Vancomycin-resistant-enterococci--colonization of 24 patients on a pediatric oncology unit

BACKGROUND

Colonization with multidrug-resistant vancomycin-resistant-enterococci (VRE) could become a serious problem, since there is no proven therapy in case of an infection or in case of transfer of glycopeptid-resistance to other organisms.

PATIENTS

Description of 24 from 48 pediatric oncology patients with VRE-colonization.

METHODS

Stool samples were taken from all patients of our pediatric oncology unit from March 1996 until June 1997. Barrier isolation was introduced in May 1996, a prudent use of glycopeptid antibiotica in July 1996.

RESULTS

193 stool sample examinations demonstrated that 24 (50%) of the 48 patients were colonized with VRE. 11 (46%) of these 24 patients were VRE-carriers at the time of their first examination; 9 (37%) patients acquired VRE during their therapy and 4 (17%) patients had come from other hospitals and already were VRE-positive when they entered our unit. In March 1997, one year after the outbreak only four patients still were VRE-positive, in June 1997 all of them were VRE-negative. The average time of colonization was 12.5 weeks. 17 (70%) of the 24 colonized patients had received glycopeptide antibiotics, 16 of them within two months before the appearance of VRE in their stool. Five colonized patients died, four of them because of their oncological illness, one because of a sepsis without proof of VRE in his blood. In the end none of our patients suffered from a VRE-infection, and besides that, the transfer of glycopeptid-resistance to other organisms was not observed.

CONCLUSION

With barrier isolation and a very restrictive use of glycopeptid-antibiotica, colonization can be decreased and even stopped. Inspite of the high number of colonized patients no VRE-infectious disease occurred.

Effect of acute, short- and long-term milnacipran administration on rat locus coeruleus noradrenergic and dorsal raphe serotonergic neurons

The effect of milnacipran on the firing activity of dorsal raphe serotonin (5-HT) neurons and locus coeruleus norepineprine (NE) neurons was assessed using extracellular unitary recording in chloral hydrate anesthetized rats. A 2-day treatment with milnacipran (20 or 60 mg/kg/day, s.c.) markedly decreased the firing rate of NE neurons, and it remained reduced after a 7- or a 14-day treatment. Although the suppressant effect of the alpha2-adrenergic agonist clonidine on the firing rate of NE neurons was markedly reduced following long-term milnacipran (60 mg/kg/day x 14 days, s.c.), that of NE remained unchanged. The firing rate of 5-HT neurons was reduced following a 2-day treatment with milnacipran (20 mg/kg/day, s.c.), but there was a partial recovery after a 7-day treatment (20 mg/kg/day, s.c.) and a complete one after a 14-day treatment (20, 40 or 60 mg/kg/day, s.c.). The suppressant effect of 5-HT and of the 5-HT1A agonist 8-OH-DPAT (8-hydroxy-2-(di-n-propylamino)tetralin) on the firing rate of 5-HT neurons was also unaltered after milnacipran (60 mg/kg/day x 14 days, s.c.). The latter milnacipran treatment did not affect the uptake of [3H]5-HT but it inhibited that of [3H]NE by 30% in hippocampal slices. The NE system was thus investigated in an attempt to explain the effects of milnacipran on the firing activity of 5-HT neurons. Acute injection of milnacipran suppressed the firing activity of 5-HT neurons (with an ED50 of 5.7+/-1.5 mg/kg, i.v.), but not in NE-denervated rats. Furthermore, the inhibitory effect of clonidine on 5-HT neuron firing activity was markedly reduced by the long-term milnacipran treatment, whereas the inhibition of electrically evoked release of [3H]NE as well as that of [3H]5-HT produced by the alpha2-adrenoceptor agonist UK 14.304 from preloaded mesencephalic slices containing the dorsal raphe was unaltered. The latter results indicate that the alpha2-adrenergic autoreceptor and heteroreceptor were unaffected in the raphe area by milnacipran. In conclusion, milnacipran had profound effects on the function of 5-HT and NE neurons, and the mechanism by which 5-HT neurons regained their normal firing during milnacipran treatment appeared to implicate the NE system.

