Pediatric perimedullary arteriovenous fistula: clinical features and endovascular treatments

ObjectivePediatric spinal perimedullary arteriovenous fistula (PMAVF) is rare but may cause permanent disability. We aim to summarize the clinical features of pediatric PMAVFs and our clinical experience in their treatment and to evaluate the effect of endovascular treatment in a large cohort.MethodsFrom 2008 to 2017, 51 PMAVFs in pediatric patients (<14 years' old) treated with endovascular techniques were retrospectively reviewed, including 24 type IVb (47.1%) and 27 type IVc (52.9%) lesions. Clinical features, radiological findings, treatment, and outcomes were evaluated.ResultsThirty-eight boys and thirteen girls were included, and the mean age at presentation was 5.6±4.1 years. Acute neurological deterioration was identified in 33 patients, and 21 of those patients (63.6%) suffered from bleeding. The annual bleeding rate before treatment was 2.55%. After transarterial embolization with coils and glue, 46 PMAVFs (90.2%) were completely occluded, and five (9.8%) were obliterated by supplementary microsurgery. During a follow-up period of 6 to 119 months (mean 58.4±16.7 months), the patients’ clinical states were improved in 42 cases (82.4%), stationary in nine cases (17.6%), and aggravated in none. Type IVc patients had a longer preoperative period, more chronic symptoms, a lower cure rate by embolization, and less improvement of symptoms than type IVb patients had (P<0.05).ConclusionsPediatric PMAVF is a special subgroup of intradural arteriovenous shunt that should be treated early. Endovascular embolization is safe and effective in the treatment of pediatric PMAVFs.

Weekend Compared with Weekday Presentations of Peritoneal Dialysis–Associated Peritonitis

ObjectiveManagement of peritoneal dialysis (PD)–associated peritonitis requires timely intervention by experienced staff, which may not be uniformly available throughout the week. The aim of the present study was to examine the effects of weekend compared with weekday presentation on peritonitis outcomes.MethodsThe study, which used data from the Australia and New Zealand Dialysis and Transplant Registry, included all Australian patients receiving PD between 1 October 2003 and 31 December 2008. The independent predictors of weekend presentation and subsequent peritonitis outcomes were assessed by multivariate logistic regression.ResultsPeritonitis presentation rates were significantly lower on Saturdays [0.46 episodes per year; 95% confidence interval (CI): 0.42 to 0.49 episodes per year] and on Sundays (0.43 episodes per year; 95% CI: 0.40 to 0.47 episodes per year) than all other weekdays; they peaked on Mondays (0.76 episodes per year; 95% CI: 0.72 to 0.81 episodes per year). Weekend presentation with a first episode of peritonitis was independently associated with lower body mass index and residence less than 100 km away from the nearest PD unit. Patients presenting with peritonitis on the weekend were significantly more likely to be hospitalized [adjusted odds ratio (OR): 2.32; 95% CI: 1.85 to 2.90], although microbial profiles and empiric antimicrobial treatments were comparable between the weekend and weekday groups. Antimicrobial cure rates were also comparable (79% vs 79%, p = 0.9), with the exception of cure rates for culture-negative peritonitis, which were lower on the weekend (80% vs 88%, p = 0.047). Antifungal prophylaxis was less likely to be co-prescribed for first peritonitis episodes presenting on weekdays (OR: 0.68; 95% CI: 0.05 to 0.89).ConclusionsPatients on PD are less likely to present with peritonitis on the weekend. Nevertheless, the microbiology, treatment, and outcomes of weekend and weekday PD peritonitis presentations are remarkably similar. Exceptions include the associations of weekend presentation with a higher hospitalization rate and a lower cure rate in culture-negative infection.

Difference in outcome of adolescents (14–17 years) with acute lymphoblastic leukemia (ALL) enrolled in the Italian pediatric (AIEOP) and adult (GIMEMA) multicenter protocols

9024 Background: Progress in the treatment of acute lymphoblastic leukemia (ALL) has led to better survival rates; however, this benefit has not extended in the same proportion to adolescents who retain a lower cure rate, compared to younger patients. Based on some recent reports, adolescents treated on pediatric ALL trials seem to have a significantly better event free-survival (EFS) than those treated on adult trials. Methods: We retrospectively compared the results obtained in 242 adolescents enrolled either in the national cooperative pediatric (AIEOP; n=150) or adult (GIMEMA; n=92) ALL trials, between 4/1996 and 10/2003. Results: The characteristics of the patients at diagnosis in the two groups under examination were comparable except for age (median age: 15 in the AIEOP vs 16 in the GIMEMA trials). Adolescents in the AIEOP protocols had a better complete remission (CR) rate (97%) compared to those treated with the GIMEMA protocols (89%). Overall treatment results estimated at 2 years were significantly superior for patients treated in the pediatric trials: survival 81% vs 71% and EFS 78% vs 47%. This difference was significant also at the multivariate analysis. Conclusions: Our results support, in keeping with other studies, the concept that adolescents with ALL have a better outcome if treated in pediatric trials. No significant financial relationships to disclose.

