Mixed pulmonary infection in an immunocompromised patient: a rare case report

Patients who are immunocompromised are predisposed to a variety of common and uncommon pulmonary infections. We report a case of mixed pulmonary infection by drug resistant tuberculosis with a nocardiosis in a 49-year-old man who was a known case of chronic obstructive pulmonary disease, on prolonged corticosteroid use with diabetes mellitus. Chronic use of corticosteroids is a predisposing factor for opportunistic infections, such as nocardiosis or tuberculosis. Since such a mixed infection is rare, maybe a combined approach to therapy early in the course of disease would be effective in such cases.

Transcatheter trans-septal antegrade closure of muscular ventricular septal defects in young children

BACKGROUND

Surgical or transcatheter closure of muscular ventricular septal defects (mVSDs) in young children may be technically challenging and associated with significant complications.

OBJECTIVE

To assess the feasibility of trans-septal antegrade closure of mVSD in a selected subset of young children.

METHODS

This is a prospective study from a single centre from July 2011 to March 2013. Nine infants and children with single or multiple mVSDs were included in the study. The median age and weight were 6 months (range 4-18 months) and 4.5 kg (range 3.8-6.2 kg), respectively. Trans-femoral trans-septal antegrade technique was used in eight children. One child was excluded from the study because of abnormally tortuous anatomy of both the femoral veins and subsequently underwent VSD device closure by the trans-jugular approach. The follow-up evaluation included chest X-ray, ECG, and echocardiogram at 1 month, 3 months, 6 months, and 1 year.

RESULTS

The defects were closed successfully in all eight patients using Amplatzer mVSD device in 5 and Amplatzer Duct Occluder II in 3. Moderate mitral regurgitation due to entrapment of the anterior mitral leaflet occurred in one patient with a posteriorly located mVSD, necessitating removal of the device, and surgical closure of the mVSD. The small additional residual mVSD in one other patient closed spontaneously during the follow-up.

CONCLUSIONS

Transcatheter trans-septal antegrade closure of mVSD in young children is technically feasible and merits further consideration. Symptomatic relief in multiple mVSD can be achieved after closing larger defects.

Iatrogenic aortopulmonary window after balloon dilation of left pulmonary artery stenosis following arterial switch operation

Branch pulmonary artery stenosis may occur in 4%-28% of patients after an arterial switch operation. Balloon dilation can be attempted with variable results, while stenting is a more definitive option when balloon dilation fails. We report the case of a young boy who underwent balloon dilation of a stenosed left pulmonary artery 9 years after an arterial switch operation and was noted to have an aortopulmonary window about a year later. This was treated with covered stent implantation, which dealt both with the aortopulmonary window and the residual stenosis. The diagnostic process with cardiac magnetic resonance imaging and cardiac catheterization of such an unusual entity as well as the transcatheter management are discussed in detail.

Highlights of the 6th World Congress in Paediatric Cardiology and Cardiac Surgery

The 6th World Congress in Paediatric Cardiology and Cardiac Surgery took place in Cape Town, South Africa, in February 2013. The congress is the largest meeting in the field of congenital and paediatric heart disease and attracts a global audience of specialists with the aim of sharing the latest multidisciplinary developments in research and clinical practice. The congress was commended as a huge success and this article aims to give a general flavor of the diverse meeting through detailing a few specific highlights from the various tracks.

Cardiovascular magnetic resonance imaging in congenital heart disease as an alternative to diagnostic invasive cardiac catheterization: a single center experience

OBJECTIVE

The study aims to assess whether the increasing use of cardiovascular magnetic resonance imaging in place of diagnostic cardiac catheterization in the management of pediatric patients with congenital heart disease has had an impact on pediatric cardiac care.

DESIGN

Retrospective analysis of data was used.

SETTING

The study was performed at the Evelina Children's Hospital Cardiology Department. PATIENTS. : Elective diagnostic cardiac catheterization or magnetic resonance imaging (MRI) from 2005-2010 are included (n = 896).

OUTCOME MEASURES

Indication, length of stay, and incidence of complications were recorded. In cases used to plan surgery, 30-day survival following the procedure was recorded. Surgical outcomes were compared between the two groups. Surgical outcomes planned using MRI were compared with national outcomes from Congenital Cardiac Audit Database.

