The diagnostic reliability of anti-endomysial antibody in celiac disease: the north Israel experience

Assessment of anti-endomysial antibody (EMA) for the diagnosis and follow-up of celiac disease (CD) is widely accepted, but its applicability has never been investigated in Israel. We therefore investigated EMA as a diagnostic tool in a pediatric population, residing in the northern part of Israel, with suspected celiac disease. EMA was assessed by an indirect immunofluorescence assay using monkey esophageal sections as a substrate in 22 active CD, 17 non-active CD, and 22 non-CD children. EMA titers were correlated with small bowel mucosal pathology. Sensitivity and specificity of EMA were 100%. EMA levels are diet dependent, increasing on a gluten-containing diet and decreasing with gluten withdrawal after 3-12 months. EMA is a reliable marker for the diagnosis of CD, and reflects gluten intake changes and patients' dietary compliance. In our laboratory, EMA is suitable for the diagnosis and follow-up of CD.

Health profile of Ethiopian immigrants in Israel: an overview

The health profile of two groups of Ethiopian immigrants in Israel was evaluated. Trichophytosis and active trachoma were observed in 5%-8.7% of prepubertal children. Among adults 13% had corneal opacities and 10.4% had cataracts. Goiter, spastic bronchitis, valvular heart disease, leprosy and onchocerciasis were prevalent. Malnutrition was common, with average body weights ranging from 72.4% to 85.2% of normal. Anemia was observed in 6.3% of young children and 70% of all immigrants. Fifty percent of children over 12 years and 98% of adults over 40 years of age had been exposed to hepatitis B virus; 9.8%-11.8% were HBsAg carriers. Tuberculin tests were positive in 9.8%-13%; and intestinal parasites were identified in 86%-98%. Hospitalization was required for 15.7% of immigrants arriving during the period 1978-90, and for 3.7% of those arriving in mid-1991 (Operation Solomon).

Cardiovascular abnormalities in children with fragile X syndrome

It has been suggested by several authors that the prevalence of mitral valve prolapse and aortic root dilation is increased in individuals with the fragile X syndrome. The prevalence of these abnormalities in young children with fragile X has not been established. Sixteen boys and 1 girl 13 years or younger were studied. Only 1 child (6%) had the typical examination findings of mitral valve prolapse, although his echocardiogram was normal. From this study it appears that cardiac abnormalities in fragile X syndrome develop in late childhood and adolescence. It seems important to follow these children carefully so that these cardiac abnormalities can be documented when they do develop.

Hepatitis B virus infection in Ethiopian immigrants to Israel

Two groups of immigrants from Ethiopia, one of 86 and the other of 165 individuals, aged 0-40, were examined for hepatitis B virus (HBV) infection in 1987-88, 3-7 years after their arrival in Israel. The results were compared with those obtained in the same age-group among Ethiopians who immigrated to Israel in 1980-82. The immigrants were found to be in good physical condition, their liver function tests were normal and no clinical evidence of chronic liver disease was found. Of the 22 children aged 0-4, 16 had anti-HBs as a result of vaccination at birth against HBV and they were excluded from the comparative study. In the age-groups 5-40 there was no significant change in the percentage of individuals positive for HBsAg, anti-HBs or anti-HBc only, compared with the group examined in 1980-82. There were two significant findings in this study: a) In 1987-88 [corrected], 8-9% of HBsAg-positive individuals had HBeAg and 64-81% had anti-HBe, while in 1980-82, 36% of those positive for HBsAg had HBeAg and only 25% had anti-HBe. b) At the time of arrival recent infection by HBV was indicated by the presence of IgM anti-HBc in 57% of those positive for HBsAg and 21% in whom anti-HBc was the sole serological HBV marker. In 1987-88 no IgM anti-HBc was found in HBsAg-positive persons or in those with anti-HBc only. These results indicate that most HBV infections in this population had occurred before their arrival in Israel. There is a profound change in the epidemiology of HBV infection in this Ethiopian population following immigration, which is probably due to environmental changes as well as to vaccination against HBV of all young children aged less than or equal to 3 years.

