BackgroundKnowledge on human papillomavirus (HPV) genotype distribution in recurrent respiratory papillomatosis (RRP) is essential to assess the impact of HPV vaccine. It is provided information for Colombia.MethodsIn all, 189 RRP primary cases diagnosed between 1985 and 2009 were identified from 5 pathology laboratories of Cali and Medellin, Colombia. HPV DNA testing in 129 cases that fulfilled inclusion criteria (available paraffin blocks, amplifiable DNA, and confirmed histologic diagnosis of RRP) was performed by the SPF‐10/LiPA25 assay (version 1).ResultsOf all cases 36.1% were juvenile (<12 years old) and a majority of adults were males (p = .09); 95% of cases were HPV positive. HPV 6, 11, and 16 contributed to 69%, 27.1%, and 7.8% of all HPV positive cases. Twelve cases (9.3%) showed multiple infections; 8 of these were HPV 6 or 11 positive.ConclusionsHPV prophylactic vaccine including HPV 6 and 11 may have a major impact against RRP. © 2012 Wiley Periodicals, Inc. Head Neck, 2013

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of opacity all over the right and left lung fields. The astic attack was relieved only after giving 100 mg of hydroordsone sodium succinate intravenously. - A 62-year-old man with grade III chronic coronary insufficiency was to be treated with propranolol in an initial daily dose of 120 mg. On compression of the right carotid sinus he was found to develop a brief syncope and marked bradycardia resulting from sinus arrest followed by junctil escapes (see fig., A). Thus a hyperactive carotid sinus refex syndrome was d. A test dose of 2 mg of propranolol was administered intravenously as a bolus injion and 10 minutes later hyperextension of the head provxed a more prologed syncope and a more marked bradycardia than previously. Thus the hyperactive carotid sinus reflex syndroe had been transformed into a carotid sinus syndrome after propralol.Digital compression of the carotid sinus for a shorter period than previously provoked a much more lasting sinus arrest 15 minutes after propranolol (see fig., B).Twenty minutes after prIpranolol 1 of atropine was ineted intravenously; five minutes later th right carotid sinus was mssaged for several seconds. No effect was observed either on the electrical activity of the heart (see fig., C) or on the clinical condition of the patient. This last procedure and the corresponding result show the innocuity of our methods. It is imperative to search for a hyperactive carotid sinus reflex syndrome in every patient who is to be treated with beta-adrenergic bloking drugs and this therapy avoided if the syndrome is diagnosed and the participation of a central cardiac mechanism in it demonstrated.-I am, etc., ARIEL J. REYES Fundacion Procardias,

Background: Subacute sclerosing panencephalitis (SSPE) is a disease of childhood and adolescence, but can affect adults. Rapidly progressive cognitive decline, seizures including myoclonic jerks, spasticity, ataxia, visual disturbances, and incontinence are typical manifestations. Case report: A 62-year-old woman who presented with rapidly progressive dementia and myoclonus was diagnosed with SSPE. There was resolution of the movement disorder with clonazepam and valproic acid treatment and some amelioration of cognitive decline after 3 months of therapy with interferon alfa and isoprinosine. Discussion: With the recent rise in measles cases worldwide, any increased incidence of SSPE would require vigilance for early interventions.

Objective. Describe factors associated with aggressive forms of recurrent respiratory papillomatosis (RRP). Materials and methods. One hundred eighty-nine RRP cases diagnosed between 1985 and 2009 were identified in pathological records. HPV was detected by the SPF-10 method with broad spectrum primers, (version 1). Results. 113 patients had only one surgery (less aggressive) and 76, two or more interventions (more aggressive). The likelihood of aggressive lesions decreased with increasing age at diagnosis and HPV- 11 was associated with no significant increase in the risk of aggressiveness. Conclusions. The age at diagnosis was the main determinant of RRP aggressiveness.

We report a case of pulmonary embolism (PE) in an Afro-Caribbean man following a short commercial flight of less than 5,000 kilometers (Km) in economy class with a 1-month interval between journeys. He had an elevated body mass index (BMI) and sickle cell trait (SCT) with hyperhomocysteinemia. No other preexisting source of venous thrombosis was found. We posit that venous thromboembolism (VTE) and/or PE may have been a complication of SCT in an individual with other multiple risk factors. We discuss the possible interaction of these risk factors for VTE and/or PE and the implications for travelers at risk. The need for a PE risk score and guidelines for the prophylaxis of thromboembolism among travelers exists.

We report a patient driven home care system that successfully assisted 24/7 with the management of a 68-year-old woman after a stroke-a global illness. The patient's caregiver and physician used computer devices, smartphones and internet access for information exchange. Patient, caregiver, family and physician satisfaction, coupled with outcome and cost were indictors of quality of care. The novelty of this basic model of teleneurology is characterised by implementing a patient/caregiver driven system designed to improve access to cost-efficient neurological care, which has potential for use in primary, secondary and tertiary levels of healthcare in rural and underserved regions of the world. We suggest involvement of healthcare stakeholders in teleneurology to address this global problem of limited access to neurological care. This model can facilitate the management of neurological diseases, impact on outcome, reduce frequency of consultations and hospitalisations, facilitate teaching of healthcare workers and promote research.