[Extralobar pulmonary sequestration in children: presentation of a case]

The pulmonary sequestration is an anatomical condition with as isle of pulmonary tissue independent from tracheobronchial tree. This tissue has an independent artery originated from aorta. Anatomically we can have two types of sequestration. The first is the condition of an isle of pulmonary tissue included without any separation in the lobe; this condition in named intra-lobar sequestration. On the other hand we have a second condition with an isle of independent pulmonary tissue surrounded with independent pleura; the last one is named extra-lobar sequestration. In the present article the authors describe a case of extralobar sequestration in a two years old girl. The symptoms presented by the girl were hyperpyrexia, tough and recurrent bronchopulmonary infections. The girl underwent surgery removal of sequestration. The authors describe their experience, the importance of symptomatology and the anatomo-pathologic characteristics of this lesions.

[Conservative treatment of post-traumatic periduodenal hematoma: presentation of a clinical case and review of the literature]

The authors describe a case of post-traumatic hematoma of the duodenum in a two years old child. This is a very rare condition in paediatric age, but with the increasing incidence of traumatic pathology it can be predicted an increase of this condition. The duodenal hematoma can be treated either with surgical approach or with conservative treatment. The authors discuss the characteristics of the pathology, the etiopathogenetic mechanism, and propose the same classification adopted by some french authors. The type of lesion indicates the adequate therapy; in particular in the case report (type 1) a conservative treatment is adopted. The laboratory parametres are significative but none is diagnostic. In the present case the amylasemia is not elevated until two weeks after the trauma. Very important for diagnosis are T.C., roentgenography and echotomography, the last one can be easily used for the control of the resolution of the hematoma. The conservative treatment is based on nasogastric suction and parenteral nutrition; although the role of nonoperative treatment is emphasized, the importance of careful assessment for signs of peritonitis or enlarging tender mass cannot be overlooked.

Immunocytochemical detection of ferritin in human bone marrow and peripheral blood cells using monoclonal antibodies specific for the H and L subunit

We have used the monoclonal antibodies 2A4 (specific for the H subunit of human ferritin) and LO3 (specific for the L subunit) for immunocytochemical detection of ferritin in bone marrow and peripheral blood cells from normal subjects and patients with various haematological disorders. Formalin-fixed slides were stained by the immunoalkaline phosphatase procedure (APAAP). In normal subjects, ferritin could be found only in bone marrow smears and appeared to be largely confined to erythroid precursors and reticuloendothelial cells. The more immature erythroid precursors contained higher concentrations of cellular ferritin. Although evaluation could be only semiquantitative, erythroblast ferritin appeared to be more reactive with the monoclonal 2A4 (15 +/- 7% positive erythroblasts) than with the monoclonal LO3 (6 +/- 5% positive erythroblasts), indicating that H-type ferritin was predominant, particularly in proerythroblasts and basophilic erythroblasts. By contrast, the ferritin present in reticuloendothelial cells appeared to be predominantly of L-type. Patients with iron deficiency showed low levels of positive erythroblast, whereas the reverse was true in patients with transfusional iron overload. Intense positivity for reticuloendothelial cell ferritin was found in patients with anaemia of chronic disease. In myelodysplastic syndromes and acute myeloid leukaemia (AML), ferritin positivity was generally very strong at any stage of erythroblast development, particularly with the monoclonal antibody 2A4. Perls-positive perinuclear granules of ring sideroblasts were not stained, confirming that mitochondrial iron deposition is not in the form of ferritin. In AML and myelodysplastic syndromes with excess of blasts, ferritin could be detected also in immature myeloid cells. These data indicate that: (a) in normal conditions ferritin is mainly expressed in red cell precursors and reticuloendothelial cells, and this is in keeping with the peculiar role of these cells in iron metabolism; (b) abnormal cell ferritin contents can be observed in both iron overload and malignancy.

A mutational analysis of the epitopes of recombinant human H-ferritin

Murine monoclonal antibodies were elicited by the recombinant human H-ferritin overexpressed in Escherichia coli. They had a specificity analogous to that of the antibodies elicited by natural human H-chain, and all of them showed low additivity in binding the recombinant ferritin. Four antibodies of each group were challenged with four H-ferritin mutants overexpressed in E. coli, altered in different accessible areas of the molecule. They consisted of deletions of the first 13 and last 22 amino acids, a duplication of an 18 amino acid sequence in the loop region, and a substitution of a 5 amino acid stretch in the three-fold symmetry axis region. Double diffusion, immunodot analyses and inhibition plots indicated that: (1) all the mutants were recognized by at least one antibody; (2) the deletion of the N-terminus and the duplication in the loop region had the strongest effect on antibody binding; and (3) epitope boundaries of the various antibodies could not be recognized. The antibodies were tested with H-containing ferritins from rat and hen hearts, and showed low or absent reactivities despite their high structural homology with human ferritin. Comparison of the amino acid sequences of human, mouse, rat and hen H-chains, together with mutational data, suggested that; (i) ferritin epitopes are large, probably encompassing a large portion of the subunit surface and (ii) Thr-5 and Cys-90 have a role in H-ferritin immunogenicity.

