Systemic lupus erythematosus and thrombotic thrombocytopenic purpura: a case and review.

Thrombotic thrombocytopenic purpura (TTP) is rare in children with systemic lupus erythematosus (SLE). We report a 15-year-old female who simultaneously presented with TTP and SLE. Kidney biopsy showed membranous nephropathy. Her condition improved with plasmapheresis, intravenous cyclophosphamide, and prednisone pulse therapy. We also reviewed the literature for this association in pediatric patients comparing presenting sequence and renal pathology with cases documented in the adult literature.

Urea resolves gross hematuria in a 15 year old with hemoglobin C trait.

Hematuria is a rare complication seen in patients with hemoglobin C trait. We report a 15-year-old African-American female with hemoglobin C trait, who presented with persistent hematuria. None of the urological, serological or histological workups revealed any other pathology. Hematuria failed to respond to all conventional modalities used in the treatment of the same condition seen in sickling hemoglobinopathies. This case is the first known case of persistent hematuria in a pediatric patient with hemoglobin C trait, which resolved with intravenous urea administration.

Cortical blindness as a complication of acute glomerulonephritis.

This case documents acquired reversible cortical blindness as a complication of hypertension secondary to acute glomerulonephritis and emphasizes the importance of recognizing this complication in children. The etiology of the cortical blindness is felt to be secondary to ischemia with edema from arterial spasm. Results of a CT scan of the head and lack of clinical sequelae support this assertion.

AIDS-like disease following mucosal infection of pig-tailed macaques with SIVsmmPBj14.

Following exposure of the rectal or vaginal mucosa to cell-free SIVsmmPBj14, four male and two female pig-tailed macaques developed a characteristic acute disease, including mucoid diarrhea, lymphopenia, and anorexia. Two macaques infected by the rectal route died within 14 days, and one female died of an AIDS-like disease at five months after inoculation. The three other animals have survived more than nine months, but all are exhibiting lymphadenopathy, thrombocytopenia, and progressive declines in percentages and numbers of CD4+ lymphocytes.

Comparative evaluation of cefadroxil and cephalexin in children and adolescents with pyodermas. Cefadroxil Once Daily Pyoderma Study Group.

This randomized, multicenter study compared the safety and efficacy of cefadroxil with that of cephalexin for the treatment of pyodermas in children and adolescents (1-18 years of age). Cefadroxil was given as a single oral daily dose of 30 mg/kg, and cephalexin 30 mg/kg/day was given in two divided doses. The maximum daily dose for both drugs was 1 gm, and treatment was administered for 10 days. Clinical and bacteriologic evaluations were made on days 4 or 5 during therapy and 2 to 4 days after therapy was completed. Of the 462 patients enrolled in the study, 156 patients in the cefadroxil group and 133 patients in the cephalexin group were evaluable. Staphylococcus aureus (56% of isolates) and Streptococcus pyogenes (39% of isolates) were isolated most frequently. The bacteriologic response was statistically greater in the patients treated with cefadroxil than in those treated with cephalexin (96% versus 89%; P = 0.042). A satisfactory clinical response was reported in 147 (94%) cefadroxil-treated patients and 122 (92%) cephalexin-treated patients (P = 0.476). The overall effective response to treatment was significantly higher with cefadroxil than with cephalexin (94% versus 86%; P = 0.024). Compliance with 9 or 10 days of therapy was similar in both treatment groups, although there was a difference between the two treatment groups with respect to completion of medication regimen: 95% of patients taking cefadroxil once daily--versus 65% of patients taking cephalexin twice daily--took 100% of their medication (P < 0.0001). Adverse events were infrequent and mild. The results of this study demonstrate that once-daily cefadroxil offers greater bacteriologic eradication and a better overall effective response than twice-daily cephalexin for the treatment of pyodermas caused by gram-positive pathogens in children and adolescents.

Bromocriptine-associated headache: possible life-threatening sympathomimetic interaction.

We present two cases of severe headache associated with the use of bromocriptine for lactation suppression in otherwise healthy women. In each case, the additional use of a therapeutic sympathomimetic agent resulted in extreme worsening of symptoms with development of hypertension and life-threatening complications (ventricular tachycardia and cardiac dysfunction in one case, seizures and cerebral vasospasm in the other). Sympathomimetics in combination with bromocriptine in patients with a bromocriptine-associated headache during the puerperium may be dangerous.

Angiodysplasia: characterization, diagnosis, and advances in treatment.

