Enhancement of lysozyme trypsin-mediated decay of intestinal bifidobacteria and lactobacilli.

Lysozyme-mediated lysis of Bifidobacteria and Lactobacilli was studied in in vitro tests using the agar gel plate and turbidometric Micrococcus luteus (lysodeikticus) procedure as a standard. Suspensions of the strains Bifidobacterium infantis, B. infantis liberorum, B. breve, B. longum, B. ssp, and Lactobacillus acidophilus proved to be resistant to egg white lysozyme and human milk lysozyme when incubated at 37 degrees C in concentrations of 5, 50, and 500 mg lysozyme/L, respectively, through 30 and 60 min. Heat treatment at 100 degrees C for 1 h and pretreatment with ether, acetone, ascorbic acid, and hydrogen peroxide failed to incline the bacteria to the lytic effects of lysozyme. Consecutive incubation of the lysozyme-pretreated bacteria with trypsin resulted in a significantly enhanced bacteriolysis in all strains of bacteria, with the exception of B. longum. The mode of action of lysozyme and proteolytic enzymes on Bifidobacteria and Lactobacilli offers an explanation for the release of microbial building blocks and their colonic absorption and retention in the breast-fed baby.

[The physiologic significance of Bifidobacteria and fecal lysozyme in the breast fed infant. A contribution on the the microecology of the intestine]. / Zur physiologischen Bedeutung der Bifidusflora und des faekalen Lysozyms beim Brustkind. Ein Beitrag zur Mikroökologie des Intestinums.

The fecal microflora of the breast-fed infant consists of nearly 100% Bifidobacteria. The importance of this long-known and unique phenomenon is still not clearly understood. Likewise, the presence of lysozyme in the feces of breast-fed infants, which is administered in significant amounts with the human milk is not adequately known. New hints and hypotheses concerning digestion in ruminants are cited. In ruminants Lysozyme c functions as digestive enzyme in the rumen. Lysozyme causes lysis of the bacterial cell membrane leading to the release of bacterial contents i.e. proteins. The proteins synthesised in bacteria are the main source of nitrogen for ruminants. The hypothesis is established, that the enormous amounts of Bifidobacteria in the colon of the human newborn can be made of use in a similar way. The lysozyme in the colon of breast-fed infants leads to lysis of Bifidobacteria in connection with tryptic digestive enzymes, in turn leading to release of proteins and protein substances. It has recently been demonstrated that catabolic products of these proteins can be absorbed in the colon. The same group has shown that lysis of Bifidobacteria can take place in the presence of lysozyme in connection with trypsin.

High-resolution real-time sonography and MR imaging in assessment of osteocartilaginous exostoses.

High-resolution real-time ultrasonography (US) and MR imaging, using both spin-echo (SE) and gradient-echo (GE) sequences, were performed prospectively in 14 patients with solitary osteocartilaginous exostoses to assess cartilage cap thickness and bursa formation. Results were compared to surgical and histopathologic findings in all cases. Both US and MR imaging were useful in evaluating exostotic cartilage cap thickness, which is supposed to be the most reliable sign of malignant transformation. Hyaline cartilage matrix had distinctive features in US and MR imaging caused by its specific histologic composition. The formation of bursae over the protruding exostoses, which results in pain and clinically could raise the suspicion of growth and malignant transformation, was demonstrated best using GE sequences. MR imaging was thus superior to US in the detection of bursa formation.

[Niikawa-Kuroki syndrome (the so-called Kabuki make up syndrome)]. / Niikawa-Kuroki-Syndrom (sog. Kabuki-make up-Syndrom).

The first case of Niikawa-Kuroki-syndrome (so called Kabuki-make up-syndrome) in Europe and the second one out of Japan has been reported. It concerns a male child with retardation of growth, mental and motoric development. The syndrome can be diagnosed through the typical dysmorphia of the face, epicanthus, arched eyebrows, broad and depressed nasal tip, large malformed ears and stubby fingers. Anomalies of the dermatoglyphic patterns of the fingers observed in the Japanese patients could not be confirmed in our case. There was a normal chromosomal pattern. No further cases in the family could be found. The etiology of this new syndrome is not yet elucidated.

Relationships between lysozyme concentration of human milk, bacteriologic content, and weight gain of premature infants.

Lysozyme concentrations and bacterial colony counts were determined in 399 human milk samples obtained from 42 mothers (18 mothers of term infants, 24 mothers of preterm or small-for-date neonates). The average lysozyme concentration was 21.39 +/- 13.19 mg/L. Lysozyme concentrations were significantly greater in preterm (24.99 +/- 15.05 mg/L) than in term milk (14.89 +/- 9.83 mg/L) (p less than 0.05). Bacterial colony counts did not decline with increasing lysozyme concentration, i.e., no correlation between lysozyme concentration and bacterial count was found. Despite this lack of correlation, a significant correlation between lysozyme concentration and rate of weight gain was observed: the higher the lysozyme concentration, the better the weight gain. The mechanism of this observation remains to be elucidated; a trophic effect of lysozyme is suggested as a possible mechanism.