Radio-ulnar synostosis in Williams syndrome. A frequently associated anomaly

Limitation of supination and pronation of the forearm has been occasionally described in individuals with Williams syndrome. It was found in 26% of 23 subjects examined, and was associated with a spectrum of severity of radio-ulnar synostosis on radiography. The occurrence of this functional motor impairment in a substantial subset of persons with Williams syndrome is relevant, because its evaluation is important in habilitation planning.

Evidence for the existence of circulating monoclonal B-lymphocytes in multiple myeloma patients

Multiple myeloma is characterized by the proliferation of a single clone of plasma cells producing a homogeneous immunoglobulin fraction. In this disease, plasma cells home essentially in the bone marrow. However, controversy exists whether peripheral blood B-lymphocytes in patients with multiple myeloma (MM) are part of the malignant clone. We investigated clonal immunoglobulin gene rearrangement (IgGR) in T-cell-depleted peripheral blood mononuclear cells as well as in bone marrow of these patients. Seven out of 17 MM patients demonstrated an identical IgGR in bone marrow and peripheral mononuclear cells, these patients were in an active stage of the disease. In nine patients in plateau phase, clonal IgGR could not be detected in peripheral blood. Peripheral mononuclear cells from ten patients with monoclonal gammopathies of undetermined significance (MGUS) were also examined and no IgGR was detected. The existence of monoclonal B-lymphocytes in the circulation of patients with MM suggests a mechanism whereby the malignant clone homes in the bone marrow through peripheral blood. These findings may also be used for the evaluation of patients with active myeloma and the determination of plateau phase.

Excretion of urinary protein induced by extracorporeal piezoelectric lithotripsy

An investigation was carried out into renal injury caused by extracorporeal piezoelectric lithotripsy (EPL) using an EDAP lithotriptor. Four urinary proteins, with a molecular weight range of 160000-14500, immunoglobulin G (IgG), N-acetyl-beta-glucosaminidase (NAG), albumin and lysozyme, were monitored in 27 patients 1 day before and 1, 7, 30, 90 and 180 days after unilateral EPL treatment. All patients had non-obstructive renal stones, previously untreated. Apart from 5 patients with stablised hypertension and 6 with persistent urinary infections due to the infected stones, all patients appeared healthy, as confirmed by clinical, haematological and biochemical investigations. Only albumin levels increased significantly 1 day after treatment; statistically nonsignificant increases and decreases were recorded in the levels of NAG and lysozome respectively. IgG was beyond the limit of detection (less than 0.5 mg%) in all patients. The albumin level returned to normal 7 days after treatment. The EPL-induced increase in albumin was recorded in 88% of patients, compared with increased levels of NAG in 46% and lysozyme in 64%, mainly in those with infected stones. These findings indicated a transient glomerular injury after EPL treatment.

Persistent Schistosoma mansoni infection in Yemeni immigrants to Israel

Following sporadic reports on persistent Schistosoma mansoni (S.m) infections in Israelis of Yemeni origin, we systematically surveyed a group of 129 individuals who immigrated to Israel 38 years ago. Physical examination was uneventful in all members of the study group. A single stool examination revealed S.m eggs in 15 of 129 subjects (12%). Specific anti-S.m. IgE was detected in the sera of 48 individuals (37%). Among the 15 egg-positives, 14 had specific IgE (sensitivity 93.3%), but only 80 of the 114 egg-negatives were also negative for specific IgE (specificity 70%). This specific IgE positivity among egg-negatives in the study group (34/114) and its complete absence from two control groups, one of them comprising Yemenites born in Israel, suggest either an S.m infection with low egg output stemming from a low worm burden or low fecundity of senescent worms, or occult infections. Since the S.m infections could not have been contracted in Israel, our findings point to inordinately persistent infections in the members of our study group, and incidentally also to the diagnostic usefulness of specific IgE testing in such cases.

