Immunogenicity of a combination vaccine containing diphtheria toxoid, tetanus toxoid, three-component acellular pertussis, hepatitis B, inactivated polio virus, and Haemophilus influenzae type b when given concomitantly with 13-valent pneumococcal conjugate vaccine

Two randomized trials of 13-valent pneumococcal conjugate vaccine (PCV13) relative to PCV7 evaluated the immune responses of coadministered antigens comprising Infanrix(®) hexa/Infanrix(®)-IPV+Hib (diphtheria, tetanus, 3-component acellular pertussis, hepatitis B, inactivated poliovirus, and Haemophilus influenzae type b). After the 3-dose infant series, immunogenic noninferiority was demonstrated for all concomitantly administered antigens between the PCV13 and PCV7 groups. All antigens elicited good booster responses after the toddler dose except pertussis toxoid; however, 99.6% subjects achieved pertussis toxoid protective antibody level ≥5EU/mL in both groups. These results support the concomitant administration of PCV13 and Infanrix hexa/Infanrix-IPV+Hib as part of routine immunization schedules.

Diagnosis of fistulae and sinus tracts in patients with Crohn disease: value of MR imaging

To investigate the potential of MR imaging in the evaluation of sinus tracts or fistulae associated with Crohn disease, 17 patients with pelvic or abdominal fistulae or sinus tracts underwent MR imaging with multislice spin-echo techniques, 500/15 and 1600/22,80 (TR/TE). The presence of fistulae and/or sinus tracts was confirmed by contrast-enhanced CT (n = 17) and/or sonography (n = 8), sinography (n = 6), or barium studies (n = 4). In all but three cases the fistulae and extramucosal inflammatory abnormalities were shown by MR. T1-weighted images provided excellent delineation of the extension of the fistulae relative to sphincters and adjacent hollow viscera and showed inflammatory changes in fat planes. T2-weighted images showed fluid collections within the fistulae, localized fluid collections in extraintestinal tissues, and inflammatory changes within muscles. The supralevator and infralevator compartments were well defined on coronal images. Thus, the perirectal spread of fistulae and sinus tracts with respect to the levator ani could be demonstrated in all cases. Our results suggest that MR imaging is useful for the demonstration and evaluation of pelvic and abdominal sinus tracts or fistulae associated with Crohn disease.

MR imaging of urinary bladder neoplasms

The diagnostic potential of magnetic resonance (MR) imaging at 1.5 T for assessment and staging of urinary bladder tumors was investigated in 10 patients with malignant urinary bladder tumors. All patients underwent complete pathologic staging. The appearance of the urinary bladder tumors and the ability to stage them by means of MR imaging was evaluated morphologically and compared with results obtained with pathologic examination. Magnetic resonance imaging permitted tumor localization in all patients. In nine patients the tumor stage was accurately determined by MR imaging. The smallest tumor detected by MR imaging was 1.5 cm. Both transverse and sagittal imaging planes were found to be essential for accurate assessment of tumor extension. Signal intensity data obtained from both dual and multi spin echo sequences showed that tumor display and depth of infiltration was best seen with a repetition time (TR) of 2,000 ms and an echo time (TE) of 90 ms. Accurate evaluation of perivesical tumor infiltration required a sequence with a TR 800 ms and a TE 30 ms. Data presented here further support the role of MR in staging urinary bladder neoplasms.