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Thomas Butler
Within 24 hours after antibiotic treatment of the spirochetal infections syphilis, Lyme disease, leptospirosis, and relapsing fever (RF), patients experience shaking chills, a rise in temperature, and intensification of skin rashes known as the Jarisch-Herxheimer reaction (JHR) with symptoms resolving a few hours later. Case reports indicate that the JHR can also include uterine contractions in pregnancy, worsening liver and renal function, acute respiratory distress syndrome, myocardial injury, hypotension, meningitis, alterations in consciousness, seizures, and strokes...
January 11, 2017: American Journal of Tropical Medicine and Hygiene
Jennifer Davis, Anthea L Raisis, Hildegriet Haitjema, Eleanor A Drynan, Giselle L Hosgood
OBJECTIVE: To describe the anesthetic management of a dog undergoing caudal vena cava (CVC) occlusion during adrenalectomy, and to discuss a reflex bradycardia that was observed during the procedure. CASE SUMMARY: General anesthesia of a 10-year-old Rhodesian ridgeback for excision of an adrenal mass and associated CVC tumor thrombus was performed. The dog was premedicated with IV methadone and anesthesia was induced with IV alfaxalone and maintained with isoflurane in 100% oxygen...
January 10, 2017: Journal of Veterinary Emergency and Critical Care
Martha W F Rac, Paula A Revell, Catherine S Eppes
Syphilis remains the most common congenital infection worldwide and has tremendous consequences for the mother and her developing fetus if left untreated. Recently, there has been an increase in the number of congenital syphilis cases in the United States. Thus, recognition and appropriate treatment of reproductive-age women must be a priority. Testing should be performed at initiation of prenatal care and twice during the third trimester in high-risk patients. There are 2 diagnostic algorithms available and physicians should be aware of which algorithm is utilized by their testing laboratory...
December 9, 2016: American Journal of Obstetrics and Gynecology
Shaalee Dworski, Ping Lu, Aneal Khan, Bruno Maranda, John J Mitchell, Rossella Parini, Maja Di Rocco, Boris Hugle, Makoto Yoshimitsu, Bo Magnusson, Balahan Makay, Nur Arslan, Norberto Guelbert, Karoline Ehlert, Andrea Jarisch, Janet Gardner-Medwin, Rawane Dagher, Maria Teresa Terreri, Charles Marques Lorenco, Lilianna Barillas-Arias, Pranoot Tanpaiboon, Alexander Solyom, James S Norris, Xingxuan He, Edward H Schuchman, Thierry Levade, Jeffrey A Medin
Acid Ceramidase Deficiency (Farber disease, FD) is an ultra-rare Lysosomal Storage Disorder that is poorly understood and often misdiagnosed as Juvenile Idiopathic Arthritis (JIA). Hallmarks of FD are accumulation of ceramides, widespread macrophage infiltration, splenomegaly, and lymphocytosis. The cytokines involved in this abnormal hematopoietic state are unknown. There are dozens of ceramide species and derivatives, but the specific ones that accumulate in FD have not been investigated. We used a multiplex assay to analyze cytokines and mass spectrometry to analyze ceramides in plasma from patients and mice with FD, controls, Farber patients treated by hematopoietic stem cell transplantation (HSCT), JIA patients, and patients with Gaucher disease...
February 2017: Biochimica et Biophysica Acta
Jukka Hytönen, Tamim Khawaja, Juha O Grönroos, Anna Jalava, Seppo Meri, Jarmo Oksi
We report two cases of louse-borne relapsing fever (LBRF) in young Somali asylum seekers having recently arrived to Finland. They had sought medical attention for a febrile illness. Blood smears were examined for suspected malaria, but instead, spirochete shaped bacteria were observed. The bacteria were confirmed as Borrelia recurrentis by PCR and sequencing. The patients survived, but their treatment was complicated by Jarisch-Herxheimer reaction. We conclude that LBRF must be considered as a diagnostic option in febrile refugees also in the northernmost parts of Europe...
January 2017: APMIS: Acta Pathologica, Microbiologica, et Immunologica Scandinavica
J Jochum, E Tannich, D Tappe, S Schmiedel
The increasing migration into Europe may confront clinicians with diseases barely known any more in this part of the world. We present a case of louse-borne relapsing fever in a Somali refugee. Blood smears led to the diagnosis of relapsing fever and DNA sequencing was positive for Borrelia recurrentis. This disease should be considered in all patients with unclear fever and a compatible travel or migration history. Blood smears are employed as the primary diagnostic method. Therapy harbors the danger of a Jarisch-Herxheimer reaction, a complication that may require intensive medical care...
November 7, 2016: Der Internist
Sanefumi Tsuha, Tomohiro Taniguchi, Soichi Shiiki, Masashi Narita, Daniel T Leung
BACKGROUND: Leptospirosis is a zoonotic disease known to have wide-ranging clinical manifestations. Despite a number of published case series, culture-confirmed series are few and there is a paucity of data on Jarisch-Herxheimer reaction (JHR) associated with treatment of leptospirosis. Our objective was to describe the clinical and epidemiological factors associated with leptospirosis in an endemic area of Japan, with a focus on the occurrence of JHR, an often unrecognized and likely underestimated phenomenon...
