Trichinella britovi outbreak: Epidemiological, clinical, and biological features.

OBJECTIVES: We aimed to describe the first cases of human trichinellosis due to Trichinella britovi in Serbia. A large trichinellosis outbreak due to the consumption of wild boar meat products took place during the 2015-2016 winter. PATIENTS AND METHODS: In January 2016, the Department of Infectious Diseases in Uzice examined 111 individuals with clinical and biological signs of trichinellosis, of whom 19 were hospitalized. Trichinella species identification was performed by multiplex PCR. Serodiagnosis was performed using immunofluorescence antibody assay, indirect ELISA, and Western Blot as confirmatory tests. RESULTS: The main symptoms included myalgia (83%), weakness (82%), joint pain (80%), fever (77%), facial edema (74%), and diarrhea (23%). Eosinophil levels>500/µl were observed in 98% of patients. Elevated CPK levels were detected in 71% of patients and elevated LDH levels in 75%. Three patients had cardiac complications. Treatment included mebendazole, nonsteroidal anti-inflammatory drugs, and corticosteroids. Anti-Trichinella antibodies were observed in 89.7% of patients two months after disease onset, including all hospital-treated patients. Among them, serum positivity detected one year later was 100%. CONCLUSIONS: This outbreak highlighted communication failures, from hunters to consumers. Awareness should be raised on the relation between trichinellosis and game meat. Trichinella species detection is important for adequate outbreak recording and could contribute to better understanding the clinical and serological signs of T. britovi infection.

Frequency of portal and systemic bacteremia in acute appendicitis.

BACKGROUND: Acute appendicitis is the most common condition requiring an emergency abdominal operation in childhood. In the present study, we analyzed the frequency of portal and systemic bacteremia in 42 patients with acute appendicitis and determined the microbial agents responsible for an acute appendicitis and for portal and systemic bacteremia. METHODS: Appendectomies were performed on 50 young patients (5-18 years of age), as well as clinical and bacteriological tests. Six independent samples from each patient isolated from the peripheral vein, superior mesenteric vein, appendix and peritoneum were obtained prior to surgery, during surgery and after surgery for biochemical, immunologic and bacteriologic examination. RESULTS: Pathohistology confirmed the diagnosis of appendicitis in 42 patients, while in the other eight patients there were no obvious pathologic findings, so they served as a control group. Of 50 patients with a clinical appearance of acute appendicitis, in 19 patients (38%) we detected portal bacteremia in the mesenteric vein, while in only three cases (6%) did we find systemic bacteremia detected from the peripheral vein. Furthermore, bacteriologic analysis revealed that Bacteroides spp. and Escherichia coli were the predominant species isolated. CONCLUSIONS: The results presented in this paper suggests that portal bacteremia did not influence peripheral blood reactions. Furthermore, in the present study we have found a positive correlation between the smear and bacteremia of the superior mesenteric vein, but not with the bacteremia of systemic blood.

Hygienic conditions in elementary and secondary schools in the county of Split-Dalmatia.

This paper gives an assessment of hygienic conditions found in 22 primary and 12 secondary schools in the city of Split during the school year 1990/91. The data were compared with the results of a similar investigation carried out in eight primary schools in the neighbouring Sinj area. The assessment consisted of the examination of the facilities, questionnaires, and microbiological analysis of numerous samples. Most schools failed to meet the recommendations for hygienic and sanitary maintenance, particularly with regard to sanitary facilities for students and staff. Exposure to noise, inadequate lighting, and poor maintenance of gymnasiums were noticed. Of the total number of smears taken from the students' hands and various surfaces in schools in the Sinj area, group D streptococcus was isolated in 62% and E. coli in 43% of samples. Both bacteria indicate faecal contamination. The data suggest a low level of personal and general hygiene in schools. It is necessary to improve the hygienic conditions in the schools of the Split and Sinj area and to focus on health education. It would reduce the risk of intestinal and respiratory infectious diseases and potential sight and hearing impairments in students.

[Thyroid function and menopausal status in benign and malignant breast diseases]. / Tireoidna funkcija i menopauzalni status u benignih i malignih oboljenja dojke.

Thyroid function was evaluated in premenopausal (healthy controls n = 7, benign breast disease n = 59, primary breast cancer n = 7) and postmenopausal (healthy controls n = 8, benign breast disease n = 51, primary breast cancer n = 10) groups of female subjects. The following parameters were measured: T3, T4, FT3I, FT3I, T3U and TSH. Except significantly higher concentration of T3 in postmenopausal healthy controls (179.6 +/- 32.9 vs. 152.3 +/- 22.4 p < 0.05), in benign and malignant breast lesions there was not any significant deviation. T3U, FT3I and FT4I did not significantly differ in relation to menopausal status. Basal TSH level was premenopausally higher in all groups, but with statistically significant difference within the group of primary breast cancer (0.98 +/- 0.22 vs. 0.47 +/- 0.17 p < 0.05). Consequently, pathologic variations of thyroid hormones plasma level together with the changes of activities of thyrotropin cells could be a significant factor in premenopausal mammary tumorigenesis, while in benign breast lesions a possible relation between thyroid hormone instability and menopausal status was not identified.

[Changes in prolactin plasma levels in relation to menopausal status in primary breast carcinoma]. / Promjene plazmatskog nivoa prolaktina u odnosu na menopauzni status kod primarnog karcinoma dojke.