[Lysozyme in children with acute and chronic inflammatory intestinal diseases]. / Lysozym bei Kindern mit akuten und chronisch entzündlichen Darmerkrankungen.

Fecal lysozyme excretion was determined in two hundred children and adolescent. In sixty three infants with enteritis due to Rotavirus the fecal lysozyme level was found to be significant higher than in the feces of a group of healthy infants (p less than 0.01). Elevated fecal lysozyme excretion could be detected in patients with untreated Crohn's disease. After treatment with Salazosulfapyridine, Prednisone and elemental diet during six week a significant drop in fecal lysozyme level was observed (p less than 0.01). In eighteen adolescent with Colitis ulcerosa and Crohn's disease the lysozyme level of colonic mucosa was found to be significant higher than a control group (p less than 0.01). The fecal lysozyme excretion can be used as an indicator for the clinical activity of the disease, as a control for therapeutic efficiency and a marker for a relapse.

[Lysozyme concentrations in the intestinal mucosa in malabsorption syndromes and chronic inflammatory intestinal diseases]. / Lysozymkonzentrationen in der Darmschleimhaut bei Malabsorptions-syndromen und chronisch-entzündlichen Darmerkrankungen.

Lysozyme levels were determined in the mucosa of gut in 80 children with chronic inflammatory bowel disease, malabsorption and acrodermatitis enteropathica.l Levels of lysozyme in the mucosa of colon were found to be significantly higher in cases with chronic inflammatory bowel disease, whereas in children with malabsorption (celiac disease) concentration of lysozyme in the mucosa of small intestine were significantly lower compared to a control group. In a 4 months old boy with acrodermatitis enteropathica there was a low level of lysozyme in the mucosa of the small intestine. After therapy with zinc for one year concentration of lysozyme was normalized.

[Feeding premature and newborn infants with native mother's milk]. / Uber die Ernährung von Früh- und Neugeborenen mit nativer Muttermilch.

Over two years 206 neonates received their mothers milk, 308 were given a formula milk. A dip-slide method, well-known from urine diagnostics (Uricult) was used for bacteriological examination. Breast milk in good condition was given untreated to the neonates. The incidence of intestinal infections was much less in babies who received breast-milk. The anti-infective properties of human milk could be demonstrated.

[Special milk formulas in the dietary treatment of diarrhea in infants (author's transl)]. / Die Verwendung von Heilnahrungen in der diätetischen Therapie der Säuglingsdiarrhoe.

233 infants with diarrhea were dietetically treated with 10 different industrially processed milk products, so called "Heilnahrungen" (healing-food) which were available in a fluid (ready to feed) or powdered-form. The curative effect of products containing 1-2% lactose was better than that of the lactose-free ones. There are no objections to the addition of 1-2% fat. The addition of MCT was not necessary. Infants on lactose containing formulas showed the quickest normalization of stools with only a few relapses. This benefit is possibly due to feeding the products in a non diluted form.

[Diagnostic significance of lactate and lysozyme concentrations in cerebrospinal fluids inchildren with meningitis (author's transl)]. / Diagnostische Bedeutung der Lactat- und Lysozymbestimmung im Liquor cerebrospinalis bei Kindern mit Meningitis.

C.S.F. lactate- and lysozyme concentrations were determined in 74 children with bacterial and aseptic meningitis, combined with other laboratory findings (white-cell count, differential blood count, total protein, glucose). Lactate and lysozyme concentrations proved to be best for the differentiation between bacterial and aseptic meningitis.

[Rare forms of chronic osteomyelitis in children (author's transl)]. / Seltene Formen der chronischen Osteomyelitis im Kindesalter.

4 cases of chronic osteomyelitis in children and adolescents are described. The first one concerns a girl with severe plasmacellular osteomyelitis of the right upperarm. As the treatment with antibiotics failed a partial resection of the right humerus, followed by plastic covering of the resulting defect was successful. Two further cases of chronic metatarsal osteomyelitis of both feet could be classified as a kind of "sclerosing osteomyelitis Garré", mostly corresponding to the clinical feature of the "chronic recurrent multifocal osteomyelitis" (Björkstén et al., 1978). Furthermore, a case of chronic ostitis localized in the symphyseal area is described, the clinical symptoms of which were resembling to the cortical osteoid, a special kind of sclerosing osteomyelitis. It is suggested that these different forms of chronic osteomyelitis in children are caused by bacterial infections. Nevertheless, this hypothesis remains to be proved. The problems of the differential diagnosis are discussed. Generally, the only therapy with antibotics is not successful, whereas the combination of removing of the inflammatory process with plastic covering of the bone-defect usually results in recovery.

[Virusenteritis in childhood (author's transl)]. / Virusenteritiden im Kindesalter.

