Relative survival of Bacillus subtilis spores loaded on filtering facepiece respirators after five decontamination methods.

This study determines the relative survival (RS) of Bacillus subtilis spores loaded on an N95 filtering facepiece respirator (FFR) after decontamination by five methods under worst-case conditions. Relative survival was obtained by testing after decontamination and after storing the FFRs at 37°C and 95% relative humidity for 24 hours. The decontamination methods involved ethanol, bleach, ultraviolet irradiation (UVA 365 nm, UVC 254 nm), an autoclave, and a traditional electric rice cooker (TERC) that was made in Taiwan. Without decontamination, 59 ± 8% of the loaded spores survived for 24 hours. When 70% ethanol was added to the N95 FFR at a packing density of 0.23, the RS was 73 ± 5% initially and decayed to 22 ± 8% in 24 hours. Relative survival remained above 20% after 20 minutes of UVA irradiation. The other four decontamination measures achieved 99%-100% biocidal efficacy, as measured immediately after the methods were applied to the test FFRs. Relative survival is a useful parameter for measuring sterilization or degree of disinfection. Bleach, UVC, an autoclave, and a TERC provide better biocidal efficacy than ethanol and UVA. Not only a higher filter quality but also a lower value of RS produced the most decontaminated FFR.

Adsorption and destruction of PCDD/Fs using surface-functionalized activated carbons.

Activated carbon adsorbs polychlorinated dibenzo-p-dioxins and -furans (PCDD/Fs) from gas streams but can simultaneously generate PCDD/Fs via de novo synthesis, increasing an already serious disposal problem for the spent sorbent. To increase activated carbon's PCDD/F sorption capacity and lifetime while reducing the impact of hazardous waste, it is beneficial to develop carbon-based sorbents that simultaneously destroy PCDD/Fs while adsorbing the toxic chemicals from gas streams. In this work, hydrogen-treated and surface-functionalized (i.e., oxygen, bromine, nitrogen, and sulfur) activated carbons are tested in a bench-scale reactor as adsorbents for PCDD/Fs. All tested carbons adsorb PCDD/F efficiently, with international toxic equivalent removal efficiencies exceeding 99% and mass removal efficiencies exceeding 98% for all but one tested material. Hydrogen-treated materials caused negligible destruction and possible generation of PCDD/Fs, with total mass balances between 100% and 107%. All tested surface-functionalized carbons, regardless of functionality, destroyed PCDD/Fs, with total mass balances between 73% and 96%. Free radicals on the carbon surface provided by different functional groups may contribute to PCDD/F destruction, as has been hypothesized in the literature. Surface-functionalized materials preferentially destroyed higher-order (more chlorine) congeners, supporting a dechlorination mechanism as opposed to oxidation. Carbons impregnated with sulfur are particularly effective at destroying PCDD/Fs, with destruction efficiency improving with increasing sulfur content to as high as 27%. This is relevant because sulfur-treated carbons are used for mercury adsorption, increasing the possibility of multi-pollutant control.

Complicated features in a young child with influenza B virus pneumonia and co-infection with Stenotrophomonas maltophilia.

A 3.5-year-old child with influenza B virus pneumonia developed pneumomediastinum and subcutaneous emphysema on the 3rd day of illness. Bronchoscopy demonstrated obstruction of the left main bronchus by mucopurulent sputum. Culture of the broncho-alveolar lavage yielded Stenotrophomonas maltophilia. After the respiratory complications resolved (11 days), the patient developed neurological symptoms and was diagnosed as acute disseminated encephalomyelitis (ADEM). Stenotrophomonas maltophilia was probably a factor in the development of pneumomediastinum. To our knowledge, this is the first case report of influenza virus infection with Stenotrophomonas maltophilia co-infection associated with spontaneous pneumomediastinum.

Acute disseminated encephalomyelitis that meets modified McDonald criteria for dissemination in space is associated with a high probability of conversion to multiple sclerosis in Taiwanese patients.