[Sex change in children with Morris syndrome]

Eleven boys with Morris syndrome underwent feminizing genitoplasty utilizing a segment of the sigmoid colon for neovaginal reconstruction. Bilateral orchiectomy was performed for cosmetic reasons and to prevent neoplasms. Patient follow-up ranging from 6 months to 13 years have demonstrated good results were obtained. No intra- or postoperative complications were observed. Patient psycho-social-sexual identification and satisfaction were achieved.

[New technic for the treatment of high intraabdominal cryptorchism: testicular autotransplantation with venous anastomosis only]

A new technique in the treatment of high intraabdominal cryptorchidism is proposed: testicular autotransplantation with venous anastomosis only. The technique consists in performing microsurgical anastomosis of the spermatic vein and homolateral inferior epigastric vein only for adequate venous drainage, leaving irrigation of testis to the deferential artery alone. We have utilized this technique in 16 cases and excellent results have been achieved. It has permitted performing surgery in younger patients (2 years). Surgical trauma and the duration of the operation are less compared to the Silber technique. There is a higher success rate and the procedure is easy to perform.

[Microsurgical spermatico-epigastric diversion in the treatment of varicocele in pre-adolescent patients]

Varicocele is not an uncommon condition in pre-adolescence. Internal spermatic vein phlebography provides insight into vascular anatomy and etiopathogenesis. Eighty-six cases treated by microsurgical spermatico-epigastric anastomosis (Belgrano technique) are reported. This technique has been shown to achieve a very high cure rate (98.8%). Several techniques of venous anastomosis are described and compared with the Belgrano technique. The results show that the latter is the ideal technique because it not only resolves reflux but also provides adequate venous drainage to the testis.

Development of an immunoassay for all human isoferritins, and its application to serum ferritin evaluation

Calibrated mixtures of anti-H and anti-L ferritin subunit monoclonal antibodies were used in a sandwich enzyme-immunoassay for the evaluation of all isoferritins. The assay was designed to have overlapping calibration plots for human liver (95% L-chain) and recombinant human H-chain ferritin (100% H-chain). It appeared to recognize all the heart isoferritins including the ones in the middle of the isoferritin spectrum. By direct comparison it was shown that these isoferritins are under-evaluated by the assays for H- and L-subunit-rich ferritins, based on the two separated antibodies. The three assays (for total, H-rich and L-rich ferritins) provide an index of the presence of the isoferritins with intermediate H/L composition. Sera from 30 tumor and non-tumor patients were analyzed. Intermediate isoferritins were found in 2 non-tumor subjects and in none of the 14 patients with Hodgkin's disease or mammary carcinoma. It is concluded that the evaluation of the total and intermediate isoferritins is possible, but does not have an evident clinical significance for tumor monitoring.

Immunohistochemical evidence for a lack of ferritin in duodenal absorptive epithelial cells in idiopathic hemochromatosis

Patients with idiopathic hemochromatosis exhibit an unexplained increase in intestinal iron absorption. The aim of this work was to study immunohistochemical H- and L-ferritin distribution in duodenal mucosal cells of patients with idiopathic hemochromatosis, and of subjects with various degrees of iron loading. Biopsy sections of gastrointestinal mucosa from 24 patients with idiopathic hemochromatosis, 10 patients with secondary iron overload, 6 normal subjects, and 13 iron-deficient subjects were analyzed with monoclonal antibodies for the presence of immunohistochemical H and L ferritin types, and with Perls' stain for hemosiderin. Ferritin content of duodenal homogenates was evaluated in 5 cases. The absorptive duodenal cells were found to contain ferritin, mostly of the L type, in apical granules; these ferritin granules were present in all normal, iron-deficient, and iron-over-loaded subjects, but were absent in 21 (87%) of the patients with established idiopathic hemochromatosis. In cells other than those of the duodenal epithelium, such as lamina propria or antral mucosa, ferritin and hemosiderin contents were related to iron loading and no difference was evident between primary and secondary iron overload. These findings indicate that (a) idiopathic hemochromatosis is associated with an altered ferritin expression in the duodenal absorptive epithelial cells, (b) this alteration cannot be detected by analysis of duodenal homogenates, (c) idiopathic hemochromatosis does not affect ferritin accumulation in the other cell types analyzed, and (d) ferritin in absorptive duodenal cells may have a regulatory role in iron absorption.

