Clinical manifestations of disseminated sclerosis in childhood]

The author studied children from 6-14 years with disseminated sclerosis in the area of a decreased risk to this disease. The early period of the disease in this age group was very difficult to discern. As a rule, disseminated sclerosis in children in detected by a retrospective analysis of the clinical development. In children, as in adults, the clinical course has a remittent development, where there are remissions and exacerbations. More frequently than in adults, the disease acquires a hyperkinetic form, which is considered to be most malignant. Probably the disease occurs not at 12-15 years, as it is being pointed in the literature but much earlier (4-5 years). Exacerbations of disseminated sclerosis in children, unlike exacerbations in adults occur not so much from the influence of cold factors as from warm. In order to avoid a hyperdiagnosis of disseminated sclerosis in children a differential diagnosis should be made between hereditary-degenerative disorders of the nervous system and progressive forms of panencephalitis.     

Sarcoidosis in children. Clinical manifestations, epidemiology, treatment and prognosis

Sarcoidosis is a granulomatous disease of unknown aetiology, which may affect various organs. The diagnosis is obtained by the demonstration of epytheloid cell granulomas in an affected organ. The incidence of sarcoidosis in Danish children less than 15 years of age is 0.22-0.27/100.000 children/year, corresponding to approximately three new cases in Denmark each year. The disease often takes an asymptomatic course. During the period 1980-1992, three cases of paediatric sarcoidosis were observed in Copenhagen Country. All three had pulmonary involvement, and one had severe hypercalcaemia. In children less than five years of age, the disease is characterized by involvement of lungs, lymph nodes and eyes. Treatment, which is symptomatic, consists of systemic steroids. Due to the risk of growth retardation, the indication for treatment should be carefully considered and steroids administered at the lowest effective dose. Due to the lack of follow-up studies, the long term prognosis is unclarified.     

Clinical epidemiology of childhood abdominal migraine in an urban general practice

The present study examined the epidemiology of abdominal migraine among 1104 children registered with a general practice. There was a similar prevalence of recurrent abdominal pain as in other studies (8.4 per cent). The prevalence of headache was higher among children with recurrent abdominal pain and significantly so among girls. Migrainous headache was not significantly more prevalent in children with recurrent abdominal pain. The prevalence of abdominal migraine with and without migrainous headache was 0.7 and 1.7 per cent, respectively. The peak prevalence of abdominal migraine without migrainous headache was between five and seven years for both sexes. When associated with migrainous headache, it peaked at five to seven years in girls and seven to nine years in boys. The syndrome was associated with travel sickness and was more common among girls and those with a maternal history of migraine. Many children were photo- and phonophobic during an attack.     

Registration quality and descriptive epidemiology of childhood brain tumours in Scotland 1975-90

Children (0-14 years) with malignant brain and central nervous system (CNS) tumours (ICD9 191 and 192) were listed from the Scottish Cancer Registration Scheme for the years 1975-90. These cases formed the basis for validation and verification procedures aimed at providing a complete and accurate data set for epidemiological analyses. A variety of data sources were cross-checked to optimise ascertainment, and resulting from this 5.7% of validated cases were found on the cancer registry with diagnostic codes outside the ICD-9 range 191-192. A further 8.4% were newly registered cases. Analyses were conducted on the validated data set showing a significant temporal increase in incidence rates over the 16 year study period with an average annual percentage change of +2.6%. Large-scale geographical heterogeneity was also found, with a particularly high incidence in the Fife and Lothian areas and a low incidence in Grampian. Examination of associations with socioeconomic status, using the Carstairs deprivation index, revealed a rising trend in incidence strongly linked to areas with increasing levels of affluence. Our results suggest that for studies of childhood CNS tumours validation of cancer registry data is necessary and large-scale geographical variation and socioeconomic factors should be taken into account in any investigation of distribution in small geographical areas.     

Urologic manifestations of hyperparathyroidism in childhood

Among renal stone-forming children 6 per cent suffer from primary hyperparathyroidism. Urologic complications were noted in 7 of 9 children (78 per cent) with surgically proved hyperparathyroidism seen in a 24-year period. These included nephrolithiasis and nephrocalcinosis (6), defective urinary concentration or acidification (5) and mild impairment of renal function (3). All children responded favorably to parathyroidectomy, which should be performed before treatment of stone disease is undertaken. The nature of urologic manifestations of hyperparathyroidism and their management are discussed.     

Epididymal manifestations of urogenital tuberculosis

We report the case of a 33-year-old man with a severe Crohn's disease since the age of sixteen. He presented with acne and palmoplantar pustulosis associated with a right knee synovitis. Investigations revealed a major axial bone condensation. The association synovitis-acne-pustulosis-hyperostosis-osteitis leaded to the diagnosis of SAPHO syndrome associated with Crohn's disease.     

