Severe isolated pulmonary hypertension as main manifestation of Crest syndrome

Interstitial pulmonary fibrosis is the leading cause of secondary pulmonary hypertension in systemic sclerosis, and it occurs in either limited or diffuse cutaneous scleroderma subset. Isolated pulmonary hypertension, without pulmonary disease, occurs primarily in patients with limited cutaneous scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly, telangiectasia [CREST] variant) although it is an unusual feature in this subset, with a worse prognosis in the short term. We present a previously undiagnosed patient with the CREST syndrome, with severe isolated pulmonary hypertension and secondary respiratory failure as major feature of its connective tissue disease. Clinical, prognostic and therapeutical aspects are commented.     

北京市社区妇女人乳头瘤病毒感染率及其对HPV和疫苗认知情况的调查分析

[目的]评估北京市社区妇女人乳头瘤病毒（HPV）的感染率;调查社区人群对HPV的认知情况以及对HPV疫苗接种的态度。[方法]采用横断面调查方法,对北京市展览路社区15￣54岁女性进行HPV认知和流行病学问卷调查,并留取了宫颈脱落细胞或会阴部标本进行HPV DNA检测。[结果]1013名女性接受了问卷调查,832例HPV DNA检测结果纳入了统计学分析。HPV总检出率为15.38%,高、低危型HPV感染率分别为13.34%和3.25%,同时感染高、低危型HPV的检出率为1.20%。1013名调查对象中有30.7%听说过HPV,其中51.78%知道HPV感染与宫颈癌有关;HPV的知晓率与年龄和教育程度有关（P〈0.05）;经过简单宣教后,75.91%愿意接种HPV疫苗。[结论]北京市社区妇女HPV现患率较高,对HPV的知晓率也较高。开展公众健康教育,提高人群的认识水平是疫苗计划获得成功的关键因素。     

Enterobacter cloacae bacteremia in children: a review of 30 cases in 12 years

A review was performed of the 30 cases of pediatric Enterobacter cloacae (EBC) bacteremia which occurred at our institution during a 12-year period. These 30 cases represented 88% of all cases in which EBC was isolated by blood culture (four other instances were considered contaminants); the rate of isolation of this organism relative to all positive blood cultures was 0.6%. There were 14 patients less than 12 months of age, with 10 less than 2 months of age. Infection was nosocomially-acquired in 17 cases. At the time the positive blood culture was obtained, 5 patients were afebrile, and 8 patients (five immunocompromised) had been receiving parenteral antibiotic therapy to which the organism exhibited in-vitro sensitivity for at least 24 hours. EBC was a constituent of polymicrobial bacteremia in 6 cases; in 5 instances the associated organisms were also gram-negative bacteria. There were a total of 33 underlying medical conditions or foci of infection associated with EBC bacteremia identified in 27 patients, the most common of which were immune-deficiency state (17) and gastrointestinal tract lesions (6). There were 3 patients who died. EBC bacteremia is a relatively rare pediatric infection. It is commonly nosocomially-acquired, and afflicts children who are younger-aged or compromised by underlying medical problems.     

Effects of sedation on motor function of the refluxing esophagus

Among the tests currently available for diagnosis of gastroesophageal reflux (GER), esophageal manometry is the hardest to perform in alert children because of their lack of cooperation. Therefore, it is usually performed under some form of sedation. In an attempt to investigate whether medication by itself modifies esophageal motility, we compared the manometric data of 18 children with pH-probe documented GER before and after sedation (meperidine 1.5 mg/kg, chlorpromazine 1 mg/kg, promethazine 1 mg/kg i.m.). Sedation induced the following changes in motor function compared to that in the unsedated state: (1) lower esophageal sphincter pressure decreased from 16.4 ± 7.3 to 11.4 ± 6.9 (P <0.001), whereas sphincter length remained unchanged; (2) esophageal peristaltic activity almost disappeared in terms of number of waves per hour (106.4 ± 60.1 vs 3.8 ± 6.2, P <0.001) while nonpropulsive activity became predominant, although only in relative terms (percent of tertiary waves 16.5 ± 13.9 vs 75.1 ± 25, P <0.001); (3) the mean pressure of the propulsive waves was also significantly decreased (65.2 ± 20.6 vs 37.9 ± 26.5, P <0.001), and as a result, esophageal motor efficiency (number of primary waves per hour multiplied by the mean pressure of the waves in mmHg) decreased enormously (from 6681.7 ± 4113.7 to 223.9 ± 372.6, P <0.001). Comparison with a group of sedated controls demonstrated that, under equal conditions, both barrier and pump functions were significantly weakened in refluxing patients. The limited diagnostic value of manometry thus remains unquestioned by the present study. Our data suggest that: (1) motor behavior of the esophagus in unsedated children with GER is quite close to that observed in refluxing adults; and (2) sedation of itself substantially modifies the esophageal sphincter barrier and esophageal propulsive pump. If sedation is to be used for manometric studies in children, the results so obtained should only be compared to those of controls under the same conditions.Investigation partially supported by a FISSS Grant (87/1605) Offprint requests to: J. A. Tovar     

Immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children

Objective: To determine the immunity to hepatitis B, poliomyelitis and measles in fully vaccinated Aboriginal and Torres Strait Island children in north Queensland.
Methodology: A cross-sectional survey of immunity in a sample of children; 101 fully vaccinated Aboriginal and Torres Strait Island children, with a median age of 24.5 months, from 10 communities in North Queensland participated in this study. The main outcome measures were the prevalence of adequate antibody levels against hepatitis B, poliomyelitis and measles.
Results: Only 54% (95% Cl 44–63%) of the children had adequate immunity (10 m iu/mL) to hepatitis B, and one child had been infected despite vaccination. Although all the children (95% Cl 96–100%) had adequate immunity (i.e. neutralizing antibodies at a dilution of 1:8) to poliovirus 2, only 93% (95% Cl 86–96%) and 60% (95% Cl 50–69%) had adequate immunity to polioviruses 1 and 3, respectively. Nearly all (96%; 95% Cl 90–98%) of the children had adequate immunity (i.e. detectable IgG antibody) to measles.
Conclusions: Although a relatively low proportion of the children had adequate antibody levels against hepatitis B the clinical significance of this observation is uncertain. Further studies are needed to determine whether fully vaccinated Torres Strait Island children have been adequately protected and whether they require a booster dose of hepatitis B vaccine. A substantial proportion of fully vaccinated Aboriginal and Torres Strait Island children are inadequately protected against poliomyelitis, and therefore any such child with acute flaccid paralysis should be investigated fully for poliomyelitis. Vaccinated Aboriginal and Torres Strait Island children are well protected against measles, as are other Australian children.     

Traumatic flap displacement after LASIK

CASE REPORT: We present a case of traumatic displacement of corneal flap in the superior temporal quadrant 13 days after LASIK. The flap was repositioned after gentle irrigation of BSS, cleaned the interface and then drying the flap to verify its stability. In the next day the flap was adhered, clear cornea,smooth and visual acuity without correction was 1.00. DISCUSSION: We should try immediately to reposition the flap after traumatic displacement, as in this case.