The potential impact of PCV-13, PCV-15 and PCV-20 vaccines in Colombia

PURPOSE

To provide information about which pneumococcal vaccine could have greater coverage in Colombia.

METHODS

This is a retrospective analysis of patients diagnosed with invasive pneumococcal disease (IPD) between 2015 and 2019 in Bogotá, Colombia. We compared the theoretical serotype coverage of the available anti-pneumococcal vaccines (i.e., PCV-10, PCV-10 SII, PCV-13, PCV-15, PCV-20, PCV-21, PCV24, PPSV-23) and the non-vaccine-covered serotypes stratified by age.

RESULTS

690 IPD cases were included. In children ≤5 y/o, of the approved vaccines PCV-20 showed the most theoretical protection (71.3 % [149/209]), while in adults aged 18-64 y/o was PCV-20 (61.8 % [164/265]), and in those ≥65 y/o was PPSV-23 (58.1 % [100/172]) followed by PCV-20 (55.2 % [95/172]). The non-covered serotypes represented one-third of the cohort (33.9 % [234/690]), being 6C (20.5 % [48/234]), 15A (12.8 % [30/234]), and 23A (11.5 % [27/234]) the most prevalent.

CONCLUSION

Introducing PCV-20 for children and PCV-20 along with a PPSV-23 booster in adults may reduce IPD frequency in all ages in Colombia. The inclusion of non-covered serotypes is required for future vaccines.

Artificial Intelligence for Modeling Complex Systems: Taming the Complexity of Expert Models to Improve Decision Making

Major societal and environmental challenges involve complex systems that have diverse multi-scale interacting processes. Consider, for example, how droughts and water reserves affect crop production and how agriculture and industrial needs affect water quality and availability. Preventive measures, such as delaying planting dates and adopting new agricultural practices in response to changing weather patterns, can reduce the damage caused by natural processes. Understanding how these natural and human processes affect one another allows forecasting the effects of undesirable situations and study interventions to take preventive measures. For many of these processes, there are expert models that incorporate state-of-the-art theories and knowledge to quantify a system's response to a diversity of conditions. A major challenge for efficient modeling is the diversity of modeling approaches across disciplines and the wide variety of data sources available only in formats that require complex conversions. Using expert models for particular problems requires integration of models with third-party data as well as integration of models across disciplines. Modelers face significant heterogeneity that requires resolving semantic, spatiotemporal, and execution mismatches, which are largely done by hand today and may take more than 2 years of effort.

We are developing a modeling framework that uses artificial intelligence (AI) techniques to reduce modeling effort while ensuring utility for decision making. Our work to date makes several innovative contributions: (1) an intelligent user interface that guides analysts to frame their modeling problem and assists them by suggesting relevant choices and automating steps along the way; (2) semantic metadata for models, including their modeling variables and constraints, that ensures model relevance and proper use for a given decision-making problem; and (3) semantic representations of datasets in terms of modeling variables that enable automated data selection and data transformations. This framework is implemented in the MINT (Model INTegration) framework, and currently includes data and models to analyze the interactions between natural and human systems involving climate, water availability, agricultural production, and markets. Our work to date demonstrates the utility of AI techniques to accelerate modeling to support decision-making and uncovers several challenging directions for future work.

Burden of invasive pneumococcal disease (IPD) over a 10-year period in Bogotá, Colombia

BACKGROUND

Invasive pneumococcal disease (IPD) is the leading cause of infectious death worldwide. This study aimed to describe the epidemiology of IPD and the impact of pneumococcal conjugate vaccine-10 (PCV-10) over a 10-year period in Bogotá, Colombia.

METHODS

This was a laboratory-based surveillance study of Streptococcus pneumoniae isolated from patients with IPD from 82 hospitals over 10 years in Bogotá, Colombia. Data were compared between two periods: 2007-2011 (before the introduction of PCV-10) and 2012-2017 (after the introduction of PCV-10).

