Verotoxigenic (enterohaemorrhagic) Escherichia coli in infants and toddlers in Czechoslovakia

The results of the investigation indicate that verotoxigenic Escherichia coli (VTEC) belonging to enteropathogenic and other serogroups including Escherichia coli O157:H7 or H- are important enteropathogens in infants and toddlers in Czechoslovakia. As to enteropathogenic serotypes, verotoxin (VT) production was proved most frequently in strains of serogroup O26, and also O111 and O128. Diseases caused by them were as a rule manifested by febrile watery diarrhoea with mucus in the stool. In two of five infants with Escherichia coli O26 :H11 with VT1 production in titres of greater than or equal to 1:512 (blood was present) in the stool and one suffered from marked abdominal pain. In one infant haemorrhagic colitis due to Escherichia coli O157:H- was found. Haemolytic uraemic syndrome associated with VTEC of serogroups O157, O26, O18, O5 and O1 with VT1 and/or VT2 was observed in six children including five who contracted the disease during an outbreak in a small town, and the source of infection was probably contaminated water. Five children recovered and one died; the postmortem examination revealed haemorrhagic colitis and necrosis of the renal cortex. Haemorrhagic colitis caused by Escherichia coli O157 in infants and toddlers differed from the course hitherto described in older subjects by fever and the presence of mucus in the stools.

[Long-term catheterization of the central venous system in children]

The authors explain the principle of central venous catheters (CVC) for long-term use, indicators for insertion, mode of insertion and principles of care of children with these special CVC. The authors inserted since 1982 42 CVC of the Broviac-Hickmann type in 32 children (age 22 days--15 years; body weight 2.4-17 kg). Since 1987 they inserted 16 CVC for long-term use with a subcutaneous capsule to 16 children and adolescents (age 1 years-17 years; body weight 11.5-73.5 kg). These CVC were inserted under general anaesthesia, in catheterization theatre. There were no technical complications. The authors treated and followed under standard protocol a group of 14 children with 20 CVC of the Broviac type (age at onset of treatment 22-715 days; body weight 2.4-10 kg) as well as the above described group of 16 children and adolescents with CVC for long-term use with a subcutaneous capsule. During treatment of children with Broviac catheters five technical complications were observed (mechanical damage of the CVC); in children with CVC with a subcutaneous capsule one technical complication was recorded (damage of the chamber of the Chemoport Vygon system, by incorrect puncture). The authors searched for thromboembolic and infectious complications. In four of 20 children with Broviac catheters purulent phlebitis of the cannulated veins was found (all died)--one thromboembolic complication developed on average after 234 days of use of Broviac catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

Vero cytotoxin-producing strains of Escherichia coli in children with haemolytic uraemic syndrome and diarrhoea in Czechoslovakia

The presence of verotoxin-producing strains of Escherichia coli (VTEC) was examined in six children with haemolytic uraemic syndrome and one child with haemorrhagic colitis. Stools were screened for strains of serogroup O157 on sorbitol-MacConkey agar for VTEC of other serogroups by serotyping. Verotoxin (VT) was tested on Vero cell monolayers: the antigenic variant of VT was assessed by neutralization experiments. Strains producing verotoxin 1 or verotoxin 2 or both were detected in the stools of all seven children. Three strains belonged to serogroup O157 (two of them to serotype O157:H7, one was non-motile) and another five belonged to serogroups O26 (two strains), O1, O5 and O18. The faeces of five children available for testing contained free VT. Production of VT was also examined retrospectively in 32 E. coli strains of serotype O26:H11 isolated from children with diarrhoea; eight (25%) of them produced moderate to high levels of verotoxin 1 despite several years storage in vitro. In conclusion, VTEC including strains of serogroup O157 seem to be an important cause of haemolytic uraemic syndrome, haemorrhagic colitis and diarrhoea in children in Czechoslovakia.

Induction of human B cell differentiation by Fc region activators. II. Stimulation of IL-6 production

Fc region fragments derived from the enzymatic cleavage of human IgG have been shown to induce human peripheral blood-derived B cells to differentiate into Ig secreting cells (ISC). The synthetic peptide p23, corresponding to residues 335 to 357 in the Fc region of human IgG1, represents a region of the molecule responsible for stimulation of ISC formation. Fc region-induced ISC formation requires at least two signals; one supplied by Fc region activators and one supplied by a T cell-derived factor(s). In this report we show that the coculture of human PBMC with pFc' or p23, results in the release of factor(s) that resemble IL-6 in its pattern of biologic activity. This conclusion is based on the observations that supernatants from Fc region-stimulated PBMC cultures contained increased levels of elements that scored as positive in two assays for IL-6: the B9.9 hybridoma growth and the CESS cell differentiation assays. Moreover, RNA from Fc region-stimulation PBMC contained increased levels of IL-6 cDNA-hybridizable elements. Finally, it was observed that rabbit anti-IL-6 inhibited the ability of supernatants derived from Fc region-stimulated PBMC cultures to induce B9.9 cell proliferation as well as p23-induced ISC formation in intact PBMC cultures. Fc region fragments induce both monocytes and T cells to produce IL-6. Taken together, these results indicate that IL-6 is produced in Fc region-stimulated PBMC cultures and is involved in B cell activation by these activators.

