Immunoglobulin abnormalities in cerebrospinal fluid and blood over the course of lymphocytic meningoradiculitis (Bannwarth's syndrome)

The conditions of 5 patients with untreated lymphocytic meningoradiculitis (Bannwarth's syndrome, probably equivalent to Lyme disease) with serologically confirmed infection resulting from Borrelia spirochetes were followed with repetitive lumbar punctures up to 221 days after the onset of symptoms. Using a protein A plaque assay, high numbers of IgG-, IgM-, and IgA-producing cells were found in the cerebrospinal fluid (CSF), whereas there were mostly normal numbers of immunoglobulin-producing cells in peripheral blood. A markedly increased CSF IgM index and an elevated IgG index were observed in all patients during the early phase, reflecting production of these immunoglobulins within the central nervous system. All patients had oligoclonal IgG bands in the CSF that persisted during follow-up; in the 2 patients tested, the bands contained Borrelia antibodies. Most serum immunoglobulin concentrations were normal and in only 1 patient was it possible to detect in serum some of the oligoclonal IgG bands present in CSF. Declining numbers of CSF cells producing immunoglobulin and decreasing immunoglobulin index values were observed during follow-up, but 3 patients had an elevated CSF IgM index in the presence of normal IgG and IgA indices when examined during the later phases of disease. An intense and prolonged IgM response within the central nervous system seems to be a characteristic of the disease.

[Intrahepatic portal venous hypoplasia in Alagille's syndrome]

One new case of arteriohepatic dysplasia (Alagille's syndrome) is reported. The case showed signs of progressive portal hypertension with the liver biopsy revealing evidence of hypoplasia of the intrahepatic portal venous branches without evident cirrhosis, next to the characteristic paucity of intrahepatic bile ducts. This venous abnormality might be responsible for the unfavourable outcome observed in some cases with Alagille's syndrome and corresponds to a severe form of the disease.

Urinary lipids in vesical carcinoma: a new biological marker. Preliminary study

We have determined urinary lipids by thin-layer chromatography in 40 patients with bladder tumors, and have evaluated their modification following tumor removal and their predictive value in terms of the presence or absence of recurrences. The results obtained were compared with those of a control group without tumoral pathology (14 patients) and 11 cases with bacterial infection of the urinary tract. There is a marked difference between the lipidogram of the tumoral group of patients and the controls (p less than 0.005), especially in the phospholipid to fatty acid (PL/FA) relationship, with a specificity of 100% and a sensitivity of 80%. With regard to recurrences, in non-recurrent cases the PL/FA value remained high in relation to the initial value (p less than 0.005), whereas in the recurrent cases the value rose to 'tumoral limits'. Macrohematuria and urinary infection modify the lipidogram, resulting in values similar to the tumoral cases. Their absence is therefore essential in order to evaluate the results. The urinary lipidogram appears to be a possible biological marker for bladder tumors.

Leukocyte kinetics in the human lung: role of exercise and catecholamines

In six normal supine subjects epinephrine infusion produced a greater leukocytosis with smaller changes in heart rate and blood pressure than did norepinephrine or isoproterenol. Upright exercise in those subjects produced a greater leukocytosis than supine exercise at the same work load. To determine the lung's participation in these events, indium-labeled neutrophils (PMN) were given to four of the subjects. We found that 20-25% were retained in the first pass through the lung when compared with technetium-labeled erythrocytes. The number of labeled PMN in the lung gradually decreased and the number in the spleen and the liver increased. Exercise and catecholamine infusion caused an acceleration in the release of labeled cells from the lung, an increase in both labeled and unlabeled cells in the peripheral blood, and an increase in the number of labeled cells in the liver and spleen. This suggests that increased perfusion of low-flow areas in the lung may contribute to the increased leukocytosis seen in association with both exercise and catecholamine infusion.

[Congenital heart block in a newborn infant born to a mother with lupus erythematosus]

We report a case of a newborn with a congenital heart-block. Clinical picture began with bradycardia and heart failure from birth. The mother had a systemic lupus erythematosus in remission during pregnancy suffering a reactivation after delivery. This report deals about the greater incidence of congenital heart-block in the lupus-mother's newborns and we expose some etiopathogenic hypothesis. Also we point-out the easy clinical and electrocardiographic diagnosis that shows a third degree heart-block with atrioventricular dissociation and atrial frequency two or three times greater than ventricular. It's established the differential diagnosis among neonatal bradycardias and congenital heart-blocks. The treatment with isoproterenol was ineffective. A pacemaker was need.

[Basal cell nevus syndrome and gigantism]

Authors report a representative case of basal cell nevus syndrome with great expressivity. The patient is a thirteen-year and ten-month-old girl. She shows the five major criteria of this disease: basal cell nevi, jaw cysts, skeletal abnormalities (bifid ribs, block vertebrae, rachischisis), ectopic calcifications (falx cerebri, tentorium cerebelli, interclinoid ligaments) and pits on the palms of both hands. Moreover the patient had a right ovarian fibroma with a lot of calcified zones inside as well as several small fibromas of the left ovary. Giantism was associated with this syndrome. This finding has not been published before.

