The diet of whiting Merlangius merlangus in the western Baltic Sea.

The diet of whiting Merlangius merlangus in the western Baltic Sea was investigated and compared to the diet in the southern North Sea. Clupeids were important prey in both areas, but especially in the western Baltic Sea where they constituted up to 90% of the diet of larger individuals. Gobies, brown shrimps and polychaetes were the main prey of juveniles in the western Baltic Sea, while a wider range of species were consumed in the North Sea. The shift to piscivory occurred at smaller sizes in the western Baltic Sea and the fish prey consumed was proportionately larger than in the southern North Sea. Estimates of prey abundance and food intake of M. merlangus are required to evaluate its predatory significance in the western Baltic Sea, but its diet suggests that it could be just as significant a fish predator here as in the southern North Sea.

[Localization of isolated atrial involvement of cardiac sarcoidosis]. / Localisation auriculaire isolée d'une sarcoïdose cardiaque. A propos d'un cas.

The authors report the first case of cardiac sarcoidosis involving only the interatrial septum and the atrioventricular node in a 30 year old man with known lymph node sarcoidosis. The diagnosis was suspected after the finding of an apparently innocent 1st degree atrioventricular block and confirmed by transoesophageal echocardiography and by IMATRON computerised tomography. Isolated atrial involvement of sarcoidosis is rare in the absence of any left ventricular disease. This explains the negative findings at transthoracic echocardiography and radio-isotopic investigations usually recommended for diagnosing cardiac sarcoidosis.

[The value of transesophageal echocardiography for the diagnosis of pulmonary embolism with acute pulmonary heart disease]. / Intérêt de l'échocardiographie transoesophagienne pour le diagnostic d'embolie pulmonaire avec coeur pulmonaire aigu.

Transoesophageal echocardiography is a method of visualising intracardiac thrombi and could therefore be useful for the diagnosis of pulmonary embolism, but its diagnostic value is unknown. The authors carried out a prospective study with this diagnostic tool in massive pulmonary embolism. The study protocol was to perform transthoracic echocardiography in patients with suspected acute pulmonary embolism and then to perform transoesophageal echocardiography when there were signs of acute cor pulmonale. The results of both echocardiographic investigations were compared with two reference radiological techniques: the spiral CT scan and/or pulmonary angiography. Fifty-six patients underwent transthoracic echocardiography. In the 34 patients with transthoracic echocardiographic signs of acute cor pulmonale, the positive predictive value of the investigation for pulmonary embolism was 91% and the negative predictive value was 54%. Twenty of these 34 patients underwent transoesophageal echocardiography. The sensitivity and specificity for the diagnosis of proximal embolism were 85% and 86% respectively. The limitations of the method were poor visualisation of the left pulmonary artery in which only one thrombus was detected, compared with 6 by spiral CT scan, and the absence of visualisation of lobar arteries. Consequently, the real sensitivity of transoesophageal echocardiography for visualisation of all thrombi in the pulmonary arteries in acute cor pulmonale was only 55%. In acute cor pulmonale, the diagnostic value of transoesophageal echocardiography is poor because the sensitivity for visualisation of intra-pulmonary arterial thrombi is low compared with other radiological techniques. However, in patients with proximal emboli in the right or main pulmonary artery, the diagnosis may be established in a few minutes without the need of other more invasive techniques. Nevertheless, normal transoesophageal echocardiography does not rule out the presence of proximal in the left pulmonary artery or distal emboli in the lobar arteries.

[Kearns-Sayre syndrome. A rare indication for prophylactic cardiac pacing]. / Syndrome de Kearns-Sayre. Une indication rare d'implantation prophylactique de pacemaker.

The authors report a case of Kearns-Sayre syndrome, a rare mitochondrial myopathy, diagnosed in a 19 year old man. Distal conduction defects are constant findings and are a dominant factor in the prognosis of this condition. Their early appearance and rapid progression pose the problem of prophylactic cardiac pacing despite the young age. In the case report, pacing was decided at the age of 23 in the absence of symptoms but with bifascicular block (right bundle branch block and left anterior hemiblock), without electrophysiological investigation. During follow-up, left bundle branch block was observed 3 years later and permanent complete atrioventricular block occurred 7 years after pacemaker implantation.

