Safety of neonatal hepatitis B vaccine administration.

OBJECTIVE: To determine whether hepatitis B vaccination of newborns increases the incidence of fever and/or suspected sepsis. METHODS: A prospective clinical study was undertaken at the Kaiser Permanente San Francisco Medical Center involving normal full term newborns born between November 1, 1991, and April 30, 1994. During this time 3302 infants were vaccinated within 21 days of birth with hepatitis B vaccine, and 2353 were not. Clinical and demographic data were collected from Kaiser Permanente's existing clinical information systems, and laboratory data for blood and cerebrospinal fluid (CSF) cultures were obtained from the comprehensive automated regional laboratory reporting system. RESULTS: There were no significant differences between vaccinated and unvaccinated newborns in the proportion of infants who received care for fever (0.8% vaccinated and 1.1% unvaccinated, P = 0.28), allergic reactions, seizures or other neurologic events in the first 21 days of life. Vaccinated newborns were significantly less likely to undergo microbiologic evaluation for possible sepsis. Among vaccinated newborns 4.0% had blood cultures and 1.6% had CSF cultures. Among infants who were not vaccinated 8.3% had blood cultures and 1.6% had CSF cultures (P <0.001 for both tests). CONCLUSION: This study found no evidence that newborn hepatitis B vaccination is associated with an increase in the number of febrile episodes, sepsis evaluations or allergic or neurologic events. In addition our data did not support any increase in medical procedures attributed to receipt of hepatitis B vaccine.

Sonographic findings in adenomyosis of the uterus.

In an attempt to define better the sonographic findings of adenomyosis of the uterus, we reviewed sonograms in seven cases of pathologically proven extensive adenomyosis without associated uterine diseases. In all cases, the uterus was enlarged. In five cases, the posterior wall of the uterus was thickened, and echoes in the endometrial cavity were eccentric. Six cases showed a slight decrease in uterine echogenicity. One case had sonographic findings suggestive of a calcified leiomyoma. The diagnosis of adenomyosis cannot be made conclusively by sonography. However, it can be suggested if the uterus is slightly enlarged and if the posterior portion of the myometrium is anechoic and thickened.

Primary Wegener's granulomatosis of the trachea: radiologic manifestations.

This is the third reported case of Wegener's granulomatosis of the trachea occurring as the primary initial event in a young patient. Roentgenographic findings consisted of a 3 cm intraluminal mass with extensive tracheal narrowing. In a young patient with inspiratory stridor, a mass causing narrowing of the trachea, and a course complicated by symptoms of vasculitis, the possibility of Wegener's granulomatosis should be considered.

Longitudinal chest x-ray changes in normal men.

To determine the changes on chest x-ray attributable to the aging process, we evaluated cardiovascular and pulmonary structures on two standard postero-anterior chest x-rays taken at least 10 years apart (M = 16.9 years) in 67 carefully screened healthy men initially aged 23 to 76 years. The aortic knob diameter increased in 79% of subjects. Although mean cardiothoracic ratio increased overall, only 3% of men developed a cardiothoracic ratio greater than .50, and none exceeded .51. Pulmonary abnormalities on initial chest x-ray consisted mainly of hyperinflation (27%) and increased markings (19%), both of which doubled in prevalence during follow-up. Kerley B lines and enlarged pulmonary arteries were rare initially but increased three- to five-fold. The prevalence of these findings did not differ between smokers and nonsmokers. Based on commonly accepted x-ray criteria, chronic obstructive lung disease was suggested in 15% of the initial films and 21% of the final films despite the absence of clinical or spirometric abnormalities.