Characterization of the murine immune response to the murine TSH receptor ectodomain: induction of hypothyroidism and TSH receptor antibodies

The thyrotropin receptor (TSHR) is the major autoantigen of human Graves' disease. In order to define the antigenicity of the TSHR in a defined model, we examined the immune response of BALB/c mice to immunization with a new bioactive, recombinant preparation of the ectodomain of the murine TSHR (mTSHR-ecd). Mice (n = 10) were immunized with 25-50 microg of insect cell expressed, purified and refolded, mTSHR-ecd in alum adjuvant containing pertussis toxin, on days 0, 21, 36, 50 and 70. Control mice received wild-type baculovirus-infected insect cell protein lysate, in a similar way. After 28 days, murine serum contained high titres of antibodies specific to mTSH-ecd and their titres continued to increase over 90 days. Antibody epitope mapping, using 26 peptides spanning the human TSHR-ecd, showed that a variety of regions of the ectodomain were antigenic. The earliest epitope included aa 22-41, but later two regions of reactivity were noted clustered towards the mid portion and carboxyl terminus of the ectodomain. The murine TSHR autoantibodies (TSHR-Abs) inhibited up to 78% of the binding of labelled TSH to native TSHR, demonstrating the presence of antibodies capable of blocking the native TSHR. We showed that these TSHR antibodies acted, in vitro, as TSH blocking antibodies, inhibiting TSH-induced generation of cyclic AMP in chinese hamster ovary (CHO) cells transfected with the hTSHR. Hence, the antibody response to mTSHR-ecd was potentially antagonistic in its influence on the TSHR. Assessment of thyroid function in the immunized mice showed a fall in serum total T3 by 90 days and markedly elevated murine TSH levels (from 64.0 to 239.6 ng/ml), confirming the onset of thyroid failure. However, thyroid histology remained grossly normal. These data demonstrate that mTSHR-ecd is a potent antigen with three major immunogenic regions. The induced mTSHR-Abs blocked TSH action in vivo and reduced murine thyroid function.

Leukocystatin, a new Class II cystatin expressed selectively by hematopoietic cells

We describe a new cystatin in both mice and humans, which we termed leukocystatin. This protein has all the features of a Class II secreted inhibitory cystatin but contains lysine residues in the normally hydrophobic binding regions. As determined by cDNA library Southern blots, this cystatin is expressed selectively in hematopoietic cells, although fine details of the distribution among these cell types differ between the human and mouse mRNAs. In addition, we have determined the genomic organization of mouse leukocystatin, and we found that in contrast to most cystatins, the leukocystatin gene contains three introns. The recombinant proteins corresponding to these cystatins were expressed in Escherichia coli as N-terminal glutathione S-transferase or FLAGTM fusions, and studies showed that they inhibited papain and cathepsin L but with affinities lower than other cystatins. The unique features of leukocystatin suggests that this cystatin plays a role in immune regulation through inhibition of a unique target in the hematopoietic system.

Analysis of metabolite formation pharmacokinetics after intravenous and oral administration of the parent drug using inverse Laplace transformation

Models describing the plasma concentration-time curves of generated metabolite after iv and oral drug administration are presented. Utilizing numerical inverse Laplace transformation, the method can readily be used for parameter estimation and model simulation in conjunction with appropriate curve-fitting software. The approach is not limited to compartment modeling and can be applied to any linear pharmacokinetic system exhibiting hepatic and renal elimination of the parent drug. The model is formulated for single and multiple dosing of the precursor, including bolus doses and/or infusions for iv administration and sustained-release dosage forms for oral administration.

