Chlamydia pneumoniae in children attending day-care centers in Gävle, Sweden.

BACKGROUND: The epidemiology of Chlamydia pneumoniae in healthy children has not been established. METHODS: This investigation used polymerase chain reaction (PCR) to study the epidemiology of C. pneumoniae in presumed healthy children. Four hundred fifty-three children and 142 personnel at 9 day-care centers were investigated for carriage of C. pneumoniae. Children found to be positive by PCR were also investigated with serology, and their family members were tested with PCR. RESULTS: One hundred and three (22.7%) children had a positive PCR, as had 33 (23.2%) personnel. Fourteen percent of the children younger than 3 years had a positive PCR test compared with 26% of the older children (P < 0.01). No correlation was found between respiratory symptoms and carriage of C. pneumoniae. Mothers were more often positive in the PCR test as compared with fathers (relative risk, 2.59; 95% confidence interval, 1.16 to 5.78). Antibodies to C. pneumoniae were found in 27 of 97 PCR-positive children; only 2 of whom were younger than 3 years. CONCLUSION: C. pneumoniae can be commonly found in young children attending day care. Most of the youngest children did not develop specific antibodies. Children may have subclinical infections with C. pneumoniae. The organism seems to be easily communicable among individuals living in close proximity.

Vaginal disinfection with chlorhexidine during childbirth.

The purpose of this study was to determine whether chlorhexidine vaginal douching, applied by a squeeze bottle intra partum, reduced mother-to-child transmission of vaginal microorganisms including Streptococcus agalactiae (streptococcus serogroup B = GBS) and hence infectious morbidity in both mother and child. A prospective controlled study was conducted on pairs of mothers and their offspring. During the first 4 months (reference phase), the vaginal flora of women in labour was recorded and the newborns monitored. During the next 5 months (intervention phase), a trial of randomized, blinded placebo controlled douching with either 0.2% chlorhexidine or sterile saline was performed on 1130 women in vaginal labour. During childbirth, bacteria were isolated from 78% of the women. Vertical transmission of microbes occurred in 43% of the reference deliveries. In the double blind study, vaginal douching with chlorhexidine significantly reduced the vertical transmission rate from 35% (saline) to 18% (chlorhexidine), (P < 0.000 1, 95% confidence interval 0.12-0.22). The lower rate of bacteria isolated from the latter group was accompanied by a significantly reduced early infectious morbidity in the neonates (P < 0.05, 95% confidence interval 0.00-0.06). This finding was particularly pronounced in Str. agalactiae infections (P < 0.0 1). In the early postpartum period, fever in the mothers was significantly lower in the patients offered vaginal disinfection, a reduction from 7.2% in those douched using saline compared with 3.3% in those disinfected using chlorhexidine (P < 0.05, 95% confidence interval 0.01-0.06). A parallel lower occurrence of urinary tract infections was also observed, 6.2% in the saline group as compared with 3.4% in the chlorhexidine group (P < 0.01, 95% confidence p interval 0.00-0.05). This prospective controlled trial demonstrated that vaginal douching with 0.2% chlorhexidine during labour can significantly reduce both maternal and early neonatal infectious morbidity. The squeeze bottle procedure was simple, quick, and well tolerated. The beneficial effect may be ascribed both to mechanical cleansing by liquid flow and to the disinfective action of chlorhexidine.

Uptake of ³H-labelled commercial toluidine blue and subfractions (thionine, toluidine blue, and azur A) in the parathyroids of rabbits.

Chromatographic separation of ³H-labelled commercial toluidine blue demonstrated four dye fractions. Following i.v. injection into rabbits, the uptakes of the dye mixture and of three separated dye fractions were determined by radioactivity assays of parathyroids, thyroid, and muscle. Mean uptake ratio per g parathyroid/thyroid of the dye mixture was 2.6 and of the different fractions varied from 2.2 to 2.7. During continuous infusion of labelled dye mixture, the concentration in the parathyroids was, on an average, 1.6 times that in the thyroids. It follows that as a means for external scintigraphy of the parathyroids, derivatives of dye fraction will probably not prove better than derivatives of the commercial dye mixture. Because of its high toxicity, thionine should be eliminated from commercial toluidine blue when given to patients in amounts necessary to stain the parathyroids.

