Upward spontaneous migration of ventriculoperitoneal shunt into the heart: A case report summary.

A male infant with a history of ventriculoperitoneal (VP) implantation due to congenital hydrocephalus presented with fever and lethargy at the age of 8 month-old. Pericardial effusion was detected in transthoracic echocardiography, and he underwent pericardial window operation and was discharged in a stable condition. At 11 months of age, he presented again with fever, lethargy, recurrent vomiting, and respiratory distress. In both plain chest radiography and transthoracic echocardiography, VP shunt migration to the heart cavity was observed. The VP shunt had entered into the right ventricle after perforating the diaphragm and pericardium. The patient underwent open-heart surgery due to vegetation at the tip of the VP shunt inside the right heart. Vegetation was removed and the tip of the shunt was returned to the peritoneal cavity. Two weeks after discharge, the patient presented again with symptoms of tachypnea and lethargy. The imaging revealed the entry of the VP shunt about two centimeters into the anterior mediastinum. The patient was transferred to the operation room and the VP shunt was shortened and re-inserted into the peritoneal cavity. Antibiotic treatment was continued for six weeks and the patient was discharged in stable condition. In follow-up visits after two years, the VP shunt functioned well and no particular complication was observed. This case demonstrates that in patients with VP shunt implantation presenting with pulmonary and cardiac symptoms such as respiratory distress, pericardial effusion, and cardiac tamponade after VP shunt implantation, the possibility of VP shunt catheter migration to the mediastinal cavity should be considered.

New solution for old challenge: Device closure of non-centrally positioned atrial septal defect.

Multiple interatrial defects, termed fenestrated ASDs that require closure are not uncommon. The problem arises when a centrally located defect or a patent foramen oval (PFO) is associated with another peripherally located defect. In cases like this, all attempts at crossing the true defect might totally fail or might be difficult because the wire or the catheter crosses the central defect repeatedly despite the use of a sizing balloon. In order to overcome such an issue, we introduce a new technique by which not only the procedure and the fluoroscopy time will be reduced, but also it ceases the mistakes about the number of defects, their size and location.

PMT: New analytical framework for automated evaluation of geo-environmental modelling approaches.

Geospatial computation, data transformation to a relevant statistical software, and step-wise quantitative performance assessment can be cumbersome, especially when considering that the entire modelling procedure is repeatedly interrupted by several input/output steps, and the self-consistency and self-adaptive response to the modelled data and the features therein are lost while handling the data from different kinds of working environments. To date, an automated and a comprehensive validation system, which includes both the cutoff-dependent and -independent evaluation criteria for spatial modelling approaches, has not yet been developed for GIS based methodologies. This study, for the first time, aims to fill this gap by designing and evaluating a user-friendly model validation approach, denoted as Performance Measure Tool (PMT), and developed using freely available Python programming platform. The considered cutoff-dependent criteria include receiver operating characteristic (ROC) curve, success-rate curve (SRC) and prediction-rate curve (PRC), whereas cutoff-independent consist of twenty-one performance metrics such as efficiency, misclassification rate, false omission rate, F-score, threat score, odds ratio, etc. To test the robustness of the developed tool, we applied it to a wide variety of geo-environmental modelling approaches, especially in different countries, data, and spatial contexts around the world including, the USA (soil digital modelling), Australia (drought risk evaluation), Vietnam (landslide studies), Iran (flood studies), and Italy (gully erosion studies). The newly proposed PMT is demonstrated to be capable of analyzing a wide range of environmental modelling results, and provides inclusive performance evaluation metrics in a relatively short time and user-convenient framework whilst each of the metrics is used to address a particular aspect of the predictive model. Drawing on the inferences, a scenario-based protocol for model performance evaluation is suggested.

Assessment of autonomic dysfunction in childhood guillain-barré syndrome.