Pharmacokinetics of morphine-6-glucuronide and its formation from morphine after intravenous administration

BACKGROUND

Morphine-6-beta-glucuronide is a primary morphine metabolite with potent opioid action. However, its low and slow brain permeability eventually prevents its central opioid effects after short-term intravenous administration. Research is needed to establish whether morphine-6-beta-glucuronide qualifies as an analgesic; this study provides the pharmacokinetic bases for such studies.

METHODS

Plasma concentration-time data of morphine-6-beta-glucuronide and morphine obtained from 20 healthy volunteers after short-term intravenous administration of either morphine-6-beta-glucuronide or morphine were described by a biexponential disposition curve. Disposition parameters of morphine-6-beta-glucuronide and morphine were estimated by nonlinear regression, and basic pharmacokinetic parameters (clearance, volume of distribution at steady state, and mean disposition residence time) were derived. A new model of metabolite kinetics was applied, and the disposition parameters of morphine and morphine-6-beta-glucuronide were then used to fit the plasma concentration-time profile of morphine-6-beta-glucuronide formed from morphine. Thereby the fraction of morphine metabolized to morphine-6-beta-glucuronide and the mean transit time of morphine across the site of metabolism were estimated.

RESULTS

The extent and time course of morphine-6-beta-glucuronide formation from morphine could be well described by a parametric model, with a fraction of morphine metabolized to morphine-6-beta-glucuronide of 7.55% +/- 1.24% and a mean metabolic transit time for morphine to morphine-6-beta-glucuronide of 0.28 +/- 0.21 hour. The underlying disposition of morphine and morphine-6-beta-glucuronide was characterized by clearance (morphine clearance, 32.7 +/- 6 ml.min-1.kg-1, morphine-6-beta-glucuronide clearance, 2.2 +/- 0.4 ml.min-1.kg-1), volume of distribution at steady state (morphine, 1.8 +/- 0.3 L.hr-1; morphine-6-beta-glucuronide, 0.12 +/- 0.02 L.hr-1), and mean disposition residence time (morphine, 1.8 +/- 0.4 hours; morphine-6-beta-glucuronide, 1.7 +/- 0.4 hours).

CONCLUSIONS

The time course of morphine-6-beta-glucuronide formation kinetics was analyzed with use of the information on the disposition kinetics of both morphine and preformed morphine-6-beta-glucuronide, which was obtained by separate data fits. The transformation of morphine to morphine-6-beta-glucuronide could be described by two parameters characterizing the extent and delay of metabolite formation. The results of this study will serve as pharmacokinetic bases of future investigations of morphine-6-beta-glucuronide in human beings.

[Differential diagnosis of erosive osteochondrosis and bacterial spondylitis: magnetic resonance tomography (MRT)]

PURPOSE

To evaluate retrospectively criteria in the differential diagnosis of erosive osteochondrosis (EO) and infectious spondylitis (IS) on the basis of MRI.

METHODS

T1-weighted sagittal images before and after Gd-DTPA application, T2-weighted TSE or T-STIR images of 23 patients with proven 15 and 41 patients with EO were evaluated. Criteria for this evaluation were morphology and extension of bone marrow edema, visibility of the low-intensity vertebral endplate, contrast enhancement and signal intensity in the disc space on T2-weighted and T-STIR images.

RESULTS

Bone marrow edema was more extensive in IS than in EO. The mean rated value for bone marrow edema on a four-level scale (0-3) was for IS 2.91 (+/- 0.29), for EO 1.32 (+/- 0.76, p < 0.001). In 37/41 cases of EO and in 22/23 cases of IS Gd-DTPA enhancement was found in the disc space (n.s.). In EO the low intensity endplate was visible in all parts in 36/41 cases (87.8%) on T1-weighted images, in IS not in a single case (0%). On T2-weighted or STIR images signal intensity of the discs was decreased in 82.1% of EO, 82.6% of segments in IS had water-equivalent signal intensity (p < 0.001).

CONCLUSION

If all the criteria are taken into consideration differential diagnosis of EO and IS on the basis of MRI findings is possible.

