Herpetic croup: two case reports and a review of the literature

Croup is an acute infectious illness usually occurring in children; it is characterized by brassy cough and stridor. The main pathogens include mainly parainfluenza and influenza viruses. Recently there have been reports of prolonged croup caused by the herpes simplex viruses. We report two cases of prolonged croup due to herpes simplex types 1 and 2. We also review and summarize the reported pediatric cases of herpetic croup.     

Primitive Neuroectodermal Tumors of the Central Nervous System

Controversial issues relating to the pathobiology and classification of central nervous system primitive neuroectodermal tumors (PNETs) have plagued neuropathologists for more than 70 years. Hypotheses advanced in the mid-1920's have remained as fixed concepts in contemporary literature, largely consequent to repetitious support by a small number of neuropathologists despite a growing body of information discrediting these ideas from neuroembryologists, oncologists, neuroscien-tists and pathologists.
Attention has largely focused upon PNETs arising in the cerebellum (commonly known as medul-loblastomas [MBs]), because about 80% of central nervous system (CNS) PNETs originate in this site. It has been asserted that the 20% which do not are biologically different, although most individuals agree that the histological features of PNETs that occur in different sites throughout the CNS are indistinguishable from those growing in the cerebellum.
The historical aspects of this controversy are examined in the face of evidence that there is, in fact, a unique class of CNS tumors which should appropriately be regarded as primitive neuroectodermal in nature. Specifically, a number of different approaches to the problem have yielded data supporting this hypothesis. These approaches include the identification of patterns of expression among a variety of cellular antigens (demonstrated by the use of immunopathological techniques), molecular analyses of cell lines derived from these tumors, experimental production of PNETs and molecular genetic analyses.
Differences of opinion among surgeons, oncologists and radiotherapists are typically resolved by conducting cooperative studies of patients with these tumors who are diagnosed and treated at multiple centers.     

Mycobacterium ulcerans-specific immune response after immunisation with bacillus Calmette-Guérin (BCG) vaccine

BackgroundBacillus Calmette–Guérin (BCG) vaccine provides partial protection against Buruli ulcer caused by Mycobacterium ulcerans in epidemiological studies. This study aimed to quantify M. ulcerans-specific immune responses induced by BCG immunisation.MethodsIntracellular cytokine analysis of in-vitro experiments done 10 weeks after BCG immunisation in 130 Australian infants randomised to one of three BCG vaccine strains given either at birth (BCG-Denmark, BCG-Japan, or BCG-Russia) or at two months of age (BCG-Denmark).ResultsProportions of polyfunctional CD4⁺ T-cells were higher in M. ulcerans-stimulated compared to unstimulated control samples. These proportions were not influenced by the vaccine strain or timing of the immunisation. The M. ulcerans-specific immune responses showed similar patterns to those observed in M. tuberculosis-stimulated samples, although they were of lower magnitude.ConclusionsOur data show that BCG immunisation induces M. ulcerans-specific immune responses in infants, likely explaining the cross-protective effect observed in epidemiological studies. (ACTRN12608000227392)     

Elevated serum cytokines in patients with malignancy and weight-loss

Tumour necrosis factor (TNF) has been implicated in the pathogenesis of cachexia in neoplastic and infectious diseases. In our study, the relationship between TNF and other cytokines in patients with malignancy was studied by measuring the serum levels of TNF, Interleukin-I (IL-1), Interleukin-2 (IL-2), and Interleukin-6 (IL-6). Eight patients with cancer had weight loss >10% of their body weight prior to starting anticancer therapy, and their weight loss was not attributable to gastrointestinal disorder, or other medical conditions. Seven patients with malignancy and no weight loss, as well as three normal donors without malignancy were also tested as controls. TNF, IL-1, IL-2 and IL-6 serum levels were determined using a quantitative ELISA test. Elevated levels of TNF, IL-1, IL-2 and IL-6 were detected in 25%, 12.5%, 12.5% and 50% of patients, respectively. In contrast, TNF levels were elevated in 28.5% of seven patients with cancer and no weight loss. In these patients, IL-1, IL-2 and IL-6 levels were undetectable. No TNF, IL-1, IL-2 or IL-6 could be detected in the sera of normal controls. Elevated cytokines serum levels, and especially IL-6, are detected in patients with cancer-cachexia. The determination of such cytokines may have a prognostic value.     

Statistical study for sonographic differential diagnosis of tumorous lesions in the parotid gland.