Unusual intestinal manifestations of tuberculosis

In an 87-year-old Swiss female referred with complaints of bloody diarrhea and weight loss, colonoscopy revealed three ulcers in the rectum and colon. Cultures from the colonic ulcers were positive for Mycobacterium tuberculosis. There was no evidence of pulmonary infection. One week after adequate therapy was begun, a perforation occurred at the rectosigmoid junction. The sigmoid was resected and left-sided colostomy was performed. Seven days after surgery the patient died. Clinical features, diagnosis and morphological changes of intestinal tuberculosis are discussed.     

Molecular epidemiology and the new tuberculosis

DNA fingerprinting techniques now exist which identify specific strains of Mycobacterium tuberculosis. These techniques may be integrated with conventional epidemiologic approaches to better understand tuberculosis in its modern form. This paper reviews the lessons learned from this approach about the pathogenesis and epidemiology of tuberculosis. In addition, it speculates about the potential future applications of molecular epidemiology, including its use as an adjunct to conventional public health measures.     

Clinico-morphological manifestations of genital tuberculosis in women

No previous studies have examined the influences of cultural background on the provision of contraceptive services to females under 16 years of age. A research project was undertaken to investigate any differences between general practitioners trained in the United Kingdom and those trained in the Indian sub-continent in relation to contraceptive service provision to females under 16 years of age. A self-completion postal questionnaire survey was distributed to 230 unrestricted principal general practitioners across Scotland. Subjects were identified from the Medical Register. Half of the sample consisted of all those working in Scotland who had been trained in the Indian sub-continent. The other half were a comparable group that had been trained in the United Kingdom and were selected by quasi-random quota sampling. The response rate was 57 per cent (131/230). General practitioners in the study who had trained in the Indian sub-continent were found to be significantly less likely to provide contraceptive services to a female under 16 years of age than those who had trained in the United Kingdom. Cultural background may be influential in general practitioner provision of contraceptive services to females below the legal age of consent for sexual intercourse. In order to obtain more conclusive evidence a larger study is necessary. Such investigations must be undertaken with appropriate sensitivity and social awareness.     

Molecular epidemiology of tuberculosis in Denmark in 1992

The incidence of tuberculosis (TB) is increasing all over the world, including in countries with a high standard of living and good social security. Denmark represents such a region. Furthermore, it is a small country (5 million inhabitants) with a long tradition in TB control, including a centralization of the bacteriological diagnostic facility. The present study was intended to analyze the transmission of Mycobacterium tuberculosis in a country in which TB has low endemicity by a combination of conventional epidemiological approaches and DNA fingerprinting techniques, whereby individual bacterial strains can be traced. M. tuberculosis isolates from 92% of all new cases of bacteriologically verified TB in Denmark during 1992 were subjected to IS6110 DNA fingerprinting to visualize the DNA restriction fragment length polymorphism (RFLP) patterns of the isolated strains. The data obtained from the RFLP analyses were interpreted by using demographic data, such as age, sex, ethnicity, and residence, for the patients. The risk factors among the patients for being part of an active chain of transmission, as opposed to demonstrating reactivation of a previously acquired latent infection, were estimated by statistical analyses. The magnitude of TB transmission in 1992 in Denmark was determined, and transmitted infections were shown to comprise at least one quarter of the total number of cases. Almost half of the TB cases involved patients of foreign origin. However, most of these isolates showed unique DNA fingerprint patterns and were rarely part of an active chain of transmission. The major chains of recent transmission were localized to distinct geographical regions in the country. TB is frequent among immigrants, especially from Asia and Africa, but it is apparently readily suspected, diagnosed, and treated by the health care system. Danish patients with pulmonary symptoms are not primarily suspected to have TB and, therefore, play an important role in recent TB transmission in Denmark.     

Utility of molecular epidemiology of tuberculosis

In Bacillus sp. YUF-4, acetylacetoin synthase was induced by acetoin, while glucose inhibited the induction. The enzyme was purified 111-fold by 6 purification steps, and a further purification followed, by HPLC using a TSK gel, Phenyl-5PW RP. The resulting enzyme gave a single band with a molecular mass of 62 kDa by SDS-PAGE and 220 kDa by gel filtration. Some enzymic characteristics were studied.     

Close contact with tuberculosis in childhood

In a 1-year prospective study 83 children, who had been in close contact with 52 adults who had tuberculosis, were examined. Thirty-six of the index cases had culture positive tuberculosis and 16 of these had smear positive tuberculosis. All the children had been BCG-vaccinated at birth. Forty-one (49%) of the children were PPD negative on examination with the Mantoux test. Of these 83 children, one 14-year-old boy was diagnosed as having primary tuberculosis and was treated. Twenty-one children received INH therapy, 12 because of their age (under 2 years of age or at puberty), nine because of a strong positive reaction to the first Mantoux test or because of the conversion of a negative test result to positive during the follow-up period. Seven of the latter nine children had been in contact with persons whose disease was culture- and smear-positive. It is concluded that as the frequency of tuberculosis declines, the practice of examining all children who have been in close contact with tuberculous adults is possible. The children who have been in contact with smear-positive index cases are at special risk of contracting tuberculosis.     

