Environmental risks of Pseudomonas aeruginosa–What to advise patients and parents

Pseudomonas aeruginosa (PsA) is commonly found in soil and water so is impossible to avoid completely. Parents/carers of children with cystic fibrosis (CF) are concerned about them acquiring PsA from the environment, and different families view risk differently. Our ethos is to enable children with CF to take part as much as possible in educational and fun home activities, in order to maintain their quality of life (and their family's), and not have them feel different from other children. This review presents advice for families as to what they must definitely avoid, what they must take precautions with but can allow, and what they must not avoid. It is mostly evidence-based, but where evidence is lacking it a consensus view from the Paediatric CF Unit at the Royal Brompton Hospital.     

Osteochondritis dissecans of the capitellum in adolescents

Osteochondritis dissecans(OCD)is a disorder of articular cartilage and subchondral bone.In the elbow,an OCD is localized most commonly at the humeral capitellum.Teenagers engaged in sports that involve repetitive stress on the elbow are at risk.A high index of suspicion is warranted to prevent delay in the diagnosis.Plain radiographs may disclose the lesion but computed tomography and magnetic resonance imaging are more accurate in the detection of OCD.To determine the best treatment option it is important to differentiate between stable and unstable OCD lesions.Stable lesions can be initially treated nonoperatively with elbow rest or activity modification and physical therapy.Unstable lesions and stable lesions not responding to conservative therapy require a surgical approach.Arthroscopic debridement and microfracturing has become the standard initial procedure for treatment of capitellar OCD.Numerous other surgical options have been reported,including internal fixation of large fragments and osteochondral autograft transfer.The aim of this article is to provide a current concepts review of the etiology,clinical presentation,diagnosis,treatment,and outcomes of elbow OCD.     

Cost-effectiveness of HIV nonoccupational post-exposure prophylaxis in Australia

Objective

The aim of the study was to determine the cost‐effectiveness of HIV nonoccupational post‐exposure prophylaxis (NPEP) in Australia.

Methods

A retrospective cost analysis of a population‐based observational cohort of 1601 participants eligible for NPEP in Australia between 1998 and 2004 was carried out. We modelled NPEP treatment costs and combined them with effectiveness outcomes to calculate the cost per seroconversion avoided. We estimated the cost‐utility of the programme, and sensitivity and threshold analysis was performed on key variables.

Results

The average NPEP cost per patient was A$1616, of which A$848 (52%) was for drugs, A$331 (21%) for consultations, A$225 (14%) for pathology and A$212 (13%) for other costs. The cost per seroconversion avoided in the cohort was A$1 647 476 in our base case analysis, and A$512 410 when transmission rates were set at their maximal values. The cost per quality‐adjusted life‐year (QALY) was between A$40 673 and A$176 772, depending on the risks of HIV transmission assumed.

Conclusions

In our base case, NPEP was not a cost‐effective intervention compared with the widely accepted Australian threshold of A$50 000 per QALY. It was only cost‐effective after receptive unprotected anal intercourse exposure to an HIV‐positive source. Although NPEP was a relatively well‐targeted intervention in Australia, its cost‐effectiveness could be improved by further targeting high‐risk exposures.     

PillCam结肠胶囊内镜检查结肠病变作用的评估：首次多中心、前瞻性、比较研究结果

结直肠癌是发达国家第二常见的恶性肿瘤,发病率和病死率较高。有效的筛查措施可预防结直肠癌,目前指南推荐具有中等结直肠癌患病风险的患者应行筛查。多数专家认为传统结肠镜检查是筛查结直肠癌和发现结肠病变的最理想的方式,但其具有侵入性、部分患者存在禁忌证,且操作过程存在一定风险,如麻醉意外等：尽管越来越多的证据支持传统结肠镜检查对筛查结直肠癌具有明显优势,但大多数符合条件的、具有中等患病风险的人群并未接受任何筛查．包括传统结肠镜检查,可能与患者对检查感到恐惧、     

High frequency oscillatory ventilation in children: an overview

The last 30 years, high frequency ventilation (HFV) has found its way from the neonatal to the paediatric and adult ICU. With its small tidal volumes, strict intrathoracic pressure variations and disengagement of ventilation from oxygenation, HFV fits in our insights nowadays in lung protective ventilation. This review provides you with an understanding of the different modes of HFV, gas exchange mechanisms during HFV which uses tidal volumes below dead space volume, and some information on nursing and weaning a child on HFV. Focus will be on the clinical use of high frequency oscillatory ventilation with a practical overview of the strategies used: the high-volume strategy designed to rapidly recruit and maintain optimal lung volume in diffuse alveolar disease and lung haemorrhage, the low volume strategy in airleak, and the open airway strategy in small airway disease where the continuous distending pressure is used to recruit and stent the airways.     

Diagnosis of primary human herpesvirus 6 and 7 infections in febrile infants by polymerase chain reaction

Primary human herpesvirus 6 (HHV-6) and 7 (HHV-7) infections were identified in febrile children by qualitative and quantitative polymerase chain reaction (PCR) assays. Diagnosis was based on the differential detection of viral DNA in peripheral blood mononuclear cells (PBMC), but not in saliva. Six of 41 febrile infants, but none of seven non-febrile controls, were identified with primary infections (three HHV-6, three HHV-7). These children had significantly higher viral loads in PBMC (HHV-6, median 24213 genomes/10(6) PBMC; HHV-7, median 6,040,000 genomes/10(6) PBMC) than DNA-aemic, saliva PCR positive children (HHV-6, median 1606 genomes/10(6) PBMC, p < 0.01; HHV-7, median 7089 genomes/ 10(6) PBMC, p < 0.05). Viral DNA was detected in serum by PCR in only 50% of primary infections. All three children with primary HHV-7 infection had febrile convulsions. Thus PCR, including quantitative assays, may identify primary HHV-6 and HHV-7 infections when an appropriate combination of clinical specimens is used.     

Second-trimester polyhydramnios: evaluation with US

The sonograms of 40 patients with second-trimester polyhydramnios were reviewed to determine (a) whether fetal and maternal conditions occur as often during second-trimester polyhydramnios as during third-trimester polyhydramnios, (b) the frequency of persistence of polyhydramnios into the third trimester, and (c) how sonography can help in maternal and fetal management. Second-trimester polyhydramnios often (62%) persisted into the third trimester. The frequencies of maternal (25%) and fetal (12%) conditions were similar to those previously reported for third-trimester polyhydramnios. Fetal anomalies were always identified on the sonogram that initially demonstrated polyhydramnios. Fetal outcome was excellent in the nondiabetic patient with polyhydramnios in whom no fetal abnormalities were detected on sonograms. In polyhydramnios associated with maternal diabetes mellitus, however, the pregnancy was often (71%) complicated by premature labor or macrosomia. In such patients serial sonographic follow-up is indicated.     

Primary pleomorphic sarcoma of the liver

A 35-year-old woman presented with abdominal distension and a palpable liver mass. Ultrasonography and computed tomography revealed a large well-delineated liver mass with bilobar involvement. Based on autopsy and immuno-histochemical findings, a final diagnosis of primary pleomorphic liver sarcoma with myogenic differentiation was established.