RESULTS

In total, 1670 patients with IPD were included in the study between 2007 and 2017. Between 2007 and 2011, the most common serotypes were 14, 1, 6B, 6A and 3. Between 2012 and 2017, the most common serotypes were 19A, 3, 14 and 1. A decrease in the incidence of IPD, particularly in children aged 0-4 years, was noted after the introduction of PCV-10. Importantly, this reduction in incidence was not observed in patients aged ≥50 years.

CONCLUSIONS

The IPD burden in Bogotá remained stable between 2007 and 2017. The incidence of IPD decreased in children but not in older adults. The introduction of PCV-10 led to a change in the most prevalent serotypes to serotypes that are not included in PCV-10.

A preliminary investigation on the effects of a hot water shrink tunnel and chill tank following vacuum packaging on commercial pork quality and bacteria growth

This research focused on establishing the effects of a hot water shrink tunnel and chill tank following vacuum packaging on pork quality and bacteria growth. These preliminary results showed advantages in water-holding capacity (as assessed with purge loss), yet minimal effects on bacterial growth of pork products when using a hot water shrink tunnel and chill tank following vacuum packaging.

Acute Kidney Injury in Cirrhosis: Baseline Serum Creatinine Predicts Patient Outcomes

OBJECTIVES

The International Ascites Club (IAC) recently defined Stage 1 acute kidney injury (AKI) for cirrhosis as an acute increase in serum creatinine (SCr) by ≥0.3 mg/dl or by ≥50% in <48 h from a stable value within 3 months. The baseline SCr may influence AKI risk and patient outcomes. The objective of this study is to determine in cirrhosis whether the baseline SCr has any effect on the in-hospital AKI course and patient survival.

METHODS

North American Consortium for the Study of End-Stage Liver Disease is a consortium of tertiary-care hepatology centers prospectively enroling non-elective cirrhotic inpatients. Patients with different baseline SCr levels (≤0.5, 0.51-1.0, 1.01-1.5, >1.5 mg/dl) were evaluated for the development of AKI, and compared for AKI outcomes and 30-day survival.

RESULTS

653 hospitalized cirrhotics (56.7±10years, 64% men, 30% with infection) were included. The incidence of AKI was 47% of enrolled patients. Patients with higher baseline SCr were more likely to develop AKI, with significantly higher delta and peak SCr (P<0.001) than the other groups, more likely to have a progressive AKI course (P<0.0001), associated with a significantly reduced 30-day survival (P<0.0001). Multivariate logistic regression showed that the delta SCr during an AKI episode to be the strongest factor impacting AKI outcomes and survival (P<0.001), with a delta SCr of 0.70 mg/dl having a 68% sensitivity and 80% specificity for predicting 30-day mortality.

CONCLUSIONS

Admitted cirrhotic patients with higher baseline SCr are at higher risk for in-hospital development of AKI, and more likely to have AKI progression with reduced survival. Therefore, such patients should be closely monitored and treated promptly for their AKI.

In-house standardization and validation of a multiplex RT-PCR assay for the detection of 13 respiratory viruses

<p>Background. Multiplex real time PCR is increasingly used to diagnose respiratory viruses and has shown to be superior to traditional methods, such as culture and antigen detection. Objective. Standardization and validation of a multiplex real-time PCR assay for the detection of 13 respiratory viruses. Methods. The assay was validated using RNA control targets and comparing results to single-target PCR’s. Results. Using RNA controls the multiplex format was found to be as sensitive and specific as the single-target PCRs, and no competition was observed between targets. The efficiencies for most of the reactions were approximately 90%, but a lower efficiency was found for Parainfluenza 2 with a rate of amplification in each cycle of 86.63%. On the other hand, a higher efficiency was observed in respiratory syncytial virus A and respiratory syncytial virus B ((93.07% each). Conclusion: This multiplex RT-PCR format shows an adequate efficiency, demonstrating an excellent sensitivity, specificity and repeatability for all the studied respiratory viruses.</p>

Type-Specific Identification of Genital Human Papillomavirus Infection in Women with Cytological Abnormality

OBJECTIVES

To estimate the frequency of human papillomavirus (HPV) infection and the genotype distribution of HPV among women with a Pap smear showing atypical squamous cells of undetermined significance (ASC-US) attending the Program for the Detection and Control of Cervical Cancer in Bogotá, Colombia.

