Severe Child Abuse Presenting as Polymicrobial Bacteremia

ABSTRACT. Life-threatening polymicrobial bacteremia in a 71/2-year-old boy, was found to be caused by willful contamination of i.v. drips by the mother. The boy, as well as his diseased twin sister, had histories of long-lasting chronic otitis of unknown etiology. The importance of obvious pathologic psycho-social factors was overlooked, and diagnosis was only reached by close collaboration with clinical microbiologists.     

COMMENTS

This review summarises the existing knowledge on the phenotype of the carcinoma in situ (CIS) cell. CIS is a common pre-invasive precursor of testicular germ cell tumours of adolescents and young adults. These tumours display a variety of histological forms. Classical seminoma proliferates along the germ cell lineage, whereas embryonal carcinoma retains embryonic features and readily differentiates into teratomas that resemble various somatic cell lineages. A thorough review of the gene expression in CIS cells in comparison to normal testicular germ cells and overt tumours supports the view that CIS is a common precursor for both tumour types. Impaired cell differentiation resulting in a partial retention of the embryonic features, associated with an increasing genomic instability may be responsible for a remarkable phenotypic heterogeneity of CIS cells. Depending on the degree of differentiation and pluripotency, CIS cells found in adult patients seem to be predestined for further malignant progression into one or the other of the two main types of overt tumours. A new concept of phenotypic continuity of differentiation of germ cells along germinal lineage with a gradual loss of embryonic features based on the analysis of gene expression in all types of germ cells during their ontogeny is presented in this review. The data point out that despite the phenotypic continuum of gene expression, there are two periods of rapid changes of gene expression: first at the transition from primordial germ cells to pre-spermatogonia, and later during the pubertal switch from the mitotic to meiotic cell division. The persistent expression of embryonic traits in CIS cells, and the high expression of the cell cycle regulators that are typical of mitotic germ cells support our long-standing hypothesis that CIS cells originate from primordial germ cells or gonocytes and not from germ cells in the adult testis.     

Severe cryptosporidiosis in children with normal T-cell subsets

Though Cryptosporidium spp. is considered to cause only a self-limiting illness in immunocompetent children, data from Guinea Bissau suggest that cryptosporidiosis may be a significant cause of deaths in developing countries. An impaired cellular immune function could explain the severe course of cryptosporidiosis in these children. We therefore investigated in a community study whether pre-infectious CD4/CD8 status had an impact on incidence and severity of cryptosporidiosis. Of 168 children below two years of age 21 experienced Cryptosporidium-infection within 156 days after blood sampling, but no tendencies of pre-infectious impaired cellular immune function was found in the cases compared with controls, nor did nine children who acquired persistent diarrhoea or three who died have impaired CD4/CD8 status.     

OXIDATION OF GLUCOSE and D-B-OH-BUTYRATE BY THE EARLY HUMAN FETAL BRAIN

Abstract. Adam, P. A. J., Räihä, N., Rahiala, E.-L. and Kekomäki, M. (Departments of Pediatrics, Case Western Reserve University at Cleveland Metropolitan General Hospital, Cleveland, Ohio USA, and the University of Helsinki at the Children's Hospital, Helsinki, Finland). Oxidation of glucose and D-B-OH-butyrate by the early human fetal brain. Acta Paediatr Scand, 64:17, 1975.–The isolated brains of 12 previable human fetuses obtained at 12 to 21 weeks' gestation, were perfused through the interval carotid artery with glucose (3 mM) and/or DL-B-OH-butyrate (DL-BOHB), 4.5 mM, plus tracer quantities of either glucose-6-¹⁴C (G6¹⁴C) or β-OH-butyrate-3-¹⁴C (BOHB3¹⁴C). Oxidative metabolism was demonstrated by serial collection of gaseous ¹⁴CO₂ from the closed perfusion system, and from the recirculating medium. Glucose and BOHB were utilized at physiological rates as indicated (mean ±SEM): G6¹⁴C at 0.10±0.01 μmoles/min g brain (n=7) or 17.5±1.9 μmoles/ min kg fetus; and BOHB3¹⁴C at 0.16±0.05 μmoles/min g (n=5) or 27.3±7.4 μmoles/ min kg. Based on fetal weight, glucose metabolism by brain apparently accounted for about 1/3 of basal glucose utilization in the fetus. On a molar basis BOHB3¹⁴C was taken up at 1.47 times the rate of G6¹⁴C. Both BOHB3¹⁴C and G6 ¹⁴C were converted to ¹⁴C0₂. The rate of BOHB3¹⁴C conversion to ¹⁴CO₂ was equal to its rate of consumption, and exceeded the conversion of glucose to CO₂ because 45% of the G6¹⁴C was incorporated into lactate-¹⁴C. Accordingly, both substrates support oxidative metabolism by brain; and BOHB is a major potential alternate fuel which can replace glucose early in human development.     

On the Interaction between Protein and Glucose in Human Blood

An interchange between albumin-bound hexose and free glucose in human plasma has been demonstrated. If there is a protein-bound hexose in the red cells, it may interfere with the distribution of glucose between the cells and plasma.     

Immunofluorescence Studies in Scabies

Direct and indirect immunofluorescence investigations performed for 11 patients with scabies. All patients had punch biopsies taken from (1) a lesion containing Sarcoptes scabiei, (2) an inflammatory papule which did not contain a mite, and (3) normal skin. In four patients IgE deposits were found in the vessel walls of the upper dermis both in biopsies containing mits and biopsies of inflammatory papules with no mites. No IgE deposits were found in biopsies of normal skin from the same patients. Two patients had IgM and/or C3 deposits along the basal membrane in biopsies containing mites and one of them also had C3 in this area in the biopsy from a papule with no mite, as well as normal skin.