Gastrointestinal bleeding accounts for 2% of all adult hospital admissions each year. Angiodysplasia is one of the most frequently reported causes of lower gastrointestinal bleeding. In 80% of patients with bleeding angiodysplasia, the bleeding will stop spontaneously, but will often recur. Although angiography may detect bleeding in 86% of actively bleeding patients, the bleeding rate must be at least 0.5 mL/min. The treatment of choice for control of bleeding has been resection of the suspected segment of bowel, but this procedure is associated with a 10% rebleeding rate and 7% to 8% mortality. Superselective catheterization with infusion of vasoconstrictors has been used to control bleeding, but effects are short-lived. Superselective embolization occludes an offending vessel, but is difficult to perform accurately and is associated with risk of infarction. Laser photocoagulation controls bleeding in 84% of patients, with a 6% complication rate. This method of controlling bleeding offers distinct advantages, especially for the hemodynamically unstable patient. Except for cases in which surgical resection is indicated, Nd:YAG laser photocoagulation is the safest, least invasive, and probably most effective means of treating angiodysplasia.

MR imaging of pancreas in cystic fibrosis.

The pancreatic regions of 18 patients with cystic fibrosis were analyzed with a 1.5 Tesla MR unit. Signal intensity of the pancreas was correlated with clinical data and ultrasound. A hyperintense pancreas on T1-weighted image was consistent with fatty replacement of pancreatic insufficiency. A pancreas of normal soft tissue intensity was found in two asymptomatic and one symptomatic patient. A very hypointense pancreas on any pulse sequence was considered to be an intermediate stage of pancreatic degeneration.

Vasopressin in neuronal cultures from neonatal rat brain.

This study was performed to characterize and quantify vasopressin in neuron-enriched primary cultures of whole brains from 1-day-old rats and to compare such cultures between spontaneously hypertensive rats (SHR) and normotensive Wistar-Kyoto (WKY) rats. Vasopressin was extracted from cells and evaluated by radioimmunoassay and high-pressure liquid chromatography. Radioimmunoassay of high-pressure liquid chromatography fractions from cell extracts showed that the major peak of immunoreactivity comigrated with synthetic vasopressin. Cell vasopressin content increased in a graded manner when one to six dishes (plated 8 x 10(6) cells/dish) were pooled (8.7 +/- 0.5 to 67.7 +/- 8.2 pg/dish). When the number of plated cells per dish was increased (2 to 16 x 10(6) cells), there was also a graded rise in dish vasopressin content (3.4 +/- 0.4 to 15.3 +/- 3.9 pg). Treatment of cultures with 100 aM to 1 nM of angiotensin II for 5 minutes caused a dose-dependent decrease in cell vasopressin content. Furthermore, the decrease in cell vasopressin content of cultures treated with 1 nM angiotensin II (12.6 +/- 0.8 to 7.0 +/- 1.0 pg/10(6) cells, p less than 0.05) corresponded with the increase in medium vasopressin concentration (3.8 +/- 0.5 to 7.5 +/- 2.3 pg/ml) and this vasopressin-releasing effect of angiotensin II was blocked by [Sar1, Thr8]angiotensin II. Treatment of cultures with potassium chloride (56 mM) and acetylcholine chloride (5.5 microM) also resulted in significant decreases in cell vasopressin content.(ABSTRACT TRUNCATED AT 250 WORDS)

Erythromycin in the treatment of streptococcal infections.

In a number of well-designed comparison studies since 1958, erythromycin has proved highly effective in the treatment of both streptococcal pharyngitis and skin infections. Of the two formulations most often prescribed, the estolate salt is better absorbed and achieves higher tissue concentrations than does the ethylsuccinate salt. For these reasons and based on results of the published clinical studies, the appropriate daily dosage for erythromycin estolate is 20 to 30 mg/kg/day and that for erythromycin ethylsuccinate is 40 mg/kg/day. Erythromycin estolate may be given in two, three or four daily doses in the treatment of streptococcal pharyngitis with efficacy rates equal to or better than that achieved with penicillin V. Erythromycin ethylsuccinate is as efficacious as penicillin V when given in three or four daily doses. Treatment of streptococcal pharyngitis should be for 10 days. Recent studies in the treatment of streptococcal skin infections have shown erythromycin to be superior to penicillin. This superiority may be due to increasing numbers of penicillin-resistant staphylococci found in these streptococcal skin lesions. Dosage and frequency of administration of erythromycin in the treatment of streptococcal skin infections is similar to that for the treatment for streptococcal pharyngitis. However, b.i.d. administration has not been well-established in the skin infection studies. Treatment should be given for 7 to 10 days. In conclusion erythromycin is a safe and effective antibiotic for the treatment of streptococcal pharyngitis. Penicillin remains the antibiotic of choice for these infections, but erythromycin is an effective alternate when penicillin allergy is suspected. The appropriate therapy for streptococcal skin infections is less clear.(ABSTRACT TRUNCATED AT 250 WORDS)

Cystic adventitial disease of the popliteal artery.