Video-intuboscopy: a new aid to routine and difficult tracheal intubation

Video-intuboscopy gives a video display of the view from the tip of the tracheal tube during conventional laryngoscopy, and was developed particularly to assist the immediate management of unexpected difficult intubation. A lightweight, malleable video-optical intubation stylet transmits the view from the stylet tip onto a monitor. It is inserted in the tracheal tube before starting anaesthesia, and the view from the tracheal tube tip enables the anaesthetist to verify tracheal tube position in the trachea. During difficult intubation the video view is used to guide the tracheal tube into the trachea. When used to allow confirmation of tracheal placement, the system did not interfere with conventional intubation procedures. The method showed the subglottic airway, gave immediate confirmation of tracheal tube position, and aided teaching and supervision. The method was used to guide intubation in two patients with unanticipated grade 3 laryngoscopic views. Intubation was simple, rapid and atraumatic, without the need for head, neck or laryngeal manipulation. Tracheal placement was instantly confirmed using the video view from the stylet tip. Clinical studies are required to define the value of this new intubation technique.

[Prognostic factors in patients with early stages of supraglottic cancer treated by radiotherapy]

Three hundred patients with early stage supraglottic cancer were treated with radiotherapy in Center of Oncology in Kraków between 1973 and 1989. The 5-year NED survival rates after the radiotherapy only were 82.9% in stage I, and 70%in stage II cancer, after the radiotherapy and surgery for recurrences--90% and 75% respectively. The stage and tumor site were an important prognostic factors in the treated group of patients.

[The prognostic significance of impaired vocal cord motility in patients with stage II glottic cancer treated with radiotherapy]

Eighty-five patients with stage II glottic laryngeal cancer were treated with radiotherapy in Center of Oncology in Kraków between 1973 and 1989. Fifty-five patients were irradiated with 60Co unit, 30 with mixed photon--electron beam. The 5-year survival rates without evidence of disease after the radiotherapy only were 65.9%, after the radiotherapy and surgery for recurrences--76.5%. The sex, age, local extension of primay tumour and vocal cord mobility were evaluated in a uni- and multivariate analysis of prognostic factors. For the end-point of 5-year survival without evidence of disease no statistically significant relationship was found between results and analysis variables, especially between survival and impaired cord mobility.

Outcome of patients with sepsis and septic shock after ICU treatment

OBJECTIVE

Today, sepsis syndrome is the leading cause of death in adult, non-coronary intensive care units (ICUs) and is of great clinical importance. The purpose of this review was to evaluate recent prospective studies concerning the short- and long-term prognosis of patients suffering from systemic inflammatory-response syndrome (SIRS), sepsis, severe sepsis and septic shock. It has been shown in multicentre prospective surveys that 1% and 0.3% of all patients admitted to hospitals suffer, respectively, from bacteraemia alone and bacteraemia with severe sepsis. This rate increases, of course, when only admissions to the ICUs are considered: the above-mentioned rates increase then by a factor of 8 and 30, respectively. Thus, approximately 10% of patients in the ICU suffer from sepsis, 6% from severe sepsis and 2-3% from septic shock. SIRS occurs more frequently and its occurrence ranges from 40% to 70% of all patients admitted to ICUs. Thereby, 40-70% suffering from SIRS progress to a more severe septic-disease state. The overall prognosis is still poor, despite the recent advances in ICU treatment. The mortality rate of SIRS ranges from 6% to 7% and in septic shock amounts to over 50%. In particular, abdominal sepsis exhibits the highest mortality rate with 72%. The long-term prognosis is equally poor; only approximately 30% survived the first year after hospital admission.

CONCLUSION

The prognosis of sepsis and septic shock remains poor, despite the advances in ICU treatment. Although prognostic factors have been identified for some patients, groups have not yet been able to identify the immediate or long-term prognosis for the majority of these septic patients.

