Neuroretinitis, aseptic meningitis, and lymphadenitis associated with Bartonella (Rochalimaea) henselae infection in immunocompetent patients and patients infected with human immunodeficiency virus type 1.

Bartonella (Rochalimaea) henselae causes a variety of diseases, including bacillary angiomatosis, peliosis hepatis, lymphadenitis, aseptic meningitis with bacteremia, and cat-scratch disease (CSD). Cases of B. henselae-related disease were collected from September 1991 through November 1993. Patients with suspected CSD, unexplained fever and lymphadenitis, or suspected B. henselae infection who were seen in the Infectious Diseases Clinic at Wilford Hall Medical Center (Lackland Air Force Base, TX) underwent physical and laboratory examinations. In addition to three previously described cases, 23 patients with R. henselae-related infection were identified. The patients included 19 immunocompetent individuals presenting with lymphadenitis (11), stellate neuroretinitis (5), Parinaud's oculoglandular syndrome with retinitis (1), chronic fatigue syndrome-like disease (1), and microbiologically proven adenitis without the presence of immunofluorescent antibodies to B. henselae (1) and four patients infected with human immunodeficiency virus type 1 presenting with isolated lymphadenitis (1), diffuse upper-extremity adenitis (1), neuroretinitis (1), and aseptic meningitis (1). A couple with neuroretinitis and their pet cat, a persistently fatigued patient, and a patient with Parinaud's oculoglandular syndrome were shown to have bacteremia. Tissue cultures were positive for B. henselae in three recent cases of adenitis. Twenty-two patients were exposed to cats. This series further demonstrates the similarities between B. henselae-related diseases and CSD and identifies several new syndromes due to B. henselae.

Coccidioidomycosis in California: regional outbreak, global diagnostic challenge.

Beginning in 1991, case reports of coccidioidomycosis in California increased dramatically, pursuant to a variety of natural and demographic factors. This highly infectious fungal disease with propensity to disseminate widely, mimic other conditions, and cause pathology at locations distant in place and time is readily treatable if recognized at an early stage. The concentration of military bases in endemic areas and the mobility of military personnel suggest a heightened potential for case presentations elsewhere and a need for elevated diagnostic suspicion on the part of military physicians worldwide. We review three cases of disseminated disease recently referred to our facility.

Testing for inter-group contamination in a controlled longitudinal study of added physical education.

OBJECTIVE: This case report examines whether there was any cross-contamination between students enrolled in classes that received additional physical education, and their siblings who were enrolled in preceding and succeeding class-cohorts. EXPERIMENTAL DESIGN: A controlled longitudinal study extending over 6 years of primary school. SETTING: An urban and a rural primary school in Québec. PARTICIPANTS: 546 primary students, comprising approximately equal numbers of boys and girls from the urban and the rural school. INTERVENTION: Entire class-cohorts were given and hour of additional physical education ach day throughout their primary schooling, with immediately preceding and succeeding class-cohorts serving as controls. MEASURES: The measured data included standing height, body mass, maximal oxygen intake (direct treadmill test) and PWC170. RESULTS: We found no evidence of cross-contamination between siblings in experimental and control class-cohorts. CONCLUSION: Although a theoretical possibility, cross-contamination between students in preceding and succeeding class-cohorts does not seem an important source of error in primary school students, presumably because such children prefer to play with friends from their immediate age cohort.

A case of Pott's disease in a 20-year-old military dependent.

Tuberculous spondylitis (Pott's disease) is an uncommon complication of Mycobacterium tuberculosis infection that may have serious consequences if the diagnosis is missed or delayed. A case of tuberculous spondylitis in a military dependent is presented. Clinical presentation, radiologic findings, laboratory findings, and treatment are discussed.

Color flow and conventional echocardiography of the Marfan syndrome.

Imaging and color flow Doppler echocardiography are an integral part of any evaluation of a patient with the Marfan syndrome. The major cardiovascular manifestations of this condition are aortic dilation, which may involve the proximal and distal aorta, aortic regurgitation, aortic dissection, mitral valve prolapse, and mitral regurgitation. Patients who have the Marfan syndrome should have serial echocardiograms to measure aortic root diameter carefully at the sinuses of Valsalva and subsequent levels (sinotubular junction, arch, descending and abdominal aorta). Additionally, color Doppler echocardiography assists in the diagnosis of aortic dissection and facilitates evaluation of the severity of aortic and mitral regurgitation that commonly complicate the Marfan syndrome. The risk of aortic dissection, which is the most serious manifestation of the Marfan syndrome, increases as the aorta enlarges. Therefore, elective composite graft surgery is recommended when the aortic root size reaches 60 mm, regardless of symptom status, or 55 mm in the presence of severe aortic regurgitation. Surgical replacement of the aortic root with a composite graft does not end the disease process. Color flow Doppler is useful in the diagnosis of dehiscence of the conduit sewing ring, coronary artery aneurysm, distal aortic dissections, and prosthetic valve dysfunction.

The "unisex phantom," sexual dimorphism, and proportional growth assessment.

