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[A new psychopediatric syndrome of toxoplasmic origin].

A preliminary exposition on the existence of a new syndrome which is of interest to pediatrics and psychiatry and has been called "chronic dystrophying adenic syndrome" or "CDA syndrome" is made. The syndrome is the clinical expression of the lymphochronic variety of the toxoplasmic disease in the child and it is clinically expressed by the triad: dystrophies, psychiatric disorders and adenopathies with a chronic course. In these patients adenopathies have a toxoplasmic origin and they represent the pathogenic factor which determines the syndrome. Atypical forms of the syndrome are pointed out. Most frequent and important atypical forms are correlated.

Child, Preschool↗

[Yersinia enterocolitica septicemia in a thalassemic girl].

We report a four-year-old girl, previously splenectomized because of thalassemia major, who was admitted with gastroenteritis, abdominal pain and high grade fever. At laparotomy she was found to have appendicitis and mesenteric adenitis. Blood and stool cultures grew yersinia enterocolitica. Clinical course was favourable under Ampicillin-Gentamycin treatment. The importance of iron metabolism in the pathogenesis of yersinia sepsis is stressed, being this topic reviewed.

Appendicitis↗

Mucocutaneous lymph node syndrome without exanthema: a case report.

A seven-year, eight-month-old Mexican-American boy was admitted to the hospital with a history of prolonged fever and cervical adenitis. The fever persisted for approximately two weeks and was associated with bilateral conjunctivitis, dryness and redness of the lips, and a deeply red tongue with marked hypertrophy of the papillae. Approximately two weeks following admission a peculiar desquamation of the perianal area was noted, followed by the desquamation of the hands and feet typically noted with mucocutaneous lymph node syndrome (MLNS).Numerous laboratory studies were performed and were not revealing. With the desquamation of the hands and feet a diagnosis of MLNS was believed confirmed. This case is unusual because there was no cutaneous eruption so characteristic of MLNS, and also because of the presence of the peculiar perianal desquamation which has not been previously reported.

Child↗

Takayasu's arteritis: the relationship with tuberculosis.

A 12-year-old girl developed Takayasu's arteritis (pulseless disease) within a month of the appearance of tuberculous cervical adenitis. This unusual form of arteritis is common in Japan and Korea but has rarely been reported in individuals born in the United States. The etiology is unclear. The literature currently hypothesizes an autoimmune basis and treatment with steroids. Although a tuberculin sensitization pathogenesis has been suggested, a close temporal relationship with the onset of a tuberculous process has not previously been documented. The likelihood of uncovering tuberculin sensitivity or active tuberculosis in patients with Takayasu's arteritis is substantially higher than in the general population in all countries analyzed. The natural history of this arteritis is highly variable. The adolescent described in this paper has demonstrated complete symptomatic remission as well as return of pulses simultaneous with antituberculosis therapy.

Adolescent↗

Atypical mycobacteria.

The atypical mycobacteria are common human saprophytes. Their presence, particularly in a healthy person, is not associated with disease. In the child they cause two conditions, cervical adenitis and swimming-pool granuloma. Both of these diseases tend to be localized and nonprogressive. The former can be treated with reasonably nontoxic drugs; if this falls, total excision can be employed. The latter is best left to heal by itself. Occasionally, the atypical mycobacteria will cause widespread systemic disease, particularly in the patient whose immunity has been compromised.

Antitubercular Agents↗

[Yersinia pseudotuberculosis and Yersinia enterocolitica].

Yersinia pseudotuberculosis is a very homogeneous species, with only six sero-groups and which can not also be lysotyped. The essential reservoir is made up of rodents, birds, cats and soil and is the origin of human infection. Y. enterocolitica has 5 biochemical types, 57 serotypes (types 03 and 09 are the most commonly involved in human pathology) and 11 lysotypes. Contamination is essentially by direct human-human contact from healthy carriers or, more rarely, via infected food. The aetiological diagnosis of the arthritis occurring after an episode of abdominal Yersinia (enteritis, mesenteric adenitis) depends on the simultaneous search for bacteria in the stools and for antibodies.

Arthritis, Infectious↗

Antipolysaccharide group-specific antibodies of Streptococcus pyogenes in children.

Evaluation of a new microtest for the detection of Streptococcus pyogenes group A antipolysaccharide antibodies in 996 control children and 562 streptococcal infections from 0 to 12 years. The case-list was divided in 4 groups, years 0-2. 2-4. 4-8. 8-12 for the evaluation of the age-related normality range. Under 2 years normal values between 60 and 120 U, from 2 to 12 years normal values under 240 U. In streptococcal infections identical patterns for the pathological values in the 4 age-ranges considered, with positivity percentage from 85% to 95%, thus confirming the same antibody response also in breast-fed children, unlike what occurs for ASO under 2 years, when the response is present only in 25% of the cases and in the 2-4 years age-range in 33.3%. Evident diagnostic superiority of MSK as compared with ASO in adenitis, pyodermic infections, bronchopneumopathies, acute tonsillitis at the onset of symptomatology. In rheumatic disease the percentage of positivity for MSK and ASO is similar, in post-streptococcal glomerulonephritis and in Schoenlein-Henoch syndrome the percentage of positivity for MSK is higher than for ASO. It is suggested the utility of insertion of MSK test in the routine assay for streptococcal infections diagnosis above all in children under 4 years and in infections with low or slow antigenic charge for 0-streptolysin.

