Diagnostic utility and clinical significance of naso- and oropharyngeal samples used in a PCR assay to diagnose Mycoplasma pneumoniae infection in children with community-acquired pneumonia

PCR assays of naso- and oropharyngeal samples among hospitalized children appear equally effective for the diagnosis of serologically confirmed community-acquired mycoplasmal pneumonia. However, the combination of results from both sites yields optimal sensitivity (57%), specificity (98%), and positive (92%) and negative (82%) predictive values when compared with Mycoplasma pneumoniae enzyme-linked immunosorbent assay.     

Risk factors of clinical dysimmune manifestations in a cohort of 86 children with 22q11.2 deletion syndrome: A retrospective study in France

In this study, we describe the biological immune profiles and clinical dysimmune manifestations (infections, autoimmune diseases, and allergies) of patients with 22q11.2 deletion syndrome with the aim of determining risk factors for clinical events. This retrospective study concerned all the patients with 22q11 deletion syndrome attending the Montpellier University Hospital from January 1, 1992, to December 31, 2014 who had at least one immune investigation before the age of 18. We analyzed the clinical features, biological tests and the course of infections, autoimmunity, and allergy of 86 children. Among these 86 children, 48 (59%) had a low T lymphocyte level. Twenty‐nine patients (34%) had a severe infection. The only risk factor for severe infection was the low level of CD4+ T‐cells (OR: 3.3; 95% confidence interval (CI) [1.020–11.108]). Eleven patients (13%) developed an autoimmune disease; the only risk factor was an antecedent of severe infection (OR: 4.1; 95% CI [1.099–15.573]). Twenty‐three patients (27%) had allergic episodes. A low level of CD8+ T‐cells (OR: 3.2; 95% CI [1.07–9.409]) was significantly associated with allergy manifestations. Patients with 22q11 deletion syndrome have a high rate of dysimmune manifestations. We found statistic correlations among CD4+ T‐cell count, infectious manifestations, and autoimmunity.     

Carbon fiber implants in osteochondral defects of the rabbit patella

Carbon fiber implants were used to fill osteochondral defects created on the articular surface of the patella of 36 rabbits, for the purpose of studying the long-term histological changes of the repair process. Six months after surgery the defect was filled by fibrous tissue, where the superficial area was organized parallel to the joint surface. Fibrocartilage developed after 9 months and, after 12 months, the defects were covered by hyaline cartilage tissue.     

Historic Trials: Montreal Tramways v. Leveille (1933) 4 DLR 338

This trial concerned an injury in a newborn child which wasallegedly caused by an accident involving the mother duringher pregnancy. The trial is widely accepted as a turning-pointin law related to fetal injury, conferring the right of a childto claim compensation at birth for injuries inflicted duringpregnancy. This material is reproduced with the permission ofthe publisher, Canada Law Book Inc., 240 Edward Street, Aurora,Ontario L4G 3S9, Canada.     

Development of the digestive tract of sea bass (Dicentrarchus labrax L). Light and electron microscopic studies

The developing gut of sea bass was studied by light and electron microscopy, four phases being established. Phase I, from hatching to the opening of the mouth, was a lecitotrophic period, in which the gut appeared as a straight undifferentiated tube lined by a simple epithelium that became stratified in the most caudal region. The epithelial cells increased in length towards the caudal zone, as did the number and height of the apical microvilli and the magnitude of the lamellar structures in their basal region. Cilia were more numerous in the caudal region than in the rest of the gut. Signs of lipid but not of protein absorption were found in the epithelial cells at this phase. Phase II, from the opening of the mouth to the complete resorption of the yolk sac, was a lecitoexotrophic period in which an esophagus, a gastric region, an intestine and a rectum, the last two separated by a valve, were present. During this phase the differentiation of the gut started at the esophagus and the rectum. In the esophagus, the epithelium became stratified and goblet cells containing acid mucosubstances, including sulphomucins, appeared. In the epithelial cells of the rectum, supranuclear vacuoles and an incipient endocytotic apparatus that seemed to be involved in the absorption and digestion of proteins were found. In both regions the mucosa was folded. Phase III, from the complete resorption of the yolk sac to the appearance of the first gastric glands, initiated the exclusively exotrophic period. During this phase the intestine formed the mucosa folds, while the first pyloric caeca and the epithelial cells acquired the ultrastructural features of mature absorptive cells with many lipid inclusions. Goblet cells containing neutral mucosubstances appeared and increased in number in both the intestine and the rectum. Neutral mucosubstances were also present in the cells lining the gastric region. During phase IV, from the appearance of the first gastric glands onwards, the intestinal absorptive surface increased with the formation of new pyloric caeca and two intestinal loops. The stomach acquired its definitive anatomy and histology with the development of the caecal and pyloric regions alongside differentiated gastric glands. The glandular cells had the ultrastructural features of the cells that secrete both pepsinogen and hydrochloride acid in the adult teleost stomach. Accepted: 7 February 2001     

