Cryptococcal meningitis in a child with hyperimmunoglobulin E syndrome

A 13-year-old boy with hyperimmunoglobulin E (hyper-IgE) syndrome presented with headache, blurred vision, photophtobia and bilateral papilledema due to cryptococcal meningitis. Treatment with amphotericin B, and S-fluorocytosine for several weeks and repeated lumbar punctures did not reduce the intracranial pressure, and a myeloperitoneal shunt was performed. The child was maintained on fluconazole for an additional six months. Patients with hyper-IgE syndrome are at increased risk of opportunistic fungal infections such as cryptococcal meningitis.     

Hypernatremic Dehydration and Hypothermia in Congenital Lamellar Ichthyosis

Several events of hypernatremic dehydration occurred in five infants suffering from severe congenital lamellar ichthyosis. Simultaneously, four of them developed hypothermia. Both phenomena were probably caused by excessive water loss through the affected skin. In lamellar ichthyosis the skin loses its function as an effective barrier and therefore its role in water and temperature homeostasis is defective.     

Determination of blood gases in children with extreme leukocytosis

The effect of extreme leukocytosis (greater than 300,000/mm3) on the PaO2 of blood stored at 22 degrees and 2 degrees C was studied in two children with leukemia. Arterial blood samples drawn from these patients at 1 and 10 min were compared to blood samples drawn from eight control patients with normal leukocyte counts and PaO2 levels in the same range. One minute after drawing the samples, the PaO2 values at 2 degrees C were significantly higher than those stored at 22 degrees C. Later, there was a rapid and progressive decline in PaO2 values in both samples stored at 2 degrees and 22 degrees C. Rapid consumption of O2 by leukocytes is liable to result in erroneous diagnosis of severe hypoxemia in patients with extreme leukocytosis. Immediate cooling of the samples is insufficient to eliminate this process.     

Simultaneous Measurement of the Photoplethysmographic Signal Variability in the Right and Left Hands

The photoplethysmographic (PPG) signal, which is a measure of the systolic oscillations in the tissue blood volume, spontaneously fluctuates in the respiration rate and in lower frequencies similar to the heart rate fluctuations. In the current study, the low frequency fluctuations, which are attributed to the sympathetic nervous system activity, were obtained from PPG examinations simultaneously performed on the right and the left hands of healthy subjects and hemiplegic patients. For normal subjects, the fluctuations in the two hands were found to be correlated, demonstrating their central origin. For some of the hemiplegic patients, the coefficient of correlation between the right and the left hands was significantly lower than the normal range. The simultaneous measurement of the PPG signal fluctuations in both hands provides information on the adequate function of the autonomic nervous system. Received for publication 2 June 1997; accepted following revision 5 February 1998.     

The clinical characteristics of condylar hyperplasia: experience with 61 patients.

PURPOSE: Much reported variation and discord exist regarding mandibular condylar hyperplasia (CH). This study evaluated some of the characteristics of this disorder in a series of 61 patients with active CH. PATIENTS AND METHODS: A total of 61 patients with active temporomandibular CH who had been evaluated in our departments were included. Demographic, clinical, radiologic, and bone scintiscan data were collected and analyzed. Asymmetries were classified as transverse, vertical, or combined. RESULTS: CH was diagnosed during the growth period in 22 patients, and 39 patients were older than 20 years (range, 11 to 80 years). In 66% of the patients, the main complaint was progressive facial asymmetry; and in the remainder, the main complaint was pain, dysfunction, or both. Transverse asymmetry predominated (52%), and vertical or combined asymmetry occurred in 31% and 16% of patients, respectively; asymmetry type was independent of age. The occlusal plane deviated in 48% of the patients. Laterality was significantly gender-biased (females, 72% right; males, 64% left; P = .017). The condylar head shape was normal in 15% of patients, deformed in 27%, and enlarged in 58%; the condylar neck was elongated in 69% and enlarged in 19%. All of these changes were uncorrelated with the type of asymmetry (vertical, transverse, or combined). CONCLUSIONS: CH may occur at any age and is more prevalent in females. Clinicians should be aware that only some patients complain primarily of facial asymmetry, and that symptoms of temporomandibular disease also may be present. Because there is no correlation between the radiologic findings and the clinical evaluation, classification should be simplified and based on clinical manifestation only--in other words, the direction of asymmetry.     

Temporomandibular joint "open lock" versus condylar dislocation: signs and symptoms, imaging, treatment, and pathogenesis.

PURPOSE: In the temporomandibular joint (TMJ) "open-lock" condition the condyle is entrapped in front of the lagging disc and cannot slide back under the fossa. The aim of this retrospective study was to describe the signs and symptoms and imaging of TMJ "open lock" versus condylar dislocation and clarify its pathogenesis. The study stresses the efficacy of arthrocentesis in restoring the functional capacity of the joint, while obviating the need for surgical intervention. PATIENTS AND METHODS: The study included 5 patients (3 females and 2 males; ages ranging from 11 to 26 years) presenting 6 open-lock joints that did not respond to conservative treatment. The TMJs postarthrocentesis status in 5 joints (follow-up period, 6 to 32 months) was determined by patient self-assessment and clinical examination. RESULTS: Five TMJs had recurrent open lock and were treated by arthrocentesis. They reacted favorably to the treatment and the open-lock events were eliminated. The first case was apparently misdiagnosed as condylar dislocation, and unnecessary surgical intervention was performed. CONCLUSIONS: Arthrocentesis is a safe and rapid procedure that prevents recurrence of open-lock conditions. This disorder should be distinguished from recurrent condylar dislocation, which requires surgical intervention.     

Risk factors for low vaccination coverage among Roma children in disadvantaged settlements in Belgrade, Serbia

Background

Full vaccination coverage for children under 59 months of age in Serbia is over 90%. This study assesses vaccination coverage and examines its association with birth registration among Roma children who resided in disadvantaged settlements in Belgrade, Serbia.

Methods

The First Roma Health and Nutrition Survey in Belgrade settlements, 2009, was conducted among households of 468 Roma children between the ages of 6–59 months. The 2005 WHO Immunization Coverage Cluster Survey sampling methodology was employed. Vaccinations were recorded using children's vaccination cards and through verification steps carried out in the Primary Health Care Centers. For those who had health records the information on vaccination was recorded.

Results

About 88% of children had vaccination cards. The mean rate of age appropriate full immunization was 16% for OPV and DTP and 14.3% for MMR. Multivariate analyses indicated that children whose births were registered with the civil authorities were more likely to have their vaccination cards [OR = 6.1, CI (2.5, 15.0)] and to have their full, age appropriate, series vaccinations for DTP, OPV, MMR and HepB [OR = 3.8, CI (1.5, 10.0), OR = 3.2, CI (1.5, 6.6), OR = 4.8, CI (1.1, 21.0), OR = 5.4, CI (1.4, 21.6), respectively].

Conclusions

The immunization coverage among Roma children in settlements is far below the WHO/UNICEF MDG4 target in achieving prevention and control of vaccine preventable diseases. It demonstrates the need to include “invisible” populations into the health systems in continuous, integrated, comprehensive, accessible and sensitive modes.