Clinical features and epidemiology of malignant pleural mesothelioma in west Glasgow 1987-1992

This project was undertaken to examine the health resource implications of performing endoscopic third ventriculostomy as an alternative to CSF shunting in appropriate patients. We carried out a retrospective study of case records and X-rays of patients shunted de novo at the INS, Glasgow for the two year period 1990-1991. We identified all those patients who would have been suitable for endoscopic third ventriculostomy and examined the shunt complications and extra days in hospital required by these patients. A total of 150 new shunts was inserted during the two year period. Of these, 23 patients (15%)were judged suitable for endoscopic third ventriculostomy as an alternative to CSF shunting. Eight out of 23 patients required a total of 29 repeat operations and an extra 230 days in hospital due to shunt complications. Assuming an 80% success (shunt free) rate for endoscopic third ventriculostomy, we calculate that 9 operations and 74 bed days per year could be saved by using this technique. We conclude that in units undertaking a large number of CSF shunt insertions, investment in neuroendoscopic equipment, training, and expertise has the potential to release significant resources for other uses.     

Genome fingerprinting in the epidemiology and epizootology of tuberculosis]

The history and modern status of tuberculosis are analyzed from epidemiological viewpoint. Different repeating genetic elements of mycobacterial genome are described, which have been recently used to develop methods for typing of pathogenic mycobacterial strains. Genome fingerprinting is compared with the traditional methods of epidemiology. The prevalence of Mycobacterium bovis in domestic and wild animals is analyzed.     

Descriptive epidemiology of childhood cancers in Bangalore, India

While fairly complete and reliable incident data on childhood cancers are available from the registries in India, mortality and survival information is not. Information concerning the latter was obtained by the Bangalore cancer registry through active follow-up involving visits to homes of patients. Between 1982 and 1989, 617 cases of cancers in childhood were registered, giving an age-standardized incidence rate of 84.8 and 48.4 per million in male and female children, respectively. Active follow-up provided mortality/survival information in 532 or 86.2 percent of these cases. Overall, observed five-year survival was 36.8 percent (both genders combined) with a relative survival of 37.5 percent when childhood mortality in the general population was taken into account. The five-year relative survival was best for thyroid carcinoma (100 percent) followed by Hodgkin's disease (73 percent) and retinoblastoma (72.9 percent). Survival was comparatively low, being 9.9 percent in acute nonlymphatic leukemia and less than 20 percent in rhabdomyosarcoma and the category grouped as 'other malignant neoplasms.' Survival in Hodgkin's disease was influenced by clinical stage at presentation, but was not statistically significant possibly due to small numbers.     

CD95 expression in aged mice infected with tuberculosis

The interaction between CD95 and its ligand is an important homeostatic mechanism that leads to the induction of apoptosis in activated T cells. In view of recent evidence that this pathway might be defective in aged mice, this study investigated CD95 expression on T cells in old mice activated by infection with Mycobacterium tuberculosis. The results of the study do not support the hypothesis that CD95 is poorly expressed on CD4 T cells from old mice; instead, it was found that similar numbers of T cells from young and old mice expressed CD95, with the intensity of expression if anything higher on the cells from the old mice. In addition, the study demonstrated that changes in CD44 and CD45RB expression previously observed in young infected mice proceeded in a similar fashion in old animals and, as would be predicted, that CD95(hi) expression was primarily associated with CD4 T cells expressing the activated CD44(hi) CD45RBhi phenotype.     

The history, epidemiology, and classification of headaches in childhood

The history of headaches in children, their epidemiology, and their classifications are reviewed. Symptoms, prevalence, school absences, risk factors, and treatments are discussed. More data is needed regarding the epidemiology of tension headaches, headaches observed in the emergency room, and headaches observed in the setting of the primary care practitioner.     

Incidence and economics of tuberculosis in swine slaughtered from 1976 to 1988

The Swine Tuberculosis Regulations, revised in 1972, stipulated that all swine carcasses with mycobacterial lesions in more than 2 primary sites should be passed for cooking (PFC). Economic loss from a condemned carcass is 100%, whereas loss from a PFC carcass is 66%. Increased condemned and PFC swine carcass rates in 1972, 1973, and 1974, and the economic losses from them were attributed to changes in the regulations. An industrial organization estimated increased economic losses from swine tuberculosis, but detected decreased rates of condemned and PFC swine carcasses in 1975 and 1986. The federal meat inspection data for 1976 to 1988 indicated that the yearly condemned carcass rate remained < 8.0/100,000 swine slaughtered, whereas the PFC carcass rate decreased by 74.1%, from 52.4 to 13.6/100,000 swine slaughtered. The incidence (condemned + PFC) per 100,000 swine slaughtered decreased by 67.7%, from 58.03 in 1976 to 18.72 in 1988. The Agricultural Statistics indicated that a yearly loss from tuberculosis of $2.3 million in 1976 decreased by 73% to $0.97 million in 1988. A yearly loss of $41,580/$100 million of animal value decreased by 70% to $12,880/$100 million in 1988. The decreased incidence of swine tuberculosis and the economic losses with this disease indicate that the swine industry in the United States was not adversely affected by the change in the Swine Tuberculosis Regulations.