INTRODUCTION: Autonomic dysfunction (AD) is a common and important complication in Guillain-Barré syndrome (GBS) and may be the cause of significant morbidity or death. Limited studies have evaluated this complication in childhood GBS. Our objectives were to show the prevalence of AD in children with GBS and investigate its association with the severity of the disease. METHODS: Study included 28 children admitted with a diagnosis of GBS. Heart rate variability (HRV), motor function disability of the upper limbs and GBS disability scores were measured at admission and the results were compared with 20 healthy age/gender matched subjects (2-13 years; 43% male). GBS subtypes were defined by electromyography: acute inflammatory demyelinating polyneuropathy (AIDP) or acute motor axonal neuropathy (AMAN). RESULTS: The mean age was 5.5±3.4 years (range 1.5-14 years; 50% male). AIDP and AMAN subtypes comprised 57.1% and 42.9% of cases, respectively. In the upper limbs, 85.7% and in the GBS disability grading, 50% of patients had ≤ 3 scores, implying less severe motor dysfunction. There was no difference in the mean heart rate between patients vs. controls (103.9 vs. 98.2 bpm; P= 0.16), but half of patients showed AD and HRV was significantly reduced in patients compared to controls. Of the 16 patients with AIDP, 11 (68.8%) showed reduced HRV compared to 3 (25%) out of 12 AMAN cases (P= 0.02). There was no significant relation between HRV and motor disability scores. CONCLUSION: AD was present in half of children with mild GBS and it showed no significant association with disease severity.

Total pulmonary artery atresia associated with abnormal pulmonary venous drainage as a rare presentation of scimitar syndrome.

Scimitar syndrome or pulmonary venolobar syndrome is a rare, complex, and variable malformation of the right lung characterized by an abnormal right sided pulmonary drainage into the inferior vena cava, malformation of the right lung, abnormal arterial supply, and sometimes cardiac malformation. Despite the varying degrees of pulmonary hypoplasia and pulmonary artery hypertension, about half of the patients with scimitar syndrome are asymptomatic or mildly symptomatic when the diagnosis is made. Neonates have severe symptoms and worse prognosis while older children come to light because of recurrent respiratory infections, heart murmur, or an abnormal chest radiograph.

Correlation Between Pediatric Open Heart Surgery Outcomes and Arterial-mixed Venous Oxygen Saturation Differences.

INTRODUCTION: Low Cardiac Output Syndrome (LCOS) contributes to postoperative morbidity and mortality. This article tries to find a predictive factor to interpret outcome after cardiac operation. METHODS: In a cross-sectional study, 100 children with congenital heart disease undergoing cardiovascular surgery with cardiopulmonary bypass (CPB) without significant left-to-right shunt were selected. Arterial and central venous oxygen saturation values were measured via blood samples simultaneously obtained in 6-hr intervals for a total of 24-hr during postoperative period at hours 0, 6, 12, 18, and 24. Postoperative ventilation support (intubation period) and cardiovascular support were also obtained from the hospital records. Statistical analysis was later performed comparing the arterial-mixed venous oxygen saturation differences and durations of required ventilatory and cardiovascular support, both for the complicated and non-complicated patient groups. The data was processed with correlation Pearson and Mann-Whitney U tests in SPSS 15 software, P less than 0.05 was significant. RESULTS: Mortality following cardiac operation is 6% and complications may happen in 45% of the cases. The highest Arterial-mixed venous oxygen saturation difference occurred immediately post operation (up to 57%). These measures were high up to 18 hours in complicated and non-complicated groups (36% vs. 31% ; P< 0.05). This factor cannot predict prolongation of intubation period in patients (P > 0.05). CONCLUSION: Arterial-mixed venous oxygen saturation difference may be high as much as 57% or as low as 23%.These different measures, being higher up to 18 hours in complicated to non-complicated groups after 18 hours, can be related to tissue ischemia during surgery and cannot be discriminative.

Asymptomatic intracardiac thrombus in a child with nephrotic syndrome.

Nephrotic patients are at risk of developing venous and arterial thromboses. Various organ manifestations have been reported. Intracardiac thrombi associated with multiorgan thrombosis have been reported in autopsy in the earlier literature, but there is only one case report in living patients with nephrotic syndrome. Here we report a 9-year-old boy with steroid-resistant nephrotic syndrome who developed an asymptomatic but potentially hazardous large intracardiac thrombus.