Human Escherichia coli O157:H7 infection associated with the consumption of unpasteurized goat's milk

A cluster of four cases of haemolytic uraemic syndrome in children occurred in Northern Bohemia, Czech Republic, between 15 June and 7 July, 1995. All the cases had significantly elevated titres of anti-O157 lipopolysaccharide (LPS) antibodies as detected by the indirect haemagglutination assay. All but one of them had drunk unpasteurized goat's milk from the same farm within the week before the disease. Evidence of E. coli O157 infection was subsequently found in 5 of 15 regular drinkers of the farm's raw goat's milk; four of them were asymptomatic, 1 had mild diarrhoea at the end of June. Verocytotoxin 2-producing E. coli O157:H7 strains of phage type 2 and of identical pulsed-field gel electrophoresis patterns were isolated from 1 of 2 farm goats and from 1 of the asymptomatic goat's milk drinkers. The frequency of anti-O157 LPS antibodies found among regular drinkers of the farm's raw goat's milk (33%; 5 of 15) was significantly higher than that found in control population (0%; none of 45) (P = 0.0005; Fisher's exact test). Our findings indicate that goats may be a reservoir of E. coli O157:H7 and a source of the infection for humans; raw goat's milk may serve as a vehicle of the pathogen transmission.

Blood pressure and renal function in autosomal dominant polycystic kidney disease

The purpose of this study was to identify hypertension in children and adolescents in an early stage of autosomal dominant polycystic kidney disease (ADPKD) by the application of ambulatory blood pressure monitoring (ABPM) over 24 h; 32 children and adolescents (mean age 12.3 +/- 4.7 years) were examined. The diagnosis was based on family history and ultrasound examination. In 21 children ADPKD was confirmed by molecular genetic analysis. At the time of the study, 45% patients were asymptomatic and all had glomerular filtration rates (GFRs) > or = 65 ml/min per 1.73 m2. By ABPM, 11 patients (34%) were defined as hypertensive (systolic or diastolic blood pressure > 95th percentile), including 4 with an exclusive nocturnal hypertension. Of 7 patients with daytime hypertension, 4 had normal blood pressure by casual measurements. The nocturnal dip in blood pressure was reduced in 2 patients. Blood pressure correlated with renal size, but not with GFR, concentrating capacity, proteinuria, and plasma renin activity. The study reveals an early trend for increased blood pressure in children with ADPKD, requiring close supervision.

Urinary uric acid excretion in healthy male infants

Blood and urine samples were collected from 23 healthy term male infants aged 2-12 months (mean 6.6 months). Data for establishing urinary uric acid reference values were obtained: urine concentration, 24-h urine output, weight-related urine output, urine output related creatinine, clearance, and fractional excretion. A negative correlation with age was demonstrated for all parameters studied.

[Detection of the Ki-ras mutation as a specific and sensitive marker of pancreatic carcinoma]

The authors describe the procedure used for assessment of a Ki-ras mutation as a specific and sensitive marker of carcinoma of the pancreas. The reliability of the method was tested in five patients with carcinoma of the pancreas.

Verocytotoxin-producing Escherichia coli in children with hemolytic uremic syndrome in the Czech Republic

Since October 1988 till July 1995, 35 children (mean age 16 +/- 15.5 months) with classical hemolytic uremic syndrome (HUS) were examined for the presence of verocytotoxin (VT)-producing Escherichia coli (VTEC) infection. Stool samples from all patients were cultured for VTEC strains and tested for free fecal neutralizable VT. Serum samples from 18 patients taken on admission were also tested for antibodies to the lipopolysaccharide (LPS) from E. coli O157, O26, O55, O111, and O128 using the passive hemagglutination assay (PHA). Diagnosis of VTEC infection was established in 28 (80%) patients by the combined use of microbiological and serological techniques. VTEC were isolated from 16 (46%) patients, 5 of them had infection with 2 different VTEC serotypes; 11 (52%) VTEC isolates belonged to the serotypes O26: H11 (5), and O157: H7/NM (6). Free fecal VT was found in 21 (60%) patients. PHA antibodies to one or more LPS were detected in 14 (78%) of 18 patients; 9 had antibodies to O157 LPS and 6 to O26 LPS. We conclude from this study that VTEC are the important cause of pediatric HUS in the Czech Republic and the strains belonging to the serogroups O157 and O26 are the most prevalent.

