Seropersistence of TBE virus antibodies 10 years after first booster vaccination and response to a second booster vaccination with FSME-IMMUN 0.5mL in adults.

Tick-borne encephalitis (TBE) is a viral disease that can have a severe acute clinical course and considerable long-term morbidity. As there is no causal treatment currently available for TBE, vaccination is the only way to combat the disease in endemic areas. The studies presented here were conducted to obtain prospective long-term TBE serum antibody persistence data of subjects up to 10years after the first booster with FSME-IMMUN. This report presents the results of 2 follow-up studies in the same study population of 315 healthy adults. Blood was drawn to assess the seropersistence of TBE virus antibodies yearly, from 2-5 and 7-10years after the first booster vaccination with FSME-IMMUN administered during a previous study. The timing of the second booster vaccination was dependent on the level of serum TBE antibodies observed during yearly follow-up serology observations. The current follow up showed that adult recipients were 84.9% seropositive 10years after a 3 dose primary series and the first booster vaccination of FSME-IMMUN. Seropositivity rates were even higher (88.6%) in subjects below 50years of age. ClinicalTrials.gov Identifier: NCT00503529. ClinicalTrials.gov Identifier: NCT01582698.

Safety and immunogenicity of the modified adult tick-borne encephalitis vaccine FSME-IMMUN: results of two large phase 3 clinical studies.

A prospective, randomised, multicentre, single-blind phase 3 study was performed to assess the safety of a vaccination schedule consisting of two vaccinations (21-35 days apart) with the tick-borne encephalitis (TBE) vaccine FSME-IMMUN "adults" (five consecutive lots) in comparison to another licensed TBE vaccine (Encepur), with polygeline) (two lots) in healthy volunteers (n=3966) aged 16-65 years. The safety of the third vaccination with FSME-IMMUN "adults" (6 months after the first vaccination) was investigated in a follow-up study on the same population (n=3705) and TBE antibody titres were analysed pre- and post-vaccination in a subgroup of volunteers (n=564). Following the first vaccination, the overall incidence of fever (> or =38.0 degrees C) was 0.8% in the FSME-IMMUN "adults" study group and 5.6% in the comparator study group; fever was mainly mild. The fever rate after the second vaccination was 0.6% and 0.5% in the two study groups, respectively. Local and systemic reactions after the first vaccination occurred with a lower frequency in the FSME-IMMUN "adults" study group than in the comparator group. Upon analysing the tolerability of the third vaccination with FSME-IMMUN "adults", similar results were determined in both study groups of volunteers previously vaccinated with FSME-IMMUN "adults" or with the comparator vaccine. The immunogenicity results demonstrated similar seroconversion rates (as determined by ELISA or neutralization test) before and after the third vaccination in the FSME-IMMUN "adults" group and in the comparator group respectively. The results of both studies demonstrate that: (1) FSME-IMMUN "adults" is safe and highly immunogenic, (2) all five production lots of FSME-IMMUN "adults" were consistent with respect to a low rate of adverse events, (3) FSME-IMMUN "adults" induces considerably lower adverse reaction rates than the comparator vaccine after the first vaccination, and (4) two vaccinations with the comparator vaccine can be successfully followed by a third vaccination with FSME-IMMUN "adults".

Identification of Neisseria meningitidis sequence type 66 in Poland.

Investigation of two cases of invasive meningococcal disease within a single family revealed the presence of isolates of Neisseria meningitidis phenotype C:2b:P1.2,P1.5 belonging to sequence type (ST) 66. The ST66 clone is a single-locus variant of the widely distributed ST8 complex, which has been observed previously in Spain, Belgium, Australia and New Zealand. This hypervariable meningococcal lineage has been responsible for local epidemics worldwide. This is the first report of ST66 meningococcal isolates of this phenotype from Poland.

A histologic analysis of three-dimensional versus two-dimensional tissue expansion in the porcine model.