BACKGROUND: Patients with acute disseminated encephalomyelitis (ADEM) may relapse and some may ultimately convert to multiple sclerosis (MS); however, no criteria that can predict MS conversion are available to date. Our aim was to describe the clinical and magnetic resonance imaging (MRI) features of patients with an initial ADEM attack and evaluate which MRI criteria can predict conversion to MS. METHODS: We retrospectively reviewed the records of 36 patients diagnosed with ADEM. We determined clinical signs/symptoms, examined the cerebrospinal fluid (CSF), and performed brain MRI scans and compared the findings between patients who did and did not convert to MS. RESULTS: Clinical signs/symptoms, and CSF analysis show no significant difference between the two groups. The rate of conversion to MS from ADEM in Taiwanese patients is low (11%) after a mean follow-up period of 28.36 months. Modified McDonald criteria were fulfilled in 19/36 patients: 21% (4/19) of those patients developed MS according to Poser criteria subsequently. Of the other patients (17/36) who did not fulfill these criteria, none converted to MS. (log rank test; P=0.027). CONCLUSIONS: It is difficult to predict from initial clinical presentations to address which patients with ADEM will convert to MS. Patients with ADEM whose brain MRI findings met the modified McDonald criteria may have clinically isolated syndrome because they have a significantly higher probability of conversion to MS. In contrast, patients whose brain MRI findings did not meeting these criteria may be considered as having classic ADEM because they have a lower probability of conversion to MS.

Pyridoxal phosphate is better than pyridoxine for controlling idiopathic intractable epilepsy.

AIM: To study the difference between pyridoxine (PN) and its active form, pyridoxal phosphate, (PLP) in control of idiopathic intractable epilepsy in children. METHODS: Among 574 children with active epilepsy, 94 (aged 8 months to 15 years) were diagnosed with idiopathic intractable epilepsy for more than six months. All received intravenous PLP 10 mg/kg, then 10 mg/kg/day in four divided doses. If seizures recurred within 24 hours, another dose of 40 mg/kg was given, followed by 50 mg/kg/day in four divided doses. For those patients whose seizures were totally controlled, PLP was replaced by the same dose of oral PN. If the seizure recurred, intravenous PLP was infused followed by oral PLP 50 mg/kg/day. RESULTS: Fifty seven patients had generalised seizures (of whom 13 had infantile spasms) and 37 had focal seizure. Eleven had dramatic and sustained responses to PLP; of these, five also responded to PN. Within six months of treatment with PLP or PN, five of the 11 patients were seizure free and had their previous antiepileptic medicine tapered off gradually. Two were controlled with pyridoxine and the other three needed PLP to maintain seizure freedom. The remaining six responders needed PLP exclusively for seizure control. Six of the 11 responders to PLP had infantile spasms (46%); four of them needed PLP exclusively. The other five responders were in the remaining 81 patients with other seizure type. CONCLUSIONS: PLP could replace PN in the treatment of intractable childhood epilepsy, particularly in the treatment of infantile spasms.

Coexistence of oto-palato-digital syndrome type II and Arnold-Chiari I malformation in an infant.

A Taiwanese infant with clinically apparent oto-palato-digital syndrome type II had Arnold-Chiari I malformation. Arnold-Chiari I malformation has not been reported previously to occur in association with oto-palato-digital type II syndrome. The pathogenesis of both conditions has remain unclear although the Arnold-Cliari I malformation is most likely due to a developmental abnormality of improperly times or incomplete closure of the neural tube. We propose the physician who care for children with OPD type II must be aware of one more condition.

Protective effects of several amino acid-nutrients on gastric hemorrhagic erosions in acid-irrigated stomachs of septic rats.