October 15, 2016: Transactions of the Royal Society of Tropical Medicine and Hygiene
Eva Rettinger, Michael Merker, Emilia Salzmann-Manrique, Hermann Kreyenberg, Thomas Krenn, Matthias Dürken, Jörg Faber, Sabine Huenecke, Claudia Cappel, Melanie Bremm, Andre Willasch, Shahrzad Bakhtiar, Andrea Jarisch, Jan Soerensen, Thomas Klingebiel, Peter Bader
Monitoring of minimal residual disease (MRD) or chimerism may help guide pre-emptive immunotherapy (IT) with a view to preventing relapse in childhood acute lymphoblastic leukemia (ALL) after transplantation. Patients with ALL who consecutively underwent transplantation in Frankfurt/Main, Germany between January 1, 2005 and July 1, 2014 were included in this retrospective study. Chimerism monitoring was performed in all, and MRD assessment was performed in 58 of 89 patients. IT was guided in 19 of 24 patients with mixed chimerism (MC) and MRD and by MRD only in another 4 patients with complete chimerism (CC)...
January 2017: Biology of Blood and Marrow Transplantation
Giovanna Lucchini, Andre Manfred Willasch, Julia Daniel, Jan Soerensen, Andrea Jarisch, Shahrzad Bakhtiar, Eva Rettinger, Joerg Brandt, Thomas Klingebiel, Peter Bader
CLS involves sudden loss of intravascular fluids into the interstitial spaces. CLS was described as a possible complication after SCT. Few studies report the incidence of CLS in pediatric populations. We aimed to assess CLS incidence, its risk factors, and impact on the survival. The clinical charts of patients <18 years of age transplanted at our institution between 2002 and 2012 were reviewed. CLS was defined by weight gain >3% in 24 hours and positive intake balance despite furosemide administration...
October 13, 2016: Pediatric Transplantation
A M Willasch, E Salzmann-Manrique, T Krenn, M Duerken, J Faber, J Opper, H Kreyenberg, R Bager, S Huenecke, C Cappel, M Bremm, V Pfirrmann, M Merker, E Ullrich, S Bakhtiar, E Rettinger, A Jarisch, J Soerensen, T E Klingebiel, P Bader
Therapy for post-transplant relapse of paediatric ALL is limited. Standardised curative approaches are not available. We hereby describe our local procedure in this life-threatening situation. A total of 101 ALL patients received their first allogeneic stem cell transplantation (SCT) in our institution. After relapse, our primary therapeutic goal was to cure the patient with high-dose chemotherapy or specific immunotherapy (HDCHT/SIT) followed by a second SCT from a haploidentical donor (transplant approach)...
September 19, 2016: Bone Marrow Transplantation
Justin Jarisch, Wen Lien, Peter H Guevara, William J Greenwood, William J Dunn
Sonication technology has recently been touted to decrease composite viscosity during delivery and may allow better cavity preparation adaptation and minimize voids. The purpose of this investigation was to evaluate the difference between conventional, hand-placed, incremental application of a standard hybrid resin-based composite (RBC) and sonicated application of a bulk-fill RBC in box-type and cylindrical cavity preparations. Experimental restorations were fabricated using molds of box-type or cylindrical preparations...
September 2016: General Dentistry
Chad Haney, Milap C Nahata
I am a 24-year-old male who was diagnosed with chronic Lyme disease after 4 years of multiple, non-specific symptoms. I have written this case as first author with my faculty mentor listed as the coauthor. The objective of this report is to highlight the experience with doxycycline treatment. In 2007, at around age 19 years, I had an acute onset of sore throat, tonsillitis, low-grade fever, stiff upper back and neck muscles, migraines and severely stiff, cracking jaw joints. This led to >24 medical visits, multitudes of tests and examinations, and exploratory surgery over the next 3 years...
July 20, 2016: BMJ Case Reports
M R Simões, B F Azevedo, J Fiorim, D D Freire, E P Covre, D V Vassallo, L Dos Santos
: Mercury is known to cause harmful neural effects affecting the cardiovascular system. Here, we evaluated the chronic effects of low-dose mercury exposure on the autonomic control of the cardiovascular system. METHODS: Wistar rats were treated for 30 days with HgCl2 (1st dose 4.6 μg/kg followed by 0.07 μg/kg/day, i.m.) or saline. The femoral artery and vein were then cannulated for evaluation of autonomic control of the hemodynamic function, which was evaluated in awake rats...
July 18, 2016: Clinical and Experimental Pharmacology & Physiology
Sabine Huenecke, Melanie Bremm, Claudia Cappel, Ruth Esser, Andrea Quaiser, Halvard Bonig, Andrea Jarisch, Jan Soerensen, Thomas Klingebiel, Peter Bader, Ulrike Koehl
BACKGROUND: Excessive T-cell depletion (TCD) is a prerequisite for graft manufacturing in haploidentical stem cell (SC) transplantation by using either CD34 selection or direct TCD such as CD3/CD19 depletion. STUDY DESIGN AND METHODS: To optimize graft composition we compared 1) direct or indirect TCD only, 2) a combination of CD3/CD19-depleted with CD34-selected grafts, or 3) TCD twice for depletion improvement based on our 10-year experience with 320 separations in graft manufacturing and quality control...
