solated noncompaction of the ventricular myocardium (INVM) is a rare disorder characterized by excessively prominent trabeculations and deep intertrabecular recesses, mainly in the left ventricle without other congenital cardiac malformations. 1 Most patients with INVM show various abnormalities on the electrocardiogram (ECG), including Wolff-Parkinson-White (WPW) syndrome, 2,3 which is currently classified into several types based on the localization of the bypass tract. It has not previously been reported which type of WPW syndrome occurs in patients with INVM. 3,4 We report 3 patients with INVM and WPW syndrome type B on ECG, which has not been previoulsy reported. 3,4 Case Reports Patient 1A 9-month-old Japanese girl was admitted to hospital because of increasing dyspnea. She was the first child of healthy nonconsanguineous parents, and the pregnancy and delivery had been uneventful.On admission, she was thin and malnourished: weight 6 kg and height 56 cm, both below the 10th percentile. She was pale and had cyanosis of the lips and nail bed. On auscultation, there was tachypnea and moderate retraction of the chest wall with moist rales over the entire lung field. A grade 3 pansystolic murmur was noted at the apex. Her abdomen was moderately distended, with the liver palpable 3 cm below the right costal margin. Chest X-ray showed marked cardiac enlargement, and pulmonary venous congestion. She died suddenly at 11 months of age. Patient 2The 6-month-old younger sister of Patient 1 was referred for examination of her cardiac function. The pregnancy and delivery had been uneventful and she was currently alert and healthy. Her heart sounds were clear and the rhythm was regular without murmur.Chest X-ray showed mild cardiac enlargement with a cardiothoracic ratio of 0.61. One year later, she still did not have symptoms, but her cardiac performance had deteriorated slightly, with a left ventricular fractional shortening (LVFS) of 24% and an ejection fraction (LVEF) of 57%. She was treated with oral angiotensin-converting enzyme inhibitor. Patient 3A 9-year-old girl was referred for an outpatient examination of an arrhythmia diagnosed previously during a school physical examination. She was alert and healthy with clear heart sounds and no murmur. No cardiac enlargement was noted on the chest roentgenogram. Electrocardiography, Echocardiography and Magnetic Resonance ImagingThe ECG of Patient 1 revealed marked tachycardia of 150 beats/min and WPW syndrome type B, with localization of the accessory pathway in the right anteroseptal area (Fig 1A). Cardiac performance was markedly depressed. A 2-dimensional (D) echocardiogram (Fig 1B) and a T1-weighted magnetic resonance imaging (MRI) scan (Fig 1C) revealed numerous, excessively prominent ventricular trabeculations and deep intertrabecular recesses, but there was no evidence of endocardial thrombus over the left ventricular wall.The ECG from Patient 2 revealed a normal sinus rhythm and WPW syndrome type B, with localization of the accessory pathway in the right anteros...
Accurate measurement of body temperature is an important indicator of the status of critically ill patients and is therefore essential. While axillary temperature is not considered accurate, it is still the conventional method of measurement in Asian intensive care units. There is uncertainty about the accuracy of thermometers for the critically ill. We compared the accuracy and precision of bladder, axillary and tympanic temperature measurements in critically ill patients.A total of 73 critically ill patients admitted to the intensive care unit of a teaching hospital were prospectively enrolled. Every four hours, we measured body temperature at three sites (bladder, axillary and tympanic). If the patient had received an indwelling pulmonary artery catheter, blood temperature was also recorded and this was compared with bladder, axillary and tympanic temperature readings. For all patients, axillary and tympanic temperature readings were compared with bladder temperature readings. Accuracy and precision were analysed using bland-Altman analysis.When blood temperature data was available, the mean difference between blood and bladder temperature readings was small (0.02±0.21°C). Compared with bladder temperature, mean difference for axillary temperature was -0.33±0.55°C and for tympanic temperature it was -0.51±1.02°C.For critically ill patients, recorded axillary temperature was closer to bladder temperature than tympanic temperature.
We compared the bronchodilator response to salbutamol (albuterol) delivered by a compressed air nebulizer through a mouthpiece and via a facemask in 18 asthmatic children, to determine the most appropriate delivery method. Patients using a mouthpiece had significantly better mean percent increases in forced expiratory volume in 1 sec (FEV1) and in forced vital capacity (FVC) than those using a facemask 30 min after inhalation (FEV1, 56.4 +/- 32.6% vs. 28.9 +/- 19.1%, FVC: 34.4 +/- 26.4% vs. 7.5 +/- 14.9%, respectively). Nebulized therapy plays an important role in the management of bronchial asthma in children and should be delivered by a mouthpiece whenever possible in cases of exacerbated asthma.
The enzymatic amplification of specific DNA sequences by the polymerase chain reaction (PCR) has provided a new approach to genetic typing of HLA-class Ⅱ region specificities.
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