Our previous report demonstrates that severe gastric mucosal damage is produced in lipopolysaccharide (LPS)-intoxicated rats. In the present study, we examined protective effects of several amino acids including taurine, phenylalanine and L-Arginine on gastric hemorrhagic erosions in acid-irrigated stomachs of LPS rats. The animals were deprived of food for 24 hr. Intravenous LPS (3 mg/kg) was challenged 12 hr after withdrawal of food. Gastric vagotomy was performed, followed by irrigation the stomachs for 3 hr with a physiological acid solution containing 100 mM HCl and 54 mM NaCl. The ulcerogenic parameters including increased gastric acid back-diffusion, mucosal histamine concentrations, lipid peroxide productions, luminal hemoglobin contents, stomach erosions and the lowered glutathione levels were markedly enhanced in LPS rat stomachs irrigated with acid solution. Both phenylalanine and taurine caused dose-dependent attenuations of these ulcerogenic parameters in LPS rats. L-arginine also was effective in inhibition. The inhibitory effect was restored by pretreatment of nitric oxide synthase inhibitors, such as N(G)-nitro-L-arginine-methyl ester or L-N(G)-(1-iminoethyl)-lysine. Furthermore, marked amelioration of hemorrhagic erosions in LPS rats was observed when a combination of these amino acid nutrients was used. The results provide evidence that these amino acid nutrients may ameliorate gastric hemorrhagic erosion via GSH synthesis stimulation, histamine cell membrane stabilization and antioxidant actions in LPS rat stomachs.

Coexistence of schizencephaly and intracranial arteriovenous malformation in an infant.

A 9-month-old infant had unilateral closed-lip schizencephaly in the right parietal lobe, which coexisted with an arteriovenous malformation in the nearby temporal area. Cranial MR showed a right parietal cleft lined with gray matter between the right lateral ventricle and the subarachnoid space, and cluster hypointensities throughout the right temporal lobe. Cerebral angiography revealed a right temporal arteriovenous malformation with feeding arteries arising from the right middle and posterior cerebral arteries and draining into the right sigmoid sinus via the engorged vein of Labbé.

Late-onset pyridoxine-dependent seizures: report of two cases.

We report two cases of late-onset pyridoxine-dependent seizures with age onset at 14 and 9 months, respectively. Their intractable seizures were refractory to diazepam, phenobarbital, phenytoin, carbamazepine, valproic acid, and adrenocorticotropic hormone, but stopped soon after intravenous administration of pyridoxine. The psychomotor development was retarded in both cases. Pyridoxine dependency is one of the few treatable intractable seizures in infancy. It should always be kept in mind, even in patients with intractable seizures beyond the neonatal period, regardless of previous patterns of electroencephalography and seizure types and responsiveness to the conventional anticonvulsants.

The therapeutic outcome of medulloblastoma in 49 children.

The medical records of 63 patients with histologically-confirmed medulloblastoma were reviewed. From these, the clinical features and treatment outcome of 49 patients were available for analysis. Following tumor resections, 44 patients were given craniospinal radiation therapy with local boosts to the posterior fossa and other macroscopically involved areas. Twenty patients received chemotherapy: 17 as postoperative adjuvant or salvage therapies, and 3 as preradiation chemotherapy. The postoperative early death occurred in two patients. The projected 5-year survival and recurrence-free survival rate of the overall group and the 41 patients who had completed radiotherapy were 61%, 70% and 50%, 57%, respectively. Two significant favorable factors were identified: complete tumor resection and combination radiotherapy. A better five-year survival rate was found in patients who had complete tumor resection (78% vs 19%); with combination radiotherapy the rate was 70% vs 0%.

Cerebral cryptococcosis in a child.