About 20% of infantile enteritis are caused by bacterial infections. The most cases of non bacterial infantile enteritis are supposed to be viral infections. Arguments for the existence of enterotropic viruses arised the first time in 1943. Since the middle of the fifties, various kinds of enteroviruses are known to be causative agents of infantile gastroenteritis. The same is true occasionally for some types of adenovirus. In 1973 the Norwalk-agent was discovered provocing enteritis mainly in adults. The most important progress was achieved by the discovery of Rotavirus. The viruses of this group nowadays are ment to be the most wide spread causes of enteritis in human beings and many mammalians. Rotavirus can be found in about 40--60% of acute infantile gastroenteritis in many parts of the world. Furthermore, in the last years of Coronavirus and Astrovirus were detected as causative agents of gastroenteritis in some domestic animals and probably in human beings too.

Acrodermatitis enteropathica. II. Zinc deficiency and ultrastructural findings.

The basic defect in acrodermatitis enteropathica (A.E.) is zinc deficiency caused by zinc malabsorption. The clinical symptoms disappear and serum zinc levels normalize after oral treatment with zinc. A report is given on two siblings suffering from A.E., both treated with oxyquinolines for a long period with changing clinical success. A permanent clinical remission could be achieved by treatment with zinc-sulphate at doses of 110-220 mg daily. The serum zinc levels normalized. The correlation between the zinc concentration of the hair and the kind of therapy was not very close. As we have shown in our first communication, the Paneth cells of the intestinal mucosa display ultrastructural changes in form of an unhomogeneous structure of the cytoplasm, formation of giant granules, and inclusion bodies. The zinc-therapy led to a complete normalization of the pathological changes in the Paneth cells. Thus, the changes in the Paneth cells in A.E. are the result and not the cause of zinc deficiency.

[The protective effect of human milk against infections and its potential causes (author's transl)]. / Uber die infektionsverhütende Wirkung der Muttermilch und deren mögliche Ursachen

The protective effect of breast feeding against infections is well proved by the experiences in underdeveloped countries and in industrial countries as well as shown by numerous investigations in several populations of different social structure. Various factors are meant to be responsible for this special property of human milk, the importance of which is to be discussed. The lysozyme and the lactoferrin are two different antibacterial factors well known since a long time, the former of which is mainly directed against grampositive organisms and against gramnegative ones only under special conditions. Lactoferrin is effective against E. coli and Staphylococcus as well. The neuraminic acid of which the human milk contains a larger quantity than cow's milk also inhibits the growth of E. coli and Staphylococcus. A further factor consisting of isomers of linoleic acid protects mice against lethal Staphylococcus - infections. The most important antibacterial principles of human milk are meant to be specific immunoglobulins, specially secretory IgA. The immunoglobulins are mainly important for the young baby in the early stage of life. The fecal bifidusflora specific for the breast-fed infant is also meant to be protective against several infections. The factors of human milk provoking this special kind of intestinal flora are to be discussed. In the artificial-fed infant bifidus flora like that of breast-fed one can arise by application of lactulose. Nowadays, bifidus-flora can probably be obtained by application of beta-lactose. It is suggested, that infants with bifidus-flora provoked by one of this means are protected against intestinal infections. The results of all investigations on mother's milk lead to the conclusion, that breast-feeding is the optimal kind of alimentation in the first time of life, not only concerning the composition of the food, but concerning protection against infections.

[Antibiotic therapy for infectious enteritis in childhood]. / Antibiotika-Therapie der infektiösen Enteritiden im Kindesalter

A brief review of the actual knowledge on the infantile enteritis caused by infectious agents is given. The antibiotic therapy of bacterial enteritis is still acute, but the range of indications is limited. This kind of therapy aims at the curative effect, but not at the sanitation of the stools, for which no reliable method exists. Any kind of infantile enteritis needs dietetic treatment.

Acrodermatitis enteropathica: recent findings concerning clinical features, pathogenesis, diagnosis and therapy.

Acrodermatitis enteropathica (AE) was diagnosed in 2 siblings, boy and girl, at the age of 10 and 6 weeks. The family history is unremarkable except for consanguinity 5 generations previously. The clinical symptoms of the 2 patients conformed to the known features of AE, the gastrointestinal involvement loosing its significance with increasing age. In one patient in a stage of exacerbation the serum level of oleic acid (18:1) was lowered and of linoleic (18:2) acid slightly increased while that of arachidonic acid was decreased (Fig. 4). In both patients the serum zinc levels were significantly lowered. Under substitution with ZnSO4 the clinical condition improved and the serum zinc levels returned to normal. Histologically the small bowel mucosa was practically normal. Ultrastructural examination of jejunal biopsies revealed rather unspecific changes in the enterocytes in the form of numerous multivesicular bodies. The Paneth cells sometimes contained irregularly formed inhomogeneous structures within their cytoplasm. In addition the secretory granules varied in size and displayed a granular heteromorphic matrix. Frequently they were confluent and formed giant granules.