Mumps-associated acute cerebellar ataxia

During a mumps outbreak between 1987 and 1988, six children presented with symptoms of acute cerebellar involvement as the sole neurologic complication. The neurologic symptoms followed parotitis and lasted for up to 3 weeks. Serologic evidence was suggestive of recent mumps infection. Symptoms spontaneously resolved in all patients without any residual signs or symptoms during 2- to 2.5-year follow-up.

Postcircumcision urinary tract infection

The possible association of urinary tract infection (UTI) with ritual circumcision on the eighth day of life was studied by analyzing the epidemiology of urinary tract infections during the first year of life in 169 children with UTI (56 males and 113 females) born in Israel from 1979 to 1984. Forty-eight percent of the episodes of UTI occurring in males appeared during the 12 days following circumcision, and the increased incidence during that period was highly significant. The median age of the males at the time of the UTI was 16 days, compared with seven months in females. Ritual Jewish circumcision as practiced in Israel may be a predisposing factor for UTI during the 12-day period following that procedure.

Autosomal recessive blepharophimosis, ptosis, V-esotropia, syndactyly and short stature

A recessively inherited syndrome of blepharophimosis and ptosis with weakness of extraocular and frontal muscles is reported in six members of three related kindreds. Prognathism, synophrys and thick eyebrows added to a typical facial appearance. Additional findings included short stature, borderline head circumference and toe syndactyly. Borderline mental retardation and anosmia were found in one patient. The clinical features and the mode of inheritance distinguish this syndrome from other blepharophimosis and ptosis syndromes.

Childhood protein-losing enteropathy associated with Helicobacter pylori infection

Helicobacter pylori was found in a gastric biopsy specimen of a child with protein-losing gastropathy. Through erythromycin therapy, clinical and ultrasonographic recovery was associated with the disappearance of the pathogen on repeated biopsy. The association of H. pylori with protein-losing gastropathy has been reported only once in children, to our knowledge. Although the causative correlation between the pathogen and the disease has not been proven yet, we suggest that future cases of protein-losing gastropathy be studied for the presence of H. pylori and followed up by ultrasonographic investigation and urea breath test. Appropriate treatment should be given to suspected cases.

Autosomal recessive Peters anomaly, typical facial appearance, failure to thrive, hydrocephalus, and other anomalies: further delineation of the Krause-Kivlin syndrome

Two cousins and an unrelated patient, all offspring of consanguineous parents, presented with Peters anomaly, unusual facial appearance, disproportionate short stature, retarded skeletal maturation, and a variable degree of mental retardation. Variable digital, cardiac, CNS, and urogenital anomalies were present. The inheritance is probably autosomal recessive. The condition is a distinct clinical entity for which we suggest the eponym Krause-Kivlin syndrome. Peters anomaly is thought to result from abnormal migration of neural crest cells. A similar mechanism was implicated in the pathogenesis of other disorders of the anterior chamber. The presence of Peters anomaly, and possibly of other corneal endothelial disorders in a newborn infant, should alert the clinician to the possibility of this syndrome. Communicating hydrocephalus (or brain atrophy) and polyhydramnios were documented in two patients, potentially allowing prenatal diagnosis in secondary familial cases.

Congenital agammaglobulinemia presenting with ecthyma gangrenosum

Two males with presumed X-linked agammaglobulinemia (X-LA) presented with ecthyma gangrenosum. This is an unusual presentation of this syndrome. Possible causes are discussed.

Familial simple hypohidrosis with abnormal palmar dermal ridges

A brother and sister born to nonconsanguineous, Iranian Jewish parents were found to have simple hypohidrosis. Pilocarpine produced only little sweating, and external heat and physical effort were associated with elevation of body temperature. Abnormal palmar dermal ridges were considered to be associated with paucity of sweat pores and glands. Biopsy supported this view since only one normal sweat gland and duct was found in a 5 mm punch.

