Sclerosing mediastinitis is a very rare benign disorder characterised by the d evelopment of dense fibrous tissue within the mediastinum. Affected patients are typically young adults with infant cases being uncommon e...Sclerosing mediastinitis is a very rare benign disorder characterised by the d evelopment of dense fibrous tissue within the mediastinum. Affected patients are typically young adults with infant cases being uncommon especially in areas wit hout endemic histoplasmosis. We report a Japanese boy with markedly elevated ser um inflammatory markers for more than 1 year in the absence of any clinical mani festations. 67Gascintigraphy demonstrated an accumulation in the mediastinal reg ion and an open biopsy revealed a hard fibrous mass in the anteriosuperior media stinum. Thus, a diagnosis of idiopathic sclerosing mediastinitis was made. Concl usion:To the best of our knowledge, this case is the youngest patient reported w ith this disorder. In patients with mediastinal mass lesions the diagnosis of sc lerosing mediastinitis should be considered as well as infectious, autoimmune or neoplastic disease even in children.展开更多
Aims and Methods: Thyroid function tests were initially carried out on 122 chi ldren with Down’s syndrome aged 6-14 years and then repeated four to six years later in 103 adolescents (85%of the group of 122) when the...Aims and Methods: Thyroid function tests were initially carried out on 122 chi ldren with Down’s syndrome aged 6-14 years and then repeated four to six years later in 103 adolescents (85%of the group of 122) when they were aged 10-20 y ears (median 14.4 years). At the second test two were hypothyroid and two with i solated raised thyroid stimulating hormone (IRTSH) were receiving thyroxine. Res ults: At the first test there were 98 (80%) euthyroid children: 83 were reteste d and four (5%) had IR-TSH. At the first test 24 had IR-TSH: 20 were retested and 14 (70%) had become normal. Seventeen with IR-TSH on initial testing had a thyrotrophin releasing hormone test within three months; TSH had become normal in eight (47%) of these children. There was no association between reported cl inical symptoms and IR-TSH, but there were clear symptoms in one of the two wit h definite hypothyroidism. Conclusions: The likelihood ratio for a positive resu lt on second testing when raised TSH and positive antibody status on first testi ng are combined is 20. This suggests initial testing results could be used as a basis to select a subgroup for further testing at say five yearly intervals unle ss new symptoms emerge in the interim. It also suggests that yearly screening (a s recommended by the American Academy of Pediatrics, 2001) is probably not justi fied in the first 20 years of life.展开更多
Tuberculosis(TB)continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born,non-Indigenous people.Inuit Tuberculosis Elimi...Tuberculosis(TB)continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born,non-Indigenous people.Inuit Tuberculosis Elimination Framework has set the goal of reducing active TB incidence by at least 50%by 2025,aiming to eliminate it by 2030.Whether these goals are achievable with available resources and treatment regimens currently in practice has not been evaluated.We developed an agent-based model of TB transmission to evaluate timelines and milestones attainable in Nunavut,Canada by including case findings,contact-tracing and testing,treatment of latent TB infection(LTBI),and the government investment on housing infrastructure to reduce the average house-hold size.The model was calibrated to ten years of TB incidence data,and simulated for 20 years to project program outcomes.We found that,under a range of plausible scenarios with tracing and testing of 25%e100%of frequent contacts of detected active cases,the goal of 50%reduction in annual incidence by 2025 is not achievable.If active TB cases are identified rapidly within one week of becoming symptomatic,then the annual incidence would reduce below 100 per 100,000 population,with 50%reduction being met between 2025 and 2030.Eliminating TB from Inuit populations would require high rates of contacttracing and would extend beyond 2030.The findings indicate that time-to-identification of active TB is a critical factor determining program effectiveness,suggesting that investment in resources for rapid case detection is fundamental to controlling TB.展开更多
文摘Sclerosing mediastinitis is a very rare benign disorder characterised by the d evelopment of dense fibrous tissue within the mediastinum. Affected patients are typically young adults with infant cases being uncommon especially in areas wit hout endemic histoplasmosis. We report a Japanese boy with markedly elevated ser um inflammatory markers for more than 1 year in the absence of any clinical mani festations. 67Gascintigraphy demonstrated an accumulation in the mediastinal reg ion and an open biopsy revealed a hard fibrous mass in the anteriosuperior media stinum. Thus, a diagnosis of idiopathic sclerosing mediastinitis was made. Concl usion:To the best of our knowledge, this case is the youngest patient reported w ith this disorder. In patients with mediastinal mass lesions the diagnosis of sc lerosing mediastinitis should be considered as well as infectious, autoimmune or neoplastic disease even in children.
文摘Aims and Methods: Thyroid function tests were initially carried out on 122 chi ldren with Down’s syndrome aged 6-14 years and then repeated four to six years later in 103 adolescents (85%of the group of 122) when they were aged 10-20 y ears (median 14.4 years). At the second test two were hypothyroid and two with i solated raised thyroid stimulating hormone (IRTSH) were receiving thyroxine. Res ults: At the first test there were 98 (80%) euthyroid children: 83 were reteste d and four (5%) had IR-TSH. At the first test 24 had IR-TSH: 20 were retested and 14 (70%) had become normal. Seventeen with IR-TSH on initial testing had a thyrotrophin releasing hormone test within three months; TSH had become normal in eight (47%) of these children. There was no association between reported cl inical symptoms and IR-TSH, but there were clear symptoms in one of the two wit h definite hypothyroidism. Conclusions: The likelihood ratio for a positive resu lt on second testing when raised TSH and positive antibody status on first testi ng are combined is 20. This suggests initial testing results could be used as a basis to select a subgroup for further testing at say five yearly intervals unle ss new symptoms emerge in the interim. It also suggests that yearly screening (a s recommended by the American Academy of Pediatrics, 2001) is probably not justi fied in the first 20 years of life.
基金support from Natural Sciences and Engineering Research Council of Canada through Individual Discovery Grant.
文摘Tuberculosis(TB)continues to disproportionately affect Inuit populations in Canada with some communities having over 300 times higher rate of active TB than Canadian-born,non-Indigenous people.Inuit Tuberculosis Elimination Framework has set the goal of reducing active TB incidence by at least 50%by 2025,aiming to eliminate it by 2030.Whether these goals are achievable with available resources and treatment regimens currently in practice has not been evaluated.We developed an agent-based model of TB transmission to evaluate timelines and milestones attainable in Nunavut,Canada by including case findings,contact-tracing and testing,treatment of latent TB infection(LTBI),and the government investment on housing infrastructure to reduce the average house-hold size.The model was calibrated to ten years of TB incidence data,and simulated for 20 years to project program outcomes.We found that,under a range of plausible scenarios with tracing and testing of 25%e100%of frequent contacts of detected active cases,the goal of 50%reduction in annual incidence by 2025 is not achievable.If active TB cases are identified rapidly within one week of becoming symptomatic,then the annual incidence would reduce below 100 per 100,000 population,with 50%reduction being met between 2025 and 2030.Eliminating TB from Inuit populations would require high rates of contacttracing and would extend beyond 2030.The findings indicate that time-to-identification of active TB is a critical factor determining program effectiveness,suggesting that investment in resources for rapid case detection is fundamental to controlling TB.