[Chronic HIV- and chronic HBV infection with hematuria and proteinuria]

HISTORY AND CLINICAL FINDINGS

A medical examination, undertaken in an apparently healthy 30-year-old man because of his occupational exposure to chemicals, revealed haematuria and proteinuria. Physical examination was unremarkable except for oral hair-leukoplakia and swelling of the cervical, supraclavicular, axillary and inguinal lymph nodes.

INVESTIGATIONS

Examination of the urine demonstrated selective glomerular proteins (1.5 g/24 h) and dysmorphic erythrocytes. SGOT and SGPT activities were raised (73 and 129 IU/l, respectively). Active hepatitis B virus (HBV) and human immunodeficiency virus (HIV-1) infections were demonstrated virologically. The CD4+ count in blood was reduced to 200 cells/microliter. Renal biopsy showed an IgA nephropathy.

TREATMENT AND COURSE

Antiretroviral treatment with zidovudine and lamivudine were started. SGOT and SGPT activities and HIV load fell steadily, while CD4+ cell count rose markedly. Renal functions have remained stable during the past 6 months.

CONCLUSION

Signs of glomerular damage are not unusual in systemic diseases, tumors or infections (Hepatitis B and HIV in this case) and they may be the first manifestations of the underlying disease.

Effect of the hydrolysis method on the determination of the amino acid composition of proteins

Fast and reproducible separation and determination of amino acids serves the economical and reliable characterization and quantification of peptides and proteins as well as the identification of proteins by amino acid composition analysis on a large-scale. A prerequisite of a successful compositional analysis is a complete hydrolysis of the peptides and proteins and a quantitative recovery of the residues in the hydrolyzate. We investigated the effect of different acid-hydrolysis methods on the compositional analysis of known proteins in solution and after blotting onto polyvinylidene difluoride membranes and worked out the conditions for the processing of large numbers of samples. The reliability of each method was studied by introducing the analysis data into the AACompIdent software and deducing the protein identification scores. All acid-hydrolysis methods delivered reliable analysis data. The most accurate data were provided by conventional, thermal hydrolysis of proteins in solution in the presence of methanesulfonic acid, closely followed by hydrolysis with hydrochloric acid and microwave radiation-dependent hydrolysis with hydrochloric or methanesulfonic acid, respectively. For blotted proteins, conventional hydrolysis delivered more accurate analysis data in comparison with the microwave radiation-induced hydrolysis. The extraction of the residues from the membrane hydrolyzate was a critical step for unambiguous protein identification. Microwave radiation-induced hydrolysis was responsible for a higher degree of racemization of the residues.

Consonant-vowel intensity ratios for maximizing consonant recognition by hearing-impaired listeners

The effect of adjusting the consonant-vowel (C-V) intensity ratio on consonant recognition in 18 subjects with sensorineural hearing impairment was investigated. C-V intensity ratios in a set of 48 vowel-consonant nonsense syllables were adjusted in steps of 3-6 dB depending on the subject's dynamic range of hearing. An increase in consonant intensity is referred to here as consonant enhancement (CE). The value of CE producing the highest consonant recognition score (CRmax) is defined as CEmax. Both CEmax and CRmax were determined for each subject for each of the 48 nonsense syllables. Consonant type was found to have a highly significant effect on CRmax, the gain in consonant recognition, and CEmax. The effect of vowel environment was also significant, but of much smaller magnitude. Audiogram configuration was found to have a small effect and was only significant for CRmax. The results of the study also showed that individualized adjustment of the C-V intensity ratio for each subject and consonant-vowel combination can produce substantial improvements in consonant recognition. These data can be used to estimate upper bounds of performance that, in principle, can be obtained by appropriate adjustment of the C-V intensity ratio.