Treatment of leishmaniasis nodosa (oriental sore) with intralesionally injected emetine hydrochloride

Treatment of 31 patients with a total of 50 leishmaniasis nodosa (oriental sore) lesions with intralesional injections of emetine hydrochloride led to 100% cure. The injections were given once in 15 days except in the case of one patient, who was treated once a week. The total amounts injected were: 10 to 13 mg for lesions up to 0.5 cm in size in one injection and 160 mg for the largest lesion, which covered almost the entire surface of the patient's nose, in five weekly injections.

Uncomplicated familial hypospadias: evidence for autosomal recessive inheritance

Uncomplicated hypospadias was found in eight members of a large, consanguineous Bedouin family. Virilization and fertility were normal in the only postpubertal individual. The inheritance is most likely autosomal recessive and we suggest that in some of the familial cases in which polygenic or multifactorial inheritance was previously proposed, homozygosity for recessive genes may be responsible for the increased risk to siblings. Dominantly transmitted hypertelorism with diastema was an independent and coincidental finding in this family.

Estimates of validity of projection approximation for three-dimensional reconstructions at high resolution

As spatial frequency increases, the electron microscope "image" deviates increasingly from a true projection of the specimen's structure. This is due to the finite radius of the Ewald sphere. Quantitative estimates of these deviations of the reconstruction from the true projection are presented for a range of accelerating voltages, spatial frequencies, specimen thicknesses, and specimen tilts.

Specimen preparative methods for electron crystallography of soluble proteins

Technical factors which influence the choice of specimen preparation method for electron crystallographic study of thin crystals of soluble proteins are discussed. Ice embedding appears to be the most desirable choice of preparation method. However, in terms of the yield of major structural information, we conclude that negative stain remains a useful method for low resolution and glucose embedding for high resolution.

Structural analysis of T4 DNA helix destabilizing protein (gp32 I) crystal by electron microscopy

Low dose electron diffraction and imaging techniques have been applied to the study of the crystalline structure of gp32*I, a DNA helix destabilizing protein derived from bacteriophage T4 gene 32 protein. A quantitative analysis of intensities from electron diffraction patterns from tilted, multilayered gp32*I crystal has provided the unit cell thickness of the crystal. The three-dimensional phases indicate that the space group P2(1)2(1)2. By taking into account the unit cell volume and the solvent content in the crystal, it was deduced that there is one gp32*I molecule in each asymmetric unit. A projected density map of unstained, glucose-embedded gp32*I crystal was synthesized with amplitudes from electron diffraction intensities and phases from electron images with reflections out to 7.6 A. Because of the similarity in the scattering density between glucose and protein, this projected map cannot be interpreted with certainty. A low resolution three-dimensional reconstruction shows that the protein molecule is about 90 A long and about 20 A in diameter. Because the dimer is formed around a dyad axis, the protein molecules comprising it must be arranged head-to-head. This dimeric arrangement of the proteins in the unit cell may be implicated as one of the conformational states of this protein in solution.

The financing of coronary artery bypass surgery

The costs and charges for coronary artery bypass graft surgery (CABG) are discussed. A paucity of national information is available; thus, more detailed data from the Maryland hospital experience are presented. The data show the interrelationship of charges, lengths of stay, sex, age and payor category. At a time when the primary concern for health care seems to be shifting from resource use to governmental budget expenditures, the data suggest that relatively few government dollars are paying for CABG.

Pelvimetry by digital radiography: a low-dose examination

Digital radiographs obtained with a CT scanner were evaluated as an alternative to conventional pelvimetry. Dosimetry studies demonstrated an absorbed radiation dose of 22 mrad for each digital radiograph, approximately 3% of the dose for comparable standard radiographs. Distance measurements were accurately made on digital radiographs and axial CT sections by cursor placement and a computer program with no needs to correct for magnification. Clinical studies of 10 patients confirmed that pelvimetry using digital radiographs is an accurate, simple, and extremely low-dose procedure which could replace the conventional method.

Surgical correction of hyperkeratosis in the Papillon-Lefèvre syndrome

In a severe case of the Papillon-Lefèvre syndrome, surgical correction of the disabling hyperkeratosis on the dorsa of the hands was first tested in a small area and, when that proved successful, the entire dorsa of both hands were resurfaced. The result was functionally gratifying and the cosmetic appearance was improved.