[The effect of electrostimulation with the Rebox apparatus on ischemic renal injury in rats]

BACKGROUND

With developing transplantation programmes the problem of protection against ischaemic renal damage had become important. The results of experimental pharmacological protection of the kidneys are not quite conclusive. The objective of the presented paper was to assess the effect of electrostimulation by means of a Rebox apparatus (generator of direct rectangular impulses at a frequency of 1 to 10 kHz), on the development of ischaemic damage of the renal parenchyma induced experimentally in rats.

METHODS AND RESULTS

The experiments were made on Wistar strains rats (n = 15) which were subjected to dextrolateral nephrectomy and the left renal artery was closed by a clamp which was released in the tested and the control group after 30 minutes. In the rebox group electrostimulation with the Rebox apparatus was implemented immediately after release of the clamp. In rats which were in metabolic cages the following parameters were assessed: diuresis, period of survival, endogenous creatinine clearance, plasma creatinine level, urea level and excretion, as well as sodium and potassium urinary excretion. No significant difference in the survival time of the rats was found nor in the plasma levels of creatinine, urea and urinary excretion of potassium and urea between the control and the Rebox group. In the Rebox group, as compared with the control group, a significantly higher diuresis was found 22.8 vs 5.6 (p < 0.001) and natriuresis 0.44 vs 0.11 (p < 0.01).

CONCLUSIONS

Electrostimulation by rebox currents in rats increases significantly the diuresis and natriuresis of the solitary kidney exposed to 30-minute ischaemia but has no impact on other parameters. The mechanism of action is not quite clear, apparently the reabsorption of sodium in the proximal tubule is inhibited.

Evaluation of selenium supply and status of inhabitants in three selected rural and urban regions of the Czech Republic

Blood serum selenium of 65 men and hair selenium of 77 men from three regions of the Czech Republic (CR) were analyzed by neutron activation analysis, and 202 samples of urine from the same populations were analyzed for Se by the fluorimetric method to assess selenium status of these regions. Low status (53 micrograms Se/L of serum and 0.29 micrograms Se/g lyophilized hair as means) and very low urine selenium (8.7 micrograms/L urine) were detected. By these data, the CR is among the countries with the lowest Se intake. A comparison of studied regions is presented. Moreover, values of serum zinc were within the reference range, but mild to moderate deficiency in the supply of iodine was detected.

Characterization of human papillomavirus type 16 activity in separate biopsies from a carcinoma of the cervix uteri

Human papillomavirus (HPV) 16-specific nucleic acid sequences were analysed in separate biopsies taken from a patient with a poorly differentiated squamous cell carcinoma of the uterine cervix. Biopsies were obtained from histopathologically normal epithelium adjacent to the carcinomatous epithelium, the primary carcinoma and a metastatic lymph node. Signals characterizing viral DNA and oncogene transcription were obviously differentiation dependent as shown by in situ hybridization of viral nucleic acids and immunofluorescence of epithelial differentiation specific proteins. In histologically normal parts of the epithelium viral DNA was amplified at the transition from basal to maturing cells, whereas E6/E7 genes were actively transcribed mainly in maturing epithelial cells following the basal cell layer. Some of the cells in the primary carcinoma and in the metastatic lymph node expressed involucrin at increased levels. Signals for viral DNA and HPV 16-specific E6/E7 transcripts decreased in intensity during differentiation in an inverse relationship to the observed involucrin increase in those cells. The absence of Ki67 in cells expressing large amounts of involucrin as revealed by immunostaining, support the inverse correlation between differentiation of cancer cells, HPV 16 replication and E6/E7 transcription. The changes in cytokine expression may indicate an HPV 16 associated disruption of normal cytokine expression pattern in the carcinoma.

