) TEA and L-NAME had no influence on the AEA effect. These findings suggest that anandamide can decrease APA and shorten APD in SAN pacemaker cells of rabbits, which may be mediated by activation of CB1 receptors, and is related to blockade of calcium channels but not potassium channels and NO.

Major Determinants and Long-Term Outcomes of Successful Balloon Dilatation for the Pediatric Patients with Isolated Native Valvular Pulmonary Stenosis: A 10-Year Institutional Experience

PURPOSE: We report herein major determinants and long- term outcomes of balloon dilatation (BD) for 27 pediatric patients with isolated native valvular pulmonary stenosis (VPS). MATERIALS AND METHODS: From May 1997 to May 2003, 27 pediatric patients with VPS (pressure gradients> or =40mmHg) were enrolled in this retrospective study. Single-balloon maneuver was applied in 26 patients, and double- balloon maneuver in 1. After BD, the pressure gradients were documented simultaneously by pullback maneuver by cardiac catheterization and echocardiography within 24 hours, at 1- month, 3-month, 1-year, and 4-to-10-year follow-ups. RESULTS: Before BD, the echocardiographic gradients ranged from 40 to 101mmHg (61+/-19, 55), and from 40 to 144mmHg (69+/-32, 60) by pressure recordings. After BD, the gradients ranged from 12 to 70mmHg (29+/-13, 27) by pressure recording (p<0.001), and from 11 to 64mmHg (27+/-12, 26) by echocardiography within 24 hrs (p<0.001). The ratios of the systolic pressure of the right ventricle to those of the left ventricle were 55 to 157% (89+/-28, 79%) before BD, and 30 to 79% (47+/-13, 42%) after BD p<0.001). Follow-up (7.7+/-5.7, 4.5 years) echocardiographic gradients ranged from 11 to 61mmHg (25+/-11, 24). Two patients did not have immediate success owing to infundibular spasm. Improved right ventricular compliance could be accounted for the ultimate success in these 2 patients. The ultimate successful rate was 100%. CONCLUSION: BD can achieve excellent long-term outcomes in the pediatric patients with isolated native VPS.

A study of Nerve conduction in patients with chronic renal faillure

Background: Many patients with chronic renal failure have abnormalities in central and nervous system function. The majority of patients are asymptomatic, requiring electrophysiologic testing to confirm the abnormality. Slowingof nerve conduction velocity frequently occurs without signs and symptoms of neurophysiological changes of the peripherial nerves in patients with chronic renalfailure. Methods: A Study of motor and sensory conduction in median and ulnar nerves was done on 22 patients, five males and seventeen femal (age range 18-75 years), with chronic renal failure. Inclusion criteria for this study were known cases of chronic renal failure, from Renal Medical Unit, Mandalay General Hospital, with persistent high serum ureas level more than 10mmo/L (at least 2 weeks apart) and ultrasonographic changes. Twenty-five normal subjects of comparable ageserved as controls. Results: Ten of the patients had clinical signs and symptomsof early peripheral neuropathy, such as decreased deep tedon reflexes or minimunsensory loss in lower and upper extremities. In patients with chronic renal failure, values of median and ulnar MNCV were found tp be 48.46+-4.1m/sec and 51.17+-4.28 m/ sec respectively. Nerve conduction velocities, motor as well as sensorywere found to be significantly reduced in chronic renal failurw patients compared to those of normal subjects (p<0.001). There was significant negative correlation between serum creatinine and motor and sensorry conduction velocities of both nerves in chronic renal failure patients. But,no significant correlation was foud between blood urea and nerve condiuction velocities.

Chlamydial infection among obstetrics and gynaecological patients of Mandalay General Hospital

Objective: To determine the prevalence rate of genital Chlamydial infection among hospital patients and their distribution by age, socio-demographic profile and complications. Methods: 140 obstetric and gynaecological patients from Mandalay General Hospital were studied in November 1993. Cervical swabs were tested with IDEA tm test for Chlamydial antigen and confirmed by Confirmatory IDEA tm Confirmatory test when positive. Data collection was by interview using a structured questionnarie. Results: The overall prevalence rate of genital Chlamydial infection was 6.42

, 5.71

for antenatal and 7.14

for gynaecological patients. Prevalence rate was highest in 30-39 age group and lower occupational grades, and in parity 5 and above, and associated with OCS ever users, PROM, and abortion, PID, infertility,cervical ectopy, cervicitis and mucopurulent discharge in 7.69

, 11.76

, 7.14

, 18.18

, 11.11

and 11.11

respectively. There were 82 patients with no discharge and 7.31

tested positive. Out of 9 infected cases, 6had no discharge and in 4, the cervix looked healthy. There were no associated gonococal infection and there was no false positive result. Conclusion: This study shows the need for being always alert to the possibility of infection even in the asymptomatic patients.