Decreased serum insulin-like growth factor I during puberty in children with insulin dependent diabetes mellitus (IDDM).

Previous reports concerning insulin-like growth factor-I (IGF-I) in diabetics are conflicting. This study describes IGF-I in children with insulin-dependent diabetes mellitus (IDDM) and healthy controls in relation to pubertal development. Sixty-six children participated (34 girls and 32 boys) of which 33 had IDDM. The mean age in the study population was 14.3 years, (range 7.1 to 19.7). Serum IGF-I was significantly decreased in diabetics. Diabetic girls had a mean IGF-I of 28.3 (14.4; = SD) nmol/l compared with 42.8 (15.0) nmol/l in controls. In diabetic boys the result was 30.0 (16.0) nmol/l compared with 44.1 (23.4) in controls. Growth hormone was measured in only one fasting morning serum sample from each individual. There was no difference between girls, but diabetic boys had higher mean serum concentration of growth hormone than controls (3.5 (4.8) vs. 1.8 (1.5) micrograms/l respectively). Diabetic girls had delayed menarche, corresponding to a slightly delayed bone maturation.

Association between Chlamydia pneumoniae antibodies and wheezing in young children and the influence of sex.

BACKGROUND: The proposed association between Chlamydia pneumoniae (Cpn) infection and wheezing needs further clarification. METHODS: Serum samples obtained from 1581 children aged 4 years in a population based cohort were tested for antibodies to Cpn and IgE antibodies to common allergens. Data on environmental factors and disease were collected prospectively from birth. RESULTS: The occurrence of IgG antibodies to Cpn at 4 years of age was associated with reported wheezing at different ages; however, these findings were most often not significant. In girls, the occurrence of anti-Cpn IgG was associated with wheezing at the ages of 1, 2, and 4 years (odds ratios (ORs) 3.41 (95% confidence interval (CI) 1.46 to 7.96), 2.13 (95% CI 1.02 to 4.44), and 2.01 (95% CI 1.14 to 3.54), respectively), and even higher ORs were observed for each age category when only high level antibody responses to Cpn were analysed. At the time of blood sampling the association between anti-Cpn IgG and wheezing was restricted to girls without atopic sensitisation (OR 2.39 (95% CI 1.25 to 4.57). No associations with wheezing were detected in boys, in whom IgE sensitisation was inversely associated with the presence of anti-Cpn IgG (OR 0.49 (95% CI 0.26 to 0.90)). CONCLUSIONS: This study suggests an association between evidence of earlier Cpn infection and a history of wheezing in young girls. Infection with Cpn may be an important risk factor for wheezing and possibly for non-atopic asthma, predominantly in girls.

Severe pancreatitis after parathyroidectomy.

Cope showed in 1957 that pancreatitis may be the presenting symptom in hyperparathyroidism. Since then, the literature has reported a coincidence of primary hyperparathyroidism and pancreatitis between 1% and 19%, but the true relationship has not been fully established. When severe pancreatitis follows parathyroidectomy, a condition familiar to parathyroid surgeons, reports are mostly anecdotal and by many authors considered to be coincidental. We present the case history of a 58-year-old man with a longstanding history of untreated primary hyperparathyroidism who developed severe pancreatitis immediately after removal of a 400-mg parathyroid adenoma. He was the first in a series of 108 operated patients to develop this complication. His preoperative levels of parathormone and serum calcium were the highest in our material. We believe that pancreatitis after parathyroidectomy is a real but rare complication that might be predicted by preoperative high values of serum calcium and parathormone.

[Primary hyperparathyroidism--a 16-year material from a central hospital]. / Primaer hyperparatyreoidisme--et 16-årsmateriale fra et sentralsykehus.