STUDY DESIGN

Cervical samples from 200 women with an ASC-US Pap smear were analyzed for the presence of HPV DNA and genotype distribution using a commercial molecular technique (Linear Array®; Roche Molecular Systems, USA).

RESULTS

HPV infection was found in 140 women (70%). High-risk HPV types were present in 46.4% of the samples; 16.4% showed a low-risk HPV type, and 37.1% showed both. Of the positive samples, 42.9% were infected with a single viral genotype, whereas 57.1% exhibited multiple HPV infections. The most common HPV genotypes were HPV 16, 53, and 52 with a prevalence of 26.4, 16.4, and 13.6%, respectively.

CONCLUSION

The epidemiological characterization of HPV infections described in this study might guide actions for epidemiological surveillance to strengthen the program in Bogotá and to develop appropriate HPV vaccination programs.

Viral Infection in Adults with Severe Acute Respiratory Infection in Colombia

OBJECTIVES

To identify the viral aetiology in adult patients with severe acute respiratory infection (SARI) admitted to sentinel surveillance institutions in Bogotá in 2012.

DESIGN

A cross-sectional study was conducted in which microarray molecular techniques for viral identification were used on nasopharyngeal samples of adult patients submitted to the surveillance system, and further descriptions of clinical features and relevant clinical outcomes, such as mortality, need for critical care, use of mechanical ventilation and hospital stay, were obtained.

SETTING

Respiratory infections requiring hospital admission in surveillance centres in Bogotá, Colombia.

PARTICIPANTS

Ninety-one adult patients with acute respiratory infection (55% were female).

MEASUREMENTS

Viral identification, intensive care unit admission, hospital stay, and mortality.

RESULTS

Viral identification was achieved for 63 patients (69.2%). Comorbidity was frequently identified and mainly involved chronic pulmonary disease or pregnancy. Influenza, Bocavirus and Adenovirus were identified in 30.8%, 28.6% and 18.7% of the cases, respectively. Admission to the intensive care unit occurred in 42.9% of the cases, while mechanical ventilation was required for 36.3%. The average hospital stay was 9.9 days, and mortality was 15.4%. Antibiotics were empirically used in 90.1% of patients.

CONCLUSIONS

The prevalence of viral aetiology of SARI in this study was high, with adverse clinical outcomes, intensive care requirements and high mortality.

CO2 laser photoacoustic detection of ammonia emitted by ceramic industries

A homemade photoacoustic spectrometer has been constructed for monitoring gas emission from several sources. Numerous air pollutant gases are emitted exhaust of industries, vehicles and power plants. The photoacoustic technique is extremely sensitive and selective in detecting various gases. This work focuses on the gas emitted by the ceramic industry in northern Rio de Janeiro State in Brazil, the ceramic industry plays a remarkable role in the economy activity of this region, in recent years, this region developed into a significant red ceramic complex. The potential impact on the atmospheric environment of the region due to gaseous pollutant emissions from these anthropogenic sources needs to be evaluated. In this work we identified NH3 present in the samples collected in the kiln of a ceramic plant, in the concentration range of 33-52 ppmV. The ammonia gas present in our collected samples might come from the excess nitrogen in the manure soil from where the ceramic material was extracted. This soil was used for the sugarcane culture which is another important economic activity of this region.

