Splenic smooth-muscle tumors in children with acquired immunodeficiency syndrome: report of two cases of this unusual location with evidence of an association with Epstein-Barr virus

Smooth-muscle neoplasms are rarely located in the spleen. They have been previously reported in five cases of children with human immunodeficiency virus (HIV) infection/acquired immunodeficiency syndrome (AIDS). Two cases of children with HIV infection/AIDS with autopsy and surgical pathology evidence of multiple smooth-muscle neoplasms with splenic involvement are presented. DNA was extracted from histology slides in both cases for analysis for Epstein Barr (EB) virus. In both cases, the presence of EB virus was confirmed. This paper documents two additional cases of the unusual phenomenon of splenic involvement by smooth-muscle neoplasms in the setting of AIDS in childhood and further supports the role of EB virus in the development of these neoplasms. Received: 27 January 1999 / Accepted: 23 August 1999     

Total occlusion of the common carotid artery with patent internal carotid artery. Identification with color flow Doppler imaging.

With common carotid artery occlusion there is usually no flow in the distal vessels. However, flow to the ipsilateral internal common carotid artery may be maintained by collateral vessels. Nine of 1100 patients referred for carotid duplex sonography were found to have occluded common carotid arteries. Five of these patients had collateral circulation with reconstitution of flow via the external carotid artery. The color Doppler sonograms of three representative patients are presented. There was antegrade flow in the internal carotid artery with retrograde flow in the external carotid artery.     

Acute rheumatic fever in western Pennsylvania and the tristate area

Acute rheumatic fever is reported to have declined and perhaps be vanishing. Prompted by the occurrence of 17 cases of acute rheumatic fever in an 18-month period in 1985 and 1986, we reviewed the records of 243 children with acute rheumatic fever who were cared for at Children's Hospital of Pittsburgh or Mercy Hospital between 1965 and 1986. Acute rheumatic fever was diagnosed using the modified Jones criteria and cases were classified by major criteria as arthritis, arthritis and carditis, carditis alone, carditis and chorea, chorea alone, and arthritis and chorea. Among the 17 recent patients, 59% had carditis, 30% had chorea, and 24% had arthritis alone. The proportion of children who had particular major manifestations was similar in the last two decades and in 1985 to 1986. The recent children with acute rheumatic fever ranged in age from 6 to 13 years with a mean and median age of 10 years. There were 16 white children and one Asian child. Only four children lived in an urban setting. When demographic features of the children were contrasted with those in the previous two decades, a decrease in the proportion of children who lived in urban areas and who were black was noted. Four children had a history of preceding sore throat but only three sought medical care; nine children had no memorable illness and four had either a nonrespiratory illness or a respiratory infection without sore throat. This resurgence of rheumatic fever serves as a reminder that a diligent approach to the diagnosis and therapy of streptococcal infections remains essential.     

Field inversion gel electrophoretic analysis of Legionella pneumophila strains associated with nosocomial legionellosis in children.

Two nosocomial cases of Legionnaires' disease occurred in children. Legionella pneumophila serogroup 1 was isolated from both patients and 30 of 39 plumbing system sites in the hospital. The patient and hospital environmental isolates yielded identical field inversion gel electrophoretic patterns which differed from patterns observed with epidemiologically unrelated strains.     

Frequency and severity of infections in day care

This study was undertaken to compare prospectively the frequency, nature, and severity of infections experienced by children in three types of child care arrangements: home care, group care (two to six children), and day care (seven or more children). Children were enrolled at birth and observed for 12 to 18 months. At entry there were 159 children in home care, 40 in group care, and 45 in day care. The families were telephoned every 2 weeks to record on a standardized form the type and severity of illnesses experienced during the previous interval. Severe illnesses were defined by high fever, duration exceeding 10 days, or physician visit. Children remaining in their original child care group for at least 1 year were compared with regard to the frequency and severity of illness. Children in group care and day care were more likely than children in home care to experience at least six respiratory infections, more than 60 days of illness, and more than four severe illnesses (P less than 0.01). Similarly, life table analyses showed that children in home care had fewer episodes of infection than did children in day care (P less than 0.01). Although no children were hospitalized because of acute infections during the first year of study, hospitalization for myringotomy and tube placement occurred in 21% of children in day care and 3% of children in home care (P less than 0.01).     