Varicella-zoster infections in pediatric renal transplant recipients.

Varicella-zoster infections developed in ten of 76 children receiving a renal transplant during 1973 to 1978. Two children had varicella and one died during this infection. Eight children had herpes zoster and one experienced encephalitis. In the latter group, reduction of prednisone and azathioprine therapy resulted in rejection and loss of the graft in two of three patients in whom this drug therapy was altered.

The use of furosemide in the treatment of edema in infants and children.

One hundred thirty-seven courses of furosemide therapy were given to 106 hospitalized pediatric patients with salt and water retention associated with cardiac or renal disease. The diuretic was effective and safe in the pediatric age group when administered acutely as a parenteral medication and over a long-term course by the oral route in the doses and at the time intervals used in this study. On the basis of each kilogram of body weight, the infants with edema as a result of cardiac failure and the children with edema secondary to renal disease responded equally well to furosemide therapy.

Plasma levels, half-life values, and correlation with physiologic assays for growth and immunity.

Plasma prednisolone levels have been measured hourly in children receiving a single dose of oral prednisone. Peak prednisolone levels occurred one to two hours after ingestion; half-life studies gave a mean value of 132 minutes in most children. Some children had marked variability in absorption and metabolism of prednisone. Somatomedin activity and cell-mediated immunity were inhibited by plasma prednisolone values which were achieved by single doses of prednisone of 0.5 mg/kg or higher. Monitoring prednisolone levels may be of value in identifying those children who accumulate excessively high levels on moderate dosage regimens.

The hemolytic-uremic syndrome: experience at a center in the Midwest.

Nineteen children with the hemolytic-uremic syndrome were treated in our hospital from 1968 to 1976. Seven were over 5 years of age. The disease occurred most often in the spring of the year. Lethargy was a prominent symptom in all patients, and seizures occurred in seven. Transfusion and dialysis were the most important treatment modalities. Heparin was used in four children and did not appear to affect the course of disease although three recovered. Thirteen of 15 children who did not receive heparin recovered. Irreversible renal failure occurred in three children, all of whom were in the older age group. Serious sequelae were rare in those who survived.

Occult lupus nephropathy: a correlated light, electron and immunofluorescent microscopic study.

Renal biopsies obtained from four adolescent girls who developed symptomatic thrombocytopenia with serologic evidence of systemic lupus erythematosus, without clinical signs of renal involvement, showed glomerular disease by electron and immunofluorescent microscopy with light microscopic changes in two cases. Subsequently, three of the patients developed proteinuria, and repeat biopsies from all four showed appearances ranging from resolution to significant glomerulitis. The findings illustrate the variable patterns of occult glomerulitis in lupus, and highlight the value of correlating light, electron and immunofluorescent studies in renal pathology.

Possible urate nephropathy of the newborn infant as a cause of transient renal insufficiency.

Oliguric renal failure, bilateral renal enlargement, and hyperuricemia were noted in three term infants. The findings on intravenous pyelography and radionuclide renography were consistent with intratubular obstruction to urinary outflow in two of the infants. The onset of diuresis appeared to follow intravenous pyelography in these infants. Urinary urate crystalluria was prominent in each infant in the first few days after the onset of diuresis, during which normal serum urate concentrations and normal renal function were established.

Familial occurrence of nonobstructive, noninfectious vesicoureteral reflux with renal scarring.

A family is described in which gross vesicoureteral reflux and renal scarring are present in the father and three sons, none with a history of urinary tract infection. Vesicoureteral reflux alone is present in an infant daughter. Father-to-son transmission of vesicoureteral reflux has not been previously reported. Autosomal dominant inheritance of the trait is suggested. The renal scarring noted in these patients may reflect generalized maldevelopment of affected renal units. The increasing recognition of vesicoureteral reflux as a familial trait suggests the need for evaluation of families in which vesicoureteral reflux is found in more than one member.