Effectiveness of oseltamivir in preventing influenza in household contacts: a randomized controlled trial.

CONTEXT: Influenza virus is easily spread among the household contacts of an infected person, and prevention of influenza in household contacts can control spread of influenza in the community. OBJECTIVE: To investigate the efficacy of oseltamivir in preventing spread of influenza to household contacts of influenza-infected index cases (ICs). DESIGN AND SETTING: Randomized, double-blind, placebo-controlled study conducted at 76 centers in North America and Europe during the winter of 1998-1999. PARTICIPANTS: Three hundred seventy-seven ICs, 163 (43%) of whom had laboratory-confirmed influenza infection, and 955 household contacts (aged >/=12 years) of all ICs (415 contacts of influenza-positive ICs). INTERVENTIONS: Household contacts were randomly assigned by household cluster to take 75 mg of oseltamivir (n = 493) or placebo (n = 462) once daily for 7 days within 48 hours of symptom onset in the IC. The ICs did not receive antiviral treatment. MAIN OUTCOME MEASURE: Clinical influenza in contacts of influenza-positive ICs, confirmed in a laboratory by detection of virus shedding in nose and throat swabs or a 4-fold or greater increase in influenza-specific serum antibody titer between baseline and convalescent serum samples. RESULTS: In contacts of an influenza-positive IC, the overall protective efficacy of oseltamivir against clinical influenza was 89% for individuals (95% confidence interval [CI], 67%-97%; P<.001) and 84% for households (95% CI, 49%-95%; P<.001). In contacts of all ICs, oseltamivir also significantly reduced incidence of clinical influenza, with 89% protective efficacy (95% CI, 71%-96%; P<.001). Viral shedding was inhibited in contacts taking oseltamivir, with 84% protective efficacy (95% CI, 57%-95%; P<.001). All virus isolates from oseltamivir recipients retained sensitivity to the active metabolite. Oseltamivir was well tolerated; gastrointestinal tract effects were reported with similar frequency in oseltamivir (9.3%) and placebo (7.2%) recipients. CONCLUSION: In our sample, postexposure prophylaxis with oseltamivir, 75 mg once daily for 7 days, protected close contacts of influenza-infected persons against influenza illness, prevented outbreaks within households, and was well tolerated.

Adenocarcinoid of the appendix presenting as a disseminated ovarian carcinoma: report of a case.

The occurrence of disseminated tumors of the appendix is a rare event. Usually appendix tumors are very small, located on the inside of the appendix, and can be pathologically diagnosed. Adenocarcinoid is an uncommon variant of carcinoid tumors that usually arises in the appendix. This report describes a case of a primary adenocarcinoid of the appendix in a patient who was preoperatively diagnosed to have uterus myomatosus but was intraoperatively found to instead have disseminated ovarian carcinoma. This case demonstrates that the clinical picture can be misleading, and that surgeons therefore always have to wait for the final pathological report before making a final diagnosis.

Fryns syndrome without diaphragmatic hernia?

We report on a child with Fryns syndrome including lung hypoplasia, characteristic facial appearance, cleft palate, cardiac anomaly, distal limb abnormalities, absent nipples, bicornuate uterus and early death. In contrast to most patients with Fryns syndrome, diaphragmatic hernia was absent in our patient. However, the diaphragm was reduced to a fibrous web with reduced muscular component.

Antenatal fetal death in twin pregnancies: a dangerous condition mainly for the surviving co-twin; a report of four cases.

The outcome of four twin pregnancies with fetal death of one twin during the late second and the third trimester is described. A review of the complications occurring after antepartal fetal death of one twin is presented. A management plan for this rare complication of pregnancy is established.

Female sterilization failure after bipolar electrocoagulation: a 6 year retrospective study.

A 6 year retrospective study was conducted from January 1983 till December 1988. During this period there were 13,014 births, 1,776 registered spontaneous abortions and 200 tubal pregnancies. 1,437 sterilizations were performed in the same period via bipolar electrocoagulation. 11.5% of the ectopic pregnancies were in patients who had previously undergone a tubal sterilization. The failure ratio following bipolar coagulation was 1.18%, and all failures were extra-uterine pregnancies, with an average interval between sterilization and ectopic pregnancy of 28.8 months. This reflects the importance of previous sterilizations as an etiologic agent in ectopic gestations. We will discuss the possible etiological factors for our sterilization failures and how these failures can be avoided or minimized. Also diagnostic difficulties and management of an extra-uterine pregnancy (EUP) following sterilization will be presented.

PIP: A 6-year retrospective study was conducted from January 1983-december 1988. During this time, there were 13,014 births, 1776 registered spontaneous abortions, and 200 tubal pregnancies. 1437 sterilizations were performed in the same period via bipolar electrocoagulation. 11.5% of the ectopic pregnancies were inpatients who had previously undergone a tubal sterilization. The failure ratio following bipolar coagulation was 1.18% and all failures were extrauterine pregnancies, with an average interval between sterilization and ectopic pregnancy of 28.8 months. This reflects the importance of previous sterilizations as a contributing factor in ectopic gestations. The authors discuss the possible etiological factors involved in these sterilization failures and how these could by avoided or minimized. Also, diagnostic difficulties and management of an extrauterine pregnancy (EUP) following sterilizations presented.

Neu (C-erbB-2) oncogene in breast cancer and its possible association with the risk of distant metastases. A retrospective study and review of literature.

By immunohistochemical staining C-erbB-2 (neu) oncogene was found on the cell membrane in 19 out of 44 primary breast cancers from a pathology archive. No obvious relation was found between neu oncogene, age, and lymph node status and tumor size. There was a tendency towards smaller primary tumors and more estrogen receptor-negative tumors in the oncogene-positive group. No case of distant metastasis during follow-up was found among the oncogene-negative patients, while 6 oncogene-positive patients developed such metastases. This suggests that the neu oncogene is an independent prognostic factor, which might predict the development of distant metastasis. Further studies including more patients and long-term survival analysis are, however, needed in order to evaluate the prognostic significance of the neu oncogene.

Myomectomy during pregnancy: uncommon case report.

A case of myomectomy during pregnancy is presented. Generally myomectomy is contraindicated during this period. On the 14th week of pregnancy our patient presented with progressive lower abdominal pain and a tender mass of nearly 12 centimeter diameter in the pouch of Douglas. Therefore an exploratory laparotomy was performed to exclude torsion of an adnexal mass or pedunculated subserous myoma. A dorsal degenerating myoma with short thick pedicle (4 cm diameter) was found. It was compressed between the promontory of the sacrum and the uterus. Myomectomy was performed and pregnancy progressed without complications.

A case report of unusual complication of myomatous uterus in pregnancy: spontaneous perforation of myoma after red degeneration.

An unusual complication of myomatous uterus in pregnancy is presented. It shows spontaneous perforation of a myoma after red degeneration, presenting as an acute abdomen. To our knowledge spontaneous perforation of a necrotising leiomyoma has not been reported earlier. A review of the literature is given.

Shigella and shigellaemia.

Two cases of bacteraemia with Shigella flexneri 2a in children are described. They illustrate the wide variety of clinical manifestations of shigellosis, ranging from benign gastroenteritis to septicaemia associated with severe extra-intestinal manifestations.