Group B streptococcal PCR testing in comparison to culture for diagnosis of late onset bacteraemia and meningitis in infants aged 7-90 days: a multi-centre diagnostic accuracy study.

The aim of this study was to compare an in-house real-time PCR assay, with bacterial culture as the reference, for the diagnosis of late onset group B Streptococcal (GBS) disease. This was a retrospective review. All children aged 7-90 days presenting to four paediatric centres that had a blood or CSF sample tested by GBS PCR were included. Of 7,686 blood and 2,495 cerebrospinal fluid (CSF) samples from patients of all ages received for PCR testing, 893 and 859 samples were eligible for the study, respectively. When compared to culture, the sensitivity of blood PCR was 65% (13/20) in comparison to the CSF PCR test which was 100% (5/5). Ten of 23 PCR-positive blood samples and 17 of 22 PCR-positive CSF samples were culture negative. The median threshold Ct values for culture-positive/PCR-positive CSF samples was lower than that of culture-negative/PCR-positive CSF samples (p = 0.08). Clinical details of 17 available cases that were culture negative/PCR positive were reviewed; seven were deemed to be definite cases, eight were probable and two were possible. The results showed that detection of GBS by PCR is useful for CSF samples from infants aged 7-90 days with suspected meningitis; however, analysis of blood samples by PCR is of limited value as a routine screening test for late onset GBS sepsis and should not replace bacterial culture.

Tumefactive fibroinflammatory lesion of the neck.

Fibrosclerotic and fibroinflammatory diseases are pelicular and unusual conditions, which may present in any part of the body. Howeverm, in the region of the head and the neck they are seldom seen and hence easily misdiagnosed. To date, about twenty-two such cases have been reported in the head and neck region. Presented here is a case of tumefactive fibroinflammatory disease of the neck in an 85-year-old woman with a detailed account of the clinical features, cytology, histology and postmortem findings. Also presented is a brief overview of the literature pertaining of this condition.

Outcome analysis of functional endoscopie sinonasal surgery for paediatric rhinosinusitis using the Lund-Mackay-Kennedy scoring system.

There are very few indications for surgical management of chronic rhinosinusitis in children. This has been partly due to the fact that the definition of what qualifies as racalcitrant sinusitis in children is still obscure. There is also significant evidence in literature that surgery, especially radical surgery, on the nose and sinuses in children would result in some interference with the growth of the facio-maxillary skeleton. The advent of Functional Endoscopie sino-nasal Surgery ( F. E. S. S. ) in recent years has changed the philosophy of surgery for paediatric rhinosinusitis and has proven to be an effective choice of management in difficult cases. We persent here our experience and preliminary results with the use of FESS in nine children with sinonasal disorders including cystic fibrosis. The usefulness of the recently described Lund- mackay and Kennedy Scoring System for chronic rhinosinusitis in terms of symptom score, radiological score, endoscopie score and surgical score has been demonstrated.

Effect of cystic fibrosis and non-cystic fibrosis plasma on 45Ca and 35SO4 uptake and retention by the small intestine at the cellular level in the guinea pig.

A highly significant increase in net fluxes across the guinea-pig small intestine for both 45Ca2+ and 35SO4(2-), in the presence of cystic fibrosis plasma compared with non-cystic fibrosis plasma, was observed (p less than 0.001). In the presence of cystic fibrosis plasma, the nuclear, mitochondrial, microsomal and soluble fractions retained greater activity when compared with non-cystic fibrosis plasma. Of all the fractions, the nuclear fraction retained the highest activity both for 45Ca2+ and 35SO4(2-). These findings indicate that cystic fibrosis plasma increases the net fluxes and raises the retention of 45Ca2+ and 35SO4(2-) in guinea-pig small intestine at the cellular level.

Histochemical changes in mucus in duodenal ulceration.

In duodenal ulceration the Alcian blue staining acid mucosubstances in goblet cells are reduced and the goblet cells themselves disappear. At the same time periodic acid-Schiff (PAS) staining neutral mucosubstances appear in the cells of the surface epithelium. These changes have been measured quantitatively with the help of a Vickers M86/0010 Scanning and Integrated Microdensitometer. During healing the changes are reversed. It is suggested that these changes suggest a metaplasia towards a gastric type mucosa as a protective response to the presence of ulceration.

