Allergic conditions in 5–8-year-old Maltese schoolchildren: Prevalence, severity, and associated risk factors [ISAAC]

Allergic conditions, especially asthma, seem to be increasingly common worldwide. The International Study of Asthma and Allergies in Childhood (ISAAC) was the first study carried out worldwide using standardized questionnaires in order to create a reliable global map of childhood allergy. The Maltese Islands were one of the centres that participated in this study and in this article the data obtained from 3,506 5–8‐year‐old children from 24 state schools (78.5% response rate), and also data obtained from some added ‘local’ questions addressed to the same children, were analyzed in order to evaluate the problem of allergic conditions in Maltese schoolchildren. Of the participants, 19.1% were wheezers ‘ever,’ while 8.8% were current wheezers. Of the latter, 15.9% experienced nocturnal wheezing at least once a week and 13.3% had a wheezing episode of sufficient severity to limit speech. Nasal problems were present in 23.4% of these children, and in 20.7% of all respondents these symptoms persisted up to the year of answering the questionnaire. Hay fever had been diagnosed in 14.7% of all the children. Seven per cent of respondents had a recurrent, itchy rash (suggestive of eczema) for at least 6 months of their lives and 5.5.% had it currently. The prevalence of wheezing and eczema were slightly lower than the global mean, unlike rhinitis which in Malta was commoner than the world average. Multiple variables, such as gender, breast‐feeding, passive smoking, family history of atopy, pets, soft furnishings, and living next to busy roads, were factors that affected the prevalence and severity of the allergic conditions studied. In conclusion, allergic conditions are very common in Maltese schoolchildren and cause great hardship to these same youngsters. The results of this study should serve as a stimulus to try to decrease this suffering through better management of these conditions, measures to control identified detrimental factors (such as passive smoking), and further research on asthma, allergic rhinitis and eczema.     

Densitometric quantitative analysis of intracoronary ultrasound images: anatomopathologic correlation

To establish if the video densitometric analysis (VDA) of the intracoronary ultrasound images (IVUS) can predict the qualitative and quantitative composition of the atherosclerotic coronary plaques, thirty-one patients with anatomopathologic study of directional coronary atherectomy (DCA) samples and pre and post intervention IVUS image were analyzed. The video IVUS images were digitized in a 512 x 512 matrix and analyzed for densitometric differences with an Automatic Image Analysis System (AIAS) (Vidas 2000, Zeiss Kontron). The components of the plaque were arbitrarily divided into three densitometric categories using a 256 gray scale: high density (HD) 121–255, medium (MD) 81–120 and low (LD) 30–80. The relative percentage of each component was automatically recorded. The DCA samples were microscopically examined and input in the AIAS. The components were divided into: collagenous tissue (CT); lipid-necrotic debris (LND); proliferative tissue (PT). The area of each component was expressed as a percentage of the total. Linear correlation analysis was applied. Comparison between the IVUS and the histological composition of the plaque showed that: HD corresponded to CT; MD to PT; LD to LND. The correlation between the percentage distribution of the densitometric categories and the anatomopathologic components showed a correlation coefficient r%equals;0.91 between HD and CT; r%equals;0.87 between MD and PT; r%equals;0.88 between LD and LND. The VDA of the IVUS can distinguish three basic components of the atherosclerotic plaque: fibrous, lipid-necrotic and proliferative tissue, allowing absolute and relative quantitative analysis. This capability may be of interest for device selection and histopathologic correlation.     

Angiographic-echocardiographic correlation in mitral valve prolapse

Although mitral valve prolapse is easily identified with echocardiography, the angiographic diagnosis has been poorly understood. To determine relative specificity and sensitivity of recently established radiologic diagnostic criteria, prospective comparison of left ventriculograms with echocardiograms and clinical observations in patients undergoing routine cardiac catheterization from 1975 to 1977 and retrospective review of earlier catheterization data have been performed. Four types of normal mitral valve configurations were determined during protodiastole in the right anterior oblique (RAO) projection of left ventriculograms by identifying the fulcrum, the point of attachment of the mitral leaflets to the annulus fibrosus, and the fornix, that part of the left ventricular wall between the fulcrum and papillary muscles. Prolapse was present when mitral leaflet tissue extended inferiorly and posteriorly to the fulcrum during systole. Angiographic prolapse of the posteromedial commissural scallop of the posterior leaflet was diagnosed in RAO ventriculograms in 21 patients, approximately 1.9 per cent of the adult catheterization population. All of these patients also had positive echocardiograms. Three other patients had positive echocardiograms despite normal ventriculograms. In one of these three, isolated prolapse of the middle commissural scallop of the posterior leaflet was present. No patient with a normal mitral valve echocardiogram had an abnormal ventriculogram. The proposed angiographic criteria for mitral valve prolapse have eliminated false-positive diagnoses, and permitted accurate identification in approximately 88 per cent of cases. Improved imaging and additional left ventriculographic projections will probably improve sensitivity. The frequencies of angiographic, echocardiogrphic, and clinical diagnoses of mitral valve prolapse are not significantly different.     

