Streptococcus Constellatus Community Acquired Pneumonia with Subsequent Isolated Pulmonic Valve Endocarditis and Abscess Formation in a Structurally Normal Heart

Pulmonic valve infective endocarditis in isolation is a rare clinical entity. The formation of an abscess in the right ventricular outflow tract as a consequence of vegetations affecting the pulmonic valve in a structurally normal heart is extremely rare and has not been reported. We report a case of isolated pulmonic valve endocarditis complicated by a regional abscess formed within the right ventricular outflow tract caused by Streptococcus Constellatus (S. Constellatus), a member of the Streptococcus Milleri group in a young male whose risk factor was alcohol abuse and he was treated medically, a comprehensive literature review on the subject is also reported. Our case is the first reported in literature with infective endocarditis caused by S. Constellatus affecting the pulmonic valve, and the first with pulmonic valve endocarditis and perivalvular abscess formation in a structurally normal heart.

Effect of low-level laser therapy on cholesterol and triglyceride serum levels in ICU patients: a controlled, randomized study

High cholesterol serum levels increases risk of coronary artery disease. To reduce this risk, statins, which is not devoid of side effects in ICU patients, have been prescribed to inhibit the enzyme responsible for cholesterol synthesis. It was proposed that Low-level laser therapy [LLLT] may reduce cholesterol and triglyceride serum levels. This randomized, controlled study investigates the influence of LLLT on the noninvasive reduction of cholesterol and triglyceride serum levels in ICU. Twenty ICU patients, 10 in each group, were enrolled in the study. The study group used ilipo LLLT device with 4 laser pads strapped around patient abdomen emitting 650-660 nm [red] laser light. The control group received sham laser. The laser therapy sessions were done for 55 minutes, twice weekly for two successive weeks with 3 days between sessions. Blood samples were drawn prior to the laser administration. A standard lipid panel was studied before the procedure to establish a baseline and at the end of the second procedure week. The serum triglyceride and total cholesterol and low and high density lipoproteins levels before and after the LLLT were compared. The total cholesterol and serum triglycerides levels in the study group revealed a statistically significant mean change of-15.43 and -13.7 respectively between study baseline and endpoint [P <0.05]. The potential application of the noninvasive chemical-free LLLT for cholesterol and triglyceride reduction tended to show favorable results in ICU patients

Bone removed in two different concepts of Hip bone conservative arthroplasty

Bone saving remains a priority in hip arthroplasty. Birmingham hip resurfacing [BHR] and thrust plate arthroplasty [TPA] are two different designs aiming at bone conservation. By measuring bone removed intraoperatively during 11 BHR, eight TPA and a control group of 15 hybrid hip arthroplasty it was found that BHR and TPA saved significant amount of bone if compared to hybrid hip arthroplasty [ANOVA p < 0.001]. Comparing BHR with TPA; BHR saved a significant amount of bone on the femoral side [ANOVA p < 0.001] while TPA saved a significant amount of bone on the acetabular side [ANOVA p = 0.03]. Preference between the two designs will depend on the long-term results and the degree of bone loss resulted from loosening and osteolysis at revision operation

Predictors affecting the results of impaction grafting for revision hip surgery

Twenty eight consecutive hips in 28 patients were evaluated at an average 47 months [range 30-75 months] after revision hip surgery reconstructed with impaction grafting. The principle revision procedure was the first revision in 20 hips [71.4%], the second revision in 4 [14.3%] hips, and the third revision in 4 hips. A collarless double tapered polished stem [CPT; Zimmer, Warsaw, Indiana] was used in 24 femora [85.8%]. Harris hip score was used to evaluate the function of the hip postoperatively. Implant migration was measured using Oswestry Roentgen Monophotogrammetric analysis software [ORMA]. By the time offollowup three hips [10.7%] had been re-revised. Two hips because of periprosthetic fracture femur and one because of recurrent dislocations. On the femora side significant correlations were found between stem tilt and two predictors: the number of previous revisions [p = 0.03] and the degree of femoral bone loss [P = 0.04]. Significant correlation was found between post operative pain and three predictors: vertical cup migration [p = 0.05], graft incorporation [p = 0.05] and the degree of pre-operative acetabular bone deficiency. [p = 0.024]. This study shows durable results using impaction grafting and identified the degree of bone loss, number of re-revision, and cup migration as important predictors in impaction grafting

