Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein* ; Catheters* ; Extracorporeal Membrane Oxygenation* ; Heart ; Hernias, Diaphragmatic, Congenital* ; Humans ; Infant, Newborn* ; Oxygen ; Radiography, Thoracic

HIV-1 Tat protein has been implicated as a causative agent in the pathogenesis of HIV-1-associated neurocognitive disorder (HAND) and Alzheimer's disease (AD)-like pathology in HIV-1 infected patients. Here, we provide insights into the potential roles of extracellular HIV-1 Tat protein in amyloid beta (Abeta) generation and Tau phosphorylation, two major neuropathological features of AD. Exposure of the rat hippocampal slices to the full-length HIV-1 Tat protein (Tat1-86) for 3 days led to the increased levels of Abeta precursor protein (APP) accumulation, which accompanied by Abeta generation in the hippocampus, the brain region most commonly damaged in HIV-1-associated dementia (HAD). Moreover, extracellular HIV-1 Tat significantly stimulated the level of phosphrylated Tau (pTau) identified using immunoblotting with AT8 antibody, which recognizes abnormally hyperphosphorylated Tau. Collectively, our data suggest that HIV-1 Tat plays important roles in increasing the levels of APP accumulation, Abeta generation and Tau phosphorylation in the hippocampus, and thereby might contribute to the development of AD-like pathology in HIV-1-infected patients.
Alzheimer Disease ; Amyloid* ; Animals ; Brain ; Dementia ; Gene Products, tat* ; Hippocampus ; HIV-1* ; Humans ; Immunoblotting ; Pathology ; Phosphorylation* ; Rats*

Posttransplant lymphoproliferative disease(PTLD) has emerged as a potential life-threatening complication of immunosuppressive therapy after organ transplantation. The occurrence of PTLD is usually associated with an Epstein-Barr virus(EBV) infection in patients who are treated by aggressive immunosuppressive therapy. PTLD is represented by diverse manifestations ranging from reactive lymphoid hyperplasia to high grade malignant lymphoma. This is a case report of a late PTLD in a child. The patient is a 14-year-old girl, who presented as malignant lymphoma 44 months after successful renal transplantation. There was no evidence of EBV infection. On bone marrow study, many neoplastic lymphoid cells were detected. Aggressive chemotherapy for PTLD had resulted in clinical remission. However the patient expired from uncontrolled sepsis and septic shock after 77 days.
Adolescent ; Bone Marrow ; Child* ; Drug Therapy ; Epstein-Barr Virus Infections ; Female ; Herpesvirus 4, Human ; Humans ; Kidney Transplantation* ; Lymphocytes ; Lymphoma ; Organ Transplantation ; Pseudolymphoma ; Sepsis ; Shock, Septic ; Transplants

Rhabdomyoma has been reported to be the most common type of cardiac tumors in fetuses and children, and multiple cardiac rhabdomyomas almost certainly signify the association with tuberous sclerosis. We report here on a case of Tetralogy of Fallot (ToF) that was associated with multiple rhabdomyomas and tuberous sclerosis. A two-year-old boy, who had undergone systemic-pulmonary shunt during the neonatal period, received total correction of his ToF after the complete regression of the cardiac tumor. The postoperative course was uneventful, and he has been follow-up for 2 months. The boy is currently in an excellent condition.
Child ; Fetus ; Follow-Up Studies ; Heart Neoplasms ; Humans ; Rhabdomyoma ; Tetralogy of Fallot ; Tuberous Sclerosis

BACKGROUND AND PURPOSE: We performed this study to explore the various diagnostic roles of video-EEG monitoring (VEM) and to assess the outcome after VEM. METHODS: 1749 patients who underwent VEM in the adult epilepsy section were included. We classified purposes of VEM and assessed outcome after VEM or epilepsy surgery guided by VEM. The outcome was assessed according to seizure frequency during the previous 12 months from the day of follow-up evaluation. RESULTS: The purposes of VEM were presurgical evaluation (68.5%), confirmation of epilepsy (15%), classification of seizures (9.4%), diagnosis of pseudoseizures (5.5%), and detection of nonconvulsive status epilepticus (1.7%). The efficiency of VEM was 89.2%, highest for presurgical evaluation (97.1%) and lowest for confirmation of seizures (66.0%). The number of events detected and the number of days needed differed according to the purposes of VEM. Epilepsy surgery was performed in 629 patients. The outcome of patients with epilepsy surgery was significantly better compared with patients without surgery despite presurgical evaluation (p<0.0001). Various other illnesses with transient symptoms as well as various epileptic syndromes were diagnosed by VEM. Better outcomes were observed in patients in whom VEM was used for classification and confirmation of seizures compared with patients in whom VEM was used for presurgical evaluation. CONCLUSIONS: VEM is a useful tool for various purposes. The efficiency, number of events and days of VEM differed according to the purposes. Patient outcome was also dependent on the purpose of the VEM as well as on treatment modalities.
Adult ; Epilepsy ; Follow-Up Studies ; Humans ; Seizures ; Status Epilepticus

Postoperative intractable arrhythmia can result in high morbidity and mortality. This report describes our experiences using mechanical circulatory support (MCS) to control medically intractable arrhythmias in three pediatric patients with congenital heart disease (CHD), after palliative or total corrective open-heart surgery.
Arrhythmias, Cardiac ; Extracorporeal Membrane Oxygenation ; Heart Diseases ; Humans ; Thoracic Surgery