Reported is one case of cerebral cryptococcosis in a 12-year-old girl. The diagnosis was confirmed by the detection of Cryptococcus neoformans with both India ink preparation of the cerebrospinal fluid and Sabouraud's media culture. Clinical presentation included progressive severe headache, vomiting, left eye pain, diplopia, dizziness and unstable gait. Fever was absent as a symptom. Initial brain magnetic resonance imaging revealed a focal lesion over the right cerebellar hemisphere with better demonstration than contrast-enhanced computed tomography. The patient was treated with amphotericin B and 5-flucytosine with good final outcome. Early diagnosis and proper therapy are necessary in order to decrease the motality of cerebral cryptococcosis.

Intracranial meningiomas in childhood.

Over the 10-year period from 1980 to 1990, ten pediatric patients were diagnosed at this hospital with intracranial meningiomas. The patients' diagnoses were confirmed by histological studies, including the incidence, age and sex distribution, duration of symptoms prior to diagnosis, signs and symptoms on onset, tumor locations, histologic type, presence of cyst, dural attachment of tumor, treatment, and prognosis. When comparing pediatric meningiomas with those of adults, some differences were noted such as a slight preference for males; the clinical history seemed to be shorter; a ventricular location is more frequent; predilection for cystic meningioma and absence of dural attachment are more common.

Dermatomyositis and polymyositis in childhood.

From January 1, 1981 to December 31, 1992, we experienced nine patients with childhood onset of dermatomyositis and polymyositis. The mean age of disease onset was 12 years (range 7 to 16 years). Seven of them fulfilled the criteria of dermatomyositis, the remaining two were polymyositis. Girls were more predominant than boys in 6:3 ratio. The clinical features included extremities muscle weakness, skin rash, periorbital swelling and dysphagia. Increased muscle enzymes including creatine phosphokinase (CPK) or lactic dehydrogenase (LDH) were all positive in nine patients. All of our nine patients were treated with prednisolone after the diagnosis was established. The duration of treatment ranged from 3 to 65 months (mean: 25.3 months). Two of the nine patients also received immunosuppressive agents, hydroxychloroquine and azathioprine respectively. At present six patients survive without treatment. Two patients continue with corticosteroid and immunosuppressive therapy. One patient died from primary peritonitis, six months after being diagnosed with JDMS. In conclusion our study shows there is a female dominance; monocyclic clinical course is more common; and the prognosis is good in general, in the cases of juvenile dermatomyositis and polymyositis.

Multiple cerebral aneurysms in a child with cardiac myxoma.

Neurologic involvement is not uncommon in cardiac myxoma, yet its association with multiple cerebral aneurysms is rare, especially in children. We describe a patient with left atrial and ventricular myxoma, who otherwise lacked cardiac symptomatology and did not exhibit auscultatory, roentgenologic, or electro-cardiographic evidence of heart disease. The clinical presentation was a sudden attack of a cerebrovascular occlusive disorder. Multiple fusiform aneurysms at the frontal and parietal branches of the left anterior and middle cerebral arteries were demonstrated on cerebral angiograms. The myxomas were surgically removed and the patient improved.

Pyogenic sacroiliitis in children: report of three cases.

We report three children who were treated for pyogenic infection of the sacroiliac joint. The disease, usually present in late childhood or adolescence, is uncommon and difficult to assess so that the diagnosis is usually delayed. The three patients were two boys and one girl, aged 14, 15 and 12 years, respectively. A detailed history and physical examination are very important for establishment of the diagnosis. All the three cases presented with typical clinical triad of fever, limping gait and buttock pain. Pelvis compression maneuver, which directly stresses the sacroiliac joint, may aggravate the joint pain and suggest this diagnosis. On physical examination, this test is positive in all our cases. Nuclear scintigraphy is useful for localization of early lesions. For detecting abscess formation, magnetic resonance imaging was performed in two cases and computed tomography in one. In one of the patients, computed tomography failed to demonstrate an iliopsoas abscess formation, which was proved by magnetic resonance imaging later. Staphylococcus aureus was isolated from blood in all three patients. Prompt antibiotic therapy reduces complication and operation is rarely needed. With rapid and appropriate medical treatment, all our patients recovered without an sequelae.