ABSTRACT
A 5-year-old male with right atrial myxoma without interatrial communication who presented with abdominal pain, vomiting, fever, and guaiac positive stool is reported. He was later found to have ischemia of a jejunal segment necessitating segmental resection. Although his symptoms persisted postoperatively, surgical removal of a right atrial myxoma was followed by complete resolution of his intestinal symptoms. We demonstrated that the mesenteric vasculitis was of nonembolic origin, and we speculate autoimmune arteritis as a possible mechanism.
Subject(s)
Heart Atria , Heart Neoplasms/diagnosis , Jejunum/blood supply , Myxoma/diagnosis , Polyarteritis Nodosa/diagnosis , Child, Preschool , Echocardiography , Follow-Up Studies , Heart Atria/pathology , Humans , Ischemia/diagnosis , Male , Neoplastic Cells, CirculatingABSTRACT
To assess the use of the Haemophilus influenzae type b vaccine and the attitudes of health professionals regarding its use in the pediatric population, we conducted a study of community clinics, health department clinics, university-based teaching clinics, and private practice groups in the state of Texas. Whereas 59.6% of the private practice groups and 57.1% of the university-based teaching clinics administered the vaccine to more than 75% of their eligible children, 72.7% of community clinics and 81.7% of health department clinics never administered the vaccine to their eligible children. Likewise, whereas 100% of the university-based teaching clinics and 95.7% of the private practice groups had the vaccine available to their patients, only 22.7% of the community clinics and 15.5% of the health department clinics did so. The two most common reasons given by health professionals concerning the nonuse of the vaccine were nonavailability and high cost of the vaccine. Our findings suggest that a large segment of eligible children do not have access to this important vaccine and that children who depend on community and health department clinics for their routine health care are particularly affected in this regard. Strategies identified to increase the use of the vaccine include providing vaccine free of charge, increasing patient awareness of the vaccine benefits, and passing mandatory state laws requiring vaccine administration before day-care enrollment.
Subject(s)
Attitude of Health Personnel , Bacterial Vaccines/administration & dosage , Haemophilus Vaccines , Pediatrics , Polysaccharides, Bacterial , Bacterial Capsules , Child , Humans , Surveys and Questionnaires , TexasABSTRACT
Absence of a vas deferens is a marker for more serious anomalies of the genitourinary tract. It is highly probable that the ipsilateral kidney, ureter or bladder is deformed or absent. The complete physical examination and the preoperative examination for vasectomy should include palpation to identify the vas. The existence of an accessory vas could explain failure of azoospermia following a ligation procedure.