OBJECTIVE: Recently, a two-dimensional Silastic Dacron stretching skin device has been developed for scalp reduction surgery. Attached subgaleally, this device stretches skin over time, while avoiding the visible volumetric distention that is typical of three-dimensional tissue expanders. Unlike three-dimensional expanders, the histological changes observed with a two-dimensional stretching device have not been described in the literature. The present study compares the histological effects of two-dimensional and three-dimensional skin tissue expansion in the porcine model. STUDY DESIGN: A university Institutional Review Board-approved study in which 16 domestic piglets were used. The 16 piglets were divided evenly into four cohorts as follows: 1, 1-week control cohort; 2, 1-week experimental cohort; 3, 4-week control cohort; and 4, 4-week experimental cohort. METHODS: Tissue expanders (three-dimensional) and Dacron Silastic tissue stretchers (two-dimensional) were surgically inserted into the lateral skin of 16 domestic pigs. Animals were killed at either 1 or 4 weeks based on group assignment. Light microscopic ocular micrometry and stereological point counting were used to determine the depth of the epidermis, dermis, and subdermal adipose tissue layer; width of the panniculus muscle; diameter of sweat gland follicles; percentage ratio of dermal collagen, blood vessels, and tissue space; and epidermal mitotic index in 100 specimens. One-way ANOVA was used to evaluate statistical differences. RESULTS: Both tissue expanders yielded increased values compared with control subjects, with respect to epidermal, dermal, and fat widths and blood vessel counts, whereas adnexal structures in the panniculus muscle width were unaltered. CONCLUSIONS: Although statistically the two types of expansion produced histologically similar changes, the degree of change varied according to the type of expander that was used and the duration of tissue expansion. Most notably, three-dimensional expansion produced more tissue gain per unit area expanded at both the 1-week and the 4-week time intervals, and early (1-week) two-dimensional tissue expansion stimulated a greater angiogenic response than three-dimensional expansion. These findings will assist the surgeon in understanding the physical changes that occur with these two forms of tissue expansion, as well as the potential clinical advantages and shortcomings of each method.

[Epidemiology and etiology of bacterial meningitis in postnatal period]. / Epidemiologia i etiologia bakteryjnego zapalenia opon mózgowo-rdzeniowych u dzieci poza wiekiem noworodkowym.

In south-east Poland in the years 1993 till 1995 we observed a decreasing number of meningococcal meningitis in children and a growth of cases caused by Haemophilus influenzae. Changes in ethiology of bacterial meningitis should give a reason for epidemiological research in Poland because there is a chance to reduce number of patients when wider use of new vaccines is introduced.

[Acute neurologic rubella complications observed in children of southeastern Poland during rubella epidemics in 1986 and 1992]. / Ostre neurologiczne powiklania rózyczki obserwowane u dzieci z Polski poludniowo-wschodniej w czasie epidemii rózyczki w 1986 i 1992 r.

During the last two rubella epidemics in 1985-1986 and 1992, 24 children (15 boys and 9 girls) were hospitalized with acute neurological complications manifested in the first week of clinical symptoms of rubella. Average age of patients was 9 years (3-15 years). Acute rubella encephalitis (ARE) was diagnosed in 22 cases. Most of these patients had sudden loss of consciousness lasting from several hours to 12 days and convulsions during the first stage of the illness. Two patients developed retrobulbar neuritis which led to a significant impairment of sight in one of them. One child suffers epilepsy as a result of ARE. The remaining children did not develop lasting complications. During hospitalization, active infection by the rubella virus was confirmed in 20 children by detecting specific IgM antibodies in serum using the ELISA method. Comparing the ARE cases in 1986 and 1992 rubella epidemics revealed a change in clinical course. Earlier manifestations of neurological symptoms and more marked changes in CSF were observed. The issue of immunoprophylaxis is discussed; these measures only started in 1989 by vaccinating 13 and 14 year old girls. This method of prophylaxis will neither stop the transmission of the virus among children nor prevent the occurrence of periodic epidemics and rubella-related complications.

Effect of magnetic resonance imaging on implantable eyelid weights.

Implanted upper eyelid gold weights are used to prevent corneal injury in patients with facial nerve paralysis. Some of these individuals require postoperative radiographic surveillance for recurrent lateral skull base disease. Magnetic resonance imaging (MRI) provides the most accurate radiologic assessment; however, there is concern about the safety of performing MRI in patients with any metallic implant. Potential risks include local tissue heating and implant migration. Gold weights of 0.8 and 1.4 g were placed in an open chamber and were exposed to a magnetic field of 1.5 T. There was no measurable motion or displacement of the weights. The results were similar in 6 rats in which gold weights were subcutaneously implanted. Additionally, histologic examination of the implant sites revealed no adverse tissue effects attributable to MRI-generated heating of the implants. When carbon steel implants in the rat model were subjected to the magnetic field, there was no displacement of the implants and no adverse tissue effects were noted, despite the fact that a carbon steel implant in an open chamber demonstrated significant migration. The absence of motion of the gold weight implants combined with the lack of adverse tissue effects suggests the relative safety of performing MRI in patients with previously placed gold weights as upper eyelid implants.

[Bacterial meningitis caused by the strains of Haemophilus influenzae type B resistant to most penicillins and cephalosporins]. / Bakteryjne zapalenie opon mózgowo-rdzeniowych spowodowane przez szczepy Haemophilus influenzae typu B oporne na wiekszosc penicylin i cefalosporyn.

