Cardiac failure in hemolytic uremic syndrome and rescue with extracorporeal life support.

Extrarenal involvement manifesting in the cardiovascular system is a rare but potentially fatal complication of hemolytic uremic syndrome (HUS). Current treatment is aimed at cardiovascular supportive measures while awaiting organ recovery. However, there are cases in which this recovery never occurs, and patients succumb secondary to heart failure. We report two cases of severe cardiac failure in children in the acute phase of HUS and the use of extracorporeal membrane oxygenation (ECMO) to support one patient to cardiac recovery. Clinicians should be aware of this potentially life-threatening cardiac involvement and should consider the use of ECMO for potentially salvageable children with HUS.

Successful radiofrequency catheter ablation of congenital junctional ectopic tachycardia with preservation of atrioventricular conduction in a 9-month-old infant.

An infant with congenital junctional ectopic tachyardia required frequent hospitalizations due to tachycardia acceleration despite multiple antiarrhythmic medications. At 9 months of age, he underwent successful radiofrequency catheter ablation of the tachycardia with preservation of AV conduction.

Glutaraldehyde treated autologous pericardium in complete repair of tetralogy of Fallot.

Pericardium has been used for decades to facilitate the repair of tetralogy of Fallot (TOF). The impact of glutaraldehyde preserved autologous pericardium when used as a right ventricular outflow tract (RVOFT) patch in TOF was analyzed in 36 consecutive children undergoing complete transventricular repair. In 18 (group I) the pericardium was treated in conventional fashion (harvested and preserved in saline solution). In the other patients, the pericardium was treated in 0.625% glutaraldehyde solution for 20 minutes and then washed in saline prior to being implanted as an RVOFT patch (group II). The perioperative (prior to hospital discharge) as well as the 6-month postoperative Doppler echocardiograms were assessed with 100% follow-up. The studies were evaluated and graded by blinded observers for the presence and severity of an RVOFT dilatation (+0 to +4) relative to the size of the aortic valve annulus. The age of patients in group I and group II (29 months, 34 months) were similar as was the incidence of transannular patching (44%, 41%). Postrepair hemodynamics revealed no significant difference in the right ventricular/left ventricular pressure ratios (42%, 41%) or in the systolic RVOFT pressure (24 mmHg, 29 mmHg). The predischarge echocardiograms showed no outflow tract (OFT) dilation in either group. There was no morbidity or mortality in either group. At approximately 6 months postoperatively (6.2 mo, 5.7 mo), 72% of group I patients had RVOFT diameters that were larger (+1, +2) than the predischarge diameters when reviewed by three observers. In group II there was a single patient with dilatation of the RVOFT and this graded as +1.(ABSTRACT TRUNCATED AT 250 WORDS)

Human pulmonary dirofilariasis: does diagnosis require thoracotomy?

The incidence of pulmonary coin lesions as a result of Dirofilaria immitis (dog heartworm) seems to be increasing. A case of human pulmonary dirofilariasis is described, and its pathogenesis and the limitations of preoperative diagnostic tests in this condition are discussed.

Massive thymic hyperplasia in an adolescent.

Massive thymic hyperplasia (weight, greater than 100 gm) is a rare lesion in adolescents, and most of the anterior mediastinal masses are true neoplasms. We present a case of massive thymic hyperplasia, in which a 680-gm thymus was resected from a 15-year-old boy. We also present the computed tomographic scan appearance of this lesion, which differed from that previously described, and correlate the histological and radiological findings.

Affect, personality, and facial expressive characteristics of older people.

This study explored the relationship between emotion-based personality traits and expressive patterns in older subjects. Specifically, the study sought to demonstrate (a) that individuals have emotion expression biases, as revealed by structural and dynamic properties of the face, and (b) that there is a link between facial characteristics (as indexed by the judgments of trained and naive raters) and personality traits. An encoding/decoding paradigm was used; 30 adult, naive judges rated five emotion-pose photographs for each of 14 older subjects who had also completed a personality trait measure. Results indicated that individuals vary in their ability to accurately encode emotion states and that these patterns are linked to personality traits in an affect-specific way. The results are discussed within the framework of Darwinian theory and Plutchik's model of personality.

Arteriovenous fistulas for hemodialysis: experience with 100 cases.

One hundred radial-cephalic fistulas were surgically created for hemodialysis between April 1970 and September 1973. A side-to-end anastomosis was constructed in 86 per cent of cases. Overall patency interval was 13 months. Factors responsible for shunt failure are outlined. Blood vessel quality and surgical technique are the most important factors in achieving a low failure rate. Use of the fistula for early hemodialysis has not been associated with complications and is advocated.