Small for gestational age (SGA) neonates show reduced suppressive activity of their regulatory T cells

Little information exists concerning the role of fetal regulatory T cells (Tregs) during intrauterine development. We examined whether complications such as reduced birth weight or the occurrence of preterm labor were associated with deficiencies in the number or in the immunosuppressive activity of Tregs in the fetal circulation. Their total number did not change during normal or complicated pregnancy. In contrast, their level of FoxP3 expression decreased continuously with gestational age and was significantly reduced in the presence of spontaneous term, but not preterm labor. In small for gestational age (SGA) neonates, FoxP3 expression was constantly decreased when compared to age matched healthy neonates. In accordance with the low FoxP3 expression, the suppressive activity of the Tregs from spontaneously term delivered and from SGA babies was significantly reduced. We propose that the level of FoxP3 expression in the fetal Tregs may be a potential regulator of their suppressive activity.     

Neonatal Pulmonary Artery Thrombosis Presenting as Persistent Pulmonary Hypertension of the Newborn

Pulmonary artery thrombosis in neonates occurs rarely. This report describes the case of a term infant with a pulmonary artery thrombosis presenting as persistent pulmonary hypertension of the newborn. The risk factors identified in the case included maternal diabetes and heterozygous factor V Leiden deficiency. The pulmonary thrombus was successfully treated with percutaneous catheter-based embolectomy.     

Laparoscopic resection for a left adrenal black adenoma

Adrenal black adenoma (pigmented adenoma) is quite rare. Recently, we performed a laparoscopic resection for a functioning adrenal black adenoma. We report the case here.     

Small intestine biopsies in children with malabsorption syndrome. Autoradiographic studies with 3H-thymidine

Bioptic material of the small intestine is suitable for short-time in-vitro incubation in 3H-thymidine labelled medium followed by autoradiography. Histological and autoradiographic investigations of the small intestine of 45 children yielded the following characteristic findings: 1. 93 per cent of the healthy controls (n = 14) showed normal mucous membrane (Type I according to Shmerling) and a mean 3H-thymidine labelling index of 13 per cent. 2. Normal histological findings but a mean autoradiographic labelling index of 22 per cent were recorded from 87 per cent of children with cow's milk or fructose incompatibility (n = 12). 3. Mucous membrane of Shmerling Type I and a labelling index of enterocytes of 32 per cent was recorded from 50 per cent of children with coeliac disease (n = 19) after diet periods of seven or three to five months. Other children with coeliac disease but without therapy up to that time showed in 80 per cent the Shmerlings Type III and in 20 per cent Type II accompanied by the highest labelling index of 35 per cent. The increase of proliferative activity of enterocytes in coeliac disease shown by autoradiography and histological observations (villous atrophy) suggested an increased rate of cell death which led to the need for high cell replacement. This autoradiographic method used complementarily to usual histological diagnosis, has proved to help saving an enormous amount of time in the diagnosis of coeliac disease.     

Pathology of vein, artery and heart catheterization. Studies of autopsies

Among 17,161 autopsies of children and adults 319 cases with complications after catheterization (catheterization of veins, arteries and heart) were analysed. The following pathologo-anatomical findings were established: Haemorrhages, thromboses, thrombophlebitis, incorrect positions of the catheter, embolism after catheterization, perforations of vessels, heart injuries, pleura injuries, pneumo- and haemothorax as well as sepsis and septicopyaemia. The complications were subdivided according to early and late injuries. In 10% the complications after catheterization were directly and indirectly connected with the cause of death. In the clinic the catheterization of the vein is a necessary diagnostic and therapeutic intervention. The evaluation of an extensive autopsy material, however, shows that severe and lethal complications may appear in connection with catheterization. For these reasons a broad use is prohibited. The demand of a strong indication is unrestrictedly to be supported.     

BACTERIOPHAGE PATTERN AND METHICILLIN RESISTANCE OF STAPHYLOCOCCUS AUREUS ISOLATED FROM HOSPITALISED PATIENTS

Ninety two strains of Staphylococcus aureus isolated from hospitalized patients were phage grouped and phage typed and their resistance pattern to methicillin were studied. Forty five (48.9%) strains were nontypable, followed by mixed group in 23 (25%). The phage groups I, II, III, V and miscellaneous groups were 3.3 per cent, 7.6 per cent, 8.7 per cent, 1 per cent and 3.3 per cent respectively. Majority of the strains were methicillin resistant. Out of 45 nontypable strains 33 (73.3%) were methicillin resistant whereas in mixed phage group methicillin resistance was found in 52 per cent. The inadequacy of available phages for typing, rising incidence of methicillin resistance in untypable strains and variance of phage group and phage types at various places has been highlighted.KEYWORDS: Drug resistance, Methicillin, Phage typing, Staphylococcus aureus     

Pacemaker Upgrade Causing New-Onset Heart Failure in a Patient with Complete Congenital Atrioventricular Block

For infants with congenital complete atrioventricular block (CCAVB), the choice of pacing modalities is limited. Due to their size and surgical limitations, neonates typically start with an epicardial right ventricular pacing system, then upgrade to right-sided dual-chamber pacing once appropriate size is achieved. These modes are generally well tolerated. However, the reported case involved a patient with CCAVB who paradoxically experienced congestive heart failure after upgrading to a dual-chamber system, a theoretically superior pacing modality. With conversion to biventricular pacing, a relatively new modality for adults with very little pediatric experience to date, the patient’s symptoms dramatically improved.     

Constitutive crosspresentation of tissue antigens by dendritic cells controls CD8+ T cell tolerance in vivo

Immature dendritic cells (DCs) sample tissue-specific antigens (TSAs) and process them for "crosspresentation" via major histocompatibility complex (MHC) class I and II molecules. Findings with adoptively transferred T cell receptor (TCR)-transgenic CD8+ T cells in transgenic mice expressing model TSA indicate that this process contributes to tolerance induction of CD8+ T cells, a phenomenon termed "crosstolerance." However, up to now it has been unknown whether "crosstolerance" can also control autoimmune T cells specific for physiological nontransgenic TSA. Here, we showed that a DC-specific deficiency in uptake of apoptotic material inhibits crosspresentation in vivo. This defect allowed the accumulation of fully functional autoreactive CD8+ T cells that could be activated for autoimmune attack in peripheral lymphoid organs. Thus, our data demonstrate the importance of crosstolerance induction by DCs as a vital instrument for controlling self-reactive T cells from the peripheral repertoire and preventing autoimmune disease.