Fragile X syndrome: recognition in young children

In recent years, a number of articles have appeared in the literature concerning the fragile X syndrome; however, in few cases was the diagnosis of the syndrome in young children discussed. A review of 20 children younger than 7 1/2 years of age who had the fragile X syndrome seen at the Cincinnati Center of Developmental Disorders was undertaken in an attempt to establish guidelines that would aid the practicing physician in determining which children should have a chromosomal analysis. All children were developmentally delayed; 95% had speech delays. Short attention span with hyperactivity, temper tantrums, mouthing of objects persisting at an age beyond when it would be expected, autistic behaviors, and poor gross motor coordination were seen in 50% or more of the children. Mental retardation was present in the family history of 65%, and 90% had a family history of at least one of the following: mental retardation, learning disabilities, or hyperactivity. The most common physical findings were long and/or wide and/or protruding ears, prominent jaw and/or long face, high arched palate, and a flattened nasal bridge. The fragile X syndrome can be recognized by noting key aspects of the behavioral and family histories as well as the physical findings.

Bone marrow biopsy in multiple myeloma: a clinical pathological study

Forty-two bone marrow aspirates and biopsies during follow-up examinations from patients with multiple myeloma were reviewed to determine whether the results correlate with the clinical state of the patient at the time of examination. The percentage of plasma cells on biopsy and aspiration, cytological immaturity, patterns of plasma cell infiltration, and the presence or absence of multiple lymphoid nodules and marked fibrosis were cross-tabulated with clinical parameters (hemoglobin levels, osteolytic lesions, and renal function). Hemoglobin levels less than 10 g/dl were more frequent in those with greater than 70% plasma cells on either aspiration or biopsy (P less than 0.05). A nodular histological pattern on biopsy, however, had a higher correlation with hemoglobin levels less than 10 g/dl, and serum creatinine levels greater than 2 mg/dl, than did plasma cell number. The presence of lymphoid nodules correlated with less lytic bone lesions. The degree of fibrosis and plasma cell immaturity did not correlate with any of the clinical parameters. Our findings suggest that reports on bone biopsies should include in addition to the number of plasma cells, the pattern of plasma cell infiltration and the presence or absence of multiple lymphoid nodules.

Uncombable-hair syndrome

Four children had short, unmanageable, pale blond hair. They had no associated abnormalities and no family histories of abnormal hair. Light microscopy of the hair was normal in three patients, with pili torti present in the fourth. Electron microscopy of hairs from all four children revealed longitudinal grooves in the hair shaft, diagnostic of uncombable-hair syndrome.

Linear nevi, hemihypertrophy, connective tissue hamartomas, and unusual neoplasms in children

The association of cutaneous nevi, hemihypertrophy, and connective tissue overgrowth has been described in many patients. We report long-term follow-up in two boys with such association who in addition developed testicular neoplasms. One patient also had progressive spinal cord compression as a result of stenosis of the spinal canal, and required amputation of a severely deformed limb. The importance of careful, long-term management in such patients is emphasized.

Hepatitis B virus infection and liver disease in Ethiopian immigrants to Israel

We assessed infection with hepatitis B virus in 357 Ethiopians who immigrated to Israel. Hepatitis B virus infection, as measured by the presence in the serum of HBsAg, anti-HBs, or anti-HBc, started at an early age (35% at the age of 1 to 4 years) and reached an overall rate of 98% in individuals over 40 years old. A high rate of HBsAg antigenemia in the young age group (19% at the age of 1 to 8 years) was associated with HBeAg and serum hepatitis B virus DNA. However, hepatitis B virus DNA was rarely detected in HBsAg-positive serum of older individuals who were anti-HBe-positive. No hepatitis B virus DNA sequences were detected in the serum of individuals who had anti-HBs. Despite the extremely high rate of hepatitis B virus infection that occurred at an early age, no clinical evidence of chronic liver disease in this population was detected.

Bisalbuminaemia in pancreatic ascites

A patient with pancreatic ascites is described. Electrophoresis of the patient's serum demonstrated bisalbuminaemia, which disappeared after resolution of the ascites.

