Anti-Staphylococcus aureus, anti-Streptococcus pneumoniae and anti-Moraxella catarrhalis specific IgE in asthmatic children.

The total serum IgE levels and the presence of anti-Staphylococcu aureus, anti-Streptococcus pneumoniae and anti-Moraxella catarrhalis specific IgE antibodies were studied in 34 asthmatic children (aged 1-12 years). Eleven of them also suffered also from subacute or chronic sinusitis. Total and specific IgE were determined by radioimmunoassay in solid phase. The total serum IgE levels were increased in 82.3% of the cases. It was observed that 73.5% of the children had detectable specific IgE antibodies to one or more bacteria. Anti-Streptococcus pneumoniae IgE and anti-Moraxella catarrhalis IgE were observed more frequently than anti-Staphylococcus aureus IgE antibodies. There was no correlation among these results. The percentage of cases with increased total serum IgE levels and detectable specific antibacterial IgE was higher in those children who did not have sinusitis. In this group anti-Streptococcus pneumoniae IgE was the most frequent finding. The detection of specific antibacterial IgE is not sufficient to explain the physiopathologic role of such antibodies in the children with asthma.

Indications for internal stenting in intestinal obstruction.

Internal stenting (sutureless plication) for intestinal adhesions was performed operatively in 16 patients. Subsequent recurrent obstruction occurred in four patients. Other complications occurred in three patients and included retained tube, jejunostomy-site abscess, and intestinal fistulization. Four patients died for an in-hospital mortality of 25%. Internal stenting for adhesions should be used cautiously. Its use should probably be restricted to the setting of severe adhesive small bowel obstruction particularly when numerous enterotomies are incurred during the course of adhesiolysis.

INFLUENCIA DEL TIPO DE ALIMENTACIÓN EN EL DESARROLLO DE LA ALERGIA A LA LECHE DE VACA. FACTORES INVOLUCRADOS EN EL PROCESO POR EL CUAL SE ADQUIERE LA ENFERMEDAD / Infl uence of the type of feeding in the development of cow's milk allergy. Factors involved in the process by which the disease is acquired

Antecedentes. Los resultados de las investigaciones sobre la historia natural de la alergia a la leche de vaca (ALV) no han provisto aún, de un cuadro claro y consistente que ayude en la práctica al médico tratante. Objetivo. Identifi car los factores involucrados en el desarrollo de la enfermedad en lactantes pequeños, con el fi n de determinar perfi les específi cos e índices predictivos. Lugar de realización: Río Cuarto, Córdoba, Argentina. Diseño. Análisis observacional y retrospectivo. Población. 91 niños con diagnóstico de ALV y 91 controles, de ambos sexos, menores de 6 años. Método. Análisis de factores seleccionados de las historias clínicas, su relación individual con el diagnóstico (prueba X2, Odds Ratios, diferencias de medias) y su incidencia conjunta en la probabilidad de ser ALV para determinar perfi les (análisis de correspondencias múltiple y regresión logística). Elaboración de 3 índices predictivos basados en: odds ratios individuales, los correspondientes a la regresión logística y la identifi cación de criterios mayores y menores, con su respectiva evaluación de efectividad diagnóstica (sensibilidad, especifi cidad, valores predictivos y curva ROC). Resultados. Se encontró que la edad de inicio de los síntomas, el tipo de alimentación recibida hasta el 3er mes de vida, la exposición al humo de cigarrillo, los antecedentes alérgicos maternos y el tipo de manifestaciones clínicas con que comienza la ALV son factores que con mayor probabilidad inciden en su desarrollo. Conclusión. La utilidad de estos perfi les e índices predictivos radica en una temprana identifi cación de pacientes con riesgo de padecer ALV(AU)

Background: The results of the research on the natural history of allergy to cow's milk allergy (CMA) still have not provided a clear picture and consistent that in practice helps the attending physician. Objective: to identify the factors involved in the development of the disease in young infants, in order to determine specifi c profi les and predictive clinical indexes. Setting: Río Cuarto, Córdoba, Argentina. Design: observacional and retrospective analysis. Population: 91 children with a diagnosis of CMA and 91 controls, of both sexes, under the age of 6 years. Methods: analysis of selected factors of the clinical histories, their relationship with the individual diagnosis (test X2, Odds Ratios, differences in average) and their combined impact on the probability of being CMA to determine profi les (multiple correspondence analysis and logistic regression). Elaboration of 3 predictive indices based on: individual Odds Ratios, corresponding to the logistic regression and the identifi cation of greater and smaller criteria, with its respective evaluation of effectiveness diagnoses (predictive sensitivity, specifi city, values and ROC curve). Results: we found that the age of onset of symptoms, the type of feeding received until the 3rd month of life, exposure to cigarette smoke, the maternal allergy history and the type of clinical manifestations with that begins the CMA, are factors that most likely have an impact on its development. Conclusion: the utility of these profi les and predictive clinics indexes lies in an early identifi cation of patients at risk of CMA.(AU)

An analysis of phytohemagglutinin lymphoblastogenesis in whole blood.