[Collagenosis in childhood (author's transl)]

A revision of the present concept of the named collagenosis in the pediatric age, supported of the experience of the Pediatrics Department at the Barcelona University is exposed. A casuist of 109 cases of the Schoenlein-Henoch syndrome, 55 observations of juvenile rheumatoid arthritis and 16 pediatric patients affected of classic collagenosis is included. A classification of the collagenosis in pediatrics, discriminating classic forms and other process and in both groups the entities of known etiology, and the unknown ones, that are majority, been considered as collagenosis in the strict sense is offered.

Prevalence of chronic bronchitis in the children of Lisbon

Portugal is one of the European countries with the highest mortality from Chronic Bronchitis (CB). This constitutes a severe problem as CB is one of the main causes of absenteeism and incapacity. To determine the prevalence of this disease, an epidemiological study was planned. The first part of this study involved the children of Lisbon because of the large number of children attending chest clinics for respiratory symptoms, because a similar study is being carried out in Europe by WHO in children from 8 to 10 years of age and because of the importance that this type of study in children may have in the prediction of the development of CB in adults. The study consisted in a standard questionnaire (WHO), a physical examination based on the CECA questionnaire, an ENT examination, a simple respiratory function test and a 70 mm microradiograph of the chest. 4148 children of both sexes, whose ages ranged from 6 to 14 were studied. The operational diagnosis of CB was based on the presence of chronic cough for the past 2 years, for at least 3 months and nearly every day during the Autumn and Winter months. The prevalence of CB in the overall population was 4.9%. The global analysis of the data collected seems to show the following: - Measles and whooping cough contribute to the incidence of CB. --Socio-economic conditions probably contribute to the increase in the incidence of CB. --A high incidence of ENT pathology was found in CB. --Atmospheric pollution does not appear to influence the incidence of CB.

[Male pseudohermaphroditism due to deficit in the conversion of cholesterol to delta5 pregnenolone (author's transl)]

One patient, aged 13 months, considered phenotipically a female, was admitted with a picture of acute dehydration. Familial history (one sister dead from the same picture at the age of 18 months), clinical data (several episodes of dehydration, dark skin and mucosae, and slight abnormalities in the external genitalia), hormonal examinations (low plasmatic levels of cortisol, aldosterone, androgens and low urinary excretion of 17 hydroxycorticoids, dehydroepiandrosterone and ethiocholanolone), chromosomal examination (karyotype XY) and histological data (normal testis) suggested a diagnosis of male pseudohermaphroditism with complete feminization due to an abnormal conversion of cholesterol in delta5 pregnenolone. Late appearance of the first episode of dehydration, particularly intense cutaneous pigmentation and statural growth and bone maturation both unaffected, are some particular traits of this patient.

[Anosmia and hypogonadism (Kallman's or Maestre de San Juan's syndrome (author's transl)]

A patient, aged 15 years and three months, with hypogonadism and anosmia (Kallman's syndrome or Maestre de San Juan's syndrome) is presented. It is an sporadic case, with no associated abnormalities, who had been seen due to a lack of sexual development. Basal levels of plasmatic LH and FSH were lower than the sensitivity threshold of the method: 1.5 mlU/ml. Administration of 100 ng of GnRH alone in one dose did not evoke any change of these levels; when the same dosage was given during five consecutive days, plasmatic levels of both gonadotropins increased. Initial treatment with HCG (5,000 IU, biweekly) evoked very favourable changes in somatic and genital development.

Vitamin D prophylaxis and the lowered incidence of fractures in anticonvulsant rickets and osteomalacia

Small doses of vitamin D can probably prevent catastrophic skeletal demineralization in patients taking antiseizure medication. Moderate doses of vitamin D can reverse this degree of demineralization once it has occurred. Prophylactic vitamin D therapy was associated with a lowered incidence of seizure patients in the overall fracture census and a decrease in the number of in-hospital days for treatment of seizure patients with fractures. Vitamin D therapy should probably be used as a routine dietary supplement in all seizure patients at dosage levels of approximately 400 units daily. Much larger doses (50,000 units once or twice weekly) should be as necessary when these patients sustain fractures or other injuries.

[Serum ige levels in healthy children (author's transl)]

Serum IgE levels have been measured in a group of 55 healthy children from 2 to 10 years of age. The IgE mean value increases with the age but no sexual differences have been found. The numerical distribution of the different genotypes observed in the unselected population, follows the Hardy-Weinberg law, which describes the segregation of two alleles at a single locus.

Cirrhosis and heterozygous alpha1-antitrypsin deficiency in a 4-year-old girl

A 4-year-old girl with hepatic cirrhosis was found to have alpha1-antitrypsin deficiency. The method of FAGERHOL detected that she is a heterozygous carrier of the Pi SZ type. Investigations with the light and the electron microscope and immunofluorescence tests confirmed the diagnosis. The values of alpha1-antitrypsin and trypsin inhibitory capacity gave intermediate values. The fact that in the patient, the Z allele was combined with an S allele may have contributed to the severity of the illness.