Classifier based on support vector machine for JET plasma configurations

The last flux surface can be used to identify the plasma configuration of discharges. For automated recognition of JET configurations, a learning system based on support vector machines has been developed. Each configuration is described by 12 geometrical parameters. A multiclass system has been developed by means of the one-versus-the-rest approach. Results with eight simultaneous classes (plasma configurations) show a success rate close to 100%.

Malignant hemangiopericytoma arising in neurofibromatosis: a case report with histological, immunohistochemical and ultrastructural studies

Subject. A 27-year-old Hispanic male with clinical manifestation of neurofibromatosis type 1 developed chronic constipation and urination difficulty along with recently increased abdominal bloating and anorexia. He also noted 40 lbs weight loss over period of 1 year. Physical and radiographic examinations revealed a large mass in the right pelvic fossa.

Results. The surgically removed tumor was demonstrated, histologically, immunohistochemically, and ultrastructurally, to be a malignant hemangiopericytoma.

Discussion.Although non-neurogenic tumors associated with neurofibromatosis have been reported in these patients, only one hemangiopericytoma case has been found in the English literature. We report here another case of this rare malignant hemangiopericytoma in a patient with neurofibromatosis.

Oil spills debris clean up by thermal desorption

Oil spills represent a significant environmental issue in Brazil. This paper presents the latest results of a comprehensive experimental programme aimed at understanding how the presence of spilled oil affects the properties of sands and at studying alternatives to remediate the affected shores. Results indicate that oil causes a slight increase in grain size and uniformity, and oiled debris presents a smaller void ratio but a larger unit weight. It was also observed that effective strength parameters for both the natural and oiled debris were the same although the undrained strength of a natural sand is much higher than that of the contaminated sand. At ambient temperature, oiled debris emits methane and ammonia, and these emissions tend to increase with rising temperatures. On the other hand, the oil and grease content from oiled debris decreases with rising temperature and prolonged exposure. Finally, in situ thermal desorption seems to be a promising method for cleaning debris from oil spills. It is simple, fast and avoids all the difficulties associated with digging up the soil for disposal or cleanup.

Unusual paranasal sinus tumors in two patients with common nasal complaints

Common nasal complaints are managed by both the otolaryngologist and the primary care physician. We describe the cases of two patients with nasal obstruction who were referred to us for evaluation--one with severe headache and the other with profuse epistaxis. Their histories prior to referral included long-term, common rhinologic complaints of low-grade headache and mild epistaxis. Neither patient had been referred to us until their symptoms had become severe. Our examination revealed that both patients had rare paranasal sinus pathology. One patient had a fibroxanthoma of the frontal sinus, and the other had extramedullary hematopoiesis of the maxillary sinus. Fibroxanthoma of the frontal sinus is rare, and extramedullary hematopoiesis of the maxillary sinus has not been previously reported. These two unique cases serve as a reminder that long-term common rhinologic complaints can occasionally be a sign of life-threatening pathology and require a full evaluation by an otolaryngologist.

Changes in hepatitis C virus population in serum and peripheral blood mononuclear cells in chronically infected patients receiving liver graft from infected donors

BACKGROUND

We have previously studied hepatitis C (HCV)-infected recipients of livers from HCV-infected donors and found that either the donor's strain or the recipient's strain predominate in serum. The current study was undertaken to determine whether these changes are complete and whether they are reflected in the population of virus associated with peripheral blood mononuclear cells (PBMCs).

METHODS

We analyzed HCV ribonucleic acid from sequential serum and PBMC samples from 11 and 8 patients, respectively. The relatively stable NS5 region was chosen for analysis because it allowed for dependable identification of donor and recipient strains. Viral sequences were analyzed by direct sequencing and by sensitive strain-specific polymerase chain reaction assays. These assays were capable of detecting the minor sequence present at a concentration 1:104-10-7 below that of the major sequence.

RESULTS

Five patients retained their original infecting strain; the donor strain was detected only transiently. In the remaining six patients, recipient strain was detected for the first few weeks, after which only the donor strain was consistently present. However, in one patient the second nondominant strain was detected from the background of the major strain on a single occasion 8 months after transplantation. All changes in serum were closely paralleled by those occurring in PBMCs.