OBJECTIVE: The purpose of this study was to clarify characteristic sonomorphologic features of parotid lesions statistically and to propose new criteria for the differential diagnosis. STUDY DESIGN: Eighty-six tumorous lesions were analyzed with regard to the following sonomorphologic features: boundary, shape, echo intensity level, distribution of internal echoes, and acoustic enhancement. Stepwise polychotomous logistic regression analysis was performed to assess characteristic sonographic features. As dependent variables, we used "pleomorphic adenoma," "Warthin tumor," "malignant tumors" and "other benign lesions"; as predictor variables, we used the aforementioned sonomorphologic features. Proportion of the occurrence of each dependent variable was calculated. RESULTS: Lobular shape and homogeneous internal echoes predicted pleomorphic adenoma. A lesion with multiple anechoic areas would be Warthin tumor with very high sensitivity. Malignant tumors showed either heterogeneous internal echoes without characteristic structures or polygonal shape. CONCLUSIONS: These sonomorphologic features should be observed to make more exact differential diagnoses for operation and therapy planning.     

A pathological classification of pleomorphic adenoma of the salivary glands (author's transl)]

Pleomorphic adenomas of the salivary glands show, despite their pleomorphism, certain histological characteristics. These are based onthe differentiation of the epithelial cell and the amount and nature of the stroma. A systematic histological analysis of 310 pleomorphic adenomas of the parotid gland resulted in the following findings and classification. 1. The most frequent epithelial cell forms were salivary duct and myoepithelial cells (75-90%) seen as epidermoid cell groups (75%). Rarer forms of differentiation were striated duct cells (5%), keratinised squamous epithelium (2,5%), oncocytes (1%), basal cells (1%), and sebaceous gland cells or goblet cells (less than 1%). 2. A myxomatous stroma represented the prototype of stromal differentiation (80%). A chondroid stroma was found in 10% of cases examined and a mixed mucochondroid stroma in 3%. Further differentiation included hyaline stroma (25%) and fibrous stroma (15%) especially in the older tumour or after irradiation. Rarely was a fascicular (0,5%) or osseous (1%) stromal change found. 3. Four subgroups of pleomorphic adenoma can be classified from consideration of the epithelial and stromal changes. Subgroup 1 (30,5%) is the classical pleomorphic adenoma with a stroma content of 30-50%; subgroup 2 (55%) has a stroma content of 80%; subgroup 3 (9%) has a poor stroma content of 20-30% or less and an epitaelial differentiation similar to subgroup 1; and subgroup 4 has also a poor stroma content (6%) with a relatively monomorphic epithelial structure. 4. Recurrences (13,5%) were seen more in stroma-rich pleomorphic adenomas than in stroma-poor tumours. 5. On the basis of cytological differentiation, pleomorphic adenomas develop from indifferent tissue adjacent to salivary intercalated or striated ducts.     

Comparing sulindac with indomethacin for closure of ductus arteriosus in preterm infants

Objectives: A prospective study comparing the efficiacy and side-effects of oral sulindac with intravenous indomethacin in clinically stable preterm infants (<1750 g) requiring non-invasive closure of haemodynamically significant patent ductus arteriosus.
Methodology: As maturity and birthweight are the two major determinants of ductal closure, infants were matched as closely as possible for these parameters. An eligible patient was first assigned to the sulindac group and a subsequent patient with similar gestational age (± 1 week) and birthweight (±100 g) to the previously recruited infant would automatically receive indomethacin. A total of eight infants were enrolled in each group.
Results: The ductus arteriosus was successfully closed in all eight infants receiving indomethacin, and in seven of eight infants receiving sulindac. No significant differences were found with regards to the ductal size between the two groups at diagnosis or on each of the consecutive days of treatment ( P >0.25). More renal adverse effects were encountered in the indomethacin group. Significant differences in changes from baseline value for urine output, plasma sodium, urea and creatinine concentrations were noted at 24, 48 and 72 h after commencement of treatment between the two groups ( P <0.05). All the parameters returned to normal or pre-treatment levels 48 h after stopping therapy. Unexpectedly, severe gastrointestinal complications were encountered in the sulindac group.
Conclusions: Sulindac is capable of promoting ductal constriction in clinically stable preterm infants without compromising the renal function. The spectrum of gastrointestinal complications observed in sulindac treated infants were similar to those described for indomethacin. The use of sulindac for ductal closure in the preterm infant should remain experimental.