Hemolytic uremic syndrome in families-an Argentinian experience.

Six hundred and thirty-one patients with hemolytic uremic syndrome (HUS) were treated from 1960 to 1992; 19 (3%) were familial cases, of which 9 were classified as concomitant (including twins), 6 as non-concomitant, and 4 as recurrent. In the recurrent group there were 15 HUS episodes, 10 being concomitant in 2 patients. Prodromal diarrhea was present only in concomitant and non-concomitant cases. Patients with recurrences were sisters from a single family. Concomitant and non-concomitant cases had clinical features, course, and age similar to typical endemoepidemic forms of HUS, in which an association with verocytotoxin-producing Escherichia coli has been reported. There may be a genetic determinant in concomitant cases; these occurred outside the season during which endemoepidemic forms are typically detected. In patients with recurrent disease a genetic factor which may lead to the development of the disease when triggered by viral infections is likely.

Verocytotoxin-producing Escherichia coli infection in family members of children with hemolytic uremic syndrome.

Thirty-four hemolytic uremic syndrome (HUS) patients and ninety-five family members were studied to determine the frequency of infection with verocytotoxin-producing Escherichia coli (VTEC) in household contacts using three diagnostic criteria: VTEC strains isolation and characterization, detection of free fecal VT (FVT) and VT-neutralizing antibodies (VT-NAbs). Gastrointestinal tract symptoms occurred in one to six family members in 8 (23.5%) of the index cases, the week before admission to hospital or simultaneously. The control group consisted of 34 children with acute gastroenteritis who did not develop HUS. Cumulative evidence of VTEC infection was found in 13 (38.2%) of 34 HUS patients, in 30 (31.6%) of 95 family members and in 10 (29.4%) of 34 control children. The serotypes of VTEC isolated were O157: H7 and O25: H2. The prevalent VT type was VT2 in VTEC and FVT; and VT1 in VT-NAbs. Both parents had the same infection rate by fecal toxin or serological data (11.1% FVT, 32% VT-NAbs). These were higher than those detected in siblings (6.2% FVT, 23.5% VT-NAbs) and grandparents (0% FVT, 18% VT-NAbs). Of 16 patients without evidence of infection, 3 had household contacts with FVT and 13 with VT-NAbs. Our results show the wide dissemination of VTEC in the population of Argentina and that family members of HUS patients are usually infected. Therefore, person-to-person transmission may play an important role in the high incidence of HUS in our country.

[Traffic casualties and injuries: a problem of costs, too. A Swiss survey]. / Morti e feriti in strada: anche un problema di costi. Un'indagine elvetica.

Based on an epidemiological observation in Ticino 1985, following statement is possible: in Switzerland every year 900 people dye in traffic casualties. Many victims of tragic accidents get lifetime disabled. Direct and indirect costs of traffic injuries are yearly 3 billions of swiss francs. Only a small percentage (6%) is devoted to medical treatment. The most part is due to compensation of income, disability with its allocations and lost productivity. Among "avoidable" deaths, traffic victims are an essential portion because the are young. More efforts should be undertaken to lower road mortality because she erodes the swiss population pyramid in a significant manner.

[Traffic injuries in the Tessin Canton in 1982 and in 1985. Epidemiology, surgery and socioeconomic aspects]. / Traumatologie routière au canton du Tessin en 1982 et en 1985. Epidémiologie, chirurgie et aspects socio-économiques.

In the paper we present the results of an epidemiological study we conducted upon injuries due to road accidents in Canton Ticino. We investigated into 1471 injured patients admitted to hospital during 1982 in Canton Ticino, all the in- and out-patients at the Ospedale Civico during 1985 and all the seriously injured patients in road accidents where the scientific police (SIR) were called in. 106 (8%) patients died, 206 (15%) were seriously injured (87 patients with chronic infirmity) and 1062 had slight injuries. The total lesions were 2900 and 839 surgical operations were necessary. These patients needed a total of 7804 days of hospitalization (677 days in the intensive care unit). Motorcycles represented 46.5 of the involved vehicles. The major risk groups by age are: 14-17-year-olds (motorcyclist), 18-29-year-olds (automobilists and motorcyclists), up to 13 and over 60 years of age (pedestrians). The percentage of the total road accidents which occur at the week-end is of 49.4%. At peak hours (17.00 p.m.) the percentage of accident is 8.1% (115 accidents) and in the small hours the percentage is of 5.5% (74 accidents). The annual hospitalization costs amounted to 3,200,000 SFr., whereas the real costs corresponding to production loss, social expenditures (25.737 were the days of disability) and in- and out-patient care are as high as 100 million francs.

[Traffic accident injuries in Tessin Canton in 1982 and 1985--epidemiology, surgery and socioeconomic aspects]. / Traumatologie routière au Canton du Tessin en 1982 et en 1985--épidémiologie, chirurgie et aspects socio-économiques.

