Lower extremity pain in a three year old: manifestations of Guillain-Barré syndrome.

Guillain-Barré syndrome (GBS) in children can present with early symptoms of limb and back pain that progress to acute generalized paralysis. Although the clinical course of this illness may be benign with spontaneous recovery, treatment is indicated for more severe cases. We report a three-year-old patient with GBS, whose symptoms were initially missed, and discuss the salient diagnostic and therapeutic issues for this disease.

Investigation of an outbreak of Salmonella enteritidis gastroenteritis associated with consumption of eggs in a restaurant chain in Maryland.

Salmonella enteritidis ser. enteritidis was isolated from patrons and employees of three restaurants in a restaurant chain in Maryland during August and September 1985. Isolates from all three restaurants had identical plasmid profiles; this profile was present in 13 of 40 randomly selected S. enteritidis isolates received by the Maryland state health department laboratory during a comparable time period. The outbreak in one restaurant resulted in at least 71 illnesses, with 17 persons known to have been hospitalized. Scrambled eggs served on a "breakfast bar" were implicated as the vehicle of transmission in this restaurant, with eggs a possible vehicle in another of the three restaurants. The data point out the risks associated with improper handling of eggs in food service establishments, provide further evidence for the observed association between S. enteritidis and eggs in the northeastern United States, and demonstrate the utility of plasmid analysis in investigation of outbreaks involving common Salmonella serotypes.

Broken semiflexible intraocular lens implant.

The haptic of a semiflexible anterior chamber intraocular lens (Kelman Quadraflex) broke inside the eye of a 70-year-old man. No history of major eye or head trauma could be elicited from the patient. Clinical manifestations included inferior corneal edema progressing toward the optical axis resulting from a free-floating haptic segment of the lens implant inside the anterior chamber. A significant decrease in endothelial density was documented over a short period of time. The surgical management of this case included removal of the free-floating haptic segment, removal of the lens implant, penetrating keratoplasty, and vitrectomy. Final visual acuity was 20/70.

An outbreak of acute nonbacterial gastroenteritis in a nursing home. Demonstration of person-to-person transmission by temporal clustering of cases.

An outbreak of acute nonbacterial gastroenteritis occurred among residents and staff in a nursing home in Baltimore, Maryland, in December 1980. A total of 101 residents and 69 staff members were surveyed by questionnaire. The attack rate (defined as acute onset of vomiting or two or more loose stools per 24 hours) was 46% in each group. Illness was brief and mild; no patients were hospitalized, and there were no deaths. Person-to-person transmission was documented by temporal clustering of cases (the demonstration of higher rate of illness among residents exposed to an ill roommate one or two days earlier than among those not similarly exposed; relative risk = 3.74), by a higher rate of illness among employees having daily contact with residents than among those without such contact (57% vs. 17%, p less than 0.01), and by secondary transmission to household contacts of ill employees (secondary attack rate = 33%). Three of 11 serum pairs from patients demonstrated a fourfold increase in antibody titer to the Norwalk virus between acute- and convalescent-phase specimens. The analysis of temporal clustering of cases was particularly useful in documenting person-to-person transmission in this outbreak and might be used for this purpose in other outbreaks caused by Norwalk or Norwalk-like viruses, as well as in outbreaks associated with other infectious organisms.

Perennial rhinitis - its causation and treatment, a trial of a new formulation of sodium cromoglycate.

A double blind cross over study on the effect on 2% aqueous solution of sodium cromoglycate in perennial rhinitis has been performed in 37 patients. It is concluded that SCG solution is a useful and effective therapy irrespective of whether the disease is due to exogen allergy or vasomotoric (intrinsic) type.

Retrospective survey of 1271 patients diagnosed as perennial rhinitis.

Data from 1271 patients with perennial rhinitis has been assessed. This condition predominantly affects children and young adults; 31-5% stated that symptoms first appeared before the age of 10 years, less than 10% were aged 50 years or more suggesting that the disease process may well disappear in later life. The total sample size was equally divided between the sexes and the mean age for the sexes was similar. In terms of age distribution a sex difference was found in that the peak incidence for males occurred in the age group 10-19 years whereas for females it was in the third decade (P less than 0-001). The duration of the disease was, in most cases, between 2 and 9 years but it can extend to over 15 years and thus become subacute or chronic. The major symptom is blocking which could be due to either histological changes in the mucosa or immunological reactions. Skin tests showed that 64% had a positive reaction to common allergens; however, nasal challenge tests were of little value in determining whether a patient could be classified as allergic. Eosinophils were noted in 66%. The value of skin tests and nasal smears is discussed.