RESULTS

For catheterizations (50 patients, [31 male, median age 3 years, interquartile range 1 to 12]), median hospital stay was 1 day (interquartile range 0 to 3), and complications occurred in 11 (22%). Median hospital stay for MRI (846 patients [517 male, median age 3 years, interquartile range 0 to 9]) was significantly shorter: 0 days (interquartile range 0 to 1, P <.001), with fewer complications (16 [1.9%], P <.0001). Twenty-four catheter and 283 MRI patients underwent surgery within 18 months. One catheter patient (2.0%) and four MRI patients (1.4%) died within 30 days (P =.48).

CONCLUSION

Replacing catheterization with cardiovascular magnetic resonance imaging has resulted in reduced rates of complication and shorter hospital stays without a significant impact on surgical outcome.

Retinal vascular changes following intravitreal ranibizumab injections for neovascular AMD over a 1-year period

PURPOSE

To assess retinal vascular calibre changes in eyes with neovascular age-related macular degeneration (AMD), treated with intravitreal anti-vascular endothelial growth factor agents, over a 1-year period and compare any such changes to untreated fellow eyes.

METHODS

Treatment naïve patients with neovascular AMD received three consecutive intravitreal injections of ranibizumab, followed by a pro re nata dosing regimen up to 1 year, with the aim of maintaining a 'fluid-free' macula. Retinal arteriolar and venular calibre was measured from digital fundus photographs at baseline and at three monthly intervals to 1 year, and summarised as central retinal artery equivalent (CRAE) and central retinal venular equivalent (CRVE), respectively.

RESULTS

A total of 53 injected eyes and 41 fellow, non-injected eyes were analysed. At baseline, there were no differences in retinal vascular calibre between injected and non-injected eyes (mean CRAE (SD) 144.93 (14.07) vs 145.74 (13.10) μm, P=0.80 and mean CRVE (SD) 216.23 (25.93) vs 219.91 (22.82) μm, P=0.53). Over a 12-month period, retinal venular calibre dilatation occurred in injected eyes (mean CRVE change +5.71 (14.71) μm, P=0.007), with no change in retinal arterioles, +0.69 (14.71) μm, P=0.68. In non-injected eyes, arteriolar narrowing occurred as a whole, mean CRAE change -4.20 (7.00) μm, P=0.001, over 12 months, with a trend for narrowing in venules, -2.16 (11.56) μm, P=0.28. In injected eyes, after controlling for covariates, the changes in CRVE over 12 months mirrored improvements in macular thickness, -0.06 (-0.005, -0.11) μm, P=0.04, and visual acuity, +9.66 (-0.30, +19.32) μm, P=0.06.

CONCLUSION

Intravitreal ranibizumab significantly dilated retinal venules after a 1-year period.

Measurements of 1/f Noise in A-Si:H Pin Diodes and Thin-Film-Transistors

We measured the equivalent noise charge of a-Si:H pin diodes (5 ∼ 45 μm i-layer) with a pulse shaping time of 2.5 μ.sec under reverse biases up to 30 V/μm and analyzed it as a four component noise source. The frequency spectra of 1/f noise in the soft-breakdown region and of the Nyquist noise from contact resistance of diodes were measured. Using the conversion equations for a CR-RC shaper, we identified the contact resistance noise and the 1/f noise as the main noise sources in the low bias and high bias regions respectively. The 1/f noise of a-Si:H TFTs with channel length of 15 μm was measured to be the dominant component up to ∼100kHz for both saturation and linear regions.

The Application of Thick Hydrogenated Amorphous Silicon Layers to Charged Particle and X-Ray Detection

We outline the characteristics of thick hydrogdenated amorphous silicon layers which are optimized for the detection of charged particles, x-rays and γ-rays. Signal amplitude as a function of the linear energy transfer of various particles are given. Noise sources generated by the detector material and by the thin film electronics - a-Si:H or polysilicon proposed for pixel position sensitive detectors readout are described, and their relative amplitudes are calculated. Temperature and neutron radiation effects on leakage currents and the corresponding noise changes are presented.