September 2016: Transfusion
Christopher A Lear, Robert Galinsky, Guido Wassink, Kyohei Yamaguchi, Joanne O Davidson, Jenny A Westgate, Laura Bennet, Alistair J Gunn
A distinctive pattern of recurrent rapid falls in fetal heart rate, called decelerations, are commonly associated with uterine contractions during labour. These brief decelerations are mediated by vagal activation. The reflex triggering this vagal response has been variably attributed to a mechanoreceptor response to fetal head compression, to baroreflex activation following increased blood pressure during umbilical cord compression, and/or a Bezold-Jarisch reflex response to reduced venous return from the placenta...
September 1, 2016: Journal of Physiology
Ha Son Nguyen, Harvey Woehlck, Peter Pahapill
Background. Symptomatic bradycardia and hypotension in neurosurgery can produce severe consequences if not managed appropriately. The literature is scarce regarding its occurrence during deep brain stimulation (DBS) surgery. Case Presentation. A 67-year-old female presented for left DBS lead placement for essential tremors. During lead implantation, heart rate and blood pressure dropped rapidly; the patient became unresponsive and asystolic. Chest compressions were initiated and epinephrine was given. Within 30 seconds, the patient became hemodynamically stable and conscious...
2016: Case Reports in Neurological Medicine
Zyrafete Kuçi, Halvard Bönig, Hermann Kreyenberg, Milica Bunos, Anna Jauch, Johannes W G Janssen, Marijana Škifić, Kristina Michel, Ben Eising, Giovanna Lucchini, Shahrzad Bakhtiar, Johann Greil, Peter Lang, Oliver Basu, Irene von Luettichau, Ansgar Schulz, Karl-Walter Sykora, Andrea Jarisch, Jan Soerensen, Emilia Salzmann-Manrique, Erhard Seifried, Thomas Klingebiel, Peter Bader, Selim Kuçi
To circumvent donor-to-donor heterogeneity which may lead to inconsistent results after treatment of acute graft-versus-host disease with mesenchymal stromal cells generated from single donors we developed a novel approach by generating these cells from pooled bone marrow mononuclear cells of 8 healthy "3(rd)-party" donors. Generated cells were frozen in 209 vials and designated as mesenchymal stromal cell bank. These vials served as a source for generation of clinical grade mesenchymal stromal cell end-products, which exhibited typical mesenchymal stromal cell phenotype, trilineage differentiation potential and at later passages expressed replicative senescence-related markers (p21 and p16)...
August 2016: Haematologica
Denise G Terra, Ewelyne M de Lima, Andrews M do Nascimento, Girlandia A Brasil, Placielle F Filete, Ieda C Kalil, Dominik Lenz, Denise C Endringer, Nazaré S Bissoli, Tadeu U de Andrade
This study evaluated the effects of the isolated use of a low dose of methyltestosterone (MT) on cardiovascular reflexes and hormonal levels and its geno- and cytotoxic safety in ovariectomized rats. Female Wistar rats were divided into four groups (n = 6), respectively: SHAM (received vehicle methylcellulose 0.5%), SHAM + MT (received MT 0.05 mg/kg), OVX (received vehicle), and OVX + MT (received MT). Twenty-one days after ovariectomy, treatment was given orally daily for 28 days. The Bezold-Jarisch reflex (BJR) was analyzed by measuring the bradycardic and hypotensive responses elicited by phenylbiguanide (PBG) administration...
August 2016: Fundamental & Clinical Pharmacology
Eva Oddby, Anette Hein, Jan G Jakobsson
INTRODUCTION: Reduced blood pressure is commonly seen associated to spinal anaesthesia for Caesarean section and efforts to reduce its occurrence and its magnitude is common practice. Cardiovascular collapse requiring cardio-pulmonary resuscitation after putting the spinal/epidural block for Caesarean section is however a rare but most dramatic event. PRESENTATION OF CASE: We describe a case with sudden short loss of circulation, circulatory collapse, short after start of emergency Caesarean section in top up epidural anaesthesia (3+12ml ropivaciane 7...
2016: International Journal of Surgery Case Reports
Volker Fingerle, Michael Pritsch, Martin Wächtler, Gabriele Margos, Sabine Ruske, Jette Jung, Thomas Löscher, Clemens Wendtner, Andreas Wieser
A 26 year-old female patient presented to the Tropical Medicine outpatient unit of the Ludwig Maximilians-University in Munich with febrile illness after returning from Southern Africa, where she contracted a bite by a large mite-like arthropod, most likely a soft-tick. Spirochetes were detected in Giemsa stained blood smears and treatment was started with doxycycline for suspected tick-borne relapsing fever. The patient eventually recovered after developing a slight Jarisch-Herxheimer reaction during therapy...
March 2016: PLoS Neglected Tropical Diseases
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