Induction of human B cell differentiation by Fc region activators. II. Stimulation of IL-6 production

Fc region fragments derived from the enzymatic cleavage of human IgG have been shown to induce human peripheral blood-derived B cells to differentiate into Ig secreting cells (ISC). The synthetic peptide p23, corresponding to residues 335 to 357 in the Fc region of human IgG1, represents a region of the molecule responsible for stimulation of ISC formation. Fc region-induced ISC formation requires at least two signals; one supplied by Fc region activators and one supplied by a T cell-derived factor(s). In this report we show that the coculture of human PBMC with pFc' or p23, results in the release of factor(s) that resemble IL-6 in its pattern of biologic activity. This conclusion is based on the observations that supernatants from Fc region-stimulated PBMC cultures contained increased levels of elements that scored as positive in two assays for IL-6: the B9.9 hybridoma growth and the CESS cell differentiation assays. Moreover, RNA from Fc region-stimulation PBMC contained increased levels of IL-6 cDNA-hybridizable elements. Finally, it was observed that rabbit anti-IL-6 inhibited the ability of supernatants derived from Fc region-stimulated PBMC cultures to induce B9.9 cell proliferation as well as p23-induced ISC formation in intact PBMC cultures. Fc region fragments induce both monocytes and T cells to produce IL-6. Taken together, these results indicate that IL-6 is produced in Fc region-stimulated PBMC cultures and is involved in B cell activation by these activators.

[Acute interstitial nephritis with uveitis in children and adolescents]

Acute non-suppurative tubulointerstitial nephritis was recorded within a five-month interval in 1988 in one girl and two boys aged 15, 16 and 12 years. The common feature was non-selective proteinuria, slight glycosuria, anaemia, a sedimentation rate of more than 100 mm/2 hrs hyperatotaemia not calling for dialyzation treatment (268, 354 and 266 mumol/l plasma creatinine resp.), a markedly impaired concentrating capacity (540, 593 and 520 mOsm/kg urine resp.). In all patients circulating serum immunocomplexes were elevated (PEG-IKEM). One patient developed acute uveitis at the onset of the disease, the remainder after 5 and 6 months resp. and in all there was a tendency of a protracted course and relapses resp. In two patients uveitis was diagnosed by an aimed examination by means of a slit lamp at a time when there were not yet any clear signs of affection of the eyes. All patients were subjected to percutaneous renal biopsy which revealed an interstitium with uneven lymphoplasmacytic cellulization with infrequent eosinophil and neutrophil polynuclear cells. Electron microscopy revealed sections of varying size with fibrotization of the tubular basal membrane; the glomerular changes were not typical. All patients had prednisone treatment and their renal functions were gradually restored. Despite extensive serological examinations, the aetiology was not cleared, however before the onset of the disease the patients had penicillin, cotrimoxazol and erythromycin resp.

[Microbiological aspects of infection with verotoxin-producing E. coli strains in children with the hemolytic-uremic syndrome]

The authors examined the faeces of five children with haemolyticuraemic syndrome for the presence of E. coli producing verotoxin (VTEC) and free verotoxin (VT). For detection of strains of serotype O157:H7 they used sorbitol MacConkey agar in combination with biochemical tests and typing of sorbitol negative strains. For detection of strains belonging to the other VTEC serogroups they used serotyping of 24 E. coli colonies from End media. VT was assessed in lysates and supernatants of cultures, on cell cultures of Vero cells, and the antigenic VT type was assessed by neutralization experiments. Strains corresponding as to serotype or O group to VTEC were detected in faeces of all five children. Two strains belonged to the serotype O157:H7 and had a typical biotype; another four strains belonged to serogroups 026 (2 strains), 05 and 01. All strains produced verotoxin, either VT1 or VT2 or both. In the faecal filtrates of all five children free VT was present. In conjunction with the haemolytic-uraemic syndrome in children in the CSSR E. coli producing verotoxin are found, incl. strains of serotype O157:H7, the detection of which was not described hitherto.

