[Toxic shock syndrome due to osteomyelitis]

An 11 3/4 year old girl contracted Toxic-Shock-Syndrome following osteomyelitis. The symptoms comprised a severe fall in blood-pressure with centralisation, petechiae and haematoma particularly in the lower extremities, hyperaemia of the oral mucosa and of the throat with profuse and unstaunchable bleeding in this area within in a short period of time. In order to stabilise the blood-pressure the patient had be given approx. 15 l colloidal solution (350 ml/kg) intravenously, mainly frozen-plasma. The risk of aggravation of a pulmonary failure along the lines of ARDS particularly due to the backward flow of the interstitial deposited fluid was avoided by the use of continuous veno-venous haemofiltration (CVVH).

[Experiences with capnometry in pediatric intensive care]

We investigated the correlation between arterial and end-tidal pCO2 in 17 children during intensive care. The indications for using capnometry were noninvasive monitoring of ventilation after cardiac surgery or during complicated course of illness or for control of intended hyperventilation. We found a good correlation between arterial and end-tidal pCO2 in the overall patient population (r = 0.82), but the relationship varied widely from patient to patient. There was only a weak correlation (r = 0.44) in pCO2 over 45 mm Hg. Hyperventilation could be identified in 64.2%, whereas hypoventilation was correctly indicated in only 23%.

Endothelial cells of rabbit cornea in different storage conditions. A quantitative cytochemical study

The metabolic functions of endothelial cells of the rabbit cornea in different storage conditions were studied using quantitative cytochemistry. The corneas were stored for 2 h, and 1, 3, 7, 14 and 21 days in dexol at 4 degrees C and in culture medium at 37 degrees C. It was shown that glycolysis as expressed by the activity of the cytosolic enzymes glyceraldehyde 3-phosphate dehydrogenase, glucose-6-phosphate dehydrogenase and lactic dehydrogenase is well preserved for 1 week in dexol and for 3 days only in the culture medium. Mitochondrial enzymes as shown by succinate dehydrogenase and fatty acid oxidation activity show a similar pattern. Uridine diphosphoglucose dehydrogenase, which plays an important part in proteoglycan synthesis, is markedly decreased in both media, but retains its activity in dexol for a slightly longer time. Keratan and chondroitin sulfate content show a sharp drop in the culture medium at 37 degrees C as compared to dexol. This study demonstrates the superiority of dexol at 4 degrees C over the culture medium at 37 degrees C. Quantitative cytochemistry is a useful tool for studying the metabolism of endothelial cells.

[Plasma separation in acute, intravenous phenytoin poisoning]

A two year old boy suffered an acute phenytoin intoxication following intravenous treatment of seizures. After two days in coma detoxification with plasma separation was started. The course of clinical symptoms and phenytoin elimination is described and the efficacy of the method in treating phenytoin intoxication is discussed.

[Life-threatening perinatal hemorrhage of a sacral teratoma]

Great sacral teratomas are rare congenital tumors. The frequency in liveborns is about 1:40,000. Well known complications of sacral teratomas are malignant degeneration, infection and, in case of intraabdominal expansion, compression of the urogenital tract. We report a case of unusual fulminant perinatal bleeding out of a great sacral teratoma ruptured during birth.

[Intracranial MR flow signal changes in extracranial occlusions of the internal carotid artery]

Spin-echo sequences allow an identification of the basal brain vessels because of their typical signal void. The increasing use of MRI also in clarification of cerebrovascular disease requires a good knowledge of intracranial flow alterations. We saw characteristic signal pattern in the carotid siphon in 22 prospective examined patients with occlusion of the internal carotid artery confirmed by ultrasound. The lower siphon showed a loss of flow void and a brain isointense signal. The signal in the upper siphon was identical or showed a flow void with significant calibre reduction, probably because of collateral filling. This diagnostic potential of MRI is a remarkable advantage in comparison to CT and should be routinely considered in patients with cerebrovascular disease.

[Pericardial tamponade as a complication of the use of peripheral percutaneous silastic catheters]

We report on two cases of cardiac tamponade by pericardial infusion in premature infants. In both infants an infusion was given via a Silastic central venous catheter. Because of the cardiac tamponade resuscitation and pericardiocentesis had to be performed. Both infants survived this serious complication of a central venous catheter.

Colour Doppler imaging of arteriovenous malformation of the vein of Galen in a newborn

We report a neonate with congestive heart failure due to a huge arteriovenous malformation of the vein of Galen. Two dimensional ultrasound showed a large cystic structure behind the 3rd ventricle and the quadrigeminal plate. The cyst compressed the posterior part of the 3rd ventricle and the aqueduct and caused an obstructive hydrocephalus. The diagnosis was established by colour Doppler imaging (CDI). With the help of CDI, flow within the aneurysm could be shown as well as feeding arteries originating from the posterior and middle cerebral arteries. The straight sinus and the torcular Herophili were markedly dilated.