CONCLUSIONS

Viral population changes in the setting of liver transplantation from HCV-infected donors to HCV-infected recipients occur simultaneously in PBMCs and serum. The takeover of one strain by another in PBMC- and serum-derived viral populations seemed to be complete and long lasting.

Initial nonoperative management for periappendiceal abscess

PURPOSE

Our goal was to compare initial operative and nonoperative management for periappendiceal abscess complicating appendicitis.

METHODS

This study is a retrospective review of 155 consecutive patients with appendicitis complicated by periappendiceal abscess treated between 1992 and 1998. Eighty-eight patients were treated initially nonoperatively, and 67 patients were treated operatively. All patients had localized abdominal tenderness and either computed tomography or intraoperative documentation of an abscess.

RESULTS

Our patient population consisted of 107 males and 48 females, with an average age of 33 (range, 16-75) years. Age, gender, comorbidity, white blood cell count, temperature, and heart rate did not differ significantly between groups. For the initial nonoperative management group, the failure rate was 5.8 percent and the appendicitis recurrence rate was 8 percent after a mean follow-up of 36 weeks. The response to treatment of the initial nonoperative group and the initial operative group was compared by length of stay (9 +/- 5 days vs. 9 +/- 3 days; P = not significant), days until white blood cell count normalized (3.8 +/- 4 days vs. 3.1 +/- 3 days; P = not significant), days until temperature normalized (3.2 +/- 3 days vs. 3.1 +/- 2 days; P = not significant), and days until a regular diet was tolerated (4.7 +/- 4 days vs. 4.6 +/- 3 days; P = not significant). Complication rate was significantly lower in the nonoperative group (17 vs. 36 percent; P = 0.008).

CONCLUSIONS

Initial nonoperative management of appendicitis complicated by periappendiceal abscess is safe and effective. Patients undergoing initial nonoperative management have a lower rate of complications, but they are at risk for recurrent appendicitis.

Exposure of hepatitis C virus (HCV) RNA-positive recipients to HCV RNA-positive blood donors results in rapid predominance of a single donor strain and exclusion and/or suppression of the recipient strain

We have analyzed three cases of hepatitis C virus (HCV)-infected recipients who received blood from HCV-infected donors. Two recipients were exposed to two different HCV RNA-positive donors, and one was exposed to a single donor. All parental genomes from the actual infecting units of blood and the recipients were defined, and their presence in the follow-up serum samples was determined using sensitive strain-specific assays. The strain from one of the donors was found to predominate in all recipients' serum samples collected throughout the follow-up period of 10 to 30 months. In two recipients exposed to two infected donors, the strain from the second donor was occasionally found at very low level. However, the original recipients' strains were not detected. Our observations show that HCV-infected individuals can be superinfected with different strains, and this event may lead to eradication or suppression of the original infecting strain. Furthermore, our findings demonstrate that simultaneous exposure to multiple HCV strains may result in concomitant infection by more than one strain, although a single strain could rapidly establish its dominance. The results of the present study suggest the existence of competition among infecting HCV strains which determines the ultimate outcome of multiple HCV exposure.

Cellular origin of gastrointestinal stromal tumors: a study of 27 cases

CONTEXT

Interstitial cells of Cajal (ICCs), also known as pacemaker cells, are cells in the gastrointestinal tract that play a role in the control of gut motility. The ICCs express the c-kit proto-oncogene encoding a type III tyrosine kinase (KIT) receptor, a ligand that is known as stem cell factor (SCF). The maturation of ICCs is dependent on SCF-KIT interaction. The cellular origin, differentiation, nomenclature, and prognosis of gastrointestinal stromal tumors (GISTs) are controversial.

OBJECTIVE

To test the hypothesis that GISTs originate from CD34-positive stem cells and differentiate toward an ICC phenotype.

