Peracute streptococcal pyomyositis: report of two cases and review of the literature

Pyomyositis occurs infrequently in temperate climates. The fulminating peracute form caused by group A Streptococcus is exceedingly rare. We present two children with streptococcal pyomyositis. One child was admitted in septic shock and required intensive supportive care during the acute stage of his illness. Persistent swelling and tenderness of his left thigh presented a diagnostic problem, which was eventually resolved with the aid of computerized tomography. Despite appropriate antibiotic therapy from the onset of illness, surgical debridement of the affected muscle was necessary. The second child presented with pyomyositis of the left paravertebral muscles and signs of incipient shock but did well on antibiotic therapy alone.     

Common bile duct calculi: updated experience with dissolution with methyl tertiary butyl ether

The authors describe their experience with methyl tertiary butyl ether (MTBE) in a larger series of patients than previously reported in order to acquaint physicians with both its effectiveness for dissolution of common bile duct calculi and the limitations of its use. Ten patients with 13 biliary calculi underwent percutaneous stone dissolution treatment with the experimental cholesterol solvent, MTBE. Three stones completely dissolved within 30 minutes, seven were reduced in size, and three were visibly unaffected. All stones not completely dissolved were easily extracted by means of a stone basket except for one in a patient taken to surgery. Although MTBE perfusion is an effective technique for management of biliary calculi, practitioners should be aware that its use is quite time consuming and its odor difficult to control.     

Modification des styles d'attachement après le premier amour

The newborn are subject to the bond between infants and their caregivers. The newborn receives the imprint of a style of attachment of which the function involves “proximity-maintenance” and “separation-protest”. The “secure-base” uses the attachment as a base from which the newly born is able to explore his environment. The continuity between childhood and adult relationships changes when romantic love and sexual appetite appear. A new kind of attachment with the love partner must develop and it has to support both attachment and sexuality. The youngster produces the same secure, avoiding, ambivalent or confused attachment as when he was an infant but, as opposed to that with his family, when the young person is attached to his partner he doesn't want to leave. In order to assess the link between the attachment with caregivers and the attachment with the first love, we proposed a questionnaire, a kind of “Love quiz”. First, the representation of attachment with their parents was assessed by four columns of ten questions. Each question referred to a style of attachment, for instance at the end of the interview, the column asking questions about avoidance displayed seven answers, whereas the secure column showed only three answers and the confused only one. Later, the same questionnaire was submitted in order to describe the new attachment with the first love. Results showed that the commitment to romantic love was similar to those observed among infants. But, after a while, the scores obtained in each column evolved: Fourteen out of twenty symptomatic adolescents improved their secure score; three remained in the same style of attachment and three others felt their first love as a traumatism. Out of eighteen no-symptomatic adolescents, fourteen were secure. Only four were insecure. After the first love, the rate of insecure adolescents increased to eight; four others were traumatised. The first love probably sets up a sensitive period in which biology, emotion and culture converge to enable us to be imprinted by a partner. An affect regulation with romantic partners is negotiated like a transaction between two styles of attachment. What is surprising is that the population of insecure adolescents benefited more from romantic love than the secure population by increasing their score in the attachment style. Adult relationships can be understood in terms of attachment. The first attachment is acquired during early interactions, and when the beginnings of life are difficult the first love gives them a second chance.     

Prévalence d''Aeromonas spp. dans les gastro-entérites de l''enfant.

A selective medium and biochemical tests were used to search for Aeromonas spp. in the stools of 536 children, more than 90% of whom had "gastroenteritis", seen at Sainte-Justine Hospital, Montreal, in June or July 1986. The organism was found in seven children, six of whom had bloody diarrhea. One of the six, a 6 1/2-year-old boy, required intravenous alimentation and later manifested ulcerative colitis; the other five recovered. The remaining child, a 14-year-old boy, had synovitis of the knee and spondylarthritis. Two of the seven carried other enteric pathogens. The authors discuss the pathogenicity of Aeromonas spp., which is not very marked in temperate climates, in human summer diarrhea and its possible role in the development of ulcerative colitis.     