[The clinical picture and course in basilar impression]

We have reviewed 29 cases of patients who suffered from basilar impression and had undergone hospital treatment since 1969. 12 of these patients were reexamined. The predominant symptoms were lesions of the long tracts while the ,,classical signs" such as headache and nystagmus occurred less frequently than expected. Only a quarter of our patients showed a marked deterioration during follow-up. The outcome for four patients who underwent operation is reported.

Haemodilution with dextran 40 and hydroxyethyl starch and its effect on cerebral microcirculation

The effect of haemodilution with Ringer's solution, hydroxyethyl starch (HAES) 200/0.5 10% and dextran 40 on cerebral blood flow (CBF) was measured in ten cats by means of the hydrogen clearance technique. As expected from theoretical considerations the haemodilution effect was short and not significant with Ringer's solution, but was 25% with HAES and 35% with dextrane 40. The corresponding rise in CBF was significant in both the latter but not with Ringer's solution. CBF was similarly highly correlated with diminution of haematocrit (Hct). The different effects of the substances on CBF could all be explained by their different effects on the Hct. Data analysis, together with recent literature, suggests that the dominating factor determining CBF was the O2-transport capacity, which in these experiments was in close relation to Hct. The results support the assumption that the increase of CBF by haemodilution is caused by a regulatory mechanism and not by a change of rheological parameters.

Localization of denatured enzyme molecules in rat lenses

Immunohistochemical localization of altered enzyme molecules was detected by the use of antibodies to denatured enzymes (ADE) conjugated with fluorescein. Denatured aldolase, glucose 6-phosphate dehydrogenase and superoxide dismutase are mostly located in the subcortical region and in the nucleus of the rat lens. In the nuclear fibres the enzyme is located near the membrane of the fibres. This study provides additional evidence that altered enzyme molecules accumulate in the lens, and indicates their exact localization. ADE antibody can distinguish between inactive enzyme molecules and active ones, using immunohistochemical techniques.

Autoregulatory capacity and the effect of isovolemic hemodilution on local cerebral blood flow

The effect of isovolemic hemodilution with dextran 40 on local cerebral blood flow was measured in eight cats by means of the hydrogen clearance technique. Under normotension the decrease of hematocrit from 35% to 25% causes a sudden increase of up to 30% in local cerebral blood flow. After lowering the mean arterial blood pressure from 140 to 80 mm Hg, hemodilution did not alter cerebral blood flow significantly. From this observation it is concluded that the increase of cerebral blood flow following hemodilution is caused by compensatory vasodilatation and not by reduction of blood viscosity. This could imply that hemodilution cannot improve blood flow in areas of impaired autoregulation.

Quantitative cytochemistry of enzymes in the epithelium of ageing rat lenses

The activities of lactate dehydrogenase (LDH), glucose 6-phosphate dehydrogenase (G6PD) and glyceraldehyde 3-phosphate dehydrogenase (GAPD) in two zones of the epithelium of the lens of 6- and 27-month-old rats were measured using quantitative cytochemical methods. In both age groups, the epithelium in the equatorial zone showed the highest enzymatic activity. LDH activity was similar in young and old rats in both areas. G6PD and GAPD activities in the central area were similar in both age groups, but their activity was markedly lower in the equatorial zone in old rats compared to young ones. This decrease in G6PD and GAPD activities may play a role in cataract formation.

[Clinical relevance of the tracheal bronchus]

We report about 6 infants with serious respiratory disease who revealed a tracheal bronchus on bronchoscopic or bronchographic examination. In two of these children this finding seemed to be the main problem; it could be cured by surgical or conservative therapy. The course of the further 4 children's disease was determined by additional serious malformations (Oesophageal atresia, congenital heart disease, anomalies of the pulmonary arteries). In these cases, the tracheal bronchus did not influence the clinical course significantly.