MATERIALS AND METHODS

We studied 27 cases of smooth muscle differentiated GISTs collected for 14 years (1985-1999), including 8 benign (leiomyoma), 15 malignant primary (leiomyosarcoma), and 4 metastatic to the liver. Immunohistochemical studies of selected lineage-directed monoclonal antibodies of c-kit (CD117), CD34, vimentin, desmin, alpha-actin, S100, and MIB-1 were performed on both normal and tumor tissues.

RESULTS

Immunoperoxidase stains of normal gastrointestinal tract showed both c-kit and CD34-positive cells surrounding the Auerbach ganglia plexus in the gastrointestinal tract. Twenty-seven of 27 tumors strongly expressed c-kit. Fourteen of 27 tumors were positive for CD34. Of the malignant GISTs, 14 of 19 were positive for CD34; of the benign tumors, 0 of 8 were positive for CD34. Thus, CD34 was the best indicator of malignant phenotype.

CONCLUSION

This is the first description of benign smooth muscle GISTs negative for CD34. The results of this study suggest that GISTs originate from CD34-positive stem cells and differentiate toward pacemaker cell phenotype. The lack of expression of CD34 in the benign GIST may indicate that benign GISTs are composed of more mature ICCs, whereas malignant GISTs are composed of dedifferentiated ICCs that express CD34-positive stem cells.

More aggressive behavior of squamous cell carcinoma of the anterior tongue in young women

OBJECTIVE

To review the combined experience from two large medical centers in treating young female patients with anterior tongue cancer to determine the clinical course of this unique subset of patients.

STUDY DESIGN

Retrospective study.

METHODS

Seventeen female patients less than 40 years of age (group A) and 17 older patients, both male and female, greater than 40 years of age (group B) who had treatment for invasive squamous cell carcinoma of the anterior tongue were studied. The charts were reviewed for the clinical staging, treatment, and outcome of each patient. The disease-free survival and recurrence rates were compared between the two cohorts.

RESULTS

The mean disease stage between the groups was II. The survival analysis showed a significant difference between the two groups in recurrences (group A = 65%, group B = 41%; P = .02). Further, of the patients who had recurrence, the young women did so significantly earlier in their disease course than the older patients (group A = 14 mo, group B = 40 mo; P < .05). Although the survival differences did not reach statistical significance (P = .15), the power of the study was low (power = 0.26) resulting in a high-level type II error.

CONCLUSION

These data suggest that young women with squamous cell carcinoma of the anterior tongue have significantly higher rates of recurrent disease and the interval to recurrence is significantly shorter than in older patients. Further investigation is warranted until a statistically significant cohort is accrued; until that time, these patients warrant an aggressive initial treatment and close surveillance for recurrence.

Can perforated appendicitis Be diagnosed preoperatively based on admission factors?

The optimal initial treatment for selected patients with perforated appendicitis may be nonoperative. For this reason it is important to be able to diagnose perforated appendicitis preoperatively. The purpose of this study was to determine the accuracy of diagnosing perforated appendicitis using only admission factors. The study population was comprised of 366 adult patients who underwent appendectomy for presumed appendicitis during 1997. Admission factors associated with perforated appendicitis were determined using univariate and multivariate analyses. These variables were then used to formulate a rule for the diagnosis of perforated appendicitis. Sensitivity and specificity were calculated for this rule. The admission factors analyzed were sex, race, age, days of pain, temperature, heart rate, symptoms, physical examination findings, and laboratory findings. Multivariate regression analysis revealed days of pain, temperature, and localized tenderness outside the right lower quadrant to be significant (P <0.05). Using two or more days of pain, a temperature of >/=101 F (38.3 C), or localized tenderness outside the right lower quadrant as criteria to indicate perforation, we achieved a sensitivity of 86% and a specificity of 58% for distinguishing perforated from nonperforated appendicitis. We concluded that (1) perforated appendicitis cannot reliably be distinguished from nonperforated appendicitis based on admission factors, and (2) two or more days of pain, localized tenderness outside the right lower quadrant, and a temperature of >/=101 F (38.3 C) define a group of patients with appendicitis who have a high incidence of perforation.