Child↗

Gonococcal inguinal lymphadenitis.

Neisseria gonorrhoeae is an unusual cause of inguinal lymphadenitis. We describe herein a male patient with no evidence of urogenital or extragenital gonococcal infection who had bacteriologically proved lymphadenitis secondary to N gonorrhoeae. We were unable to elucidate the pathogenesis of this entity, but concluded that urethral, rectal, and pharyngeal cultures for gonorrhea should be included in the evaluation of sexually active persons with adenitis of uncertain etiology even in the absence of urogenital or extragenital symptoms or findings.

Adult↗

The distribution of ABO, MNSs, Rhesus, Kell, Duffy and Kidd blood groups of Jews originating from 20 countries.

The distribution of red blood cell antigens of 10,000 Jewish Israeli men are presented by their country of birth. The ABO, MNSs, Rh, Kell, Duffy and Kidd blood groups were examined, and their frequencies were analyzed for each of 20 countries of birth. These results can serve as control and reference data for various studies, both basic and applied, concerning Jewish communities. The data are shown in various ways: phenotype and allele frequencies are presented alphabetically by countries of birth, and the allele frequencies are also shown by lowest to highest frequencies among the communities. The data indicate that Jews from Europe and Morocco tend to have intermediate allele frequencies. At the extremes are mainly Jews from Yemen, Aden and Yugoslavia. These observations are in accordance with previous studies on genetic distances.

ABO Blood-Group System↗

The stereochemical course of phosphoric residue transfer catalyzed by beef heart mitochondrial ATPase.

The stereochemical course of phosphoric residue transfer has been determined for beef heart mitochondrial ATPase. When aden 5'-(3-thiotriphosphate), stereospecifically labeled with 18O in the gamma position, was hydrolyzed in [17O]water in the presence of the ATPase, the product inorganic [16O, 17O, 18O]thiophosphate was chiral. The configuration of the product showed that the hydrolysis had proceeded with inversion at the gamma-phosphorus atom. This result suggests that there is a direct, in-line transfer of the phosphoric residue between ADP and water and that there is no phosphoenzyme intermediate.

Adenosine Triphosphatases↗

Short-course chemotherapy for tuberculosis in children.

Short-course, largely twice-weekly chemotherapy for tuberculosis was introduced in the United States for treatment of adults with pulmonary disease by the Arkansas State Department of Health in 1976. Since 1977, 50 children with tuberculosis have been treated with rifampin, 10 to 20 mg/kg, and isoniazid, 10 to 20 mg/kg daily for one month followed by 10 to 20 mg/kg of rifampin and 20 to 40 mg/kg of isoniazid twice a week for another 8 months. Ages ranged from 4 months to 15 years with a median age of 3 years. A presumptive diagnosis of tuberculosis was made on the basis of 10 mm or more of induration to 5 TU of purified protein derivative and a chest film or other findings compatible with tuberculosis. Three children had extrapulmonary disease (two had cervical adenitis, one had tuberculosis arthritis). Of the 47 children with pulmonary disease, 32 were asymptomatic. The results were excellent. Symptoms cleared in 1 to 2 months. Most pulmonary infiltrates had cleared by 10 months, but hilar adenopathy rarely cleared in less than 2 years. Drug toxicity occurred in only one patient (vomiting of rifampin). This treatment appears to be safe, effective, inexpensive, short and simple enough to ensure cooperation or to allow personnel to administer drugs directly to children from socially disorganized families.

Adolescent↗

Carotidynia.

Carotidynia is a common but seldom recognized syndrome in which the patient typically complains of a sore throat. Closer questioning usually reveals the soreness to be in the neck. On physical examination, tenderness is noted along a localized segment of the carotid artery. Often the syndrome is misdiagnosed as cervical adenitis and inappropriately treated with an antibiotic. Etiology is unknown. Anti-inflammatory therapy is effective.

Anti-Inflammatory Agents↗

The vulvar vestibule.

Vulvar pain, burning and dyspareunia are challenging complaints that often defy attempts at specific diagnosis. The vulvar vestibule is being recognized increasingly as a site of these symptoms, but the entities found at this location are not recognized widely. The clinical and histologic features of the minor vestibular glands, mucinous cysts, vestibular adenitis and vestibular papillae are given as they appeared in 28 patients.