Regeneration of Carbon Black from Waste Automobile Tyres and its Use in Carcass Compound

Post-consumer tyre provide a real challenge for recovery and re-use, since they must be disposed of in an environmentally sound and sustainable manner. Pyrolysis has proved an attractive method. The authors have already established a process of pyrolysis to regenerate the carbon black from waste tyres; it was elaborated in an earlier paper. The regenerated blacks(RB) have now been characterized by various methods. They were mixed in a typical virgin carcass compound, the required properties of the mixed compounds were measured, and then the compounds were cured under standard conditions of time and temperature. The physico-mechanical properties of the cured specimens were measured and compared to those of samples made using virgin (VB) and heat-treated blacks (HTB). It was concluded that the regenerated black has a higher surface area, and gives a higher elongation at break, with a higher heat build up, lower cure rate and lower modulus than virgin blacks, but a comparable state of cure, dispersion, hardness, tensile strength, tear strength and high adhesion strength. It was also found that regenerated black had a slightly different structure and agglomerate size. Some polar groups were incorporated into the carbon black, either during pyrolysis or during heat treatment. The regenerated black gave better ageing properties than the virgin or heat-treated blacks.

Studies on Maleic Anhydride Grafted Reclaimed Rubber/Acrylonitrile Butadiene Rubber Blends

Blends of Acrylonitrile rubber with Maleic anhydride grafted Whole Tyre Reclaim WTR (MA-g-WTR) have been prepared and the cure and mechanical properties have been studied with respect to reclaim content. Control compounds containing unmodified WTR were also prepared for comparison. Grafting was confirmed by IR studies. Blends containing grafted WTR showed higher minimum torque and (max-min) torque. They also showed longer cure time, scorch time and lower cure rate. Grafting of the WTR with maleic anhydride also resulted in the improved tensile strength, abrasion resistance, compression set and resilience. However, the heat build up under dynamic loading was marginally higher for the blends containing grafted reclaimed rubber.

Radioiodine Treatment of Hyperthyroidism—Prognostic Factors for Outcome

There is little consensus regarding the most appropriate dose regimen for radioiodine (131I) in the treatment of hyperthyroidism. We audited 813 consecutive hyperthyroid patients treated with radioiodine to compare the efficacy of 2 fixed-dose regimens used within our center (185 megabequerels, 370 megabequerels) and to explore factors that may predict outcome. Patients were categorized into 3 diagnostic groups: Graves’ disease, toxic nodular goiter, and hyperthyroidism of indeterminate etiology. Cure after a single dose of 131I was investigated and defined as euthyroid off all treatment for 6 months or T4 replacement for biochemical hypothyroidism in all groups. As expected, patients given a single dose of 370 megabequerels had a higher cure rate than those given 185 megabequerels, (84.6% vs. 66.6%, P &lt; 0.0001) but an increase in hypothyroidism incidence at 1 yr (60.8% vs. 41.3%, P &lt; 0.0001). There was no difference in cure rate between the groups with Graves’ disease and those with toxic nodular goiter (69.5% vs. 71.4%; P, not significant), but Graves’ patients had a higher incidence of hypothyroidism (54.5% vs. 31.7%, P&lt; 0.0001). Males had a lower cure rate than females (67.6% vs. 76.7%, P = 0.02), whereas younger patients (&lt;40 yr) had a lower cure rate than patients over 40 yr old (68.9% vs. 79.3%, P &lt; 0.001). Patients with more severe hyperthyroidism (P &lt; 0.0001) and with goiters of medium or large size (P &lt; 0.0001) were less likely to be cured after a single dose of 131I. The use of antithyroid drugs, during a period 2 wk before or after 131I, resulted in a significant reduction in cure rate in patients given 185 megabequerels 131I (P &lt; 0.01) but not 370 megabequerels. Logistic regression analysis showed dose, gender, goiters of medium or large size, and severity of hyperthyroidism to be significant independent prognostic factors for cure after a single dose of 131I. We have demonstrated that a single fixed dose of 370 megabequerels 131I is highly effective in curing toxic nodular hyperthyroidism as well as Graves’ hyperthyroidism. Because male patients and those with more severe hyperthyroidism and medium or large-sized goiters are less likely to respond to a single dose of radioiodine, we suggest that the value of higher fixed initial doses of radioiodine should be evaluated in these patient categories with lower cure rates.

Open Randomized Study Comparing Doxycycline and Co-Amoxiclav in the Treatment of Acute Suppurative Tracheobronchitis in Adults

Doxycycline and co-amoxiclav were compared in a randomized clinical trial involving adult patients with acute suppurative tracheobronchitis. Patients were treated for 5 to 10 days with either antibiotic following three schemes: co-amoxiclav 500 mg three times daily, or doxycycline 200 mg on day 1 followed by 100 mg daily, or 200 mg daily. Assessment after 5 – 9 days was based only on clinical parameters. Patients with inadequate response to the initial treatment were crossed over to the alternative antibiotic. Of the 210 patients enrolled, 206 were available for evaluation of efficacy. Both antibiotic regimens proved equally efficacious, with rates of clinical response (cure or improvement) of 89% and 91% for doxycycline and co-amoxiclav, respectively. Patients who were crossed over to the alternative antibiotic had a significantly lower cure rate after their second course of antibiotics (22% compared with 70%). Adverse effects, most often of gastro-intestinal origin, were more common in the co-amoxiclav group than in the doxycycline-treated group, but rarely caused cessation of treatment.