Patient Care Hematology & Oncology - October 2007 - (Page 27)

port an association between cannabis use and psychotic symptoms, including disabling ones, developing later in life. Jeff Kirchner, DO Lancaster General Hospital, Lancaster, Pa. I A common respiratory pathogen implicated in encephalitis in children Christie LJ, Honarmand S, Talkington DF, et al. Pediatric encephalitis: what is the role of Mycoplasma pneumoniae? Pediatrics. 2007;120(2):305-313. I When is it time to place an ICD for hypertrophic cardiomyopathy? Maron BJ, Spirito P, Shen WK, et al. Implantable cardioverter-defibrillators and prevention of sudden cardiac death in hypertrophic cardiomyopathy. JAMA. 2007;298(4): 405-412. A multicenter registry study of implantable cardioverter defibrillators (ICDs) placed in 506 unrelated patients with hypertrophic cardiomyopathy (HCM) reviewed the relationship between clinical risk profile and ICD intervention for HCM. The data show that, with a mean follow-up of 3.7 years, ICD interventions appropriately terminated ventricular tachycardia/fibrillation in 103 patients (20%). For secondary prevention after cardiac arrest, ICD interventions were 10.6% per year; for primary prevention, they were 3.6% per year. The single sudden death due to an arrhythmia (in the absence of advanced heart failure) resulted from ICD malfunction. ICD complications included inappropriate shocks in 136 patients (27%). Risk factors for sudden death included a family history of sudden death due to HCM, massive left ventricular hypertrophy, nonsustained ventricular tachycardia on Holter monitoring, and prior unexplained syncope. Impact for clinicians The patient population was young (mean age 42 years) and had little or no limiting symptoms. Of the 51 patients with appropriate ICD interventions for primary prevention, 18 of them (35%) had undergone implantation for only a single risk factor. Prophylactic use of an ICD when a patient presents with a single marker of high risk for sudden death may therefore be justified. David Nicklin, MD University of Pennsylvania School of Medicine, Philadelphia, Pa. OCTOBER 2007 Encephalitis is one of the most frightening and debilitating conditions found in pediatric practice. Mycoplasma pneumoniae (MP), a common respiratory pathogen, is occasionally isolated in children with encephalitis. Its role in this disease remains unclear because of variability and reliability in diagnostic testing. In an attempt to better understand the clinical profile and etiologies of unexplained encephalitis, the California Department of Health Services in conjunction with the CDC collected the data from an extensive battery of diagnostic tests, as well as clinical information on patients. In the study population, MP was the most commonly identified pathogen, with 76% of cases found among pediatric patients. These children progressed rapidly from onset to hospitalization, and 55% went to the intensive care unit. Presenting symptoms included fever, lethargy, altered consciousness, and, less commonly, respiratory and GI symptoms. Acute and convalescent serology, rather than CSF polymerase chain reaction, was the most useful test to identify MP in these children (80% versus 2%). Impact for clinicians Unfortunately, this study does not shed any light on the role that MP might play in pediatric encephalitis (eg, true pathogen, coinfection, or precursor to another pathogen). The clinician is still in the dark regarding a better approach to preventing and managing MP in this population. Charles A. Pohl, MD Jefferson Medical College of Thomas Jefferson University Philadelphia, Pa. Clinical Clips is adapted from Clinical Update, which is formatted for Palm OS devices and delivered electronically. Contact the publisher at http://www.redi-reference.com/ beweek.htm for information on how to subscribe. PATIENT CARE HEMATOLOGY & ONCOLOGY 27 http://www.redi-reference.com/biweek.htm http://www.redi-reference.com/biweek.htm

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Patient Care - Hematology & Oncology - October 2007 Research Digest Contents Information for Authors Medicine in the News Strategies for Bridge Anticoagulation Therapy How to Integrate the New Cervical Cancer Guidelines into Practice Dermatology Case Challenge Clinical Clips Classified Advertising

Patient Care Hematology & Oncology - October 2007

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