[Recurrent otitis media with effusion and food allergy in pediatric patients]. / Otitis media recurrente con efusión y alergia a los alimentos en pacientes pediátricos.

INTRODUCTION: Recurrent otitis media with effusion continues to be important pediatric clinical problem and is related to food allergy. OBJECTIVE: The purpose of the present investigation was to determine if the recurrent otitis media with effusion was associated to food allergy. METHODS: We reviewed medical charts from children with food allergy and otitis media with effusion for a period of three months of duration or every month for the last six months seen in an allergy clinic. Patients with anatomic abnormalities, polypous or immunologic deficiencies were excluded. Every patient was challenged with foods to which he/she was allergic in order to demonstrate cause-effect. In all patients we performed tympanometries. RESULTS: We found twenty five patients with recurrent otitis media with effusion and food allergy demonstrated by positive skin testing. The most common food found to be associated was milk, egg, beans, citrus, and tomato. The elimination of the food diet led to a significant amelioration of the otitis in 22 patients, in whom clinical and tympanometry evaluation was performed. The challenge diet with suspected offending food provoked a recurrence of the otitis problem. CONCLUSION: These results demonstrated the association between recurrent otitis media with effusion and food allergy. Therefore, all patients with recurrent otitis media with effusion should be investigated for food allergy.

[Klebsiella pneumoniae glycoproteins as coadjuvants in the prevention of recurrent respiratory infections in children 1-6 years of age]. / Glicoproteínas de Klebsiella pneumoniae como coadyuvantes en la prevención de infecciones recurrentes respiratorias en niños de 1 a 6 años de edad.

MATERIAL AND METHOD: Forty two children with clinical diagnosis of recurrent high and low respiratory infections, were treated with an extract of P1 and F1 glycoproteins; fraction of Klebsiella pneumoniae, 1 g/day for one week a month for three months, according to a double-blind, randomized, parallel group trial. RESULTS: Improvement of clinical and laboratory results were compared with 44 control patients with the same age and similar sex distribution, that were treated with placebo. At the end of study, clinical analysis at 6, 9 and 12 months after the initial dose of Klebsiella pneumoniae, decreased in the number of respiratory infections, sick days, and school assistance were observed in the study group when compared with the control group (p < 0.001 in all parameters). There were not statistical significant changes in hemolytic complement, C3, C4 and immunoglobulins (IgA, IgG, IgM and IgE) levels before and after treatment and between groups. There were not observed adverse reactions to oral treatment with this extract of Klebsiella pneumoniae. CONCLUSIONS: These results suggested that the extract of Klebsiella can be used as a coadjuvant in the treatment of pediatric patients with recurrent high and low respiratory infections.

[Myocardiopathy diagnosed in utero in a mother with SS-A antibodies treated with plasmapheresis]. / Miocardiopatía diagnosticada in utero en madre con anticuerpos contra SS-A tratada con plasmaféresis.

We report a 36 years old patient with Sjogren's syndrome, who during her second pregnancy, the product developed a miocardiopathy with complete heart block that was diagnosed in utero at 26 weeks of pregnancy. Simultaneously, laboratory data reported a SS-A/Ro titer of 1:50,000 with positive antiphospholipids antibodies. Patient was subjected three times to plasmapheresis with three blood volume exchange each time. During the procedures, we had monitor the product and no hemodinamic changes were observed. Unfortunately, 25 days later the patient reported absence of fetal movement and by ecosonography and Doppler was not observed fetal movement or cardiac function. This pregnancy ends in cesarea. The patient is in perfect clinical conditions under control using prednisone and methotrexate.

[Identification of antinuclear, nucleolar and SS-A antibodies, using an immunoassay system]. / Identificación de anticuerpos antinucleares, nucleolares y SS-A, con el uso de un sistema de inmunoensayo.

In this paper we report a solid phase ELISA for screening of antinuclear, nucleolar, and SS-A antibodies. The test system was evaluated with 158 sera that were positive by immunofluorescence (IF), some of which were immunologically characterized as containing antibodies to Sm, RNP, SS-A, SS-B, nucleolar, and DNA, and 247 IF negative that were used as a control group. Ninety eight per cent of serum samples with an antibody of known specificity and/or positive IF, were positive by the ELISA system including antinucleolar samples. Reproducibility of the assay was demonstrated by using five sequentially prepared antigenic extracts. The lineal regression from the last experiment was between 0.75 and 0.91. With this system, positive and negative ANA can be identified as the screening procedure without the need of additional studies. To our knowledge this is the first ELISA system report for the screening of antinucleolar antibodies.

[The rapid diagnosis of rubella and measles by the dot immunoassay method]. / Diagnóstico rápido de rubéola y sarampión por el método de inmunoensayo en mancha.

A procedure is described for the routine laboratory identification of IgM or/and IgG antibodies to measles and rubella simultaneously. A rapid dot-immunobinding assay on nitrocellulose was compared with ELISA systems. 58 serum samples from patients with an exanthematous disease and 15 serum negative samples for both virus were studied. The type of antibody found in all samples was variable and was always related to the presence of immunity in each individual. However, all known negative samples were negative. When results were compared with commercially available ELISA systems or reference laboratories, we found an excellent correlationship including titers. We concluded that the dot-immunobinding assay is a rapid, specific, sensitive, reproducible and economic test that can be used simultaneously for identification of several antigens.

The frequency of antinuclear antibody (ANA) in children by use of mouse kidney (MK) and human epithelial cells (HEp-2) as substrates.

