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Infection by Haemophilus influenzae type b bacteria can lead to a variety of serious complications, including meningitis, in which the membranes that surround the brain and spinal cord become inflamed. Some population groups, including certain Native American tribes, have infection rates several times higher than the general population. To evaluate the effectiveness of a new vaccine among Navajo infants, a controlled study was carried out. Infants aged between 42 and 90 days were randomly assigned to receive either the vaccine (2,588 subjects), a conjugate of H. influenzae type b capsular polysaccharide and parts of the outer-membrane protein complex (OMPC) of Neisseria meningitidis serogroup B, or a placebo (2,602 subjects), an inactive substance. Second injections were given between the ages of 70 and 146 days. Blood samples were obtained at different points during the study and analyzed to determine the infants' levels (titers) of antibodies against H. influenzae; the safety and efficacy of the vaccine were also monitored. The study began in July 1988; by August 1990, after 23 cases of H. influenzae infection had occurred, it was decided to stop the study. The group that had received the vaccine had far fewer cases than the placebo group (1 case versus 22 cases) by the age of 18 months. Thirteen of the 22 placebo cases developed meningitis. No infections occurred in the vaccine group between the first and second doses of vaccine; eight occurred in the placebo group. Antibody levels did not increase noticeably after the second vaccination, but the vaccine was effective up until 18 months of age. The overall efficacy of the H. influenzae type b OMPC vaccine was more than 90 percent in this population. This was much higher than the efficacy reported for another conjugate vaccine in another study of Native Americans in Alaska. Use of this vaccine should eliminate H. influenzae type b infection. (Consumer Summary produced by Reliance Medical Information, Inc.)

Haemophilus influenzae Type b bacteria cause severe illness, such as meningitis and pneumonia, and death in children under the age of five. Development of an effective, safe vaccine against this bacteria is an important step in preventing or minimizing these illnesses, which can leave children with residual neurological problems. A new vaccine, PedvaxHIB, has been prepared using the sugars (polysaccharides) from the bacterial coat, conjugated, or linked, to proteins from a different bacteria which causes a type of meningitis. Previous vaccines using the polysaccharides alone did not protect children under the age of two, and these children make up three-quarters of all H. influenzae Type b cases. The conjugate vaccine was tested on 500 children under the age of six, using a two-injection schedule. Adverse reactions were minor and transient, consisting of local problems such as reddening and swelling of the skin around the injection site, and few systemic reactions such as irritability, drowsiness, digestive upsets, and rash. Levels of antibodies to the vaccine increased greatly in patients, such that 91 percent under age 18 months would be expected to have protective immunity to the bacteria. Of the children immunized under six months of age, 80 percent would be expected to have immunity to the bacteria. Other conjugate vaccines are available, but these may provide less immunity. Further studies of the immunized children are in progress and should help to clarify the usefulness of PedvaxHIB in limiting illnesses caused by H. influenzae Type b. (Consumer Summary produced by Reliance Medical Information, Inc.)

Deals with a study which examined the clinical use of the PedvaxHIB conjugate haemophilus influenzae type b vaccine developed at Merck Sharp & Dohme Research Laboratories in the United States. Methodology; Results; Discussion.

 Thermal, chemical, and electrical injuries contribute to some of the most disabling and deforming wound injury patterns. These challenges, ultimately cared for by burn and reconstructive specialists, require an evolution in the understanding of functional and aesthetic prioritization, 3-dimensional geometric rearrangement of tissues, anatomic considerations of neurovascularized constructs, as well as the development of fundamental technical skills. Flaps, generally defined as tissue constructs, transferred along with a defined vascular supply are considered principle elements in the armamentarium of the reconstructive specialist. The transfer and design of these flaps can augment most tissue type deficits, protect or transfer functional neurovascular and musculotendinous structures, and provide bone and durable soft tissue elements to restore both form and function. The history of flap construct and reconstruction precedes available written text and spans independent cultural, temporal and geographic divides. Several key flaps currently utilized in burn and reconstructive surgery will be reviewed with some historical context provided. A comprehensive review of the history of flaps in reconstructive surgery certainly exceeds the scope of any simplistic chapter or text.