Chemical analysis of whole saliva in Sjögren's syndrome

In some studies, but not in all, abnormally high concentrations of salivary Na+, K+, and IgA have been found in patients with Sjögren's syndrome (SS). The lack of agreement between various reports might be due to the different ways in which saliva was collected. Some analysed stimulated parotid or whole saliva, whereas others used unstimulated saliva. In this study, therefore, the rate of flow and Na+, K+, and IgA levels in unstimulated and stimulated whole saliva in normals and in rheumatoids with and without SS have been determined. The results confirmed significantly raised levels of Na+, K+, and IgA in unstimulated whole saliva in SS. In response to stimulation there was marked decrease in Na+, K+, and IgA levels, whereas normally, as shown by the other two groups, there is an increase in Na+, no change in K+, and a mild decrease in IgA. As a result, the differences between SS and normals became much less significant (K+, IgA) or were even completely obliterated (Na+). The abnormal response of SS to stimulation may be partially explained by the initially low rate of flow and by the extremely high IgA levels. Thus chemical analysis of unstimulated whole saliva is much more sensitive than analysis of stimulated whole saliva in the detection of salivary gland involvement in SS.

Defective superoxide-dismutase molecules accumulate with age in human lenses

The specific activity of superoxide dismutase (SOD) in human transparent lenses declines as a function of age. Immunotitration using monospecific antibodies showed that, with increasing age, lenses exhibit an accumulation of catalytically inactive, but antigenically reactive, enzyme molecules. Antiserum produced against denatured enzyme removed the inactive molecules from the lens homogenates without affecting the enzyme activity. These aberrant molecules are at least partially denatured and are totally devoid of catalytic activity.

Left ventricular volume during supine exercise: importance of myocardial scar in patients with coronary heart disease

Existing studies suggest that exercise-induced ischemia produces an increase in left ventricular end-diastolic volume; however, all of these studies have included patients with previous myocardial infarction. To test whether the end-diastolic volume response to exercise is related to the extent of myocardial scar, the results of gated radionuclide supine exercise tests performed on 130 subjects were reviewed. The patient group comprised 130 subjects were reviewed. The patient group comprised 130 men aged 35 to 65 years (mean +/- SD 52 +/- 5) with documented coronary heart disease. The extent of myocardial ischemia and scar formation was assessed by stress electrocardiography and thallium-201 scintigraphy. Patients were classified into three groups on the basis of left ventricular end-diastolic volume response at peak exercise: group 1 (n = 72) had an increase of end-diastolic volume greater than 10%, group 2 (n = 41) had a change in end-diastolic volume less than 10% and group 3 (n = 17) had a decrease in end-diastolic volume greater than 10% (n = 17). At rest there was no significant difference among groups in heart rate, systolic blood pressure, end-diastolic (EDVrest) or end-systolic volumes or ejection fraction (p greater than 0.05); however, at peak exercise the end-systolic volume response was significantly greater for group 1 (p less than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

Immunogenetics of juvenile chronic arthritis in Israel

Typing for HLA-A,B,C and DR antigens was performed in 61 Israeli patients with juvenile chronic arthritis (JCA) and in 120 unrelated controls. No significant associations were apparent in the overall patient group. DR5 was significantly increased in the non-Ashkenazi patients with pauciarticular onset of disease. The only three DRw8 positive patients in the study had pauciarticular onset. DR5 and DRw8 were found in 9 of 10 patients with age of onset less than 3 years. Increased frequencies of Bw50 and Cw6 were observed in patients with systemic onset. Typing for properdin factor (Bf) and glyoxylase (GLO) was carried out in 45 and 50 of the patients, respectively. No associations with alleles of the complement Bf system or the HLA linked GLO system were evident. The confirmation in the ethnically distinct Israeli population of the previously described association of DR5 with pauciarticular JCA suggests that this gene may be closely related to the disease susceptibility gene.

G6PD molecules devoid of catalytic activity are present in the nucleus of the rat lens

The specific activity of glucoso-6-phosphate dehydrogenase (G6PD) in the rat lens declines as a function of animal age. G6PD activity could be found only in the cortex of the lens. Previous work showed that antibodies against the 'native' form of G6PD could not recognize any cross-reacting material (CRM) in the lens. It was speculated that this could be due either to disappearance of G6PD from the nucleus by degradation or by alterations of the molecules which resulted in the loss of their antigenic determinants. In order to investigate this question, an antibody was prepared against denatured G6PD. This antibody did not interact with 'native' (active) forms of the enzyme; it was shown, however, to recognize antigenically cross-reactive but catalytically inactive intact G6PD molecules in the nucleus of the lens. This finding suggests that altered enzyme molecules are at least partially denatured and accumulate in the lens without being further cleaved proteolytically.

[Ductus aneurysm as a rare cause of inspiratory stridor in the newborn infant]

A paralysis of the left vocal cord was seen by laryngoscopy in a 3-days-old boy with inspiratory stridor. A ductus aneurysm was established by angiocardiography, which was believed to be the cause of the vocal cord paralysis. Within 8 days after the angiocardiography the aneurysm became smaller and the stridor disappeared. Twelfth months later the control-angiocardiography showed the total obliteration of the ductal aneurysm.