[The physician and the computer. 30. Evaluation of time, different aspects of the same problem]

The authors mention different ways in which a give problem can be described within the framework of the theory of sets, logic, mathematical analysis, statistic and cybernetics. As an example of the confrontation of the mentioned aspects they discuss different approaches to the evaluation of time as a variable--temporal logic, Markov chains, theory of catastrophes which play a part in medicine, in particular in prognostic considerations. These different aspects make possible solutions which may differ and their application depends in particular on the purpose for which they are intended.

[The physician and the computer. 29. Learning systems and neuron networks]

The authors discuss basic properties of the process of learning as a form of artificial intelligence. They deal with the application of adaptive and learning systems in the area of identification, regulation, manipulation and recognition. A very important perspective trend is learning in a medium of neuron networks which are actually software or hardware simulation of the functional architecture of the CNS. The authors discuss peculiar features of representation of knowledge, structure and mode of function of this neuron network. Finally the authors give examples of the solution of optimalization and classification tasks within the framework of neurocomputers.

[The nomenclature and concept of care of children and adolescents with renal insufficiency]

The standard of care of children and adolescents with chronic renal failure and chronic renal insufficiency in the CSR does not correspond to the european average so far. Dialysis- treatment, contrary to treatment of adults, was started at the beginning of the eighties. The reason was that equipment for dialysis was not readily available. At presents the basic prerequisites have been created for dialysis and transplantation in the mentioned age groups. Rapid improvement will be helped also by organizational provisions the concept of which outlined in the paper.

[Familial hematuria and Alport's syndrome]

In their review the authors discuss the history of Alport's syndrome, its nomenclature, incidence, genetics, clinical diagnosis. The authors emphasize electron microscopic findings and criteria of the diagnosis (haematuria or renal failure in the family, progressive nervous deafness, typical changes of the basal glomerular membrane (GBM) and ophtalmological findings of lenticonus or perimacular spots. Familial haematuria (FH) is according to the authors defined as haematuria in several members of the family. Based on data in the literature and the authors' experience, the authors discuss the differential diagnosis of FH where Alport's syndrome is relatively rare. A far more frequent unit is benign familial haematuria characterized morphologically as isolated thinning of the GBM. In some cases these patients are threatened by iatrogenic damage from unnecessary and invasive diagnostic method. The finding of thinned GBM and normal renal function in the parents and grandparents suggest a favourable prognosis also in child patients. Cases of familial glomerulonephritis or idiopathic syndrome with glomerulosclerosis or familial IgA nephropathies are relatively rare. Familial haematuria is are relatively rare. Familial haematuria is relatively frequent (according to the authors 20% of all obscure haematurias) and their diagnosis is based on systematic examination of the urine in other members of the patient's family who also suffer from haematuria.

[Skeletal muscle involvement in enthesopathy of the lateral epicondyle of the humerus (so-called tennis elbow)]

Muscle specimens from the origin of the m. extensor carpi radialis brevis, were obtained from 53 patients suffering from chronic enthesopathy of the lateral epicondyle of humerus (EELH). Frank neurogenic atrophy as well as disuse atrophy were caused by radicular irritation due to the cervicobrachial syndrome. The borderline and/or reinnervation patterns of the muscle lesion may be due to the compression neuropathy of the peripheral branches of the radial nerve or may reflect adaptation of the muscle to the chronic nociceptive stimulation in sense of chronic reflex atrophy of the muscle. The elbow joint, and especially the humeroradial joint in cases of EELH represents a functional unit. Any damage to any part leads to secondary reparative and adaptive changes in other structures including the muscle.

Freeman-Sheldon syndrome: a disorder of congenital myopathic origin?

Freeman-Sheldon syndrome was diagnosed in an unrelated adult man and woman, with severe abnormalities of the extremities but only slight anomalies of the face. Electromyography and muscle biopsy showed a myopathy which was classified as a congenital disproportion of fibre type and seemed to be the primary cause of the deformities. This allowed classification of the syndrome as a separate type of myopathic arthrogryposis.

[Calcifying uremic arteriopathy]

28 cases of calcifying arteriopathy were found among 217 autopsies of uremic patients (96 of them treated by hemodialysis). It was confined to one organ (10 cases) or generalized (18 cases). Morphology and relation of arteriopathy to secondary hyperparathyroidism were presented. Calcifying uremic arteriopathy ranks among calcifylactic syndromes and is taken for a dystrophic calcification from the formal pathogenetic point of view.

[Skeletal muscle in uremia]

A post mortem histochemical study of girdle muscles was performed in 54 persons having died of uremia (42 of them treated by long-term dialysis). The most important findings was an atrophy of 2B-type fibres which was combined with osteomalacia in 36% dialysed patients. An etiopathogenetical discussion included toxic effects of parathormone and aluminium ions, disturbance of glycolysis and uremic carnitine deficiency.