General vaccination of children against influenza?

Due to the high incidence of influenza in children, general vaccination has been discussed. There are, however, reasons to believe that general vaccination of children will not solve the influenza problem because influenza vaccines induce type-specific immunity of short duration.

Conclusion: Vaccination of several cohorts of children will be a tremendous commitment, probably with little hope of success in decreasing the morbidity and spread of influenza.     

Pitfalls in the diagnosis of hemophilia severity: What to do?

Measurements of factor VIII coagulation activity (FVIII:C) may vary and result in misclassification of hemophilia A with delay in initiation of prophylactic treatment. We describe two young brothers who were diagnosed as moderate hemophilia patients and therefore not prophylactically treated with factor VIII concentrate despite frequent bleeding events. These findings emphasize the importance of (i) multiple measurements of FVIII:C by certified laboratories, (ii) adjustment of treatment when test results do not correspond to clinical symptoms, (iii) relevance of additional DNA mutation analysis in patients with hemophilia A, and (iv) treatment in centers with expertise.     

Thoracoscopic resection of congenital pulmonary malformations in infants: is the feasibility related to the size of the lesion?

Background

The size of congenital pulmonary malformation (CPM) in infants might interfere with the feasibility of thoracoscopic resection. This study was undertaken to evaluate the impact of the size of CPM on the applicability of video-assisted thoracic surgery (VATS) in infants.

Methods

Twenty-two infants were operated on for CPM from November 2000 to June 2009. The intra- and postoperative course was analyzed retrospectively from patient charts. Preoperative scans were evaluated blindly by a radiologist to calculate the relation between the maximum size of the lesion and the thoracic diameter in VATS and open procedures.

Results

VATS was performed in 14 (64%) of the 22 patients and thoracotomy in 8. VATS was successfully performed in 11 (79%) of the 14 patients, whereas VATS was converted to thoracotomy due to lack of overview in 3 (21%). The mean relative size of CPM at preoperative imaging was 0.34 ± 0.05 (range: 0.3?C0.4) in patients who received successful VATS, 0.57 ± 0.06 (range: 0.5?C0.6) in converted cases, and 0.68 ± 0.10 (range: 0.5?E8) in infants who underwent thoracotomy. The relative CPM size was significantly lower in successful VATS than in cases of conversion (P<0.01) and thoracotomy (P<0.01).

Conclusions

The relative size of CPM at preoperative imaging might be useful information for a decision-making on the use of VATS in infants. A relative CPM size below 0.5, which is less than half of the thoracic diameter, indicates a good feasibility for thoracoscopic resection of CPM. A larger size may indicate that VATS might be technically difficult.     

Penile duplication: Is it necessary to excise one of the penises?

A 37-day-old boy presented with a duplicated penis. Examination revealed presence of two penises, one dorsally located and one ventrally, a large left inguinal hernia and absent right thumb. Abdominal ultrasound and micturating cystourethrogram showed normal kidneys, a single urinary bladder, and partial urethral duplication with no vesicoureteric reflux. The patient was subjected to a new technique, reconstructing the penis without removal of corporal tissue, and therefore not compromising its size. A satisfactory result was achieved. The case is being reported due to its rarity and different surgical approach, in contrast to previous reports of management of diphallia involving excision of one of the penises.