Scurvy in an autistic child: early disease on MRI and bone scintigraphy can mimic an infiltrative process.

Scurvy is uncommon in the industrialized world and is rarely reported in the paediatric population. Children with developmental and neuropsychiatric disorders and poor oral intake are at increased risk. The classic appearance of scurvy on radiographs is well documented. However, in early disease, radiographs may be normal. Bone scintigraphy can detect early disease, but involves radiation and findings are usually non-specific. MRI can detect very early disease in patients with scurvy prior to radiological findings and does not involve radiation. We present a case of unsuspected scurvy in an autistic child who had abnormality confined to the metaphysis seen on both MRI and bone scintigraphy. Early diagnosis and treatment in our patient prevented more serious complications such as fractures and subperiosteal haemorrhages.

Two episodes of cytomegalovirus-associated colon perforation after heart transplantation with successful result.

A patient with end-stage heart disease was discharged from the hospital on postoperative day 7 after orthotopic heart transplantation. Three weeks from the day of operation, he developed sigmoid colon perforation, which required Hartmann's procedure, and 2 weeks later he had cecal disruption. A pathologic specimen showed underlying diverticular disease with associated cytomegalovirus colitis. Subsequently, the patient had multiple complications. Three months after colon perforation, the patient left the hospital, and now 1 year after transplantation he continues to do well. To the best of our knowledge, this is the first reported case of a patient who survived multiple colon perforations soon after heart transplantation.

True aneurysm of the pancreaticoduodenal artery: a case report and review of the literature.

A case of aneurysm of the pancreaticoduodenal artery is reported. Its differences from false aneurysms of the same artery are defined. The use of CT as a screening instrument and angiography as the definitive diagnostic tool is suggested to avoid undue delay in corrective treatment.

Unusual symptom in patient with pseudoaneurysm of the left ventricle and review of the literature.

A case of pseudoaneurysm developing 2 years after left ventricular aneurysmectomy and single coronary artery bypass graft is reported. A hypothesis that pseudoaneurysms developing after transmyocardial incision begin in surgery or shortly thereafter is postulated. Chest X-ray films as a preliminary test to direct attention to the diagnosis are recommended. An aggressive surgical approach is suggested. To our knowledge, this is the sixth known reported case in the literature with hemoptysis as the chief symptomatic feature.

Antihypertensive 5,6-diarylpyridazin-3-ones.

The synthesis of a series of 5,6-diarylpyridazinones is described. Some members of this series display an antihypertensive effect in both the spontaneously hypertensive rat (SHR) model and the deoxycorticosteroid (DOCA) model of hypertension. The most potent compounds in the series have halogen substituents on the 5,6-diphenyl rings, a beta-substituted alkyl group at the 2 position of the ring, and acetyl or cyano substituent at the 4 position.

Training in advanced cardiac life support.

The nationally recognized training and certification program in Advanced Cardiac Life Support consists of lecture material and a new concept in training and testing for the practical skills of Advanced Cardiac Life Support. The course content follows closely the concepts of advanced life support as explained in the standards on cardiopulmonary resuscitation and emergency cardiac care.

Hemoglobin McKees Rocks (alpha2beta2145Tyr leads to Term). A human "nonsense" mutation leading to a shortened beta-chain.

The first example of the premature termination of a polypeptide chain in man appears to be Hb McKees Rocks, beta145 Tyr leads to Term, discovered in polycythemic members of a Caucasian family. Point mutation has apparently occurred at the codon for Tyr beta145 from UAU to a "nonsense" codon, UAA or UAG, resulting in a shortened polypeptide chain with Lys 144 as its carboxyl-terminal amino acid. Evidence for this structural conclusion is the absence of tryptic peptide betaT-15 from "fingerprints" of the abnormal beta-chain, the finding of C-terminal Lys, and the similarity between the functional properties of this variant hemoglobin and those of des Tyr (145)-His(146)beta hemoglobin resulting from carboxypeptidase-A digestion of normal human hemoglobin. Hb McKees Rocks has markedly abnormal properties: its oxygen affinity is the highest of the human variants described to date; its Bohr effect is reduced; it is devoid of subunit cooperativity; and it is unaffected by 2,3-diphosphoglyceric acid. These properties are probably the consequences of decreased stability of the T quaternary conformation and are partially restored in the presence of the strong allosteric effector inositol hexaphosphate.