Prolactin plasma level was measured in healthy controls, 110 benign breast lesions and 17 primary breast cancers, and results were correlated in regard to pre and postmenopausal groups of female subjects. Prolactin concentration in healthy controls and benign breast lesions was higher postmenopausally, and in breast cancer premenopausally, with the absence of statistically significant difference. At the same time menopausal cases of primary breast cancer had a significantly higher prolactin level than the same subgroup of healthy controls (222.7 +/- 16.7 vs. 91.8 +/- 11.6; p < 0.05). It can be concluded that the changes of prolactin basal level had a different consequence in female patients with primary breast cancer in correlation with benign breast lesions and healthy controls. Consequently, in future investigations of unclear roles of prolactin in mammary tumourogenesis a possible relation among various hormonal factors, premenopause and primary breast cancer should be discussed.

[Stewart-Treves syndrome of the edematous arm following breast cancer operation]. / Stewart-Treves-Syndrom am ödematösen Arm nach Brustkrebsoperation.

In 1948, Stewart and Treves (158) described a lymphangiosarcoma on the edematous arm for the first time with reference to six cases involving arm edema after breast cancer operation. Since their publication, a further 313 cases have become known. In 1982, with communication of one case we published a statistical compilation comprising of 248 cases (Zeitschrift für Lymphologie VI, 1982, 51-66). A statistical compilation totalling 290 observations is now presented on the basis of further studies of the older literature supplemented by observations of the last six years including two of our own cases. So far, a total of 319 single observations has become known: 21 cases of Yap et al. (182), eight cases of Oshmianskaia et al. (123) and 290 cases in the statistical compilation we have drawn up and which is the basis of this publication. By histological investigation of the tissue material taken from a female patient within six weeks (exploratory excision, radical excision), detailed information could be obtained on the histological development of the Stewart-Treves-Syndrome (STS) from a preneoplasia to a mature lymphangiosarcoma. The second female patient is a relatively rare observation of an STS of fulminant course which remained restricted to the extremity, chest wall and neighboring parts of the back during the entire course.

[Staging in non-Hodgkin's lymphomas]. / Staging bei Non-Hodgkin-Lymphomen.

In the period from 1970 to 1986, 46 patients with non-Hodgkin's lymphoma were laparotomized and splenectomized at the Surgery Division, University of Göttingen. The operation was frequently carried out in advanced or generalized stages with a therapeutic indication and served for purely diagnostic purposes in only a proportion of the cases. The Kiel classification was chosen for the histology. Accordingly, hairy-cell leukemia (14 cases) and chronic lymphatic leukemia (12 cases) were the most frequent diagnoses, followed by LP immunocytoma and centroblastic-centrocytic lymphoma (seven cases each). In four out of the 20 clinical pictures which were not already generalized by definition, i.e. in 20% of the cases, exploratory laparotomy resulted in a change of stage (comprising two improvements and two deteriorations). The spleen was affected in 41 out of the 46 patients; in addition, lymphomatous infiltrations were found in six of the 12 liver biopsies taken and in 15 out of 17 lymph node preparations taken. The average spleen weight in the NHL patients (1,623 g) was markedly higher than in a reference group of Hodgkin patients (317 g). With critical establishment of the indication, exploratory laparotomy with splenectomy in histologically verified NHL and lymphography in the clinical staging are the most precise methods of investigation in graduated diagnosis of non-Hodgkin's lymphomas.

[The thyroid gland and the breast]. / Schilddrüse und Mamma.

The results of experimental clinical and epidemiological studies published so far from 1896 until today on the connection between thyroid and breast diseases doubtless require critical examination, since these results are highly contradictory. Without being able to go into details of the sources of methodological errors and the highly heterogenous investigation material, two pathophysiological mechanisms can be discussed in the investigation of the interrelationship between the thyroid and the breast: 1. A low level of thyroid hormone might make the breast hypersensitive to prolactin, which might induce dysplasia or neoplasia of the mammary epithelium. In addition, there is the almost identical neurohumoral regulation of the hormones of the thyrotropic and lactotropic cells in the anterior pituitary. 2. Thyroid hormones have an effect on peripheral androgenic and estrogenic metabolism. The hyperthyroid state may cause an increase in the concentration of sex hormone-binding globulins, which might give rise to an alteration of the beneficial effect of sex hormones on the cellular levels. Compared to this, the iodine deficit might lead to neoplastic transformation of the mammary epithelium via the enhanced gonadotropin stimulation and the subsequent chronic hyperestrogenism. For better understanding of the always topical problem of the not yet completely elucidated correlation between thyroid function and breast diseases, a two-track procedure is appropriate: 1. Thyroid receptor assay on animal and human breast tumor tissue and 2. prospective clinical studies on a large scale.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prolactin--significance in benign and malignant breast diseases]. / Prolaktin--Bedeutung bei benignen und malignen Brustdrüsenerkrankungen.

At present, the role of prolactin has not yet been precisely determined both in the development and in the progression of benign and malignant diseases of the breast. Experimental investigations and data of the human receptor assay have clearly indicated the initial and promoting activity of prolactin in the genesis of breast tumors. However, the data published so far, which is in some cases highly contradictory, does not allow a positive appraisal on the correlation of the prolactin level and breast diseases in clinical research and experimental studies. The studies still to be carried out in human medicine with precise definition of the TRH-prolactin-target cell axis compared with the proof of the receptor radioimmunoassay in healthy and malignant breast tissue which has still not yet been provided might give rise to rather more clarity in this rather manifold problem.