Subcutaneously implanted central venous access device infection in pediatric patients with cancer.

BACKGROUND AND PURPOSE: Subcutaneously implanted central venous access devices (SICVADs) are a common route of intravascular access for pediatric patients with cancer. This study was performed to evaluate the risk for SICVAD-related infection in a large consecutive series of unselected children with cancer in a single medical center. METHODS: The medical charts of 209 pediatric patients with cancer who received a SICVAD from January 1, 2001 to December 31, 2005 were retrospectively reviewed, and the patients were followed-up until June 30, 2006. The demographics, clinicopathologic features, and infectious complications were collected for analysis. RESULTS: There were 137,924 SICVAD days (median, 660 days; range, 16-1962 days). The rate of SICVAD-related infections was 0.15 episodes/1000 SICVAD days. There were 21 episodes of SICVAD-related infection among 17 patients, 18 were bloodstream infection among 14 patients and the other 3 were local infection among 3 patients. Sixteen SICVADs were removed, 13 were associated with bloodstream infection and 3 with local infection. Young age (<2 years) was associated with a high risk for SICVAD-related infection. Staphylococcal spp. and fungi were the most common pathogens associated with SICVADs. CONCLUSIONS: The rate of SICVAD-related infection in children with cancer was low. Children younger than 2 years had a higher risk for SICVAD-related infection than older children. Fungi play an important role in SICVAD-related infection.

Mid-aortic syndrome: a case report and review of the literature.

Renovascular disease is an important cause of secondary hypertension in children. In contrary to the adult patients whose major cause of renal artery stenosis (RAS) is atherosclerosis, fibromuscular dysplasia is responsible for the renovascular hypertension in most children. Mid-aortic syndrome (MAS) is a rare abnormality referring to an isolated disease of the distal thoracic and abdominal aorta resulting in significant tubular narrowing with stenosis of the visceral and renal arteries. It is usually diagnosed in young adults, but may present in childhood as a challenging problem. Patients with MAS are often first detected due to refractory hypertension. Other later presentations include intermittent claudication, congestive heart failure, renal insufficiency and symptoms of hypertensive associated end-organ damage. We report a case of a 16-year-old patient with MAS who suffered from malignant arterial hypertension. A percutaneous transluminal renal angioplasty (PTRA) was first performed, however the stenosis proved resistant to dilatation and only resulted in a minimal angiographic improvement. Due to persistent hypertension, an aortorenal bypass using the saphenous vein was performed. We also reviewed the literature on PTRA and the surgical management of RAS in MAS patients, in which PTRA often carries poor results.

The clinical manifestations and risk factors of a delayed diagnosis of Kawasaki disease.

BACKGROUND: Kawasaki disease (KD) is an acute febrile vasculitis and may cause coronary artery abnormalities. Due to the higher incidence in Asian countries, most pediatricians in Taiwan are familiar with KD. However, there are still some patients being diagnosed 10 days after the onset of the illness and not receiving a highly effective therapy. In this study, we analyzed the risk factors and clinical manifestations of patients with a delayed diagnosis of KD. METHODS: A retrospective review was made of the medical records of the patients diagnosed with KD at our institution between January 1996 and December 2005. The patients were divided into 2 groups: early-diagnosis group (EDG: diagnosis was made within 10 days after the onset of the fever) and delayed-diagnosis group (DDG: diagnosis was made 10 days after the onset of the fever). RESULTS: Fourteen of a total of 78 children (17.9%) were grouped into the DDG group, and 64 into the EDG group. There were no statistical differences between the 2 groups in terms of age, gender, number of antibiotics used, day of the first medical visit, total days of skin rash, conjunctivitis, mucosa changes, lymphadenopathy or laboratory examinations except for the higher white blood cell count and serum immunoglobulin G level in the DDG group. The patients in the EDG group had a clustered onset of symptoms as compared to the DDG group with a dispersed and late onset of symptoms. There was a higher risk of coronary artery abnormalities in the DDG group than the EDG group (42.9% vs. 14.1%; p = 0.036), and in the patients with KD who were younger than 1 year (29.0% vs. 12.7%; p = 0.043). CONCLUSION: Patients with delayed diagnosis of KD were associated with higher risk of developing coronary arterial lesions. It is necessary to develop a diagnostic test for KD and provide more education to health care providers for early recognition of KD.

Cor triatriatum with repeated episodes of syncope in an eighteen month-old girl: a rare cause of cardiogenic syncope.

Syncope can be caused by either cardiogenic or noncardiogenic causes. Structural heart diseases should be considered as a possible cause of recurrent episodes of syncope if no other causes are found. We report an 18 month-old girl who presented with recurrent syncope as well as dyspnea, failure to thrive, and frequent episodes of pulmonary infections, suggesting congestive heart failure. A prominent pulmonic component of the second heart sound and congested lungs noted from chest X-rays indicated pulmonary hypertension. An echocardiogram revealed an abnormal membrane with a small orifice in the left atrium (LA). An intact atrial septum and no evidence of other congenital heart diseases were observed. The result after surgical resection of the membrane was good during follow-up. Cor triatriatum may be one of the structural heart diseases responsible for repeated unexplained syncope. An echocardiogram performed by an experienced cardiologist would facilitate the diagnosis considerably and an excellent prognosis can be achieved via surgical resection of the obstructing membrane.