Elastic intramedullary titanium rod fixation of paediatric forearm fractures

Fourteen patients with unstable fractures of both bones of the forearm were treated with flexible titanium intramedullary nails during the period from January 2000 through July 2001. The mean age of the studied group was 8.4 years. Ten patients were treated by closed reduction under image intensifier, while four needed open reduction to allow insertion of the nails. Full union was achieved at a mean time of 12.5 weeks ranging from 10 to 16 weeks. There were no recorded cases of re-displacement or nonunion. All cases healed with good alignment less than 5 degrees of angulation. Pull range of motion at wrist, elbow and radioulnar joints were achieved in all patients except one [7.2%] who had ten degrees limitation of supination

Autograft of tibial deffects in primary total knee arthroplasty: reliability and cost effecticeness

Twenty-one cases of advanced arthritis of the knee with tibial bone loss and varus angle greater than 15 degrees were treated by total knee arthroplasty with autogenous bone graft to fill the tibial defect. All operations were performed at El-Hadara university hospital and Karmouse insurance hospital, Alexandria, Egypt. This study was 4 carried out in the period from July 1999 through March 2005. The average age at the time of surgery was 64.7 years. The primary diagnosis was osteoarthritis in eighteen cases [85.7%], rheumatoid arthritis in one case [4.8%], and post traumatic in two cases [9.5%.]. The mean period of follow up was 25. 7,months. Cases were assessed clinically and radiologically both pre and postoperatively and scored according to the Knee Society Score. Nineteen cases had excellent knee score at the final follow up while two had good results. There were no fair or poor results. Union of the graft occurred in 18 cases [85.7%]. Two cases had non union. One case had absorption of the graft on the final follow up x-ray. None of the cases showed collapse of the graft or any lucent lines at the bone cement interface

Abdominal ultrasonography: clinical significance in the pediatric out-patients' clinics

Ultrasound is the basic first-line investigation for an enormous variety of abdominal symptoms in pediatric patients, This is because it is non-invasive and because of its accessible nature, and its success in terms of diagnosis depending on the skill of the operator, The objective of this prospective study is to further elucidate the role of abdominal ultrasonography for screening purposes as well as investigating the relevance of sonographic findings in patients with clinical problems related to the abdomen. This work was conducted on 10114 infants and children [4900 males and 5214 females], ranging in age from 1 day to 12 years. They were referred to the various outpatients' clinics, Cairo University Children's Hospital. Proper history taking, thorough clinical examination, and ultrasonography of the abdomen and basal parts of the thorax were done for all patients. Other investigations were done for certain cases to reach the final diagnosis. Patients were divided into 2 groups: Group I consisted of 2668 patients [26.4%] without specific symptoms in the abdomen, it represented the screening group. Group II consisted of 7446 patients [73.6%] with abdominal symptoms and therefore well-defined sonographic requests. The results revealed that 60% of the whole group had pathologic sonographic findings. Pathological findings were discovered in 61.7%, 59.3% of group I and group II patients respectively. According to their individual influence on the patient's disease course, sonographic findings were subdivided into 3 categories: Relevant, prospectively relevant and irrelevant findings. In each of group I, and group I1 patients these findings constituted 47.8%, 76% and 36%, 10.6% and 16.2%, 13.3% of total findings in each group respectively, The difference between both groups was statistically significant, Most of relevant findings [81%] were detected in group I1 patients as compared to 19% in group I, The nephrology clinic was ranked as the No 1 clinic regarding the frequency of pathologic findings discovered in patients referred from it [27%]. Also, the highest frequency of relevant findings was detected in patients from the hepatology [87%] and nephrology [82%] clinics

Conclusion: abdominal ultrasonography can detect various relevant findings in asymptomatic out- patients as well as in patients with a clinical problem related to the abdomen. Also, ultrasonography completes the physical examination, adding a substantial amount of clinically important information to the patient's medical record and physician's report

Lactatemia during treatment of status asthmaticus in children

Background: Transient increase of lactate levels with or without metabolic acidosis has been seldom reported as a complication of beta2-adrenergic therapy administered during asthma attacks in children

Objective: The study is aimed to investigate the frequency of lactatemia in children with acute asthma treated with nebulized beta2-agonists, and to delineate its causes and effects on prognosis