Structural analysis of hepatitis B surface antigen by monoclonal antibodies

A method has been developed for the analysis of hepatitis B surface antigen (HBsAg) antigenic structure at the molecular level that creates "fingerprints" or "signatures" of various hepatitis B viral (HBV) strains. This technique employs high affinity IgM and IgG monoclonal antibodies (anti-HBs) directed against distinct and separate determinants on HBsAg. In performing this antigenic structural analysis, separate binding curves for different monoclonal anti-HBs are generated by measuring immunoreactivity in serial dilutions of HBsAg-positive serum by radioimmunoassay. Since the HBsAg concentration in serum is unknown, the binding profiles of groups of samples are aligned by an iterative least-squares procedure to generate the numerical signature characteristic of the viral strain. The numerical signatures are then displayed on a computer-graphic plot. The signature profiles of HBsAg subtypes are a true reflection of their antigenic structure, and in vertical and horizontal transmission studies the molecular characteristics of the viral epitopes are conserved. By signature analysis we found substantial antigenic heterogeneity among the ayw3 strain both in the U.S. and France, as well as in populations of the Far East and Africa. Populations in Ethiopia, Gambia, and the Philippines were infected with two antigenically distinct HBV strains. In some newly identified HBV strains, it was found that epitopes identified by some monoclonal antibodies were absent or substantially reduced, which suggested that a genetic mutation may have occurred. Thus this study suggests that there is far more antigenic heterogeneity in HBV than previously recognized. These variants are antigenically distinct from each other at the epitope level, and were heretofore unrecognized by polyvalent anti-HBsAg antibodies.

Rubella immunity measured by hemagglutination inhibition and enzyme-linked immunosorbent assay

Evaluation of the immunity to rubella by the hemagglutination inhibition (HI) test and an enzyme-linked immunosorbent assay (ELISA), in a series of 1,697 sera collected from women of childbearing age, showed a 65% agreement; 33% were ELISA-positive and HI-negative at a 1:16 dilution and only 2% were ELISA-negative and HI-positive. Among 241 women given the rubella vaccine following an HI titer of less than 1:16, no change was observed in 208 in the postimmunization HI test, but only 11 were negative when ELISA was used. The retesting by ELISA of 110 preimmunization sera showed that 67 (61%) were positive, and therefore the vaccine had been unnecessarily administered. In a series of 72 HI tests that did not permit interpretation because of a nonspecific reaction, ELISA provided quite clear results. ELISA appears to be a sensitive technique for the evaluation of the true immune status to rubella in sera with low HI levels (less than 1:16), as well as in circumstances where the HI test reacts nonspecifically.

Metacarpophalangeal pattern profile analysis in Sotos syndrome

The metacarpophalangeal pattern profile (MCPP) was analyzed on 16 Sotos syndrome patients. A mean Sotos syndrome profile was produced. Correlation studies confirm clinical homogeneity of Sotos syndrome individuals. Discriminant analysis of Sotos syndrome patients and normal individuals produces a function of two MCPP variables and age, which may provide a useful tool for diagnosis.

Epidemiology of rubella and congenital rubella infection in Israel, a country with a selective immunization program

A rubella immunization program directed at girls aged 12 years started in Israel in 1973, and its extension in 1980 to women of childbearing age had produced by 1983 several changes in the epidemiologic pattern of rubella infection in women of childbearing age and in the risk of congenital rubella: a 55%-77% decline in the incidence of the disease in the 15-44-year age group; a progressive reduction in the rate of seronegativity among women from greater than 20% to less than 10%; a risk of infection during pregnancy and a percentage of abortions associated with rubella infection in the 1983 outbreak that were one-twelfth and one-tenth, respectively, the values associated with the 1978 and 1979 epidemics; and an evident decrease in the frequency of cases of congenital rubella, as detected by either passive or active surveillance. It is predicted that of the women who will be pregnant in 1985, 98.2% and 94.3% of those in the 18-23 year and 24-44 year age groups, respectively, will be immune by the end of 1984.

Monocyte suppressor function in burns: T cell-monocyte interaction in mediating suppression

Reduced in vitro T cell mitogen-induced transformation, low proportion of T cells and increased proportion of non-T cells were found in blood mononuclear cells of patients with severe burns 3-12 days after the injury. High spontaneous proliferation of non-T cells was observed and could be related mainly to the B cell fraction. Monocytes mediated suppression of mitogen-stimulated T cell proliferation. We further studied the role of monocytes in the enhanced suppressor activity of Con A-activated T cells and found that in this assay system, the patient's T cells mediated suppression in collaboration with monocytes. In vitro, increased suppressor function was probably the result of in vivo stimulation of inhibitory activity ascribed to both monocytes and T cells of patients. Addition of indomethacin to cell cultures markedly reduced suppression of lymphocyte proliferation. Less significant reduction was noted when the patient's T cells were activated in vitro by Con A. Adjuvant treatment of burn patients with indomethacin may play a role in alleviating suppression of immune response in these patients.

