Point-of-care multiplex-PCR enables germ identification in haemolytic uremic syndrome 94 h earlier than stool culture

Haemolytic uremic syndrome often affects children causing a relevant morbidity and mortality. We compared the time to diagnosis by multiplex-PCR and stool culture in 15 children from two centres. Multiplex-PCR accelerated the time to diagnosis by 94 (95% confidence interval, 80-119; P = 0.0007) hours. Multiplex-PCR offers a time advantage of stool culture that may aid in earlier identification of outbreak clusters.

Postdiarrheal Shiga toxin-mediated hemolytic uremic syndrome similar to septic shock

The inflammatory response of host endothelial cells is included in the development of vascular damage observed in enterohemorrhagic Escherichia coli (EHEC) infection, resulting in hemolytic uremic syndrome (HUS). The response to a non-conventional treatment for a group of D+ HUS (diarrhea positive HUS) patients, with clinical hemodynamic parameters of septic shock was evaluated in this prospective study (1999-2003). Twelve children 2.8 +/- 0.6 years old, with D+ HUS produced by E. coli infection with serological evidence of Shiga toxin, presenting severe unstable hemodynamic parameters and neurological dysfunction at onset, were studied. The protocol included fresh frozen plasma infusions, methylprednisolone pulses (10mg/k/day) for three consecutive days and plasma exchange for five days, starting after admission to the intensive care unit (ICU). The twelve patients with increased pediatric risk of mortality (PRISM) score: 18 +/- 2 after admission to intensive care unit (ICU), required dialysis for 17.4 +/- 4 days, mechanical ventilator assistance for 10 +/- 1 days and early inotropic drugs support for 10.5 +/- 1 days. Neurological dysfunction included generalized tonic-clonic seizures lasting for 5.4 +/- 1 days, n:8. Focal seizures were present in the remaining patients. Dilated cardiomyopathy was present in 6 children. Eight children suffered hemorrhagic colitis. Nine patients survived. Within one year of the injury, neurological sequelae, Glasgow outcome scale (GOS) 3 and 4, were present in two patients, chronic renal failure in one patient. We suggest that early introduction of this protocol could benefit D+ HUS patients with hemodynamic instability and neurological dysfunction at onset. Further studies are likely to elucidate the mechanisms involved in this early adverse clinical presentation of D+ HUS patients.

[Nonprogressive, late-onset atrophy of the cheek]

Lipodystrophies are rare conditions in which the most remarkable feature is an atrophy of the subcutaneous tissues. Until two decades ago, they were all considered under the name of "lipoatrophic diabetes", and only recently they have been properly classified. Currently four syndromes are recognized: congenital total lipodystrophy, late onset or acquired lipodystrophy, cephalothoracic or partial progressive lipodystrophy and partial face-sparing lipodystrophy. We report the case of a 73-year-old patient, long distance bus driver, who presented to our clinic for the correction of a malar atrophy located on the left side of his face. Until he was 48 years old his appearance was normal, but at the time he reports the slow onset of a facial atrophy which was confined to the cheek. The atrophy was very slowly progressing, so that at this moment at 73 years of age he presented to our observation for the correction of the asymmetry. Clinical examination and history oriented us towards a variation of Parry-Romberg's syndrome characterized by a non progressive late onset hemifacial atrophy. No muscle or bony involvement is present. No other important abnormalities, excluding a moderate hyperglycemia have been observed. A biopsy of the region shows a marked elastosis and a complete atrophy of the subcutaneous fat. Correction of the deformity was achieved with autologous fat injection and was still satisfactory after one year.

[Liposuction treatment for lipodystrophy of the pelvis and the legs]

In a series of 20 lipolysis procedures, there have been no serious major and few minor complications. Selection of patients is important and the best results can be acquired in the patients under 35 years of age. The postoperative circulation and diuresis control are very important particularly during the first 24 hours.