Condylomata Acuminata↗

Keratoconjunctivitis sicca: histopathologic study of nictitating membrane and lacrimal glands from 28 dogs.

Forty nictitating membrane glands and 9 main lacrimal glands were obtained for histologic evaluation from 28 dogs with keratoconjunctivitis sicca as the result of azosulfapyridine toxicity, canine distemper, multisystemic autoimmune disease (Sjögren's syndrome-like syndrome), congenital origin, and unilateral and bilateral idiopathic keratoconjunctivitis sicca. Similar glands from 6 control dogs were studied. The most prevalent (87%) histopathologic finding was variable degrees of multifocal chronic adenitis, characterized by acinar atrophy and replacement with increased numbers of plasma cells and lymphocytes within increased amounts of interacinar fibrous connective tissue stroma. Occasional tubular structures were dilated and filled with neutrophils and cellular debris.

Animals↗

Necrotizing lymphadenitis. A study of 30 cases.

Thirty patients with necrotizing lymph-adenitis, a disorder initially described in Japan and commonly misdiagnosed as malignant lymphoma, have been studied, in addition, stains for immunologic markers were performed. The patients included 21 United States residents and most commonly were young women with a subacute illness characterized by persistent, painless cervical adenopathy with or without fever. The excised lymph nodes were moderately enlarged and typically showed focal, well-circumscribed, paracortical, necrotizing lesions, and abundant karyorrhectic debris, scattered fibrin deposits, aggregates of large mononuclear cells, and a paucity of plasma cells and neutrophils. Immunohistochemical stains on frozen tissue sections were positive for 63D3 and Leu-2a, indicating an admixture of of histiocytes/macrophages and cytotoxic/suppressor T-lymphocytes in the necrotizing lesions. The etiology of necrotizing lymphadenitis and its distinction from other causes of reactive lymphadenitis are discussed. To our knowledge, this disorder has not previously been reported in the United States.

Adolescent↗

[Cytostatistical classification of stomach cancer using a taxonomic method].

To elaborate certain objective rules for the differential cytological classification of gastric cancer the initial material was studied, which was obtained from 100 gastric cancer patients based on cytological characteristics for 28 morphometric parameters. The results were processed on a computer by an approximation method of statistical classification, and 4 taxons were obtained: the 1st taxon (21 observations) comprised "diffuse" type tumors, characterized cytologically by an isolated arrangement of mucous and signet-ring cells; the 2d and 3d taxons (10 and 51 observations combined "intestinal" type gastric cancer, characterized by adenous complexing of columnar cells without mucus in the cytoplasm; the 4th taxon is characterized by the greatest variance in morphometrical indices and included tumors of anaplastic gastric cancer. The cytostatistical classification according to cell types corresponds to the Lauren histological classification of gastric cancer.

Adult↗

Tuberculous peritonitis in children.

Twelve patients with tuberculous peritonitis were studied. The provisional diagnosis was based on clinical, laboratory and radiological investigations. Later on peritoneoscopy with biopsy established the diagnosis. The presenting symptoms varied and not one symptom or sign was of definite diagnostic significance. Ten of the twelve patients gave a history of exposure to tuberculosis. Ascites was present in three patients, while liver enlargement was observed in seven patients. At the original clinical examination none was diagnosed as tuberculous peritonitis. The results of 5 TU tuberculin test were 10 mm or more in six patients. The chest roentgenogram was abnormal in seven patients, while multiple calcified mesenteric lymph nodes were demonstrated in three patients on the abdominal roentgenogram. Proven sites of tuberculosis besides the tuberculous peritonitis were discovered in seven patients, including pulmonary tuberculosis and tuberculous cervical adenitis. The ascitic fluid studies did not allow a conclusive diagnosis; only one of three ascitic fluid yielded acid-fast bacilli. Peritoneoscopy performed at the same time with peritoneal biopsy seems to be the best approach to establish a definite diagnosis. This disease may easily be overlooked and misdiagnosed, and without specific treatment may give rise to serious complications.

Child↗

Head and neck manifestations of mycobacteria in the absence of pulmonary disease.

Mycobacterial infections, once relatively rare in North America have recently shown an upsurge with the influx of Asian and African immigrants. The infections are usually due to M. tuberculosis and present with pulmonary symptoms. However, an uncommon presentation is that of a mass in the head and neck region without any pulmonary manifestations. Although these infections are usually secondary to invasion by "atypical" mycobacteria, unusual presentations due to mycobacterium tuberculosis have been noted. Case reports depicting the very rare presentations of M. tuberculosis in the thyroglossal duct cyst, parotid, and submandibular lymph node are described. A very unusual case of atypical mycobacteria in the larynx is noted and cervical adenitis is also included. The initial subtle presentation emphasizes the importance of mycobacteria in the differential diagnosis of lesions in the head and neck region.

Adult↗