ABSTRACT
Childhood vaccine-associated immune thrombocytopenia (ITP) has a mostly favorable prognosis. To identify factors associated with prognosis, a retrospective survey was conducted with children with ITP who were registered in the Japanese Society of Pediatric Hematology/Oncology registry from 2008 to 2011. A total of 477 patients were categorized into four groups by event preceding ITP onset: vaccine-precedence (VP; n = 43), vaccine/infection-precedence (VIP; n = 34), infection-precedence (IP; n = 162), and no vaccine/infection-precedence (NVI; n = 238). Compared to IP and NVI, VP and VIP were significantly younger at diagnosis, with the age distribution peaking at infancy, and more frequently had favorable prognosis. Time to platelet recovery to 100 × 103/µL was significantly faster for VP and VIP than NVI. Multivariate Cox regression analysis with sex, age at diagnosis, infection-precedence, and vaccine-precedence as variables revealed age < 36 months (HR 0.992, 95% CI 0.989-0.995; p < 0.001) and male sex (HR 0.770, 95% CI 0.623-0.952; p = 0.015) as associated factors, but not infection-precedence (p = 0.149) or vaccine-precedence (p = 0.650). In subgroup analysis in patients < 36 months, age at diagnosis (p < 0.001) was the only associated factor. Favorable prognosis of childhood vaccine-associated ITP is correlated with young age at vaccination, but not with vaccination itself.
Subject(s)
Purpura, Thrombocytopenic, Idiopathic/etiology , Vaccination/adverse effects , Adolescent , Age Distribution , Age Factors , Child , Child, Preschool , Female , Health Surveys , Humans , Infant , Japan , Male , Prognosis , Registries , Retrospective Studies , Vaccination/methodsSubject(s)
Bone Marrow/pathology , Purpura, Thrombocytopenic, Idiopathic/diagnosis , Purpura, Thrombocytopenic, Idiopathic/therapy , Acute Disease , Blood Chemical Analysis , Combined Modality Therapy , Dexamethasone/therapeutic use , Follow-Up Studies , Humans , Immunoglobulins/therapeutic use , Infant , Male , Platelet Count , Platelet Transfusion/methods , Purpura, Thrombocytopenic, Idiopathic/diagnostic imaging , Risk Assessment , Severity of Illness Index , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
A 38-year-old male healthy donor for renal transplantation was scheduled to undergo laparoscopic nephrectomy of the left kidney. After commencement of the surgery under general anesthesia, his vital signs were stable. When pneumoperitoneum was commenced using CO2, a rapid increase in the airway pressure was observed, and it became difficult to perform mechanical ventilation. After manual ventilation was initiated, the cause of the increased airway pressure was investigated. As a result, a defective pore, 3 cm in diameter, was confirmed in the left diaphragm and it was determined that pneumothorax developed from the pure CO2. A transient decrease in oxygen saturation was easily restored by manual ventilation. The blood pressure was relatively stable, and tension pneumothorax was not observed. For the defective pore in the diaphragm, endoscopic cerclage of the diaphragm was performed after insertion of a thoracostomy tube. Postoperative chest X-ray showed no signs of atelectasis, mediastinal emphysema, or aerodermectasia, suggesting the development of pneumothorax due to pure CO2. In this case, the defective pore in the diaphragm was caused accidentally by pneumoperitoneum, although the subject had had no prior symptoms. Latent diaphragmatic defect may be an important factor in pneumoperitoneum and other surgical procedures.
Subject(s)
Diaphragm/abnormalities , Laparoscopy , Pneumothorax/etiology , Adult , Humans , Intraoperative Complications , Male , NephrectomyABSTRACT
We describe the clinical use of a new video-laryngoscope (GlideScope, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. In 2 patients, showing a Cormack-Lehane grade IV view with Macintosh direct laryngoscope, Cormack-Lehane grade II view of the glottic opening was obtained. GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.
Subject(s)
Intubation, Intratracheal/instrumentation , Laryngoscopes , Video Recording/instrumentation , Adult , Aged , Female , Humans , Male , Middle Aged , Obesity, MorbidABSTRACT
In this study, we detected autoantibodies to platelet glycoproteins GPIIb/IIIa and GPIb/IX on platelets and in plasma in a patient with immune thrombocytopenia associated with Epstein-Barr virus-related infectious mononucleosis. In addition, we present our findings on the effectiveness of intravenous immunoglobulin therapy for immune thrombocytopenia associated with Epstein-Barr virus.