Methods: We studied 32 asthmatic children; 68.8% had intermittent asthma, and 31.2% had mild persistent asthma. Their ages ranged from 6 to 8 years with a mean of 6.48 +/- 0.68 years. Patients were enrolled during acute asthma exacerbation [62.5% had severe and 37.5% had moderate attacks] from the Cairo University Children's Hospital. Patients underwent clinical evaluation, and routine investigations [CBC, PEFR, and total serum IgE] then received nebulized salbutamol at 0.1 mg/kg/dose [minimum 2.5 mg] every 20 min for three doses together with O2. Plasma lactate was determined before, 1 h after, and 24 h following the inhalation therapy. Blood gases were also evaluated before and after the beta2-agonist treatment

Results: At 1 h post-treatment, all patients had appreciable lactatemia [4.44 +/- 0.78 mmol/L, p<0.001] compared to the pre-treatment level with a rise of 257 +/- 121.5%. Patients with severe attacks demonstrated a higher mean value compared to those with moderate attacks [4.69 +/- 0.8 mmol/L versus 4.02 +/- 0.6 mmol/L, p<0.05]. At 24 h post-treatment, lactate levels returned to the normal values in most patients [1.91 +/- 0.59 mmol/L, p<0.001] as compared to the 1 h post-treatment level. None of our patients developed metabolic acidosis and all of them showed significant clinical improvement. Our results strongly accuse nebulized salbutamol as the possible pathogenetic factor for lactatemia during therapy of acute asthma attacks, while overworked respiratory muscles and hypoxemia have been excluded as contributing factors

Conclusion: Transient lactatemia is not uncommon during beta2-agonist therapy in asthmatic children with acute exacerbation, and is harmless in most cases. Prediction of lactic acidosis prevents inappropriate intensification of therapy especially in patients with more severe attacks or impending respiratory failure

Viral hepatitis: clinical, laboratory and ultrasonographic evaluation

Viral hepatitis is a major health problem allover the world. Perihepatic lymph nodes [LN] enlargement detected by ultrasonography [US] has been observed in acute and chronic hepatitis; a correlation has been found between hepatic inflammatory activity and total LN volume. Ultrasonography can detect many other changes in patients with acute viral hepatitis. This study included 35 patients with viral hepatitis; 20 with acute viral A hepatitis [11 males and 9 females, their age ranged from 2.5-7 years [yr]], and 15 with chronic viral hepatitis [10 HCV and 5 HBV] [9 males 8. 6 females, their age ranged from 3-16 yr]. Patients were taken from the hepatology clinic, Cairo University Children's Hospital. Another 15 children were taken as controls. History taking, thorough clinical examination, investigations [CBC, liver function tests, and serologic liver markers], and liver biopsy [for some chronic cases] with histopathologic examination were done for patients. Abdominal US was done for patients and controls. Results revealed that in chronic hepatitis patients, the most frequent risk factors for acquisition of hepatitis include dental extraction [60%], blood transfusion [40%], and surgical operation [33%]. Also, there was a low HB vaccination coverage among chronic hepatitis patients [33%]. Anorexia, malaise, jaundice, and dark-colored urine were the main symptoms present in all patients with acute viral A hepatitis. On examination, jaundice and tender hepatomegaly were detected in 65% of cases. In patients with chronic viral hepatitis, malaise was present in all cases while anorexia and abdominal pain were present in 65% of cases. On examination, firm hepatomegaly was detected in 50% of cases whilejaundice and splenomegaly were detected in 33% of cases. No evidence of fulminant hepatitis or liver cell failure was found in all patients. Concerning laboratory parameters, serum transaminases were significantly elevated in patients with acute viral A hepatitis compared to those with chronic viral hepatitis. Also, chronic hepatitis patients were significantly anemic [mean HB concentration = 10.6g/dl] and thrombocytopenic [mean platelets count = 202 x 10 3/mm3] compared to patients with acute viral hepatitis [anemia was detected in 33% and thrombocytopenia was detected in 25% of chronic cases]. Abdominal US revealed that LN at the hepatoduodenal ligament [HDL] were found in 90% of patients with acute viral A hepatitis compared to 53% of patients with chronic viral hepatitis [B, C], and this difference was significant. Of importance, a direct positive relationship was found between total LN volume and liver function tests in patients with acute and chronic hepatitis, but this relationship was significant only for serum bilirubin [total, direct] of acute hepatitis patients

Conclusion: Abdominal US being an easy to perform, safe, and non-invasive diagnostic tool is recommended to be used for the evaluation and lollow-up of patients with acute and chronic viral hepatitis