Effect of cystic fibrosis and non-cystic fibrosis plasma on the movement and retention of 45Ca2+ and 35SO42- in guinea-pig stomach and small intestine.

The effect of cystic fibrosis plasma on the net fluxes of 45Ca2+ and 35SO42- across the guinea-pig stomach and small intestine was investigated, using an automatic short-circuit current apparatus. A significant increase in net fluxes across the stomach and small intestine for 45Ca2+ in the presence of cystic fibrosis plasma compared with non-cystic fibrosis plasma was observed. There was an increase in net flux for 35SO42- across the stomach in the presence of cystic fibrosis plasma when compared with non-cystic fibrosis plasma. However, there was a more highly significant increase in net fluxes for 35SO42- across the small intestine in the presence of cystic fibrosis plasma when compared with non-cystic fibrosis plasma. The amount of 45Ca2+ activity retained by the stomach and small intestine is more highly significant in the presence of cystic fibrosis plasma than in the presence of non-cystic fibrosis plasma. The retention of 35SO42- activity by the stomach and small intestine in the presence of cystic fibrosis plasma when compared with non-cystic fibrosis plasma was also highly significant. These findings indicate that cystic fibrosis plasma increases the net fluxes and raises retention of 45Ca2+ and 35SO42- in guinea-pig stomach and small intestine.

Effect of splanchnectomy and vagotomy on the pepsinogen response to intragastric acid.

Perfusion of the stomach in the anaesthetized rat with saline acidified to pH 2.5 with hydrochloric acid induced a small but significant release of pepsinogen into the perfusate. This stimulus to secretion was unaffected by splanchnectomy but was abolished by vagotomy. It is concluded that a modest degree acid secretion in the rat may stimulate pepsinogen secretion by a vagal pathway.

Separate hypoglycaemic thresholds for gastric acid and pepsin secretion following insulin or posterior hypothalamic stimulation.

The level of hypoglycaemia required to elicit gastric secretion of acid and pepsin was studied in urethane-anaesthetized rats. Hypoglycaemia was induced by intravenous injection of insulin or by electrical stimulation of the posterior hypothalamus. In each case the blood glucose values below which gastric secretion was stimulated were significantly higher for pepsin than for acid secretion. This consistently resulted in the onset of pepsin secretion in advance of the onset of acid secretion. These observations suggest that the production of the different components of the gastric juice was under the influence of either separate hypothalamic glucoreceptors, or a single set of glucoreceptors able to respond selectively to different blood glucose levels.

Acid mucins in human intestinal goblet cells.

Acid mucins in goblet cells of the duodenum, jejunum and ileum of neonates and infants with cystic fibrosis (CF) and without CF were measured by scanning microdensitometry after alcian blue staining according to the protocol of McCarthy and Reid (1963) which characterises four groups of acidic mucins. In CF infants over 6 mth of age, but not in controls, there was an increase along the gut from duodenum to ileum of both weakly acidic and strongly acidic sulphomucins. In the ileum the increase was in total mucins from 6 mth previously in the same CF patients and this difference could be accounted for by an increase of sialidase-resistant mucins. The increase in sulphomucins was more marked at the tip than at the base of the villi. In CF neonates there was significant difference in the quantities of acidic mucins. The question whether the mucins of CF are chemically abnormal or merely accumulated to an abnormal extent is probably best investigated by analysis of sialidase-resistant mucins and sulphomucins of the ileum and strongly acidic sulphomucins of the duodenum and jejunum in CF infants over 6 mth of age.

Hypothalamic stimulation induces acid secretion, hypoglycemia, and hyperinsulinemia.

Electrical stimulation of the posterior hypothalamus brought about an increase in plasma insulin accompanied by a fall in blood glucose. If glucose fell below 55 mg/100 ml, gastric secretion of HCl ensued. The same relationship between acid secretion and glucose was observed when hypoglycemia was induced by intravenous injection of insulin. Stimulation outside the posterior hypothalamus did not give either a fall in glucose or an increase in gastric acid secretion. It is concluded that posterior hypothalamic stimulation causes gastric acid secretion by inducing insulin release and a consequent hypoglycemia.