Successful closure of the arterial duct in the setting of rubella syndrome

A 9-year-old boy, with significant left-to-right shunting across a large duct in the context of rubella syndrome, was tested during catheterization to establish the feasability of occluding the duct with a device. The testing, including temporary closure of the duct and monitoring of pulmonary vascular reactivity to vasodilative substances, lead to the decision to implant an Amplatzer occluder. Sixteen months later, there was no residual shunting across the duct, and pulmonary arterial pressures had normalised. It remains unclear why the patient had not developed irreversible pulmonary vascular disease.     

The incidence of combined facial and cervical spine injuries

BACKGROUND: The association between facial and cervical spine injuries has been documented. However, only severe spinal injuries were included in previous analyses. It was the purpose of this study to evaluate the incidence of and risk factors for these injury combinations including the complete injury spectrum. METHODS: Between 1995 and 1997, 4,907 patients with cervical spine injuries were treated at our hospital. One hundred five (2.14%) of these patients had suffered a concomitant facial injury. This group was compared with the group of patients with cervical spine injury but without facial trauma. RESULTS: The majority of cases (98%) consisted of minor lesions to both regions. With increasing severity of cervical spine trauma, the risk for facial injury increased. Age and male gender represent significant (p < 0.05) risk factors for combined injuries. CONCLUSION: Patients sustaining cervical spine trauma have a small but real chance of injuring their face as well. The cervical spine must be examined carefully, whenever facial injuries are present.     

Bilateral chronic conjunctivitis and corneal scarring in a boy with X-linked hypogammaglobulinaemia

ABSTRACT We report an unusual case of bilateral chronic conjunctivitis and corneal scarring in a boy with X-linked hypogammaglobulinaemia (XLH) who did not respond to the usual antibacterial and antiviral therapy. An immunofluorescence test for Chlamydia trachomatis from an eye swab was strongly positive. Within days of commencement of local and systemic tetracycline therapy, he showed marked improvement. Since conjunctival follicle formation, which depends on the presence of a B-cell population, may not occur in XLH, clinical examination in chlamydia conjunctivitis may be misleading and lead to a delay in diagnosis and treatment with resulting corneal complications, unless laboratory evidence of chlamydia infection is specifically sought.     

Health care and its costs for children with perinatally acquired HIV infection

Objective : To describe survival patterns, use of health services and related costs for Australian children with perinatally acquired human immunodeficiency virus (HIV) infection.
Methodology : A retrospective cross-sectional survey was made of 20 children with HIV infection (91% of those diagnosed) and 13 children with maternal antibodies who subsequently seroreverted, treated at 10 medical centres. Details of disease progression and use of health services were obtained from hospital medical records. Monthly costs for three phases of infection were estimated by linking service usage rates with estimates of the unit cost of each service. The average lifetime cost was estimated by combining monthly costs and phase duration estimates from the literature.
Results : Patterns of disease progression were similar to those reported internationally, with a median survival of 8 years. Use, of health services increased with severity of illness. Mean monthly costs were $120 per month (1992 Australian dollars) for children with maternal antibodies who subsequently seroreverted, $320 per month for children with HIV infection but no acquired immunodeficiency syndrome (AIDS)-defining illness, and $1830 per month for children with AIDS. The present value of total lifetime cost for a child with HIV infection was $48174,46% of which was for treatment of AIDS.
Discussion : The mean lifetime cost for a perinatally infected child was just over half that for a man with HIV in Australia. Health service usage and costs were lower for Australian than American children with HIV.     

Simultaneous measurement of gallbladder emptying with cholescintigraphy and US during infusion of physiologic doses of cholecystokinin: a comparison

Both ultrasonography (US) and cholescintigraphy are used to study gallbladder dynamics. The present study was undertaken to determine whether the two methods provide the same or different information relating to gallbladder emptying. Emptying was simultaneously studied with both methods during infusion of graded physiologic doses of cholecystokinin (CCK) in six healthy subjects. Infusion of stepwise increasing doses of CCK, ranging from 0.03 to 0.5 Ivy dog units per kilogram of body weight per hour (IDU/kg.h), induced significant dose-related increases in plasma CCK, decreases in gallbladder volume assessed with US, and gallbladder emptying assessed with cholescintigraphy. The threshold dose for inducing significant gallbladder emptying was 0.13 IDU/kg.h, as determined with both techniques, indicating similar detection limits. There was a highly significant correlation between decreases in gallbladder volume and decreases in radioactive counts over the gallbladder region, with a tendency toward greater gallbladder responses at sonography during the early phase of gallbladder contraction and toward greater responses at cholescintigraphy during the later phase of gallbladder contraction. It is concluded that these methods can be used interchangeably for the quantitation of gallbladder emptying.     

Untersuchungen über den kohlenhydratstoffwechsel von meerschweinchen-alveolarmakrophagen und permanenten m äusefibroblasten nach phagocytose von quarz- und korundstaub verschieden hoher konzentrationen in vitro

Zusammenfassung Die toxische Wirkung von Quarz- und Korundstaub auf einen permanenten L-Zellstamm Bowie auf ausgeschwemmte Alveolarmakrophagen in vitro wurde geprüft. Hierbei untersuchten wir Zellwachstum, Milchsäurebildung, Glucoseverbrauch, O₂-Verbrauch und Dehydrogenase-aktivität in Abhängigkeit von der den Zellen angebotenen Staubteilchenzahl.Durch die Gabe größerer Staubmengen läßt sich der Stoffwechsel von Alveolarmakrophagen Bowie von L-Zellen hemmen. Diese Wirkung ist nicht quarzspezifisch, da sie auch mit Korundstaub gleicher Teilchenkonzentration erzielt wird.