Respiratory syncytial virus-associated mortality in a healthy 3-year-old child: a case report.

BACKGROUND: Respiratory syncytial virus (RSV) is the most frequently identified pathogen in children with acute lower respiratory tract infection. Fatal cases have mainly been reported during the first 6 months of life or in the presence of comorbidity. CASE PRESENTATION: A 47-month-old girl was admitted to the pediatric intensive care unit following sudden cardiopulmonary arrest occurring at home. The electrocardiogram showed cardiac asystole, which was refractory to prolonged resuscitation efforts. Postmortem analyses detected RSV by polymerase chain reaction in an abundant, exudative pericardial effusion. Histopathological examination was consistent with viral myoepicarditis, including an inflammatory process affecting cardiac nerves and ganglia. Molecular analysis of sudden unexplained death genes identified a heterozygous mutation in myosin light chain 2, which was also found in two other healthy members of the family. Additional expert interpretation of the cardiac histology confirmed the absence of arrhythmogenic right ventricular dysplasia or hypertrophic cardiomyopathy. CONCLUSIONS: RSV-related sudden death in a normally developing child of this age is exceptional. This case highlights the risk of extrapulmonary manifestations associated with this infection, particularly arrhythmia induced by inflammatory phenomena affecting the cardiac autonomic nervous system. The role of the mutation in this context is uncertain, and it is therefore necessary to continue to assess how this pathogenic variant contributes to unexpected sudden death in childhood.

Wrist fracture in a 6-year-old girl after an accidental electric shock at low voltages.

Bone injuries related to electric shocks are usually seen with high-voltage current exposure or with additional traumas, such as falls. Few cases of fractures after electric shocks at low-voltages (with no direct blunt trauma) are reported in the literature. They result from electrically-induced tetanic muscle contractions. Most of them involve the proximal appendicular skeleton, while distal fractures of limbs are uncommon. We report the case of a 6-year-old girl who suffered local superficial burns of the hand and a distal radius buckle-type fracture after sustaining a 230-V electric shock. The accident occurred while the girl was touching with the right hand the metallic stand of a non-insulated street lamp. She felt a sudden jolt and managed to pull her hand free quickly, without falling or losing consciousness. The superficial burns of the hand were consistent with Jellinek's electric marks, while the buckle fracture of the radius was consistent with a forceful contraction of the flexor muscles of the hand. Only four cases of radius fractures resulting from accidental electric shocks at low voltages have been previously reported in the literature. All of them involved pediatric patients, suggesting that a child's vulnerability to this kind of fracture may exist. The present case is the youngest one ever described.

The number of lymph nodes is correlated with mesorectal morphometry.

BACKGROUND: Lymph node involvement is one of the most significant prognostic factors of patients with rectal cancer. However, the distribution of mesorectal lymph nodes is not well known. This study was designed to assess lymph nodes in the mesorectum and to evaluate the correlation between the volume and weight of the mesorectum and the number of lymph nodes. METHODS: The mesorectums of 20 human cadavers were studied. The volume and weight of the superior rectal mesentery, superior mesorectum and inferior mesorectum were measured. Lymph nodes were sought by manual dissection and were submitted for histological examination. The correlation between the number of lymph nodes and the volume and weight of the mesorectum was evaluated by non-parametric Spearman test. RESULTS: A total of 178 lymph nodes were identified. The mean number of lymph nodes per specimen was 9.2 +/- 4.5. The lymph nodes were mostly smaller than 3 mm and located in the superior and posterior parts of the mesorectum. A positive correlation was found between the number of mesorectal lymph nodes and the volume and weight of the mesorectum. The number of lymph nodes in the superior rectal mesentery was independent of its volume and its weight. CONCLUSIONS: Mesorectal lymph nodes are mainly located above the peritoneal reflection within the posterior mesorectum. The positive correlation between the volume or the weight of the mesorectum and the number of mesorectal lymph nodes should be considered as a possible means to determine the minimum number of mesorectal lymph nodes required for histological examination.