Use of tissue expanders with external ports

The high number of reconstructive dilemmas brought about by more aggressive treatment of congenital malformations and burns has created the need for large quantities of donor skin for local coverage. Tissue expansion with external ports has become part of the authors' surgical armamentarium. From January 1996 to November 1998 the authors placed 34 expanders in 28 patients to correct congenital malformations or burn sequelae. The average patient age at the time of operation was 6.3 years, the average time of expansion was 49 days, and minimal and maximal expansion volume was 60 and 600 cc respectively. Serial injection was carried out every 2 days until total expansion was achieved, and the expanded area was two to three times as wide as the recipient defect. No major complications occurred. The most serious complications of infection and erosion of tissue overlying the device occurred in 17.6% of patients. There are several advantages to this technique: less tissue dissection, painless injections, shorter operating time, and early detection of leaks. Lozano ST, Drucker MZ. Use of tissue expanders with external ports.     

Inverted papilloma of the prostatic urethra

The inverted papilloma is a rare urothelial tumor, and its localization at the prosthatic urethra is also exceptional. We present a case of inverted papilloma of the prostatic urethra in a 72 years-old male, with symptoms of urinary flow obstruction. The diagnose is obtained after urethrocistoscopy and transurethral resection at the same time. We discuss about the etiology, clinical presentation, diagnose and treatment of this rare tumor, making special attention to its malignancy ability.     

Clinical management of cUTI,cIAI, and HABP/VABP attributable to carbapenem-resistant Gram-negative infections in Spain

IntroductionCarbapenem-resistant Gram-negative (CRGN) infections are a major public health problem in Spain, often implicated in complicated, healthcare-associated infections that require the use of potentially toxic antibacterial agents of last resort. The objective of this study was to assess the clinical management of complicated infections caused by CRGN bacteria in Spanish hospitals.MethodsThe study included: 1) a survey assessing the GN infection and antibacterial susceptibility profile in five participating Spanish hospitals and 2) a non-interventional, retrospective single cohort chart review of 100 patients with complicated urinary tract infection (cUTI), complicated intra-abdominal infection (cIAI), or hospital-acquired bacterial pneumonia/ventilator-associated bacterial pneumonia (HABP/ VABP) attributable to CRGN pathogens.ResultsIn the participating hospitals CRGN prevalence was 9.3% amongst complicated infections. In the retrospective cohort, 92% of infections were healthcare-associated, and Klebsiella pneumoniae and Pseudomonas aeruginosa were the most common pathogens. OXA was the most frequently detected carbapenemase type (71.4%). We found that carbapenems were frequently used to treat cUTI, cIAI, HABP/VABP caused by CRGN pathogens. Carbapenem use, particularly in combination with other agents, persisted after confirmation of carbapenem resistance. Clinical cure was 66.0%, mortality during hospitalization 35.0%, mortality at the time of chart review 62.0%, and 6-months-post-discharge readmission 47.7%.ConclusionOur results reflect the high burden and unmet needs associated with the management of complicated infections attributable to CRGN pathogens in Spain and highlight the urgent need for enhanced clinical management of these difficult-to-treat infections.     

TP53 mutation and haplotype analysis of two large African American families

Two large apparently unrelated African American families with a high incidence of breast cancer and other tumors characteristic of Li‐Fraumeni breast sarcoma cancer family syndrome were studied. Mutation screening revealed that in both families the affected members carried a germline mutation of the TP53 gene at codon 133 (ATG→ ACG, M133T). In order to determine whether an ancestral haplotype was shared by these two families, polymorphic markers within and flanking the TP53 gene were studied. Haplotype analysis using five markers revealed an identical haplotype shared by the two families. Loss of heterozygosity at the TP53 locus in the probands' tumor tissues from each family was observed; in each case, the retained allele carried the common haplotype. The frequency of this haplotype in the general African American population is <0.003. This unique haplotype, combined with the rare TP53 mutation, suggests that these African American families share a common ancestry. This finding suggests that other African Americans may be carriers of this mutation and thus may be at risk of early‐onset breast cancer or other cancers characteristic of the Li‐Fraumeni breast sarcoma cancer family syndrome. The finding of recurring mutations in African Americans may facilitiate carrier screening and identification in this population. Hum Mutat 14:216–221, 1999. © 1999 Wiley‐Liss, Inc.