The "unisex phantom" tactic of Ross and associates attempts to examine proportional growth, expressing body measurements relative to a phantom created from arbitrary mean dimensions and the observed coefficients of variation for an arbitrary sample of adult men and women. Fundamental assumptions of the model are (1) that data treated in unisex fashion have the normal distribution required of Z-type statistics throughout the period of growth, and (2) that it is reasonable to consider anthropometric measurements in all populations (regardless of ultimate size) as growing toward the common height chosen for the phantom. The validity and possible usefulness of this approach has been tested using anthropometric data collected on 546 francophone primary school children from the Trois Rivières district who had been measured repeatedly from 6 to 12 years of age. Over this age range, the mixing of data for girls and boys does not create a bimodal distribution, and has only a marginal effect upon skewing and kurtosis; however, the requirement of a normal distribution is not satisfied by quite a number of common anthropometric measurements even at this age. Moreover, application of the unisex phantom procedure to the Trois Rivières sample does little to clarify anticipated sex-related differences in regional growth, and it is argued that univariate standardization against a power function of an arbitrary adult height may not provide the best method of examining the multivariate problem of growth. Comparison of results with data from Saskatoon, previously treated by unisex phantom methodology, reveals puzzling inconsistencies; it is suggested that interlaboratory differences of methodology rather than ethnic differences are responsible for apparent discrepancies in growth patterns. It is urged that interlaboratory validation of techniques and landmarks should precede the ascription of apparent differences in body build to constitutional factors.

Body dimensions of Québecois children.

The present study examined the impact of sociocultural factors upon the body dimensions of primary school children (age 6-12 years) living within a uniquely francophone region of Québec. Data was collected prospectively on 546 students, drawn in approximately equal numbers from the two sexes and from urban and rural environments. Habitual activity was modified by allocating a half of the sample to an experimental programme that incorporated an additional five hours of required endurance activity per week into the primary school curriculum. Body dimensions at any given age were less in rural than in urban Québec, probably because of continuing socio-economic constraints. However, an increase of habitual physical activity did not modify body size. Stature was comparable with Demirjian 's Montr eal sample of francophone children, but was less than for anglophone children. Our within-sample variance suggests that socio-economic factors could explain only a part of the discrepancy. Relative to Toronto students, other dimensions such as height were affected less than standing height.

Alternative forms of lethality in mitomycin C-induced bacteria carrying ColE1 plasmids.

We have studied the physiological effects of mitomycin C induction on cells carrying ColE1 plasmids with differing configurations of three genes: the structural gene coding for colicin (cea), a gene responsible for mitomycin C lethality (kil) that we located as part of an operon with cea, and the immunity (imm) gene, which lies near cea but is not in the same operon. kil is close to or overlaps imm. When cea(+) plasmids are present mitomycin C induction results in 100-fold or greater increases in the level of colicin. Within an hour after induction more than 90% of cells carrying cea(+)kil(+) plasmids are killed and macromolecular synthesis stops, capacity for transport of proline, thiomethyl beta-D-galactoside, and alpha-methyl glucoside is lost, and the membrane becomes abnormally permeable as indicated by an increased accessibility of intracellular beta-galactosidase to the substrate o-nitrophenyl beta-D-galactoside. All of these events occur when a cea(-)kil(+)imm(+) plasmid is present and none does when the plasmid is cea(+)kil(-)imm(+), so the damage can be attributed solely to the Kil function and not to the presence of colicin. However, cells carrying a cea(+)kil(-)imm(-) plasmid are killed upon induction, apparently by action of endogenous colicin on the nonimmune cytoplasmic membrane. The pattern of accompanying physiological damage is distinguished from the kil(+)-associated damage by an enhancement of alpha-methyl glucoside uptake and accumulation and efflux of alpha-methyl glucoside 6-phosphate and by an absence of the alteration in membrane permeability for o-nitrophenyl beta-D-galactoside. These features are typical of colicin E1 action on the membrane. The induced damage is not prevented by trypsin and occurs in cells of a strain specifically tolerant to exogenous colicin E1, indicating that the attack is from inside the cell.

[Bone maturity and physical performance]. / Maturité osseuse et performance physique.

We have examined the relation between physical performance (as measured with the CAHPER tests), bone age (Greulich and Pyl's wrist evaluation) and dental age (Garn's method). Our study included 164 boys and 149 girls aged from 7 to 11. In spite of interesting significant simple correlation between most of the CAHPER tests and bone age measurements for the pre-pubescent period, the latter remains of negligible value in predicting physical performance in the studied children when variables like chronological age, body height and body weight are already included in the prediction equation.

Effects of cigarette smoking on intraocular pressure and vision.

In a survey of 426 patients of Toronto ophthalmologists the correlations of reported smoking habits with (1) intraocular pressure and (2) visual acuity were examined. Average tonometer readings were closely similar in smokers, ex-smokers, and non-smokers, and multiple regression analysis showed similar age coefficients for the 3 categories. However, in women (but not in men) there was also a significant coefficient related to total cigarette exposure (puff-pack-years). It is suggested that this was due to recent smoking rather than a permanent effect on tonometer pressures, pointing the need to standardise this aspect of ocular pressure measurements. Visual acuity showed similar age coefficients in smokers, ex-smokers, and non-smokers, with no independent effect of exposure to cigarette smoke.