ABSTRACT
Eosinophilic esophagitis and herpes simplex esophagitis are separately well-described entities, but their simultaneous occurrence may pose a special challenge to the clinician, especially regarding the optimal therapeutic approach. The following case report describes a patient with a history of cow's milk and dairy products intolerance, but without an underlying immunologic defect, in whom eosinophilic esophagitis was diagnosed in the course of primary herpes simplex virus 1 (HSV1) infection that clinically presented as herpes labialis and severe esophagitis. The diagnosis was confirmed by a polymerase chain reaction from cytological brush and by immunohistochemical staining that detected the presence of HSV1 DNA in esophageal mucosa, and histologically by persistent eosinophil-predominant inflammation, typical of eosinophilic esophagitis. Despite severe clinical presentation, the HSV1 infection was self-limited. After a directed elimination diet was introduced, the clinical course was favorable, without the need for antiviral therapy.
Subject(s)
Eosinophilic Esophagitis/diagnosis , Eosinophilic Esophagitis/immunology , Herpes Labialis/diagnosis , Herpes Labialis/immunology , Immunocompetence/immunology , Adolescent , DNA, Viral/analysis , Diagnosis, Differential , Eosinophilic Esophagitis/diet therapy , Eosinophilic Esophagitis/pathology , Esophagus/immunology , Esophagus/pathology , Female , Herpes Labialis/diet therapy , Herpes Labialis/pathology , Herpesvirus 1, Human/genetics , Humans , Mucous Membrane/immunology , Mucous Membrane/pathology , Polymerase Chain ReactionABSTRACT
The objective of this study was to present our data on ambulatory blood pressure monitoring (ABPM) in children and adolescents referred to our Department because of casual BP elevation over the 95th percentile on at least 3 visits in primary care office. ABPM studies in 139 children, 94 boys and 45 girls, mean age 14.14 (range 4-19) years, were reviewed. A total of 107 (76.98%) children had hypertension according to the ABPM criteria. Primary hypertension (PH) was diagnosed in 89 (64.03%), secondary hypertension (SH) in 18 (12.95%) and white coat hypertension (WCH) in 32 (23.02%) children. In both PH and SH groups, hypertension was predominantly systolic (60.67% and 55.56%, respectively). There was no statistically significant difference in diurnal and nocturnal systolic and diastolic blood pressure (BP) loads between PH and SH groups. The non-dipping phenomenon was detected in 49.44%, 66.66% and 40.62% of children with PH, SH and WCH, respectively. The mean pulse pressure values were 60.41, 58.58 and 52.25 mm Hg in the PH, SH and WCH groups, respectively. A statistically significant difference was found in pulse pressure values between PH and WCH (df=55, t=6.15, P<0.01) groups and between SH and WCH groups (df=31, t=3.18, P=0.001). Target organ damage was diagnosed in 16 (17.98%) children with PH and in 5 (27.78%) children with SH. None of the children with WCH had target organ damage. ABPM is indispensable for establishing the diagnosis of hypertension in children. It is the only reliable method of WCH diagnosis.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Hypertension/diagnosis , Adolescent , Child , Child, Preschool , Female , Humans , Hypertension/etiology , MaleABSTRACT
This study was aimed at evaluating the clinical outcome of infants with antenatally diagnosed hydronephrosis. Our objective was also to determine whether there is a significant correlation between anterior posterior pelvic diameter (APPD) and urinary tract abnormalities detected. We retrospectively analyzed data of 145 infants collected between January 2000 and May 2010. Inclusion criteria were the presence of APPD > or = 5 mm on prenatal US scan after 20 weeks of gestation, at least 6-month follow-up and at least two postnatal US scans. Most patients underwent renal scintigraphy (n = 140, 96.6%) and micturating cystourethrography (n = 141, 97.2%). Of 145 infants, 77 (53.1%) had idiopathic or transient hydronephrosis. The second most common diagnosis was vesicoureteral reflux found in 21 (14.4%) infants, followed by ureteropelvic junction obstruction without significant kidney damage found in 18 (12.4%) infants. The relative risk of significant urologic abnormality according to the degree of antenatal hydronephrosis (ANH) was 21.25 (95% CI: 2.95-156.49) for severe ANH, 1.57 (95% CI: 0.94-2.62) for moderate ANH and 0.47 (95% CI: 0.33-0.66) for mild ANH. There was a significant increase in the riskper increasing degree of hydronephrosis. In 19 out of 145 (13.2%) infants, immediate surgery was required. These data support the need of antenatal detection and long-term postnatal follow-up of infants with ANH.
