[Perinatal pertussis: from mother to child]. / Perinatale pertussis: van moeder naar kind.

Two infants, a girl, aged four weeks, and a boy, aged three weeks, came to our attention with poor feeding and weight loss. Later the typical cough of pertussis appeared. Serological testing confirmed that both patients' mothers had recently had pertussis. One mother suffered from severe and typical coughing periods even throughout labour. Despite the vaccination program in the Netherlands, each year new-born infants with pertussis require hospitalisation. Pertussis during the neonatal period is seldom described. Adults can suffer from pertussis, even when they have been vaccinated in childhood. They then become contagious for unvaccinated infants. Pertussis during the neonatal period is an insidious disease with sometimes severe complications. If pertussis is suspected in mothers with new-born infants or pregnant women towards the end of the pregnancy, they should be treated with antibiotics to prevent pertussis in the new-born infant.

New insights into the pathogenesis of Langerhans cell histiocytosis.

Langerhans cell histiocytosis (LCH) is an enigmatic disease, usually occurring in the young. Despite the fact that clinical entities of the disease have been known for some time, the pathogenesis and etiology remain obscure. A major stride toward understanding LCH was taken when ultrastructural and immunohistochemical studies identified the "histiocytic" cells in LCH lesions to be members of the Langerhans (dendritic) cell system. Another finding of importance was the discovery that LCH cells within the lesions are clonal. Clonality alone, however, is not enough to define LCH as a neoplasm. In this article, we review the recent developments in the pathogenesis and etiology of LCH and discuss the implications of these findings.

The presence of cytokines in Langerhans' cell histiocytosis.

Langerhans' cell histiocytosis (LCH) is characterized by an accumulation and/or proliferation of cells with a Langerhans' cell (LC) phenotype. The aetiology and pathogenesis of LCH are unknown; it is suggested that LCH is caused by an immunological dysregulation. Production of cytokines is a central feature of immunological regulation. LCH lesions and normal LCs were studied for the presence of cytokines known to influence the functioning of LCs: IL-1 alpha, IL-1 beta, IL-4, GM-CSF, IFN-gamma, TGF-alpha, TGF-beta, bFGF, and TNF-alpha. Cytokines were abundantly present within LCH lesions; LCH cells stained for IL-1 alpha, IL-1 beta, IL-4, GM-CSF, TGF-alpha, TGF-beta, TNF-alpha, and IFN-gamma. Macrophages, lymphocytes, eosinophil granulocytes, and, surprisingly, multinucleated giant cells were also sources of cytokines. These results suggest that cytokines play a prominent role in the pathogenesis of LCH and may explain phenomena that often occur in LCH, such as osteolysis and fibrosis and the recruitment of typical inflammatory infiltrates. The results also suggest that a 'down-regulatory' signal is lacking in LCH, resulting in an accumulation and/or proliferation of abnormal LCs.

Expression of cellular adhesion molecules in Langerhans cell histiocytosis and normal Langerhans cells.

Langerhans cell histiocytosis (LCH) is characterized by lesions with an accumulation and/or proliferation of Langerhans cells (LCs). Little is known of the etiology and pathogenesis of LCH. Although the relation between the LCH cell and normal LCs is currently uncertain, the localizations of the LCH cells is considered aberrant when compared with normal LCs. Cellular adhesion molecules (CAMs) are known to play an important role in a variety of cell functions such as migration, antigen presentation, and activation. Aberrant migration of LCs may play a role in the pathogenesis of LCH. We investigated CAMs in 27 tissue specimens of 20 patients with LCH retrieved from our files during the last 15 years. LCH cells showed strong expression of CAMs such as CD54, CD58, and the beta 1-integrin alpha 4 that are upregulated during activation of normal LCs. In contrast, CAMs not found on normal LCs could be demonstrated in a number of cases on LCH cells like CD2, CD11a, and CD11b. Also CD62L, normally expressed only by epidermal LCs, could be detected on LCH cells. The integrins alpha 5 and alpha 6, not or only weakly found on epidermal LCs and highly expressed by activated LCs, could not be demonstrated on LCH cells. Our data suggest abnormal expression of CAMs on LCH cells that may contribute to abnormal migration of LCs in LCH. The aberrant phenotype of LCH cells has characteristics of both epidermal LCs and activated LCs and may be indicative of an arrested state of activation and/or differentiation of LCs.

Paraneoplastic manifestations in children.

Paraneoplastic manifestations are signs and symptoms observed in patients with cancer, distant from the tumour or its metastases and not caused by invasion, obstruction or bulk mass. In children with cancer, paraneoplastic manifestations are rare and distinct from those observed in adults. Knowledge about paraneoplastic manifestations can be of great clinical importance because they may be the presenting sign of a tumour or its recurrence and hence facilitate early diagnosis. In contrast, they sometimes mask the symptoms of a tumour and cause diagnostic delay. In this review, paraneoplastic manifestations in children are described, including hypercalcaemia, Cushing syndrome, precocious puberty, opsoclonus/myoclonus, acquired von Willebrand disease, watery diarrhoea syndrome, and hypertension. The mechanisms causing these manifestations are also discussed.