Residual renal function in children on haemodialysis and peritoneal dialysis therapy

Residual renal function was studied in 28 haemodialysis (HD) and 31 peritoneal dialysis (PD) patients aged 1-20 years observed over 6-43 (median 19) months. After the start of dialysis urine volume (UV) decreased to 57%, 46% and 26% of initial mean values in HD patients after 6, 12 and 24 months, respectively. In PD patients the corresponding figures were 57%, 69% and 62%. Mean UV calculated from all individual mean UV measurements observed was higher in PD than HD patients (954 vs. 537 ml/m2 per 24 h, P < 0.01). A better conservation of diuresis in PD patients was also suggested by a significantly longer persistence of a UV greater than 500 ml/m2 per 24 h compared with HD patients. Cox proportional hazard analysis identified dialysis modality and pre-dialysis UV of less than 1,000 ml/m2 per 24 h as the only significant risk factors for UV survival. However, the decline of UV per time was similar in both modes of treatment. No significant changes of glomerular filtration rate were observed during both HD and PD treatment.

[An unusual constellation of findings in polymyositis--differential diagnosis and clinical course]

Clinical and biochemical findings are described in a 34-year-old female with atypical polymyositis. Uncommon clinical features in this patient included distally accented decreased muscle strength and myalgias, atypical electromyographic findings, a remarkable discrepancy between clinical findings and laboratory parameters of myolysis, unexplained episodes of somnolism, presence of increased serum lactate levels, and a unilateral mamma aplasia. For this combination of signs a polymyositis or an inclusion body myositis, but also a metabolic or heredodegenerative myopathy was considered. Finally, the idiopathic polymyositis was confirmed histologically and a marked improvement in the clinical and biochemical signs occurred after commencement of high-dose methylprednisolone.

[Primary diffuse leptomeningeal leiomyomatosis]

A female patient aged 28 fell ill with manifestations of sensory aphasia, headache and signs of cerebral compression. Except for a bilateral papilledema there were no further pathological clinical and paraclinical findings. Later on, amaurosis, deafness, anosmia and generalized muscular hypotonia developed. The nuclear magnetic resonance image revealed a major accumulation of contrast medium in the leptomeninx. Biopsy demonstrated a mesenchymal neoplasm in the leptomeninx. After a strong rise in intracranial pressure, the patient died from a bulbar brain syndrome. Microscopy revealed a diffuse neoplasm limited to the leptomeninx of brain and spinal cord as well as the immediate neighbourhood of small cortical vessels which, by morphological criteria, was classified as low-grade malignant. With the aid of electron microscopy, the tumour cells could be identified as descendants of smooth muscle cells.

[Fibromatosis of the breast--a case report and review of the literature]

A case of fibromatosis of the breast mimics a carcinoma by its clinical and mammographic features. The morphological image of this rare disease of the breast is described. The fibromatosis of the breast has to be distinguished histologically from a fibroma and from a low-grade fibrosarcoma. The dignity of the lesion is confirmed by histological and immunohistochemical examination. The possibilities of therapy are discussed and compared with data of the literature.

[The solitary kidney in patients after nephrectomy in Wilm's tumor]

A single kidney in patients with agenesis or after nephrectomy is regarded as a risk factor. Primarily, the role of glomerular hyperfiltration and later possible glomerular sclerosis are emphasised. Complex treatment of Wilms tumour patients includes previous chemotherapy and radiotherapy. The aim of our study was to investigate late sequelae of this aggressive treatment on the morphology and function of a single kidney and to compare these results with a group of single kidney patients, where the diagnosis of Wilms tumour was excluded.

[Severe Amanita phalloides poisoning in a 7-year-old girl]

Authors describe a case of a very severe poisoning, the prothrombin-time was less than 10% of the normal value and the child developed hepatic coma. We suppose, the favourable outcome may have been influenced by the treatment with Silymarin in combination with high doses of G-Penicillin.