In the paper we present the result of an epidemiological study we conducted upon injuries due to road accidents in Canton Ticino. We reviewed 1471 injured patients during two periods: in 1982 we examined all patients evaluated in the Emergency Room and admitted - if required - in all the Canton Ticino Hospitals. In 1985 we reviewed only patients seen at Ospedale Civico Lugano and patients seen by the police department (SIR) because the lesions were life-threatening. 106 (8%) patients died, 206 (15%) were seriously injured (87 patients with chronic infirmity) and 1062 had slight injuries. The total lesions were 2900 and 839 surgical operations were necessary. These patients needed a 7804 days of hospitalization (677 days in the intensive care unit). Motorcycles represented 46.5% of the involved vehicles. The major risk groups by age are: 14-17 years old (motorcyclist), 18-29 years old (automobilists and motorcyclists), up to 13 and over 60 years of age (pedestrians). The percentage of the total road accidents which occur at the week-end is of 49.4%. At rush/hours (5.00 pm) the percentage of accident is 8.1% (115 accidents) and in the early morning hours the percentage is 5.5% (74 accidents). The annual hospitalization costs amounted to 3,200,000 sFr., whereas the real costs corresponding to production loss, social expenditures (25.737 were the days of disability) and in- and out patient care are as high as 100 million francs.

Dysfunction of the monocyte-macrophage system in the idiopathic minimal change nephrotic syndrome.

We studied the function of phagocytes and the distribution of lymphocyte subpopulations in 23 patients with Idiopathic Minimal Change Nephrotic Syndrome. All the patients were in relapse at the time of the study. The latter was performed before specific therapy was started. Our control group consisted of 26 normal children who were studied while undergoing routine analysis prior to plastic surgery. Polymorphonuclear leukocytes from the patients showed no alterations in their ability to ingest and to kill candidas. On the contrary, peripheral blood monocytes had a normal phagocytic function with a decreased candidacidal activity when compared to normal controls (p less than 0.001). No correlation was found between serum immunoglobulin levels and the monocyte lytic function. The absolute number of B lymphocytes was significantly increased (p less than 0.05), whereas the absolute number of total lymphocytes, T lymphocytes and T4+ and T8+ cell subsets did not differ from those of the age-matched normal controls. Natural killer cells were functionally normal.

Nefropatía diabética en la infancia / Diabetic nephropaties in infants

Entre 1974 y 1984 se estudiaron 62 pacientes diabéticos de edad pediátrica. Se comprobó la presencia de nefropatía por proteinuria o hematuria en repetidos estudios en 23 de ellos, 37,1%, con un promedio de 7,6 años de evolución de su diabetes. A los 4, 9, 14 y más años de evolución de la diabetes, la frecuencia de nefropatía fue de 11,3, 31,2 46,2 y 66,7% y la de retinopatia de 3,3, 14,3, 65,7 y 100% respectivamente. Siete pacientes fueron hipertensos; 6 de ellos presentaban nefropatía y 4 retinopatía. Uno de los pacientes hipertensos no presentaba ni nefropatía ni retinopatia. Seis pacientes presentaron síndrome nefrótico; 4 de ellos fueron biopsiados, uno en dos oportunidades. La lesión histopatológica observada fue glomeruloesclerosis mesangial difusa y en una oportunidad glomeruloesclerosis nodular. Dos de las biopsias mostraron lesiones de hialinosis arteriolar. No se vio en estos enfermos la coexistencia de nefropatía con retinopatía en la medida en que fuera referida en los adultos. Tampoco fue significativa la presencia de infección urinaria a diferencia de lo referido en los adultos diabéticos. Tres enfermos mostraron elevados filtrados glomerulares, entre 177 y 198 ml/minuto/1,73 m2. Siete pacientes mostraron insuficiencia renal, 3 de ellos con filtrados glomerulares inferiores a 30 ml/minuto/1,73 m2 con cerca de 10 años de evolución (AU)

Nefropatía diabética en la infancia / Diabetic nephropaties in infants

Entre 1974 y 1984 se estudiaron 62 pacientes diabéticos de edad pediátrica. Se comprobó la presencia de nefropatía por proteinuria o hematuria en repetidos estudios en 23 de ellos, 37,1%, con un promedio de 7,6 años de evolución de su diabetes. A los 4, 9, 14 y más años de evolución de la diabetes, la frecuencia de nefropatía fue de 11,3, 31,2 46,2 y 66,7% y la de retinopatia de 3,3, 14,3, 65,7 y 100% respectivamente. Siete pacientes fueron hipertensos; 6 de ellos presentaban nefropatía y 4 retinopatía. Uno de los pacientes hipertensos no presentaba ni nefropatía ni retinopatia. Seis pacientes presentaron síndrome nefrótico; 4 de ellos fueron biopsiados, uno en dos oportunidades. La lesión histopatológica observada fue glomeruloesclerosis mesangial difusa y en una oportunidad glomeruloesclerosis nodular. Dos de las biopsias mostraron lesiones de hialinosis arteriolar. No se vio en estos enfermos la coexistencia de nefropatía con retinopatía en la medida en que fuera referida en los adultos. Tampoco fue significativa la presencia de infección urinaria a diferencia de lo referido en los adultos diabéticos. Tres enfermos mostraron elevados filtrados glomerulares, entre 177 y 198 ml/minuto/1,73 m2. Siete pacientes mostraron insuficiencia renal, 3 de ellos con filtrados glomerulares inferiores a 30 ml/minuto/1,73 m2 con cerca de 10 años de evolución