A case-control study of laparoscopic versus open sigmoid colectomy for diverticulitis

Laparoscopic sigmoid colectomy (LSC) for diverticular disease accounts for a limited number of laparoscopic colon cases performed nationally because of the technical challenge it presents. Our objective was to determine the feasibility and impact of the laparoscopic approach in elective sigmoid colectomy for diverticular disease and to compare these results with those of the open approach. Twenty elective laparoscopic sigmoid colectomies (LSCs) were performed for diverticulitis between April 1992 and July 1999 at a university-affiliated urban hospital. A case-control study was performed comparing LCS with a matched control group of conventional open sigmoidectomies. Fourteen of 20 sigmoidectomies were successfully completed laparoscopically. The mean operative time for LSC was similar to that for open sigmoid colectomy (251 vs 243 minutes). There was earlier return to oral intake in the LSC group (1 vs 5 days; P < 0.001). The mean length of stay was significantly shorter (P = 0.029) in LSC (4.8 days) versus open sigmoid colectomy (7.8 days). Conversion to open sigmoidectomy extended hospital stay to 8.16 days. The overall complication rate was 10 per cent in both groups. We conclude that LSC can be performed effectively and with a low complication rate for diverticular disease. LSC provides the benefit of quicker return of bowel function and shorter hospitalization.

Nonoperative management of perforated appendicitis without periappendiceal mass

BACKGROUND

Initial nonoperative treatment for patients with periappendiceal mass has been shown to be safe and effective. Our goal was to evaluate the safety and efficacy of initial nonoperative management for perforated appendicitis not accompanied by a palpable mass.

METHODS

The study population consisted of 77 patients with appendicitis treated initially nonoperatively between 1992 and 1998. All had localized abdominal tenderness and computed tomography findings of abscess or phlegmon. None had a palpable abdominal mass. Outcome parameters evaluated were rate of failure, complication, and recurrence.

RESULTS

There were 49 males and 28 females with a mean age of 35 years (range 16 to 75). Initial nonoperative management was successful in 95% of patients. Complications occurred in 12% of patients. Recurrent appendicitis developed in 6.5% of patients after an average follow-up of 30 weeks.

CONCLUSIONS

Perforated appendicitis patients with localized abdominal tenderness and abscess or phlegmon can safely and effectively be treated in an initial nonoperative fashion.

A pilot study evaluating the treatment of postparotidectomy sialoceles with botulinum toxin type A

OBJECTIVE

To report our experience in treating 4 cases of recurrent siacloceles with botulinum toxin type A after partoid surgery.

DESIGN

This is a prospective, nonrandomized, nonblinded pilot study describing a new use for botulinum toxin type A.

SETTING

Tertiary academic medical center.

PATIENTS

Four patients (2 men and 2 women) with persistent postparotidectomy sialoceles who had undergone various treatment failures were included. The diagnosis was made by fine-needle aspiration of the mass based on well-recognized cytologic features of the entity, as well as an elevated amylase level and no evidence of tumor or infection.

INTERVENTIONS

Sialoceles were aspirated before local injection of botulinum toxin type A (30-50 U) subcutaneously.

MAIN OUTCOME MEASURES

The patients were followed up 1 week after receiving botulinum toxin type A injection and then at monthly intervals. They were extensively questioned and examined for any evidence of side effects or recurrence.

RESULTS

All patients had total resolution of sialocele or external salivary fistula within 1 month of treatment. None of the patients to date have demonstrated recurrences at 7 through 13 months, and there were no complications, particularly facial nerve weakness.

CONCLUSION

Our findings suggested that botulinum toxin type A offers a highly effective, safe, and noninvasive method of treatment in postparotidectomy sialocele.