PURPOSE: As the incidence of bronchopulmonary dysplasia (BPD) has increased, it is important to understand the clinical outcomes of BPD patients discharged from neonatal intensive care units (NICU). The purpose of our study was to describe the characteristics of BPD patients who are re-hospitalized in a pediatric intensive care unit (PICU) and to evaluate the prognostic outcome factors. METHODS: We retrospectively reviewed the medical records of BPD patients who were admitted to our PICU between May 2006 and November 2014. In total, we identified 101 cases which were divided into two groups, group 1, those who required intensive care for an acute illness or disease aggravation (n=62), and group 2, those who were admitted for post-operative care unrelated to having BPD as a control group (n=39). We subsequently compared the characteristics. RESULTS: Most patients in group 1 were aged less than 1 year, with weight below the 3rd percentile for age at the time of their PICU admission. The main cause for their admission was respiratory failure, requiring mechanical ventilation. When comparing the two groups, group 1 showed higher gestational age at birth, and a longer duration of mechanical ventilation, oxygen support, and NICU hospitalization than group 2. However, we failed to identify any factor significantly associated with the duration of the PICU stay, hospital stay, and mortality. Further large-scale, long-term follow-up studies will be necessary. CONCLUSION: As the majority of patients are admitted to PICU because of respiratory symptoms during their infantile period, careful follow-up with supportive care and prevention of respiratory infection are required.
Bronchopulmonary Dysplasia* ; Critical Care* ; Follow-Up Studies ; Gestational Age ; Hospitalization ; Humans ; Incidence ; Infant, Newborn ; Intensive Care Units* ; Intensive Care Units, Neonatal ; Length of Stay ; Medical Records ; Mortality ; Oxygen ; Parturition ; Respiration, Artificial ; Respiratory Insufficiency ; Retrospective Studies

Acute kidney injury (AKI) is a common complication in critically ill children. However, the common lack of baseline serum creatinine values affects AKI diagnosis and staging. Several approaches for estimating baseline creatinine values in those patients were evaluated. Methods: This single-center retrospective study enrolled pediatric patients with documented serum creatinine measurements within 3 months before admission and more than two serum creatinine measurements within 7 days after admission to the pediatric intensive care unit of a tertiary care children’s hospital between January 2016 and April 2020. Four different approaches for estimating AKI using serum creatinine measurements were compared: 1) back-calculation using age-adjusted normal reference glomerular filtration rates, 2) age-adjusted normal reference serum creatinine values, 3) minimum values measured within 7 days after admission, and 4) initial values upon admission. Results: The approach using minimum values showed the best agreement with the measured baseline value, with the largest intraclass correlation coefficient (0.623), smallest bias (–0.04), and narrowest limit of agreement interval (1.032). For AKI diagnosis and staging, the minimum values were 80.8% and 76.1% accurate, respectively. The other estimated baseline values underestimated AKI and showed poor agreement with baseline values before admission, with a misclassification rate of up to 42% (p < 0.001). Conclusion: Minimum values of serum creatinine measured within 7 days after hospital admission showed the best agreement with creatinine measured within 3 months before admission, indicating the possibility of using it as a baseline when baseline data are unavailable. Further large-scale studies are required to accurately diagnose AKI in critically ill children.

Malposition of the extracorporeal membrane oxygenation (ECMO) venous cannula in the azygos vein is not frequently reported. We hereby present such a case, which occurred in a neonate with right-sided congenital diaphragmatic hernia. Despite ECMO application, neither adequate flow nor sufficient oxygenation was achieved. On the cross-table lateral chest radiograph, the cannula tip was identified posterior to the heart silhouette, which implied malposition of the cannula in the azygos vein. After repositioning the cannula, the target flow and oxygenation were successfully achieved. When sufficient venous flow is not achieved, as in our case, clinicians should be alerted so they can identify the cannula tip location on lateral chest radiograph and confirm whether malposition in the azygos vein is the cause of the ineffective ECMO.
Azygos Vein ; Catheters ; Extracorporeal Membrane Oxygenation ; Heart ; Hernias, Diaphragmatic, Congenital ; Humans ; Infant, Newborn ; Oxygen ; Radiography, Thoracic

Coronavirus disease 2019 (COVID-19) is associated with a variety of neurologic manifestations. Acute necrotizing encephalopathy (ANE) is a rare, life-threatening complication characterized by rapid deterioration of neurologic status following viral infection, such as influenza or human herpesvirus 6. Since the COVID-19 pandemic, a rise in ANE cases associated with the infectious disease has been reported in adult patients. We present a case of COVID-19-associated ANE in a 9-year-old boy. The patient experienced 3 days of fever and mild respiratory symptoms, followed by lethargy. Magnetic resonance imaging on day 4 showed hyperintensity in the bilateral thalami, midbrain, pons, hypothalamus, and cerebellum, along with some areas of hemorrhage. From the imaging findings, ANE was strongly suspected, leading to the initiation treatment involving a 5-day course of remdesivir and multiple immunomodulator therapies, including high-dose corticosteroids, intravenous immunoglobulin, tocilizumab, and 10 cycles of therapeutic plasma exchange. Subsequently, the patient gradually improved, experiencing only minor neurological sequelae and showing favorable radiologic improvement. In COVID-19-infected patients presenting neurologic symptoms, it is crucial to promptly suspect and investigate unexplained encephalopathy using neuroimaging. Early administration of immunomodulator therapy is vital for the diagnosis and optimizing clinical outcomes.