Influenza: Diagnosis,epidemiology, prophylaxis

Sans résumé     

Thromboembolic diseases in neonates and children

Acquired and inherited prothrombotic risk factors increase the risk of thrombosis in neonates, infants and children. After suffering thrombosis white paediatric patients should be screened for common gene mutations, i.e. the factor V G1691A, factor II G20210A and MTHFR C677T genotypes, rare inherited prothromboticrisk factors, i.e. deficiencies of protein C,protein S, and antithrombin, plasminogen, probably inherited risk factors, i.e. fibrinogen, factor VIIIC, factor XII, new candidates, i.e. elevation of lipoprotein (a),and fasting homocysteine concentrations (3-6 months after thrombotic onset). Data interpretation is based on age-dependent reference ranges or the identification of causative gene mutations/polymorphisms with respect to individual ethnic backgrounds.     

An electrical admittance based index of thoracic intracellular water during head-up tilt in humans

During 50 degrees head-up tilt (HUT), the number of erythrocytes within the thorax has been shown to be reduced by approximately 25% and this level is retained during a maintained tilt, whilst that in the thigh increases by approximately 70%. To evaluate whether the electrical admittance of intracellular water (ICW) may be used to monitor this redistribution of red cells in humans, we determined the regional difference in the reciprocal value of the impedance at 1.5 and 100 kHz for the thorax (thoraxICW) and for the leg (legICW). In ten subjects all variables remained unchanged during head-down tilt but during HUT, presyncopal symptoms were induced in eight subjects after a mean of 27 (SEM 7) min as mean heart rate dropped from 85 (SEM 4) to 66 (SEM 3) beats x min(-1), mean arterial blood pressure from 80 (SEM 3) to 60 (SEM 5) mmHg, and mean oxygen saturation of venous blood from 76 (SEM 2)% to 73 (SEM 3)% (P < 0.05). The mean haematocrit increased from 50 (SEM 5)% to 52.5 (SEM 3.5)% (P < 0.01) and mean central venous pressure decreased during tilting (from a mean of 1 (SEM 1) to a mean of -1 (SEM 1) mmHg; P < 0.05) and returned to value at rest during the maintained tilt. Mean thoracic impedances increased by 7.0 (SEM 1.0) ohms (1.5 kHz) and 5.4 (SEM 1.2) ohms (100 kHz), and mean leg impedances decreased by 9.3 (SEM 1.2) ohms (1.5 kHz) and 3.1 (SEM 1.0) ohms (100 kHz) (P < 0.01). Mean thoraxICW decreased at 40 degrees HUT and remained reduced by 11 (SEM 2) S x 10(-4) (P < 0.05) until the presyncopal symptoms developed, at which time it was lower by 16 (SEM 2) S x 10(-4) (P < 0.01). Mean legICW increased from 97 (SEM 15) to 99 (SEM 15) S x 10(-4) (P = 0.08) during HUT but decreased during maintained tilt (to 94 (SEM 15) S x 10(-4); P < 0.05). The results suggested that during HUT, the difference in electrical admittance at a high and a low frequency current reflects the reduced number of red cells within the thorax.     

Pore size in implanted polypropylene filters is critical for tissue organization

Widely different implant materials induce surprisingly similar tissue reactions in vivo in contrast to their in vitro responses. Increasing attention has recently been given to the surface texture of the material. When both the material composition and the surface topography are varied, the surface topography seems to be the predominant factor for the induced tissue response. The present study addresses differences in the tissue response to commercially available Millipore mesh filters of polypropylene with pore sizes of 0.6, 10.0 or 30.0 microm. The Millipore filters with adjacent tissue were directly sectioned in a cryostat and evaluated via an immunofluorescence technique with double and triple staining, allowing simultaneous analysis of different antigens in tissue sections. These results show that macrophages, total cells, necrotic cells, nitric oxygen distribution, early angiogenesis, and capsule thickness were influenced by the surface structure. Implants with pore sizes of 0.6 microm, where entrance of inflammatory cells was inhibited, induce the most pronounced foreign body capsule formation. The 10- and 30-microm filters, in contrast, had large amounts of macrophages inside the filter structure, although very few inflammatory cells were found outside the filters. The inflammatory cells within the filters appeared not to influence the foreign body capsule induction. The critical factor for the formation of a foreign body capsule seems to be the localization of implant-close macrophages. Whether this is due to differences in cell activation or in signal transduction to collagen-synthesizing fibroblasts remains an open question.     

Pseudodicentric chromosome 18 diagnosed by chromosome painting and primed in situ labelling (PRINS).

We report on a newborn white male infant with marked dysmorphic features and various congenital malformations. The initial clinical evaluation showed Crouzon-like features as well as some features of trisomy 18 syndrome and trisomy 13 syndrome. The results from conventional cytogenetic analysis showed a structurally abnormal chromosome replacing one normal chromosome 18, but only by applying molecular cytogenetic methods could the architecture of this abnormal chromosome be characterised clearly. The primed in situ labelling (PRINS) technique, using a newly synthesised alpha 18 oligonucleotide, showed the dicentric pattern and direct chromosome painting established the origin to be from chromosome 18. The combination of conventional cytogenetics and molecular cytogenetics showed the karyotype in the proband to be 45,XY,-14,-18,-21,+t(14;21),+psu dic(18) (qter-->cen-->p11.3: :p11.3-->psu cen-->qter). This was supported by molecular analysis using chromosome 18 specific DNA markers, which showed the paternal origin of the abnormal chromosome.     