Cystic adventitial disease of the popliteal artery has been recognized as a cause of arterial stenosis and calf claudication for 30 years. It is reported infrequently and its etiology remains unknown. In addition, a peculiar geographic distribution of the reported cases of this disorder has been noted, with a majority of cases from Europe and Australasia. The authors report here a case from South Carolina in which a fibrous band may have contributed to compression during exercise. Noninvasive studies and angiographic studies were negative before exercise and positive after exercise. Current ideas of diagnosis, surgical treatment and possible etiology are presented.

Diagnosis and management of thoracic outlet syndrome.

During the past 15 years, using plethysmography and maneuvers originally described by other researchers, we have tested 1,140 patients who had thoracic outlet symptoms. The vascular compression was recorded noninvasively, which also reflected the pressure on accompanying nerves in the brachial bundle. If the neurologic symptoms were reproduced at this time, the diagnosis of thoracic outlet syndrome was positive. Following exercise treatment (without improvement), 194 patients underwent operative exploration. By performing costoclavicular and hyperabduction maneuvers during axillary exploration, the tissue causing compression was identified and the muscle, bone, or tendon was divided or resected. Division of soft tissues in 180 patients resulted in improvement in the conditions of 173 patients (96%). Bone resection allowed relief of symptoms in six (43%) of 14 patients.

A noninvasive method to assess sympathetic activity.

Reflex adjustments of the blood flow through the skin are mediated largely by the sympathetic nervous system and play a fundamental role in the regulation of body temperature. Since blood flow in the digits is almost entirely through skin vessels, surface temperature measurements and digital plethysmography are useful methods of studying the changes in digital blood flow. Sweating is also primarily controlled by the sympathetic system and can be monitored by measuring the electrical resistance of the skin. A noninvasive test to assess sympathetic activity is described comparing the findings in normal subjects and patients with arterial diseases, vasospasm, and diabetes. Digital arteries obstructed by diseases or clot can be delineated from obstruction due to vasospasm, and diabetic neuropathy can be objectively identified. Follow-up studies in more than 1200 patients have demonstrated that an accurate prediction of the outcome of sympathectomy or nonoperative treatment can be made after assessing the results of this safe and inexpensive noninvasive test.

The effect of magnesium sulfate on fetal heart rate variability and uterine activity.

The effect of magnesium sulfate on fetal heart rate (FHR) variability and uterine activity is evaluated in 19 preeclamptic patients at term in active labor. Magnesium sulfate was given by intramuscular injection in nine patients and by intravenous infusion in 10 patients after an intravenous loading dose over a period of 15 minutes. No significant change was noted in FHR variability. There was only a transient, mild decrease in the frequency of uterine contractions during the magnesium sulfate loading dose, and there was no significant change in the intensity of uterine contractions. The conclusion is that, when magnesium sulfate is used for treatment of mild preeclampsia in patients at term in established labor, there is no clinically significant effect on FHR variability or uterine activity.

Negative phleborheography: clinical follow-up in 593 patients.

Approximately 500,000 cases of pulmonary embolism appear each year in the United States, with most having clots that originated in the deep veins of the lower extremities. Since the clinical diagnosis of deep venous thrombosis (DVT) is accurate only half the time, a safe method that affords immediate and definitive diagnosis of DVT is urgently needed. One diagnostic technique now available is phleborheography (PRG). We examined 1,076 patients (2,152 limbs) during the period of 1976 to 1979. By performing PRG before hospital admission, 392 patients who had negative study results were not hospitalized, resulting in an estimated savings of +960,400 and avoiding both the hazardous treatment and the stigma associated with a diagnosis of DVT. After one to three years of follow-up in 593 patients (1,186 limbs) who had had negative results from PRG, only three (0.5%) have shown evidence of postphlebitic swelling and one (0.2%) has had pulmonary embolus.