A previously healthy, white 12-year-old girl presented with diffuse body aches and poor perfusion. She developed severe respiratory failure and marked rhabdomyolysis and was mechanically ventilated. Although her CPK peaked at 500,000 IU/L, her renal function was mildly affected and her creatinine did not exceed the 0.8 mg/dL. The rhabdomyolysis was gradually resolved following aggressive fluid hydration. The patient did not require dialysis and made a complete recovery. Genetic studies revealed the diagnosis of McArdle disease.
Our study provides for the first time evidence for the implication of NKT-like cells in the pathogenesis of COP, as part of both localized and systemic cytotoxicity.
Preterm AGA infants with birth weights 9 0 0-1 4 0 0 g are studied in this controlled randomized multicenter trial. The infants are followed from 3 t o 8 weeks of age with a further assessment a t the age of 1 6 weeks. Only "healthy preterms" are included. Human milk is given throughout the study, and both treatment group and controls receive extra protein and iron t o ensure sufficient supply for increased red cell production. Milk protein (0.9 gllOO rnl human milk) and oral iron I18 mg Fe++lday increasing t o 36 mglday if serum iron falls below 1 6 pmolll) are given. EPO (Eprex, Cilag AG) is given s.c. thrice weekly; 1 0 0 IUIkgldose from week 3 t o week 7. Until now 2 4 children have been included (1 0 treated & 1 4 controlsl. Preliminary data show : BW of the groups are similar (1 2 9 4 g and 1 2 4 4 g). There
The findings suggest the possibility of two kinds of ectopic rhythm in AV block: the "normal" escape rhythm which is only moderately affected by arterial pressure changes; and an "abnormal" faster pressure dependent rhythm which is generated by high arterial pressure and abolished by pressure near zero, as if there were a mechano-electrical association. This abnormal rhythm may prevail completely in digitalis toxicity so that if cardiac arrest occurs, no automaticity can be expected to appear unless arterial pressure is raised.
Background: This case report highlights the fact that clinical suspicion is the key prerequisite for methemoglobinemia diagnosis and should be high in every case of peripheral cyanosis with normal PaO 2. Methods: We present the case of an adult patient presenting with clinical features suggestive of asthmatic bronchitis, due to respiratory tract infection, a low pulse oximetry reading and mild peripheral cyanosis of the fingernail beds. His physical examination and the concomitant clinical investigation (spirometry, cardiology evaluation, computed tomography angiography) did not lead to findings consistent with the low pulse oximetry reading (SpO 2). Subsequently, since the findings of the analysis of the arterial blood gas were normal, the patient was prescribed medication for his asthmatic bronchitis and was discharged. On his re-evaluation, despite clinical improvement, a low SpO 2 86% was detected again, leading to a new ABGs analysis on a different blood gas analyzer. The results revealed a high methemoglobin (MethHb) level of 13%, suggestive of methemoglobinemia, along with normal SaO 2 and PaO 2. Consequently, the patient was referred to a haematology specialist for further evaluation. Results: Hereditary methemoglobinemia diagnosis was reached on the basis of an elevated MethHb level in blood gas analysis on two different time points, with no prior oxidising agent exposure, normal physical and laboratory testing, and in view of the peripheral cyanosis preexistent for several years. Genetic confirmation of the diagnosis is not available in any laboratory in our country. Conclusions: Presence of a wide discrepancy in haemoglobin oxygen saturation, as assessed by pulse oximetry (SpO 2) and arterial blood gas analysis (SaO 2), along with normal arterial blood partial pressure of oxygen (PaO 2) are findings highly suggestive of elevated methemoglobin concentration. Measurements of SpO 2 and SaO 2 are, due to technical reasons, unreliable in cases of methemoglobinemia, either hereditary or due to exposure to an oxidizing agent, and alternative methods for tissue oxygenation estimation have to be used.
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