Distribution of whaleworm (Anisakis simplex,Nematoda, Ascaridoidea) L3 larvae in three species of marine fish; saithe (Pollachius virens (L.)), cod (Gadus morhua L.) and redfish (Sebastes marinus (L.)) from Norwegian waters

The frequency distribution of Anisakis simplex L3 larvae between host tissues was investigated in three host species: saithe, cod and redfish. Fish were sampled from Norwegian coastal waters and examined for the presence of A. simplex in muscle and viscera. In all three of the host species, A. simplex larvae were most frequently detected in the viscera; the percentages of total infection for saithe, cod and redfish were 99.6%, 97.8% and 88.0%, respectively. In general, the distribution patterns of A. simplex L3 between muscle and viscera were not significantly affected by host size. The observations that distributions vary between species and are not affected by host size do not support an earlier hypothesis which states that A. simplex L3 distributions are determined by an optimal pre-encapsulation migratory distance within host tissues. In contrast, it is suggested that A. simplex L3 distributions are governed by the conditions encountered within host tissues, and are possibly related to the availability of nutrients. Received: 9 July 1997 / Accepted: 15 September 1997     

Zur Frage der Hepatitishäufigkeit nach Austauschtransfusionen bei Neugeborenen

Zusammenfassung 63 Neugeborene wurden nach insgesamt 93 Austauschtransfusionen während eines Zeitraumes bis zu 6 Monaten auf das Risiko einer Transfusionshepatitis untersucht. Dabei wurden zusätzlich zur klinischen Beobachtung die Transaminasen und der Nachweis des Australia-Antigens als Kontrollkriterien gewertet. Klinisch wurde in keinem Fall eine Hepatitis beobachtet, eine SGPT-Erhöhung nach 3 Monaten in einem Fall könnte für eine anikterische Hepatitis sprechen. Ein Australia-Antigen-Nachweis konnte bei negativen Ausgangsbefunden bei Spendern und Empfängern nirgends in den Nachuntersuchungen erbracht werden. Demnach ist das Hepatitisrisiko einer Austauschtransfusion bei Wahrung der heute üblichen Spenderauslese praktisch nicht zu befürchten.     

Isodicentric 7p, idic(7)(q11.2), in acute myeloid leukemia associated with older age and favorable response to induction chemotherapy: a new clinical entity?

Three adult de novo acute myeloid leukemias (AML M1, M2, and M4) with an isochromosome 7p are presented. No additional abnormalities were detected by G-band and multicolor, using combined binary ratio labeling, fluorescence in situ hybridization (FISH) analyses, indicating that the i(7p) was the sole, i.e., the primary, chromosomal aberration. Although the patients were elderly--68, 72, and 78 years old--they all responded very well to chemotherapy, achieving complete remission lasting more than a year. Further FISH analyses, using painting, centromeric, as well as 7q11.2-specific YAC probes, revealed that the i(7p) contained two centromeres and that the breakpoints were located in 7q11.2. Thus, the abnormality should formally be designated idic(7)(q11.2). The detailed mapping disclosed a breakpoint heterogeneity, with the breaks in 7q11.2 varying among the cases, being at least 1,310 kb apart. Furthermore, the breakpoints also differed within one of the cases, being located on both the proximal and the distal side of the most centromeric probe used. Based on our three patients, as well as on a previously reported 82-year-old patient with AML M2 and idic(7)(q11) as the only chromosomal change, we suggest that this abnormality, as the sole anomaly, is associated with AML in elderly patients who display a good response to induction chemotherapy and, hence, have a favorable prognosis. Furthermore, the heterogeneous breakpoints in 7q11.2 suggest that the important functional outcome of the idic(7)(q11.2) is the genomic imbalance incurred, i.e., gain of 7p and loss of 7q material, rather than a rearrangement of a specific gene.     

Crystal Containing Membrane Bound Intracellular Inclusion Bodies in the Epithelium of Experimentally Infected Sinus Mucosa

The sinus mucosa of 16 rabbits was experimentally infected with Bacteroides fragilis. This paper describes and discusses large inclusion bodies, which were found in abundance by light and electron microscopy inside ciliated cells of the sinus epithelium in 3 of the studied animals. The spindle-shaped inclusions were located in the apical portion of the cytoplasm. They were bound by a trilaminar membrane with several coils to the interior as well as to the exterior. The interior of an inclusion body consisted to a large extent of electron-lucent, floccular substance, but fibrogranular aggregates and rod-shaped crystals with a line periodicity center-to-center of about 15 nm were also conspicuous. These peculiar formations may be constituted by abnormally stored material from defective synthesis of cilia.