Identification of the CC chemokines TARC and macrophage inflammatory protein-1 beta as novel functional ligands for the CCR8 receptor

Chemokines are key molecules in directing leukocyte migration toward sites of inflammation. We have previously cloned a putative CC chemokine receptor gene, TER1, whose expression is restricted to lymphoid tissues and cell lines. Recently, this receptor has been shown to signal in response to the human CC chemokine I-309 and thus it has been renamed CCR8 according to the current nomenclature. In the present study, we report the identification of the CC chemokines thymus and activation-regulated cytokine (TARC) and macrophage inflammatory protein-1 beta (MIP-1 beta) as CCR8 ligands, as they induce chemotaxis in CCR8 Jurkat stable transfectants. Furthermore, we have generated a polyclonal antiserum that is able to recognize the CCR8 molecule in transfectant lysates. The pattern of CCR8 mRNA expression and the functional effects exerted by its ligand suggest that the triggering of this receptor may regulate multiple functions including activation, migration and proliferation of lymphoid cells.

Mutation screening of the BTK gene in 56 families with X-linked agammaglobulinemia (XLA): 47 unique mutations without correlation to clinical course

OBJECTIVES

To determine the utility of single-stranded conformation polymorphism (SSCP) analysis for mutation screening in the BTK (Bruton's tyrosine kinase) gene, we investigated 56 X-linked agammaglobulinemia (XLA) families. To obtain genotype/ phenotype correlations, predicted protein aberrations were correlated with the clinical course of the disease.

PATIENTS

This study included 56 patients with XLA, with or without a positive family history, who were diagnosed on the basis of their clinical features, low peripheral B-cell count, and low immunoglobulin levels. Ten patients with isolated hypogammaglobulinemia and 50 healthy males served as controls.

METHODS

SSCP analysis was performed for the entire BTK gene, including the exon-intron boundaries and the promoter region. Structural implications of the missense mutations were investigated by molecular modeling, and the functional consequences of some mutations also were evaluated by in vitro kinase assays and Western blot analysis.

RESULTS

We report the largest series of patients with XLA to date. All but 5 of the 56 index patients with XLA screened with SSCP analysis showed BTK gene abnormalities, and in 2 of the 5 SSCP-negative patients, no BTK protein was found by Western blot analysis. There were 51 mutations, including 37 novel ones, distributed across the entire gene. This report contains the first promoter mutation as well as 14 novel missense mutations with the first ones described for the Tec homology domain and the glycine-rich motif in the SH1 domain. Each index patient had a different mutation, except for four mutations, each in two unrelated individuals. This result supports the strong tendency for private mutations in this disease. No mutations were found in the controls.

CONCLUSIONS

Our results demonstrate that molecular genetic testing by SSCP analysis provides an accurate tool for the definitive diagnosis of XLA and the discrimination of borderline cases, such as certain hypogammaglobulinemia or common variable immunodeficiency patients with overlapping clinical features. Genotype/ phenotype correlations are not currently possible, making prediction of the clinical course based on molecular genetic data infeasible.

[Fibrillary glomerulonephritis. Case report for differential nephrotic syndrome diagnosis]

A 67-year-old male patient presented with a nephrotic syndrome. Biopsy of the kidney revealed the characteristic of fibrillary glomerulopathy on light and electron microscopy. Other non-nephritic causes of a nephrotic syndrome (e.g. amyloidosis, immunotactoid glomerulopathy, light-chain glomerulopathy, cryoglobulinaemia, collagen-III glomerulopathy, fibronectin glomerulopathy) could be excluded. Besides the case report, differential diagnosis of fibrillary glomerulopathies is presented.

Renal reabsorption of inorganic phosphorus in pregnancy in relation to the calciotropic hormones

OBJECTIVE

To measure renal reabsorption of inorganic phosphorus and the calciotropic hormones in early and late pregnancy.

DESIGN

Prospective, cross-sectional study.

SETTING

Endocrine Institute at Assaf Harofeh and E. Wolfson Medical Centers; the Department of Obstetrics and Gynaecology, Sheba Medical Centre and Tel Aviv University.