Langerhans' cell histiocytosis: expression of leukocyte cellular adhesion molecules suggests abnormal homing and differentiation.

Langerhans' cell histiocytosis (LCH) is characterized by an accumulation of cells with a Langerhans' cell (LC) phenotype. Most patients present with solitary skin or bone lesions, but multi-organ lesions may appear. Twenty-two LCH-tissue sections from 13 children and adolescents, with lesions at different sites, were investigated for the expression of leukocyte cellular adhesion molecules. Surprisingly, the LCH cells showed expression for CD2 in 11 lesions. Staining of LCH cells for CD11a and CD11b was positive in six and three lesions, respectively. Staining for CD11c, CD44, CD54, and CD58 was found consistently positive in all lesions. The strong reactivity for CD54 (intercellular adhesion molecule-1) and CD58 (leukocyte function antigen-3) is in contrast with the epidermal LC. LCs in culture are known to up-regulate the expression of CD54 and CD58. These changes are thought to reflect the in vivo situation during migration of activated LCs from the skin to the draining lymph node. It can be concluded that the abnormal cells in LCH not only share characteristics with the epidermal LC, but have additional characteristics of the activated LC, a cell capable of migration. The presumed immunological dysregulation in LCH may affect the expression of cellular adhesion molecules, reflected by the inconsistent expression of CD11a and CD11b and the unexpected expression of CD2. These features may contribute to migration of LCs to aberrant sites in combination with abnormal persistence and proliferation.

Properties of a potent LHRH antagonist (Org 30850) in female and male rats.

Org 30850 (Ac-D-pClPhe1,2,D-Bal3,D-Lys6,D-Ala10-LHRH) is a novel LHRH antagonist, which is being developed for the treatment of hormone-dependent disorders. The activities of this compound with respect to its endocrinological properties and side-effects were tested in rats and the results were compared with one of the first LHRH antagonists: Ac-D-pClPhe1,2,D-Trp3,D-Arg6,D-Ala10-LHRH (Org 30276). A single subcutaneous (s.c.) dose of 0.3 micrograms/kg Org 30850 administered to rats in pro-estrus gave inhibition of ovulation in approx. 50% of the rats, whereas Org 30276 was approx. 4 times less potent. The effect of a single s.c. injection of Org 30850 on testosterone levels in young adult male rats was also studied. The administration of 250 micrograms/kg or higher of Org 30850 induced a significant decrease in testosterone levels after 3 h, this effect lasted for at least 48 h. Treatment of female rats for 14 days with a daily dose of 12 micrograms/kg Org 30850 decreased statistically significantly uterine and ovarian weights. At a daily dose of 50 micrograms/kg Org 30850 completely suppressed estrous cycles and significantly decreased estradiol and FSH serum levels. The LH levels were below the detection level in both control and treated animals on the (expected) second day of di-estrus. Treatment of male rats for 14 days (25-200 micrograms/kg) resulted in a dose-dependent reduction of the gonads, accessory sex organs, testosterone levels and gonadotrophins. The decrease in gonadal function in both sexes was reversible since the females proved to be as fertile as the controls 6 weeks after the last treatment and an almost complete recovery of the weight of testes, seminal vesicles and ventral prostate was observed in the males 4 weeks after cessation of treatment. In contrast to Org 30276, Org 30850 exerted very slight irritation at the site of injection and no edematous reactions in the extremities at a daily dose of up to 8 mg/kg in male rats. It is concluded that Org 30850 is a very potent LHRH antagonist without edematous reactions and with a more favourable therapeutic index than Org 30276.

Deep juvenile xanthogranuloma: a lesion related to dermal indeterminate cells.

Juvenile xanthogranuloma (JXG) is considered to represent a lesion originating from histiocytes. Three cases of deeply located JXG and one case of cutaneous JXG were studied. One case with extensive mesenteric involvement presented with hypercalcemia and one case with liver involvement had hypergammaglobulinemia. Immunohistochemistry, electron microscopy, karyotyping, and DNA flow cytometry were used to determine the phenotype of the cells involved and to find further clues as to the histogenesis of these lesions. Immunohistochemically, all lesions studied expressed the CD1a antigen but showed no labeling for S-100 protein. The cells did not contain Birbeck granules. From these data it is suggested that the cells involved are of indeterminate dermal histiocyte lineage and that occurrence of deep located lesions of JXG may be due to migration of CD1 a-positive histiocytes.