In recent years bacterial meningitis caused by Haemophilus influenzae appears to have occurred more frequently in Poland. In this paper the author presents three specific cases treated in one typical month at the Department of Neuroinfections at John Paul the II Hospital, Kraków. Each of the cases in question proved difficulty to treat because the strains of bacteria encountered were resistant to the most of penicilins and cephalosporins.

Irradiated cartilage grafts in the nose. A preliminary report.

Many nasal deformities require some form of graft or implant material for complete correction. Various well-recognized disadvantages are associated with currently used autografts, allografts, and alloplastic materials, thereby maintaining a continued search for the ideal nasal graft. Irradiated homograft costal cartilage is an allograft that has been used with variable success in the head and neck region. Isolated reports have suggested favorable results with irradiated homograft costal cartilage implantation in the nose. This study details the findings of 306 irradiated homograft costal cartilage grafts that were used in 122 nasal augmentation procedures.

Facial paralysis reconstruction with Gore-Tex Soft-Tissue Patch.

No procedure perfectly restores a face paralyzed by surgical ablation of the facial nerve. Although dynamic reconstructive procedures are preferred for treating patients with complete facial paralysis, various conditions contraindicate their use, making static suspension of the paralyzed face a reasonable surgical alternative. Expanded polytef soft-tissue patch (polytetrafluoroethylene; Gore-Tex Soft-Tissue Patch, Gore-Tex, W. L. Gore & Assoc Inc., Flagstaff, Ariz) was used to help correct midfacial and perioral asymmetries in 11 patients with complete unilateral facial paralysis. All patients had previous surgical ablation of the facial nerve and were not considered good candidates for dynamic facial reconstruction. Midfacial and perioral asymmetries were improved in all patients using this technique of static soft-tissue suspension. One postoperative infection and two cases of postoperative suture extrusion were observed in the patient population. Other complications associated with the use of Gore-Tex Soft-Tissue Patch for facial suspension were limited to technical factors.

Controlled nasal tip rotation via the lateral crural overlay technique.

Pronounced nasal tip ptosis is generally regarded as an unattractive facial feature. Besides its aesthetic ramifications, marked inferior displacement of the nasal tip adversely affects nasal function by restricting airflow through the nares. We present a new technique that is a modification of a lateral crural flap procedure that was described in 1975. This technique, which is performed using an open rhinoplasty approach, predictably rotates the nasal tip upward by restructuring the alar cartilages via controlled overlay of the lateral crura. When overprojection accompanies tip ptosis, the controlled lateral crural overlay technique permits graduated retrodisplacement of the tip, in addition to rotation, giving the surgeon full control for reliably and accurately repositioning the nasal tip superiorly and posteriorly.

Selected approaches to the aging face.

The desire for a more attractive, youthful appearance knows no upper age limit. We highlighted a number of conditions that are more severe or more frequently seen in the geriatric patient. Appropriate, tested, and logical techniques for their correction are described. Figure 2 illustrates the results of these techniques.

Dome truncation for management of the overprojected nasal tip.

The nasal tip highlights the facial profile, and in its most aesthetic configuration subtly projects anterior to the dorsum to create a soft supratip break. Overprojection of the tip in relation to the vertical facial plane and the nasal dorsum represents one variant of nasal-facial disproportion that can adversely affect an otherwise pleasant facial appearance. Several strategies for reducing either the lateral or the medial crus to deproject the tip have been suggested. This article describes a method of direct truncation of the dome using an external rhinoplasty approach that can reliably produce tip retrodisplacement while maintaining, or enhancing, tip rotation. Tip definition and projection are optimized by precise, direct reduction of the overprojected dome region and accurate sculpting and realignment of the remaining crural units. When the tip is retrodisplaced, alar flaring can occur; therefore, alar base reduction can substantially enhance the final outcome.

Advances in nasal tip surgery. The lateral crural steal.

Increasing nasal tip projection, rotation, and definition have classically been attempted through a variety of lobular cartilage incising or excising techniques. Resultant long-term complications, including bossing, alar notching, pinched tips, and alar collapse, have occasionally resulted from the use of these techniques. The majority of these complications have arisen secondary to a loss of structural support following the interruption of the lower lateral cartilages. This article describes the "lateral crural steal," a method of increasing nasal tip projection and nasal tip rotation while preserving the integrity of the lobular cartilage complex. The procedure uses the external rhinoplasty approach for exposure. By elevating both the dorsal and the vestibular skin from the domes of the lobular cartilages, the lateral crura may be advanced onto the medial crura to further project the nasal tip and to reorient the tip upward. This technique along with its philosophy and long-term follow-up results are presented.