[A 70-year-old male exhibiting parkinsonism-hyperpyrexia syndrome during levodopa carbidopa intestinal gel (LCIG) treatment and suspected carbidopa allergy due to positive drug-induced lymphocyte stimulation test (DLST)].

A 70-year-old male who has medical history of Parkinson's disease for 26 years admitted to our hospital for trial of levodopa carbidopa intestinal gel (LCIG) therapy because of severe dyskinesia and frequent wearing-off. He developed deterioration when he was treated with one of the levodopa (LD) decacrboxylase inhibitor compounds in the past. Five days after LD had changed into equivalent dose of LD/carbidopa (CD), high fever with hyperCKemia appeared. He was diagnosed as having Parkinsonism-hyperpyrexia syndrome (PHS). Exchange of LD/CD to LD drugs improved the symptoms quickly. Four days after LCIG administration, PHS reappeared. Simultaneously, the patient developed sepsis and disseminated intravascular coagulation (DIC). Thrombocytopenia did not improve after recovery from infection and DIC. Anti-PA IgG and drug-induced lymphocyte stimulation test (DLST) against LCIG showed positive. Exchange of LCIG to LD drugs and intravenous methylprednisolone administration improved the symptoms and thrombocytopenia. CD induced type II and type IV allergy were suspected. This case offers a caution that physicians should be aware of drug allergy in cases of which unexpected symptoms occurred in altering one LD compound to another.

Cerebral hemoglobin oxygenation in children with congenital heart disease.

BACKGROUND: It is important to identify the pathological characteristics of cerebral circulation and oxygen metabolism at the bedside in children with congenital heart disease (CHD) to prevent neurodevelopmental impairments. The brain regional oxygen saturation index (rSO2 ) can be easily obtained at the bedside with near-infrared spectroscopy and has been widely used in the management of children with CHD in recent years. METHODS: To determine if the rSO2 before or after CHD surgery is a good predictor of cerebral oxygen metabolism, we investigated the impact of different clinical variables on the correlation between rSO2 and reference values under steady ratios of hemoglobin oxygen saturation in the internal jugular vein (SjvO2 ) or femoral artery (SaO2 ) (0.75:0.25, 0.66:0.34, and 0.50:0.50) in 186 children with CHD undergoing cardiac catheterization. RESULTS: In three patient groups-double ventricles before surgery, double ventricles after surgery, and single ventricle before surgery-there were significant relationships between rSO2 and the reference values of SO2 under all three steady ratios of SjvO2 and SaO2 . No relationship with the reference values was found for the single ventricle after surgery group. CONCLUSIONS: Regional oxygen saturation index is useful for assessing cerebral oxygenation in children with CHD, but knowledge of the underlying cardiac pathology in CHD, especially in the case of a single ventricle after surgery, is important for the correct interpretation of rSO2 measurements obtained using near-infrared spectroscopy.

Intravascular ultrasound shows the detailed appearance of an unraveled coil identified on echocardiography.

A 4-year-old boy who underwent coil embolization 17 months earlier was admitted for catheter assessment after the Fontan operation. Echocardiography showed a bright linear shadow in the abdominal aorta. Enhanced computed tomography of the chest showed that the coil had unraveled from the collateral arteries to the celiac branch artery. Subsequent catheter examination was performed safely. Intravascular ultrasound (IVUS) showed the unraveled coil floating in the aorta without a thrombus. This is a rare case to assess the appearance of unraveled coil with echocardiography and IVUS.