POPULATION

Three groups of healthy women were studied: pregnant women at the end of the first trimester (n = 20), pregnant women at the end of the third, trimester (n = 22), and nonpregnant controls (n = 27).

METHODS AND MAIN OUTCOME MEASURES

The renal tubular maximal phosphorus reabsorption per decilitre of glomerular filtrate (TmP/GFR) was measured in all women. Circulating levels of intact parathyroid hormone, calcitriol (1,25-dihydroxy vitamin D3) and insulin-like growth factor I were assayed in part of the women (8-11 of each group).

RESULTS

TmP/GFR was elevated in the first trimester group (mean 0.263 mmol/L) compared with controls (95% CI 0.07-0.46, P = 0.003). Third trimester values did not differ from controls. Serum calcitriol in the first trimester group was higher (mean difference 17.68 pg/mL) compared with controls (95% CI 3.89-31.47, P = 0.006) and was higher still (mean difference 20.75 pg/mL) in the third trimester group (95% CI 1.01-40.49, P = 0.042). Serum parathyroid hormone in the first trimester group was lower than in controls or the third trimester group: mean differences were 4.40 pg/mL (95% CI-1.40 to 10.15, P = 0.078) and 8.18 pg/mL (95% CI 0.51-15.85, P = 0.019) respectively. Parathyroid hormone levels correlated negatively to calcitriol levels in the combined control and first trimester groups (r = -0.54, P = 0.022) and negatively to TmP/GFR values in the combined three groups (r = -0.68, P = 0.042). First trimester levels of insulin-like growth factor I were lower than those in controls or in the third trimester: mean differences were 10.24 nmol/L (95% CI 2.05-18.43, P = 0.007) and 13.57 nmol/L (95% CI 4.23-22.91, P = 0.003), respectively.

CONCLUSIONS

The dominant change in mineral metabolism in pregnancy is a rise in calcitriol which most probably is responsible for the relative suppression of parathyroid hormone and thereby for the rise in TmP/GFR in early pregnancy. All the above support the transfer of minerals to the fetus without compromising maternal bone. The significance of circulating insulin-like growth factor I remains unclear.

[Lyme borreliosis]

Lyme borreliosis in childhood is a tick-borne disease that includes a variety of clinical symptoms in different organs. Most frequently dermatological manifestations such as erythema migrans and borrelial lymphocytoma are observed. Uni- or bilateral peripheral facial palsy and meningitis with lymphocytic pleocytosis represent typical symptoms of neuroborreliosis. Lyme arthritis occurs as an acute or chronic manifestation that should only be diagnosed after careful consideration of other causes of arthritis in childhood. After clinical and/or laboratory diagnosis of Lyme borreliosis, systemic antibiotic treatment should be initiated. Oral treatment with amoxicillin can be recommended for the treatment of erythema migrans and borrelial lymphocytoma. In contrast, the intravenous administration of 3rd generation cephalosporins is indicated for all generalized manifestations including facial palsy, meningitis, arthritis or involvement of other organ systems. Lyme borreliosis in childhood is characterized by a good prognosis. At the present time, many efforts are given to the development of vaccines using subunits of the different genospecies of Borrelia burgdorferi. First clinical trials with Lyme borreliosis vaccines have been started.

Occupational sitting and low hip mineral density

In order to evaluate the contribution of habitual physical activity to bone remodeling, we determined bone mineral density (BMD) at the lumbar spine (L2-4) and the hip by dual energy X-ray absorptiometry in 55 clerks and 44 nurses. Our data indicate similar L2-4 BMD in both groups due to equal weight load of the upper part of the body on the spinal column in both study groups, but higher femur BMD in the nurse group (0.6-0.8 SD, at various hip measurement sites) than in the clerk group. The age-adjusted hip BMD was correlated with serum osteocalcin levels, and was related to the duration of standing at work, indicating a cause and effect relationship. We conclude that prolonged working in a sitting position may induce a low hip BMD, and thereby increase the risk for osteoporotic hip fracture.