[Acute enteritis and dietetic errors in the first 6 months of life]

The dietary habits of 174 infants under 6 months old and suffering from enteritis were analysed revealing a high incidence of feeding errors (almost always feeding with artificial formulas, wrong concentration of milk powder, failure to sterilise the bottle and the water used to dilute the milk, too early administration of undiluted, unboiled bottled cow's milk, too early and incorrect weaning). Such mistakes appeared to be linked to the poor economic and sociocultural conditions of the families concerned. It is claimed that dietary errors conditioned by the poor economic and sociocultural conditions encountered may have favoured the onset of enteritis and that the adequate prophylaxis of acute infantile enteritis will depend on improving people's dietary habits and living conditions.

[Acute bacterial enteritis in children. Etiological, clinical and epidemiological findings in a 5-year hospital case series]

The Authors carried out retrospective research into bacterial enteritis observed during the past 5 years (Jan. 1982-Dec. 1986) in Pediatric Clinic R of Palermo. The pathogenic agents more frequently isolated were minor salmonellas, followed by E. Coli and shigellas. The first ones showed an incidence almost constant during the five years, while the second and third ones presented epidemic tops in 1982 and 1985. Inside the salmonellas' group it was evidenced a prevalence of S.T. Murium (44.71%), of S. Corvallis (21.13%) and of S. Enteridis (11.38%) and inside the shigellas' group S. Sonnei was more evident (80.43%). A higher incidence of bacterial enteritis appeared: during the period summer-autumn, in patients under one year or undernourished, in those coming from lower social classes, not breast-fed or wrongly fed. An accurate analyses of symptoms has not allowed an aetiological diagnosis, and clinical course of illness was always favourable. The therapy more often used was rehydration, associated with antibiotics only in very serious cases.

Immunochemical characterization of human liver and heart ferritins with monoclonal antibodies

A library of 27 murine monoclonal antibodies was obtained by using human liver and heart ferritins as immunogens. The specificity of the antibodies for the two ferritins and their subunits was studied with five different methods. The antibodies elicited by the liver ferritin bound preferentially the immunogen and were specific for the L subunit. Some antibodies elicited by the heart ferritin had characteristics similar to the anti-liver antibodies, other ones bound preferentially the heart over the liver ferritin and were specific for the H subunit. Only two antibodies were able to bind both ferritins and subunits. Some anti-H and anti-L chain antibodies were used to develop and compare four types of immunoassay to quantitate isoferritins. The results indicate that heart ferritin is immunologically more heterogeneous than liver, the H and L subunits having large immunological differences with few, if any, identical epitopes; and that that the architecture of the immunoassays have a strong influence on the crossreactivity of the antibodies with the two isoferritins, probably because H and L chains are not arranged randomly in the assembled protein.

Use of a monoclonal antibody against human heart ferritin for evaluating acidic ferritin concentration in human serum

Immunoassays for acidic ferritins rich in H subunits have shown that these isoferritins are predominant in some cells such as monocytes and red blood cells but have provided conflicting results about their presence in human serum. We have used an immunoradiometric assay based on a monoclonal antibody against human heart ferritin (monoclonal 2A4) for evaluating acidic ferritin concentration in human serum. This assay proved to be highly specific for acidic isoferritins having more than 60% H subunits. Heart-type ferritin was detected in only one fifth of normal sera and sera from patients with iron overload; values were very low compared with those for basic ferritin. Acidic ferritin was found in relatively high concentrations in most patients with iron deficiency anaemia. In other disease states characterized by increased serum concentrations of basic ferritin, acidic ferritin was always less than 21% of the total ferritin. Dialysis in low-ionic-strength buffer showed that both normal and pathological sera had binding factors for human heart ferritin. We conclude that: (i) human serum contains low concentrations of acidic isoferritins which, at variance with basic ferritin, do not appear to be directly related to the amount of storage iron; (ii) the findings of the present study reinforce the opinion that basic and acidic ferritins have different functional behaviours.

[Prevention of retinal detachment in massive endovitreous hemorrhage 1a]

We have made a prophylaxis of retinal detachment resulting from massive endovitreous hemorrage by applying a silicone encirclement on rabbit eyeballs in which we have previously injected autologous blood. Because of the opacity of the means echography has shown us the moment of intervening. Retinal detachment has taken place in the 64,28% of cases, against the 91,3% of a previous experience of ours in which we made no prophylactic.

[Inhibitory action of Hodgkin's disease patients serum on T lymphocytes E rosette forming ability (author's transl)]

We have studied the E rosette forming-phenomenon on normal and pathologic lymphocytes after 24 hours of incubation in Fetal Calf Serum. The percentage of E rosette forming cells decreases more after incubation in Hodgkin's disease patients serum than in normal control serum. The findings suggest a specific interaction between serum factors and Hodgkin's disease lymphocytes surface receptors.