The purpose of this study was to determine the frequency of antinuclear antibody (ANA) in a normal pediatric population. Sera from 241 children (age range 4 months to 16 years) were tested for IgG ANA by use of indirect immunofluorescence and two commercially available substrates, mouse kidney and human epithelial cells. Patients' sera were tested at three different dilutions. The positivity of the ANA was related to the substrate used. When a screening dilution of 1:5 or 1:10 was used, 2.0% and 1.6% were positive with the mouse kidney or human epithelial cell substrates, respectively, but the positivity dropped to 0.4% when the dilution was 1:20 and 1:40, respectively. Only one serum was positive with both substrates.

Cryoprecipitates in Kawasaki syndrome: association with coronary artery aneurysms.

Cryoprecipitates are postulated to play a role in the pathogenesis of several vasculitis illnesses and infectious diseases. To investigate the presence of cryoprecipitates in Kawasaki syndrome, we studied sera from 25 children with acute Kawasaki syndrome. None of the subjects was treated with intravenous gamma-globulin. Cryoprecipitates were detectable in sera of 11 of 25 (44%) children studied. The mean (+/- SE protein concentration of the cryoprecipitates was 88.0 (+/- 20.2) micrograms/ml serum. Cryoprecipitates consisted primarily of IgG and IgM; no complement components were detected but highly sensitive methods were not used. The presence of cryoprecipitates in the serum of children with acute Kawasaki syndrome was associated with the subsequent development of coronary artery aneurysms detected by echocardiogram (P less than 0.05). There was no association between detectable cryoprecipitates and either peak platelet count or erythrocyte sedimentation rate. In one patient, measurement of cryoprecipitates in serial samples showed a reduction in concentrations that paralleled subsidence of disease activity. We speculate that cryoprecipitates may be a marker for increased risk of coronary aneurysm formation and may play a role in the pathogenesis of the cardiac disease in Kawasaki syndrome.

Cobra venom factor, an activator of the complement system, enhances the bowel necrosis induced by platelet-activating factor.

We have previously produced an experimental model of ischemic bowel necrosis in the rat by injecting platelet activating factor (PAF) (7 micrograms/kg) into the mesenteric vascular bed. The dose of PAF required to produce necrosis could be reduced to 50% if the animal was pretreated with bacterial endotoxin (lipopolysaccharide) (20 micrograms/rat). The mechanism of this potentiating effect of lipopolysaccharide is unclear, but activation of the complement system may be one of the contributing factors. To investigate the role of the complement system, we injected cobra venom factor (CVF) (1 unit/kg) to activate the complement system before injection of PAF (2 micrograms/kg) into the superior mesenteric artery. CVF and PAF were also injected separately at the same dosage to other groups of rats. CVF activated the complement system, but by itself did not produce gross necrosis of the bowel. PAF alone caused 3 out of 9 rats treated to develop bowel necrosis. In contrast, combination of the two produced bowel necrosis in all 6 rats thus treated. CVF did not enhance the effects of PAF on hemoconcentration and leukopenia, but aggravated the hypotension caused by PAF. PAF, on the other hand, also enhanced activation of the complement system by CVF. To investigate the specificity of PAF on complement activation, lyso-PAF was used in combination with CVF. It was found that lyso-PAF did not have a significant potentiating effect on CVF-induced complement activation and, by itself, it had no effect on complement activation, blood pressure, white blood cell count or hematocrit. Lyso-PAF, with or without CVF, also failed to produce bowel necrosis.(ABSTRACT TRUNCATED AT 250 WORDS)

Scleromyxedema with corneal deposits.

Scleromyxedema (Arndt-Gottron syndrome) is a rare cutaneous disease in which hyaluronic acid is deposited in the dermis. The authors describe a patient with scleromyxedema and corneal deposits. A corneal biopsy demonstrated hyaluronic acid deposition in the corneal stroma and amyloid P component in Bowman's membrane. This is the first report of scleromyxedema involving the cornea. It is also the first report of amyloid P component deposition in the cornea occurring independent of corneal amyloid deposits.

Identification of C3b as the major serum protein that stimulates prostaglandin and thromboxane synthesis by macrophages.

We have previously reported that heterologous, homologous and autologous sera, all stimulated rabbit alveolar macrophages to synthesize prostaglandins (PG). Gel permeation chromatography of serum showed multiple fractions possessing this stimulatory activity, with the major one at 150-160K daltons. In the present study, we have shown that: (a) Fresh rabbit serum stimulated PG release by macrophages. (b) Serum depleted of C3 and C5 lost its stimulatory activity. (c) Trypsinized serum, sera activated by aggregated IgG and zymosan, partially purified C3, C5 and the C3, C5 preparation or purified C3 activated by zymosan, all stimulated PG release by macrophages with the following order of potency: activated C3, C5 = activated C3 = zymosan-activated serum greater than trypsinized serum = aggregated IgG-activated serum greater than partially purified C3, C5 = serum. PGE2 was the predominant PG synthesized by stimulated macrophages. However, thromboxane (TX) production seemed to be more selectively enhanced i.e., increase in TX production was more pronounced than the increase in PGE release. To further identify the active complement component, we blocked the C3b receptor (C3 b R) by preincubating macrophages with anti-C3bR, and showed that subsequent treatment with activated C3 and C5 failed to elicit any PG release. This pretreatment with anti-C3bR had no inhibitory effect on subsequent zymosan stimulation of PG release. Thus we concluded that C3b was the major serum protein that stimulates PG synthesis by macrophages.