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《Vaccine》2020,38(3):570-577
IntroductionPediatric pneumococcal pneumonia complicated by parapneumonic pleural effusion/empyema (PPE/PE) remains a major concern despite general immunization with pneumococcal conjugate vaccines (PCVs).MethodsIn a nationwide pediatric hospital surveillance study in Germany we identified 584 children <18 years of age with bacteriologically confirmed PPE/PE from October 2010 to June 2018. Streptococcus pneumoniae was identified by culture and/or PCR of blood samples and/or pleural fluid and serotyped.ResultsS. pneumoniae was identified in 256 of 584 (43.8%) children by culture (n = 122) and/or PCR (n = 207). The following pneumococcal serotypes were detected in 114 children: serotype 3 (42.1%), 1 (25.4%), 7F (12.3%), 19A (7.9%), other PCV13 serotypes (4.4%) and non-PCV13 serotypes (7.9%). Between October 2010 and June 2014 serotype 1 (38.1%) and serotype 3 (25.4%) were most prevalent, whereas between July 2014 and June 2018 serotype 3 (62.7%) and non-PCV13 serotypes (15.7%) were dominant. Compared to children with other pneumococcal serotypes, children with serotype 3 associated PPE/PE were younger (median 3.2 years [IQR 2.1–4.3 years] vs. median 5.6 years [IQR 3.8–8.2 years]; p < 0.001) and more frequently admitted to intensive care (43 [89.6%] vs. 48 [73.8%]; p = 0.04). Seventy-six of 114 (66.7%) children with pneumococcal PPE/PE had been vaccinated with pneumococcal vaccines. Thirty-nine of 76 (51.3%) had received a vaccine covering the serotype detected. Thirty of these 39 breakthrough cases were age-appropriately vaccinated with PCV13 and considered vaccine failures, including 26 children with serotype 3, three children with serotype 19A and one child with serotype 1.ConclusionFollowing the introduction of PCV13 in general childhood vaccination we observed a strong emergence of serotype 3 associated PPE/PE in the German pediatric population, including a considerable number of younger children with serotype 3 vaccine breakthrough cases and failures. Future PCVs should not only cover newly emerging serotypes, but also include a more effective component against serotype 3. 相似文献
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超声引导穿刺置入微导管法治疗恶性心包积液的评价 总被引:4,自引:0,他引:4
目的探讨超声引导下穿刺置入微导管法在恶性心包积液治疗中的价值.方法13例恶性心包积液在超声引导下进行心包穿刺,置入硬膜外麻醉导管(微导管),通过导管抽出心包积液并注入化疗药物.结果13例均成功穿刺并顺利置入微导管,引流积液400~780 ml,平均530 ml.治疗后3、12、24个月存活率分别为92%(12/13),78%(7/9)和60%(3/5),无心包积液复发.结论超声引导穿刺置入微导管法治疗恶性心包积液安全、微创、有效、可行. 相似文献
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采用核桃仁泥外敷治疗138例(实验组)肌肉注射后皮下硬结,并与40例(对照组)采用新鲜土豆片外敷硬结法比较。结果表明:实验组患者治疗15天后Ⅰ度和Ⅱ度硬结治愈率分别为81.13%和42.25%,总有效率达92.03%,明显优于对照组(P<0.001)。 相似文献
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Beatrix Tirkanits M.D. F.R.C.S.C. Rollin K. Daniel M.D. F.A.C.S. 《Aesthetic plastic surgery》1990,14(1):111-117
A new technique of forehead rhytidectomy is presented that combines the best features of the coronal incision with those of the anterior hairline incision. The plane of dissection is formed by an anterior subcutaneous plane dissecting a lateral subgaleal plane. This approach is particularly valuable in patients with high foreheads, severe static wrinkling, and asymmetrical eyebrows.Presented in part at the Annual Meeting of the American Society of Aesthetic Plastic Surgeons, Boston, MA, 1984 相似文献
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Maryla Z Stelmach MB BS Justin O'Day FRACO FRACS † Hugh Ryan FRACO FRACS ‡ 《Clinical & experimental ophthalmology》1994,22(2):139-143
The history and clinical findings are presented of a patient who suffered from the uveal effusion syndrome over a 10-year period from 1956. The funduscopic appearance is illustrated both at the time of initial presentation and 36 years later. This condition typically affects healthy middle-aged men and causes recurrent, spontaneous, serous retinal and ciliochoroidal detachments, often resulting in significant visual impairment. Two separate hypotheses have been postulated to explain the pathogenesis of the uveal effusion syndrome, one relating to abnormally thickened sclera, the other to chronic bulbar hypotony. Both are discussed, as is the rationale behind the current management of this unusual condition. 相似文献