A population of 80 defined normal people ranging in age from 20 to 62 years were used to define a dose response curve in whole blood phytohemagglutinin blastogenesis of lymphocytes. Maximum stimulation occurred at four days of incubation and 18 hours of pulse labeling with tritiated thymidine using 50 micrograms per milliliter of phytohemagglutinin and 1 microcurie of tritiated thymidine. An analysis of variants indicates a statistically significant trend of reduction of disintegrations per minute per milliliter with advancing age. Likewise, there was an extremely significant difference between measurements performed in the morning and late in the afternoon. Measurements referred to sex and sequential testing were not shown to be significant. Therefore, whole blood phytohemagglutinin blastogenesis may be meaningfully performed and interpreted using nonparametric statistics and the raw blastogenesis of a standard amount of peripheral whole blood, provided that the remainder of the test conditions are rigidly controlled.

Intramural squamous cell carcinoma of the esophagus.

A case of squamous cell carcinoma arising from an esophageal intramural squamous epithelial cyst is reported. Review of the literature reveals no previous reports of malignant transformation of esophageal cysts, although there have been reports of approximately 64 cases of benign esophageal cysts, and 35 cases of carcinoma arising in esophageal diverticula. In the present case, there was a history of increasing dysphagia for 2 months. Esophagram demonstrated a 4.5-cm concentric narrowing of the proximal esophagus just below the superior esophageal ring. Esophagoscopies revealed an esophageal stricture with intact mucosa, and bronchoscopy showed the lesion to be producing tracheal deviation. Multiple esophageal biopsies revealed mild mucosal hyperplasia with deep submucosal inflammatory changes suggesting an underlying lesion. Despite lack of histologic proof of malignancy, the patient underwent radiation therapy and bleomycin chemotherapy on the basis of the highly suggestive radiographic findings, but died with bilateral bronchopneumonia 6 months after admission. Autopsy demonstrated a 1.5-cm long intramural esophageal squamous epithelial cyst, from which arose a locally invasive squamous cell carcinoma, without mucosal involvement or metastases. There was no demonstrable evidence of any associated esophageal diverticulum.

Serum antibody in patients with breast disease: Correlation with histopathology.

Antibody to a breast cancer antigen was detected by immunodiffusion or complement fixation in at least one serum sample in 46% of 84 patients with a diagnosis of carcinoma, 34% of 96 patients with fibrocystic disease and 25% of 44 patients with fibroadenoma. A single serum sample obtained from screenees of the Detection Center for Breast Diseases was tested by immunodiffusion only and antibody was found in 3 of 206 screenees (1.5%). Eleven of 13 patients with breast cancer metastatic to lymph nodes and no detectable serum antibody either had recurrence or were dead within 12 months of mastectomy. Fifteen of 18 patients with breast cancer metastatic to lymph nodes and with detectable serum antibody were alive and free of disease for up to 24 months. Histologic slides from patients with a diagnosis of fibrocystic disease or fibroadenoma were reviewed for the presence of ductal epithelial hyperplasia. Ductal epithelial hyperplasia was present in a similar per cent of patients with no detectable serum antibody as those with antibody detected in the serum. Severe sinus histiocytosis of the axillary lymph nodes was present in 45% of those cancer patients with serum antibody and only 11% of those cancer patients with no detectable serum antibody.

Renal infarction and thrombosis of the infrarenal aorta in a 35-year-old man with primary antiphospholipid syndrome.

Renal manifestations of the "primary" antiphospholipid syndrome are rare. We report the case of an athletic 35-year-old man with an unremarkable medical history who suddenly developed hypertension and a renal infarction. Laboratory and radiological investigations showed a complete thrombosis of the infrarenal aorta, extensive collateral circulation arising from the superior mesenteric artery, and the primary antiphospholipid syndrome. Eight cases of renal infarction have previously been reported in the primary antiphospholipid syndrome. To our knowledge, this represents the first case of an infrarenal aortic thrombosis attributable to this syndrome.