Properties of two epithelial cell lines derived from HPV-associated cervical and vulvar lesions

Two epithelial cell lines were established from human papilloma virus (HPV) 18 or 16 associated tumours, characterised as poorly and well differentiated squamous cell carcinomas of the cervix uteri (EC) and the vulva (GC), respectively. The cell lines are described by their morphology, biological parameters, and immunological markers. Both cell lines have undergone approximately 35 passages in vitro. HPV16 and 18 DNA are maintained integrated into the host cell DNA. Expression of epithelial cell markers--cytokeratins K1, K10, K13, K14 and involucrin, proliferation-specific proteins, proliferating cell nuclear antigen (PCNA) and Ki67 as well as the epidermal growth factor (EGF) receptor were monitored by indirect immunofluorescence studies. The cytoplasmic and membrane-associated locations of EGF receptor molecules in EC and GC cells, respectively, suggest a differently regulated expression. Studies of the HPV18 oncogene transcription revealed marked differences of amplimers between HeLa and EC cells, such as an additional fragment, probably corresponding to a E6**--E7 splice product, and a radical shift in transcription pattern observed in various sections of the tumour tissue. Injected subcutaneously into nu/nu mice both cell lines were non-tumorigenic.

[Immunologic reactivity in children on a chronic dialysis program and after kidney transplantation]

Dialysis and transplantation of the kidney have become in Czechoslovakia part of routine therapy of chronic renal failure (ChRF) in children and adolescents. The authors examined 16 children aged 4-17 years (x = 10.5) treated in a chronic dialyzation programme (ChDP) by haemodyalisis and 20 children after transplantation of a cadaverous kidney, age 4.5-16.5 years (x = 11.5), incl. 14 patients with a stable function of the graft and six patients during the period of acute rejection of the graft. The authors tested the basic parameters of humoral and cellular immunity in all three groups of children. In the group of the CRI a significant drop of the level was found only in serum IgA, the other parameters, incl. examination of sub-populations of lymphocytes CD3+, CD4+ and CD8+, did not differ significantly from normal values. In patients with a stabilized function of the graft treated by Cyclosporin A, prednisone, and in some cases also with azothioprim, the authors found a significantly lower absolute number of lymphocytes of the mentioned sub-populations as compared with controls and patients included in a ChDP. During the period of acute rejection the absolute number of CD3+, CD4+, CD8+ increased significantly, as compared with the period of stabilized function of the graft. Thus patients in CRI do not manifest despite the serious affection of the organism serious changes of immune reactivity within the scope of examinations made by the authors. Monitoring of immunity parameters in patients with transplants can contribute to evaluation of the effect of immunosuppression (it can draw attention to low dosage of drugs) and in the context with other clinical and laboratory examinations it can contribute to the diagnosis of acute rejection.

[Determination of the calcium/creatinine index in urine in healthy neonates, infants and children]

The authors examined a total of 107 healthy subjects--neonates (n = 13), infants (n = 23), toddlers (n = 16), 3-6-year-old children (n = 15) and school children (n = 40). They correlated the urinary Ca excretion mmol/kg/24 h) with the Ca/cr index which was obtained by examination of postprandial urine sample. They revealed a significant correlation of the excretion and index in infants p less than 0.001, in school children p less than 0.01 with a regression coefficient of 0.9 and 0.7 resp. The index was significantly age dependent, the value of the 95th percentile in neonates was 1.38, in infants 1.025, in toddlers 1.26, in three-year-old children 0.835 and in school children 0.56. The urinary Ca/cr values must be thus interpreted in relation to the child's age; the index declines with age. The reason for high indices in young children is the low creatinine concentration in the excreted urine which rises significantly with age. Examination of the Ca/cr index should be part of routine screening in all cases with suspected nephropathy. The accepted upper range of the index, 0.6 (mmol/mmol), applies only to school children, but not to younger children.

[Infantile cortical hyperostosis (the Caffey-Silvermann syndrome)]

In 1984-1989 at the First Paediatric Clinic of the Motol Faculty Hospital six patients with the diagnosis of infantile cortical hyperostosis (Caffey-Silvermann syndrome) were hospitalized. Non-familial concurrence of the disease was involved. All children developed the disease before the age of 4.5 months, four before the age of three months. Among the six patients was only one girl. As to pathological findings there was a markedly elevated FW in 5/6, leucocytosis in 5/6, thrombocytosis in 3/4, eosinophilia in 3/6, elevated alkaline phosphatases in 2/6. The affection was four times on the mandible, once in the area of the hip joints and in one instance it was multifocal. The authors present one detailed case-history with extreme affection of the clavicle which was originally taken for a bone tumour.