Pediatric manpower needs in the area of developmental disorders and other chronic handicapping conditions

The purpose of this study was to determine the availability of and need for pediatricians specifically trained in the diagnosis and care of children with developmental disorders and/or other chronic handicapping conditions. Questionnaires were sent to department chairmen of 260 pediatric residency programs. Results of the survey are presented. On the basis of 73% responses, it is concluded that a need for pediatricians trained in developmental disorders and/or other chronic handicapping conditions exists. There were at the time of the study 32 open positions for pediatricians with such training. Eighty-four pediatric residents were interested in a fellowship and an additional 79 were considering it.

A recognizable phenotype in a child with partial duplication 13q in a family with t(10q;13q)

A case of partial duplication 13q14 leads to qter is reported in a 9-year-old male with clinical symptoms which include trigonocephaly and synophrys, producing an easily identifiable phenotype. The chromosome duplication resulted from a familial t(10;13)(qtr;q14). Subsequently, a normal balanced carrier sibling was diagnosed prenatally.

A new surgical procedure for correction of lip deformity in cranio-carpo-tarsal dysplasia (whistling face syndrome)

A child with cranio-carpo-tarsal dysplasia or whistling face syndrome is described together with a new surgical procedure for the correction of the mouth deformity. The syndrome is rare; only approximately 40 cases have been described in the literature since 1938. Correction of the facial appearance is of great importance to the affected individuals because of emotional problems they may develop as a reaction of their anomalies. Although the majority of cases have been sporadic, the syndrome can be transmitted as an autosomal dominant trait. Therefore, genetic counseling for affected persons should be offered.

Rubella antibodies in women of childbearing age during an epidemic and the two years thereafter

An epidemic of rubella started in the south of Israel late in 1971, and reached the north of the country in the spring of 1972. Between April 1972 and April 1975, 14,149 women of childbearing age from Haifa and the north of Israel were examined for rubella antibodies by hemagglutination inhibition (HI) and complement fixation (CF) tests. During the year of the epidemic, CF antibody titers of greater than or equal 16 were found in 9.3% of cases with HI antibody titers of 64, in 37.7% of cases with HI titers of 128, and in 71.7% of cases with HI titers of greater than or equal 256. Two years later there were no women with CF antibody titers of greater than or equal 16 among those with HI titers of 64, and the percentage with CF antibody titers of greater than or equal 16 had decreased to 4.3% among women with HI titers of 128 and to 38.7% among those with HI antibody titers of greater than or equal 256. These results show that the determination of CF antibody titers may be useful in the serodiagnosis of recent rubella infection, especially diring an epidemic occurring several years after a previous one. The epidemic hardly altered the percentage of women susceptible to rubella. Although vaccination of 12-year-old girs was introduced in Israel in 1972, careful surveillance of women of childbearing age still remains necessary for detection and vaccination of susceptible nonpregnant women.

Early results of an extensive rubella epidemic

The extensive rubella epidemic which occurred in Israel in 1972, had a considerable impact on the population at risk: 1. The spread of rubella infection into the community strongly influenced the extent of legal abortions: (a) 1 x 5 as many abortions for all causes were recorded in the epidemic year, as compared to the average number recorded in the three-year pre-epidemic period; (b) about 20 per cent of all abortions were associated with a history of exposure to rubella in the first months of pregnancy. 2. The incidence of congenital rubella diagnosed up to six months from birth varies greatly: the attack rate was 11.8 per thousand live births in an area inhabited by a population whose religious belief generally prevented the practice of abortions, as opposed to a significantly lower rate of 1 x 7 per thousand in a population with a liberal approach to abortions. 3. Ten months after the epidemic subsided, the percentage of female subjects of childbearing age lacking rubella HI antibody was very similar to that found in the same age group, several years before the epidemic.