Adjunctive treatment of disseminated <Emphasis Type="Italic">Mycobacterium avium</Emphasis> complex infection with interferon alpha-2b in a patient with complete interferon-gamma receptor R1 deficiency

We report adjunct treatment of (interferon) IFN-α2b (Intron-A) in a patient with complete interferon-γ receptor R1 (IFNGR1) deficiency suffering from disseminated infection with Mycobacterium avium complex (MAC) resistant to multiple anti-mycobacterial agents. A low dose of IFN-α2b (3 × 10⁶ units/m² three times weekly subcutaneously) successfully attenuated progressive hepatosplenomegaly and abdominal/retroperitoneal/pelvic lymphadenopathy, although the patient continued to be mycobacteremic. This is the first report of a complete IFNGR1 deficiency treated with adjuvant IFN-α2b for disseminated MAC infection.     

Yolk sac diameter and shape at endovaginal US: predictors of pregnancy outcome in the first trimester.

Four hundred eighty-six consecutive women who underwent endovaginal sonography when their fetuses were less than 10 weeks menstrual age (MA) were evaluated to establish the normal size and shape of the secondary yolk sac (YS) and to assess the value of YS measurement in predicting pregnancy outcome in the first trimester. A YS diameter more than two standard deviations (SDs) above the mean when compared with the mean gestational sac diameter allowed prediction of an abnormal pregnancy outcome with a sensitivity of 15.6%, a specificity of 97.4%, and a positive predictive value of 60.0%. A YS diameter more than two SDs below the mean allowed prediction of an abnormal outcome with a sensitivity of 15.6%, a specificity of 95.3%, and a positive predictive value of 44.4%. No pregnancy with a normal outcome had a YS diameter of greater than 5.6 mm at less than 10 weeks MA. In six patients, the YS diameter was greater than 5.6 mm. All six had an abnormal outcome. Of seven patients with abnormal YS shape at initial sonography, three had abnormal YS shape at follow-up examinations. All three had an abnormal outcome.     

Comparison of two antigen assays for rapid intrapartum detection of vaginal group B streptococcal colonization.

As part of a clinical investigation evaluating the efficacy of intrapartum antigen detection for screening for heavy vaginal colonization with group B streptococci (GBS), we compared the performance of modified Bactigen and Directigen GBS latex particle agglutination (LPA) kits. Paired vaginal swabs obtained from women in labor were rapidly transported to the laboratory and used for culturing (both swabs) and LPA testing (one swab by each method). GBS growth was estimated semiquantitatively and further designated as light or heavy growth. Performance specifications for each method were determined by comparing LPA and culture results from the same swab. A total of 4,251 paired swabs were evaluated during the study period. The performance specifications for detecting GBS growth of any degree for Bactigen and Directigen, respectively, were as follows: sensitivity, 20 and 24%; specificity, 99 and 99%. The performance specifications for heavy colonization for Bactigen and Directigen, respectively, were as follows: sensitivity, 57 and 62%; specificity, 99 and 99%. Neither LPA kit was a sensitive indicator of vaginal colonization with GBS or neonatal infection.     

Sonographic characteristics of the urethrovesical anastomosis in the early post-radical prostatectomy patient.

It is possible that the advent of more aggressive surgical approaches to carcinoma of the prostate, including neoadjuvant and adjuvant therapy, will lead to a higher incidence of pelvic recurrence rates in coming years. A method of sequentially monitoring the region of the urethrovesical anastomosis for early recurrence that is more accurate than digital rectal examination is required. Transrectal ultrasound is an established technique for the preoperative assessment of prostate cancer. It has also been used postoperatively to guide a biopsy needle into palpably suspicious areas at the urethrovesical junction or for random biopsies in patients with elevated prostate specific antigen levels. However, the sonographic anatomy of the postoperative urethrovesical junction has not previously been described. In this prospective study we analyze the transrectal sonographic characteristics of the neoanatomy in 30 patients, all within 3 months following surgery for clinically intracapsular disease. We describe features of the neoanatomy, such as anterior tissue nodules and anastomotic rings. Because of distinct variations in the neoanatomy of different patients we recommend early postoperative transrectal biplanar sonography to establish a baseline image for each individual case. This would be useful for later comparison and may prevent a false positive scan on subsequent followup studies.