HLA-DRw4 in pemphigus vulgaris patients in Israel

Pemphigus vulgaris (PV) is relatively common in Jews. Three HLA antigens were significantly more frequent in 39 Israeli Jewish PV patients than in controls A26 - 59% vs 20%; Bw38 - 61% vs 20%; and DRw4 - 90% vs 38%. The joint occurrence of A26-Bw38-DRw4 was observed in 46% of PV patients and in 10% of controls. Similar results were recently reported for Jews in the Los Angeles area. Yet, when our patient sample was grouped into Ashkenazi and non-Ashkenazi Jews, it was evident that each of the three antigens had a higher frequency both in Ashkenazi patients and controls as compared to non-Ashkenzai. The relative risk for DRw-4 in Ashkenzim was 33.8 as compared to 14.4 in the total sample of Israeli PV patients. The phenotype A26-Bw38-DRw4 was present in 57% of Ashkenazi patients and in 13% of controls. Ashkenazi Jews have the highest prevalence of PV, and HLA associations were strongest with Ashkenazi PV patients. These associations were with three antigens, all of high frequency in that group.

Monocyte function in psoriasis

Monocytes derived from the peripheral blood of psoriatic patients demonstrated a significantly higher phagocytic capacity (36 to 40%) for both 125I-labeled Shigella flexneri and 125I-labeled Staphylococcus albus compared with monocytes from healthy subjects. Monocytes from psoriatic patients showed a 2-to-4fold increase in bactericidal capacity against S. albus when compared with normal monocytes. However, the bactericidal capacity of monocytes from diphylline-treated patients did not differ from that of the control subjects. The antibody-dependent cellular cytotoxicity (ADCC) activity against EL4 tumor cells was found to be similar in both psoriatic patients and control subjects. It is postulated that these abnormalities of monocyte function in psoriasis are caused by a decreased cAMP/cGMP ratio similar to the decreased cAMP/cGMP ratio found in the lesional epidermis of this disease. It seems therefore, that the psoriatic abnormality is not confined to only one type of cell, the epidermal cell.

Herpes simplex virus isolation from pyoderma gangrenosum lesions in a patient with chronic lymphatic leukemia

Herpes simplex virus type 2 was isolated and identified from the vesicular border of pyoderma gangrenosum lesions on the genital region of a patient with chronic lymphatic leukemia. Dramatic relief of pain as well as quick disappearance of the vesicular margin of the lesions and of the inflammatory halo around them occurred as a result of local treatment with a solution of zinc acetate. A careful search for a viral agent should be done in every case of pyoderma gangrenosum occurring in a patient with a hematological malignancy or/and impaired immunity, especially if the lesions are on the face or in the genital region.

Evaluation of segmental left ventricular wall motion by equilibrium gated radionuclide ventriculography

The ability of equilibrium gated radionuclide ventriculography to detect segmental left ventricular (LV) wall motion abnormalities was determined in 26 patients undergoing cardiac catheterization. Multiple gated studies obtained in 30 degrees right anterior oblique and 45 degrees left anterior oblique projections, played back in a movie format, were compared to the corresponding LV ventriculograms. The LV wall in the two projections was divided into eight segments. Each segment was graded as normal, hypokinetic, akinetic, dyskinetic, or indeterminate. Thirteen percent of the segments in the gated images were indeterminate; 24 out of 27 of these were proximal or distal inferior wall segments. There was exact agreement in 86% of the remaining segments. The sensitivity of the radionuclide technique for detecting normal versus any abnormal wall motion was 71%, with a specificity of 99%. Equilibrium gated ventriculography is an excellent noninvasive technique for evaluating segmental LV wall motion. It is least reliable in assessing the proximal inferior wall and interventricular septum.

Treatment of mycosis fungoides with heat-killed BCG and cord factor

6 patients with mycosis fungoides in different stages of the disease were successfully treated with intralesional injections of 1% mineral oil emulsions of killed BCG and cord factor, and/or topical application of an ointment containing killed BCG and cord factor.