BACKGROUND: In Norway, population 4.3 million, approximately 160 patients a year have undergone surgery for primary hyperparathyroidism during the last ten years. Previous reports are rare. MATERIAL AND METHODS: A retrospective analysis of all patients operated for primary hyperparathyroidism during 16 years at Vestfold Hospital, which serves a population of 200,000. Late recurrences and persisting hypocalcaemia were evaluated with laboratory tests median eight years after surgery. RESULTS: 104 patients were operated (88 females and 16 males; median age 64 years, range 22-78). Adenomas were found in 88 patients, of which four had double adenomas, and hyperplasia in 16 patients. Three patients died postoperatively, within 30 days, all of them high-risk patients. Two patients were reoperated because of bleeding. In one patient an infection was drained. Median hospital stay was five days. Two patients had persisting hypercalcaemia; eight patients needed permanent vitamin D substitution. Four recurrences were detected. Normocalcaemia was achieved in 91 patients (90%). INTERPRETATION: Surgical treatment leads to normocalcemia in 90% of patient, but is not risk-free in severely ill patients. To assess the true benefit of the operation for the individual patient, better preoperative mapping of symptoms and better follow-up protocols should be implemented.

Necrosis of the colon and the rectum after resection of ruptured abdominal aortic aneurysm.

Two male patients with gangrene of the rectum and left colon following operation for a ruptured abdominal aortic aneurysm are reported. Both patients were in shock over a prolonged period, but ligation of the inferior mesenteric artery in the presence of insufficient collateral circulation to the large bowel was regarded as the main responsible factor for the visceral infarction. Both patients died postoperatively. The anatomical and pathophysiological factors generally involved in the development of colon ischaemia after abdominal aortic aneurysm surgery are analyzed. The different modalities of prevention of colon necrosis, diagnosis and management of the established lesions are described.

Bilateral primary bronchial carcinoma.

Three cases of bilateral primary bronchogenic carcinomas, one simultaneous and two consecutive, were encountered among 1033 patients treated for primary lung malignancies. Consecutive bilateral surgical resections were performed in two instances. The third case underwent irradiation therapy alone. The risk of developing a second primary bronchogenic carcinoma increases during survival time. Therefore, all patients successfully treated for lung cancer should have lifetime follow-up examinations.

Stones in renal transplants.

In a 50-year-old man (case 1) and a 17-year-old girl (case 2) stones developed in a functioning renal transplant. The respective intervals from transplantation to appearance of stone were seven years and six months. The serum calcium was elevated to approximately 3.00 mmol/l in case 1 and 2.65 mmol/l in case 2. The concentration of parathyroid hormone in serum was increased in case 1. Subtotal parathyroidectomy was performed in both patients, with removal of 2550 mg (case 1) and 150-160 mg (case 2) parathyroid tissue. In case 2 slight hypercalcaemia reappeared two months later. When stones in a transplanted kidney are associated with only slight hypercalcaemia and there is no deterioration of the renal function, conservative measures to reduce the serum calcium should be tried before subtotal parathyroidectomy is undertaken.

Perforated appendicitis--lavage or drainage?

A comparison was made regarding the observed frequency of intraperitoneal complications between two groups of patients operated upon for perforated appendicitis during a 5-year period (1968-73). The two groups, corresponding to two different general surgical departments at the same hospital, were given different forms of adjuvant treatment. The first group (78 patients) received postoperative intraperitoneal lavage, with antibiotics added to the lavage solution. In the other department (77 patients), the peritoneal cavity was drained postoperatively. No lavage was performed in this group, but antibiotics were given systemically. Sixteen patients in the drainage group developed intraperitoneal complications, as compared with 5 in the lavage group.

Pindolol (Viscén) in persistent ventricular fibrillation. A case report.

The beneficial effect of a beta-blocking agent (pindolol), given as an adjuvant to DC-shock and lidocaine therapy in a case of heart resuscitation is reported. A 65-year-old female patient was operated for an abdominal aortic aneurysm. At the conclusion of the operation, which was prolonged and difficult, the patient developed alternating ventricular tachycardia and fibrillation. Within a time interval of 50 min electrical defibrillation was performed 20 to 25 times, and as much as 1100 mg of lidocaine was administered. Simultaneously, combined internal/external cardiac massage was performed. The patient's arrhythmia continued to recur after defibrillation until pindolol in dosages of 0.2 mg had been given twice intravenously. A permanent sinus rhythm was then achieved.

