Seroconversion and adverse reaction of live-attenuated (OKA strain) varicella vaccine

Background Live-attenuated varicella vaccine was used to pre-vent Shingle disease.Objective The aim of this study was to find out seroconversionrate and safety of this vaccine.Methods An open clinical trial was conducted on 313 children atCipto Mangunkusumo Hospital, Jakarta between March and Octo-ber 1998. The data were analyzed to distribution frequency andtables.Results Only 43 out of 356 (12.1%) children had positiveantivaricella antibody before vaccination. Seroconversion exami-nation by indirect immunoflouresence method was done only onrandomly 150 of 313 (50%) children due to financial limitation. Itwas found that 99.3% of patients had positive seroconversion.Among 298 children who were followed, the nature of symptom ofadverse reaction was mostly general than local. Only one patienthad local symptom after vaccination that appeared within 7 daysof the follow up period.Conclusion Varicella vaccine (OKA strain) gives highseroconversion rate with minimal adverse events

Long-term Efficacy of Ultrasound-Guided Laser Ablation for Benign Solid Thyroid Nodules. Results of a Three-Year Multicenter Prospective Randomized Trial

Background: The aim of the present trial on ultrasound (US)-guided laser ablation therapy (LAT) of solid thyroid nodules is to assess long-term clinical efficacy, side effects, and predictability of outcomes in different centers operating with the same procedure. Patients: Two hundred consecutive patients were randomly assigned to a single LAT session (group 1, 101 cases) or to follow-up (group 2, 99 cases) at four thyroid referral centers. Entry criteria were: solid thyroid nodule with volume of 6–17 mL, repeat benign cytological findings, normal thyroid function, no autoimmunity, and no thyroid gland treatment. Methods: Group 1: LAT was performed in a single session with two optical fibers, a 1064 nm Nd-YAG laser source, and an output power of 3 W. Volume and local symptom changes were evaluated 1, 6, 12, 24, and 36 months after LAT. Side effects and tolerability of treatment were registered. Group 2: Follow-up with no treatment. Results: One patient was lost to follow-up in each group. Group 1: Volume decrease after LAT was −49 ± 22%, −59 ± 22%, −60 ± 24%, and −57 ± 25% at 6, 12, 24, and 36 months, respectively (P < .001 vs baseline). LAT resulted in a nodule reduction of >50% in 67.3% of cases (P < .001). Local symptoms decreased from 38 to 8% of cases (P = .002) and cosmetic signs from 72 to 16% of cases (P = .001). Baseline size, presence of goiter (P = .55), or US findings (fluid component ≤ 20% [P = .84], halo [P = .46], vascularization [P = .98], and calcifications [P = .06]) were not predictive factors of a volume decrease > 50%. The procedure was well tolerated in most (92%) cases. No changes in thyroid function or autoimmunity were observed. In group 2, nodule volume increased at 36 months (25 ± 42%; P = .04). The efficacy and tolerability of the procedure were similar in different centers. Conclusions: A single LAT treatment of solid nodules results in significant and persistent volume reduction and local symptom improvement, in the absence of thyroid function changes.

Solitary plasmacytoma of bone and asymptomatic multiple myeloma

Most patients with multiple myeloma (MM) present with symptoms, have evidence of generalized disease, and require chemotherapy promptly to reduce the malignant clone. Some patients present with a local symptom from a single plasmacytoma but no myeloma elsewhere. Such patients usually become free of symptoms after local radiotherapy. In patients with MM without symptoms, the diagnosis is made on the basis of screening laboratory tests. In patients with either solitary plasmacytoma of bone or asymptomatic MM, systemic treatment should be deferred until there is evidence of disease progression.

Solitary plasmacytoma of bone and asymptomatic multiple myeloma

Most patients with multiple myeloma (MM) present with symptoms, have evidence of generalized disease, and require chemotherapy promptly to reduce the malignant clone. Some patients present with a local symptom from a single plasmacytoma but no myeloma elsewhere. Such patients usually become free of symptoms after local radiotherapy. In patients with MM without symptoms, the diagnosis is made on the basis of screening laboratory tests. In patients with either solitary plasmacytoma of bone or asymptomatic MM, systemic treatment should be deferred until there is evidence of disease progression.

Lilium and the relative value of symptoms

SummaryTape recordings are presented of a case where Lilium tigrinum provided the cure, and to begin with an attempt is made to solve the case with the aid of the repertory only, without consulting the materia medica. Lachesis emerges as the result, and not Lilium. The reason is shown to be that the short rubrics needed for repertorization are by their very nature incomplete, so that the right remedy is often excluded.Next, some highly characteristic Lilium symptoms are quoted from the provings, and these are then brought out more clearly with the aid of further tape recordings. A surprisingly close correspondence emerges of its own accord between some highly differentiated Lilium symptoms and certain symptoms presented by the patient—demonstrating the application of the “keynote system”. It is established that this system is not, in fact, in opposition to repertorization based on the totality of symptoms. Quotes from the literature show that Kent himself certainly also used keynotes to find the remedy, and was against purely mechanical repertorization.The conclusion to be drawn is that the value of a symptom in our search for the right remedy does not depend on whether it is a mental, general or local symptom, but that the really valuable symptoms are only those which are characteristic as defined in § 153 of the Organon, i.e. “More accurately described”.