[Spontaneous cervico-mediastinal haematoma--report of a case].
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Biomedical subjects
Publications and source records attributed to T Togo.
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A 54-year-old man with mitral valve prolapse syndrome diagnosed by echocardiography complained of anginal pain associated with ventricular tachyarrhythmia. One day he suddenly lost consciousness, and ECG at that time revealed ventricular fibrillation. Thereafter, he developed ST elevation, sporadic premature ventricular contractions, and R on T phenomenon leading to ventricular fibrillation during the attack of anginal pain. His coronary arteriogram was normal. This case implies that coronary artery spasm may be one of the causes of chest pain and ventricular tachyarrhythmias in patients with mitral valve prolapse syndrome.
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Cefotetan (CTT), a new cephamycin antibiotic having a long serum half-life (2.93 +/- 0.78 hours), was evaluated for its safety and efficacy in children. Twenty-four patients were treated with a daily dose of 30 to 100 mg/kg of CTT by intravenous administrations mostly in 2 divided doses. The diagnoses of the effective patients were acute bronchitis (5), pneumonia (4), acute urinary tract infections (4), acute enterocolitis (2), presumed septicemia (1), and phlegmon (1); and the effectiveness was 77.3%. The pathogens recovered from these patients were S. pneumoniae (1), H. influenzae (3), S. marcescens (1), E. coli (2), and K. oxytoca (1). CTT was not effective in staphylococcal pneumonia and empyema (each 1 case), in Pseudomonas pneumonia (2), and in a case of brain abscess and mastoiditis of unknown etiology. Diarrhea (2), and transient elevations of the serum GOT, GPT, and LDH (1) were associated with the CTT therapy, but no severe adverse reaction was encountered. The CSF level of CTT seemed to be lower among several new cephalosporins. From the present study, CTT appears to be a safe and effective antibiotic when used in children with susceptible bacterial infections. A twice-a-day schedule was recommended from its long serum half-life.
The first case of multiple peripheral pulmonary stenoses undergoing uneventful pregnancy and delivery is described. The course of pregnancy in a patient with peripheral pulmonary stenoses may generally be uneventful, because increased pulmonary blood flow in pregnancy may cause little influence on pulmonary circulation in this disease by the same mechanism as in pulmonary stenosis, the course of which is known to be uneventful during pregnancy.
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There are still a number of unsolved problems concerning the total correction of interruption of the aortic arch. Here we report a histopathological investigation of the patent ductus arterious and pulmonary vascular disease using autopsy material of a patient with Celoria type B interruption of the aortic arch who died postoperatively. The so-called ductus arteriosus between the pulmonary arterial trunk and the descending aorta was lacking in elastic fibers and smooth muscle cells at the media showing discontinuous, transverse fibrous tissue. The vessel walls were weak and normal development was apparently impossible. Consequently, it was concluded that in the reconstruction of the aortic arch in such cases with PDDT, it is advisable not to use the patent ductus arteriosus. In this case, hypertrophy of the media of small pulmonary arteries was marked, but pulmonary vascular intimal lesions were mild. With regard to the pathogenesis, it is thought that there was sufficient thickening of the media of the pulmonary arterial system in response to the pulmonary hypertension present from birth, and it prevented the progression of the intimal lesions by accommodating to the intraarterial pressure.
Cyclocytidine (Cyclo-C) was evaluated as an antiviral chemotherapeutic agent in 10 children with herpes-group virus infections. The diagnoses of the patients were severe cytomegalovirus (CMV) syndrome with pneumonitis in acute leukemia (2), congenital or infantile CMV infections (3), herpes zoster encephalitis in acute leukemia (1), severe nosocomial varicella in compromised patients (2), varicella pneumonia (1) and acute encephalitis due to herpes simplex type-1 (1). Cyclo-C was effective in all the cases with acute infections, although it had no benefit on the course of chronic CMV infection with irreversible damages. However, complete or transient ceasing of viral shedding was obtained in all the 5 cases with CMV infections. From the present small open study, further evaluation of Cyclo-C as an antiviral agent especially in acute CMV infections is warranted.
Ceftizoxime (FK 749, CZX) was evaluated in 24 children with a suspicion of bacterial infection. Of the 17 confirmed bacterial infections, 16 were shown to be effective (effective rate, 94.1%). The diagnosis included acute pharyngitis (2), pneumonia (6), staphylococcal empyema (1), cervical purulent lymphadenitis (2), acute enterocolitis (2), acute pyelonephritis (1), SSSS (1) and suspected septicemia (2). The etiological pathogens recovered were Streptococcus anginosus (1), Streptococcus pneumoniae (1), Staphylococcus aureus (2), Haemophilus influenzae (3), enteropathogenic Escherichia coli (1) etc. A case of suspected Pseudomonas aeruginosa septicemia was not effectively treated with CZX. The serum half-life of CZX was 1.36 hours after intravenous bolus infection. A cerebrospinal fluid level of CZX was 6.2 mcg/ml 1 hour after intravenous bolus injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. No severe adverse reaction was encountered with the CZX therapy. The data suggest that CZX is an excellent candidate for the first choice parenteral antibiotic in the pediatric infections.
Cefmenoxime (CMX) was evaluated in 25 children with a suspicion of bacterial infection. Of the 20 confirmed bacterial infections, 19 were cured by CMX therapy (effective rate, 95%). The diagnoses included acute pharyngotonsillitis (4), acute bronchitis (1), pneumonia (7), streptococcal dacryocystitis (1), infections accompanied with acute leukemia (4), and acute urinary tract infections (3). The etiologic pathogens were beta-hemolytic Streptococcus group A (1), and F (1), Staphylococcus aureus (4), Haemophilus influenzae (4), Escherichia coli (4), Klebsiella pneumoniae (2), etc. CMX was very effective for 2 children with respiratory infections due to ampicillin resistant H. influenzae type b. The half life of serum concentration of CMX was 0.76 +/- 0.17 hour after an intravenous bolus injection. A cerebrospinal fluid level of CMX was 5.2 mcg/ml 1 hour after intravenous injection of 1 g (23.8 mg/kg) in a child with inflamed meninges. However this level was not as high as those of cefotaxime, latamoxef, or ceftizoxime measured in the same case. No severe adverse reaction was encountered with CMX therapy. The data suggest that CMX is a safe and effective parenteral antibiotic when used in children with susceptible bacterial infections.
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