Chlamydia pneumoniae in children with acute respiratory tract infections.

Children seeking medical attention for acute respiratory tract infections were investigated for evidence of Chlamydia pneumoniae infection. Blood samples were obtained from 367 children. Nasopharyngeal or throat swabs for PCR analysis (polymerase chain reaction) were taken from 360 children. Serology was found to be useful for diagnosis of infection only in children aged > 5 y. Using PCR, a prevalence of 8 and 10% of C. pneumoniae was found in male and female children aged < 2 y; 17 and 19%, respectively, in the age group 2-4 y and 32 and 21%, respectively, in the age group 5-16 y. We conclude that Chlamydia pneumoniae is a common finding in young children with respiratory tract infections. Younger children were more often found to have a moderate disease, but may have been ill for a long period.

Skin necrosis between parallel abdominal incisions.

Four cases of skin necrosis between vertical abdominal incisions are presented. Even though many years may elapse between the abdominal operations, necrosis of the skin as well as of the underlying fascia may develop between new and old vertical incisions parallel with each other. Such necrosis probably takes place particularly in patients with impaired peripheral circulation.

Dose dependent uptake of 125I-toluidine blue of 75Se-selenomethionine in the parathyroids of rabbits.

Different dosages of 125I-toluidine blue and 75Se-selenomethionine were injected intravenously into rabbits, and the concentration of radioactivity was measured in the parathyroids and surrounding tissues. The response of i.v. injected glucagon was also determined. It was found that 0.16 mg 125I-toluidine blue gave a concentration ratio of parathyroid/thyroid and parathyroid/muscle which was significantly higher than both lower and higher doses at 1 minute after i.v. injection of the labelled dye. Glucagon had little or no effect on the uptake of 125I-toluidine blue and 75Se-selenomethionine.

Secretion of calcitonin and gastrin in rats with transplanted medullary thyroid carcinoma.

Rats transplanted with medullary thyroid carcinoma (MCT) were followed with radio-immuno assay of serum calcitonin (iCT) using antisera to human CT and I125 labelled calcitonin-M. From the 4th month after transplantation, serum from the tumour rats contained iCT in concentrations 8-10 fold higher than serum from the control rats. The tumour cells had retained their ability to react on pentagastrin and calcium injections with increased CT release. It was further shown that the tumour bearing rats had elevated basal gastrin concentratkons in serum. While calcium injection lead to a rise in the serum gastrin concentration in the control group, the adverse effect was seen in the tumour bearing rats. The morphological features and the responsiveness of the rat tumour cells to physiological secretagogues make this tumour a suitable animal model for the study of interactions between CT and gastro-intestinal factors. It is suggested that the gastrin response to calcium might be of interest also in the diagnosis of human MCT.

[Sexual abuse of children--a public health problem?]. / Seksuelle overgrep mot barn--et folkehelseproblem?

Owing to variation in the reported prevalences of sexual abuse of children, international publications were reviewed to analyse the definitions and other criteria used. Reported prevalences varied from 4 to 67 per cent, the variation being due, among other things, to inconsistency in the definitions used. By some of the investigators sexual acts without actual physical contact between the offender and the victim had been included in the category, exhibitionism. Approximately half of the reported experiences were isolated events. Future research in this field will require greater conformity in the definitions and criteria used.

Use of 131I-toluidine blue in radionuclide imaging of enlarged parathyroid glands.

Parathyroid scintigraphy with 131I-labelled toluidine blue was performed in 40 patients, 30 of whom were operated for suspected hyperparathyroidism. Hyperplastic glands or adenomas could be localized by scintigraphy in 18 of 27 patients who proved to have hyperparathyroidism. The correlation between scintigraphy and operative finding was always correct when the parathyroids weighed more than 2 g. Scintigraphy was correctly negative in one, falsely negative in 6, and falsely positive in 5 of the operated patients. In a group of 10 unoperated patients, scintigraphy was positive in one of the 3 patients with suspected hyperparathyroidism, but negative in the others. Although 131I-toluidine blue is not ideal as a scintigraphic agent for the parathyroids, we are of the opinion that it represents an improvement compared with 75Se-selenomethionine.