Expression of cadherins and CD44 isoforms in ovarian endometrial cysts

We evaluated the immunohistochemical expression of cadherins and CD44 variants in 20 endometriomas, 20 cystadenomas, 20 borderline ovarian tumours as well as 20 ovarian carcinomas, and the serological and cystic fluid concentrations of soluble E-cadherin and soluble CD44 standard (sCD44sdt) in 20 endometriomas, 20 cystadenomas, six borderline and 11 carcinomas of the ovary. In endometriomas, immunostaining of E- and N-cadherin was negative (20 and 30% respectively). CD44 H, v3 and v6 immunostaining were detected in 63, 10 and 40% respectively. A difference in immunostaining for E-cadherin was found between endometriomas and cystadenomas (P < 0.001) and for N- cadherin between endometriomas and carcinomas (P < 0.001). A difference in CD44H immunostaining was observed between endometriomas and cystadenomas (P < 0.035) but not with borderline ovarian tumours and carcinomas. No difference in serum concentrations of soluble E- cadherins and CD44 standard was found between the four groups of tumours. Cystic fluid concentrations of E-cadherin were lower in endometriomas than in borderline tumours and ovarian carcinomas (P < 0.001). High concentrations of soluble CD44 standard cystic fluid were found in endometriomas than in other ovarian cysts. Endometriomas and borderline tumours share alterations of cadherins and CD44 isoforms which may help in the understanding of the aggressive and invasive potentials of endometriotic cells.      

Genital asymmetry in men

This study examined genital asymmetry in a large sample of men. The probands were 6544 non-delinquent men who were interviewed by the Kinsey Institute for Research in Sex, Gender and Reproduction from 1938 to 1963. The measures were four indicators of penile and scrotal asymmetry, along with self-reported handedness, from Kinsey's interview protocol. Most men reported some degree of lateral asymmetry in their flaccid penis and in their testicles; less asymmetry was reported for their erect penis. The asymmetry typically occurred in the left direction, and this pattern occurred in both right- and nonright- handers. However, this 'leftward' pattern was significantly less pronounced in nonright-handers. The results are discussed in relation to previous findings of genital asymmetry in men, the possible relationship of genital asymmetry to functional cerebral asymmetry, and recent data suggesting genital asymmetry may predict patterns of cognitive performance and genital/sexual organ cancers.      

Immune deficiencies in chronic intestinal pseudo-obstruction

Aim: Chronic intestinal pseudo-obstruction has been associated with urinary disorders, myopathy, and ophthalmoplegia in adults and cholelithiasis in children. We observed a high percentage of total-parenteral-nutrition-dependent patients with pseudo-obstruction and recurrent infections requiring gammaglobulin infusions. Methods: AH records for 23 children with chronic intestinal pseudo-obstruction (10 females and 13 males, mean age 9.8 y ± 4.9 y, range 4–24 y) referred for a nutritional evaluation from 1992 to 1995 were reviewed. Chronic intestinal pseudo-obstruction was diagnosed by clinical, radiographic findings and antroduodenal manometry. Intestinal full-thickness biopsies were performed in seven children. Results: Hypogammaglobulinemia was diagnosed in 18 patients (78%): 16 patients had various immunoglobulin deficiencies and 2 had selective antibody deficiency. Intravenous gammaglobulin was administered in 14 patients. Other medical conditions affecting the children are summarized as follows: autonomic dysfunction in 10 patients (43%), recurrent hypoglycemia in 9 (39%), asthma in 9 (39%), cholecystitis in 7 (30%), low serum carnitine level in 6 (26%), urinary dysfunction in 6 (26%), pancreatitis in 5 (22%), behavioral problems in 5 (22%), myopathy in 2 (9%), idiopathic thrombocytopenia in 2 (8%), velopharyngeal insufficiency in 1 (4%), oculocutaneous albinism in 1 (4%), Pierre-Robin syndrome in 1 (4%), and protein C deficiency in 1 (4%). Munchausen syndrome was suspected in two patients. Conclusions: Chronic intestinal pseudo-obstruction appears to be associated with immune deficiencies. It is unclear if the immune deficiencies, intestinal pseudo-obstruction, and the other medical conditions have a common underlying etiology. Repeated infections may be due to impaired immune function in children with chronic intestinal pseudo-obstruction. We recommend screening for immune deficiencies in children with chronic intestinal pseudo-obstruction.