Erste Erfahrungen mit der Korrelation biochemischer Parameter und fetalem und utero-plazentarem Blutfluß

Ohne Zusammenfassung     

Structure of the Krasnovskii Photoreduction Product of Chlorophyll a

A proton magnetic resonance study at 220 MHz shows the Krasnovskii intermediate in the photoreduction of chlorophyll a by hydrogen sulfide to be beta,delta-dihydrochlorophyll a.     

Simultaneous ipsilateral trochanteric and femoral shaft fracture

Thirteen cases of concomitant trochanteric and shaft fracture of the same femur are reported. The hip fracture was initially missed in two cases. Os-teosynthesis of both fractures was performed in ten cases. Both fractures healed in the 12 cases followed for 6 months or more. Osteosynthesis of both fractures is recommended, preferably by fixation with angled or straight plates, and Ender nailing in selected cases.     

Multislice proton magnetic resonance spectroscopic imaging in X-linked adrenoleukodystrophy

Multislice proton magnetic resonance spectroscopic imaging permits metabolic analysis of brain tissue in vivo by data acquisition in four oblique axial slices, each 15-mm thick and divided into 0.8-ml single-volume elements. We applied this technique to the systematic study of 25 patients with adrenoleukodystrophy: 3 with the severe childhood or adult cerebral form of the disease, 5 with adrenomyeloneuropathy, 12 with no demonstrable neurological involvement, and 5 women heterozygous for adrenoleukodystrophy who had some degree of neurological disability. Abnormalities on magnetic resonance spectroscopic imaging included a reduction in N-acetyl aspartate, an increase in cholin-containing compounds, and at times, an increase in lactate. Five patients showed abnormalities in the presence of normal-appearing magnetic resonance images, and in 8 other patients the alterations on spectroscopic images were more severe than those demonstrable by magnetic resonance imaging. Correlation with clinical course suggests that an increase in the choline-containing compounds is associated with an active demyelinative process, whereas such compounds are not elevated in lesions that are stable. We conclude that magnetic resonance spectroscopic imaging is a more sensitive indicator of early neurological involvement thatn is magnetic resonance imaging, and that the character of abnormalities detected by the former technique may serve as a gauge of the degree of activity of the demyelinating process and as a guide to the selection and evaluation of therapeutic approaches.     

Thoracic Epidural Analgesia Augments Ileal Mucosal Capillary Perfusion and Improves Survival in Severe Acute Pancreatitis in Rats

Background: Acute pancreatitis has been linked to intestinal barrier dysfunction and systemic inflammatory response with high mortality. Thoracic epidural analgesia improves intestinal perfusion. The authors hypothesized that thoracic epidural analgesia influences microcirculation injury, inflammatory response, and outcome of acute pancreatitis in rats.

Methods: Control groups underwent a sham procedure or untreated pancreatitis induced by intraductal taurocholate injection. In the treatment groups, epidural analgesia was commenced immediately or after a 7-h delay. Fifteen hours after injury, the ileal mucosal perfusion was assessed by intravital microscopy. Thereby, the intercapillary area between all perfused capillaries and between continuously perfused capillaries only was used to differentially quantify total and continuous capillary mucosal perfusion. Villus blood flow and serum levels of amylase, lactate, and interleukin 6 were determined, and pancreatic injury was scored histologically. Seven-day survival was recorded in an additional 30 rats undergoing untreated pancreatitis or pancreatitis with epidural analgesia.

Results: In untreated pancreatitis, decreased total capillary perfusion increased the total intercapillary area by 24%. Furthermore, loss of continuous perfusion increased continuous intercapillary area to 228%. After immediate and delayed epidural analgesia, continuous perfusion was restored (P < 0.05). Blood flow decreased 50% in untreated pancreatitis but was preserved by epidural analgesia (P < 0.05). Biochemical and histologic signs of pancreatitis were not affected by epidural analgesia. Lactate and interleukin-6 levels increased in untreated pancreatitis, which was prevented in the treatment groups (P < 0.05). Epidural analgesia increased 7-day survival from 33% to 73% (P < 0.05).     

Stress and lambliasis in patients with respiratory allergic disease

The association between stress, humoral and cellular immune response and intestinal parasites was evaluated in 102 patients in a randomized double-blind study. Sixty-four (62.7 per cent) presented respiratory allergic disease (RAD) at the time of the clinical and laboratory tests; the other 38 (37.3 per cent) were normal individuals. Higher levels of IgE associated with RAD were observed in patients with family dysfunction (p < 0.05). All the other immunological parameters that were measured — total B and T lymphocytes, helper (CD4) and suppressor/cytotoxic (CD8) T lymphocytes as well as IgG and IgA levels — were similar in both the allergic and the control groups. Twenty-two patients (22.5 per cent) were positive for Giardia lamblia, 86.3 per cent of them suffering RAD (p < 0.03). Regression analysis showed that patients with high levels of IgE and eosinophilia were associated with G. lamblia infection. This study indicates a higher frequency of lambliasis in RAD and shows that family stress was significantly associated with this allergic condition.