Cow's milk-based beverage consumption in 1- to 4-year-olds and allergic manifestations: an RCT.

BACKGROUND: Nutrients such as docosahexaenoic acid (DHA), prebiotics and ß-glucan have been associated with reduced incidence of respiratory illnesses and allergic manifestations (AM). Our objective was to assess if consumption of a cow's milk-based beverage with these and other nutrients supports respiratory, gastrointestinal, and skin health in otherwise well-nourished, healthy children. METHODS: In this double-blind, randomized, controlled trial, healthy children (1-4 years of age) from two daycare centers in Brazil were fed three servings/day of a cow's milk-based beverage (CMBB; n = 125) containing DHA, the prebiotics polydextrose (PDX) and galactooligosaccharides (GOS), ß-glucan, and other key nutrients, or a control cow's milk-based beverage (control; n = 131) for up to 28 weeks. Occurrence of respiratory infections, diarrheal disease and AM was assessed by study pediatricians and the number of episodes were analyzed with the Cochran-Mantel-Haenszel test and the Andersen-Gill model. RESULTS: The CMBB group had fewer episodes of AM, which included allergic rhinitis or conjunctivitis, wheezing, allergic cough, eczema and urticaria, compared to the control group (p = 0.021). The hazard ratio for increased number of episodes of AM was lower in the CMBB group compared to control (HR, 0.64; 95 % CI 0.47-0.89; p = 0.007). There was no difference in the incidence of respiratory infections and diarrheal disease between groups. CONCLUSION: A cow's milk-based beverage containing DHA, PDX/GOS, and yeast ß-glucan, and supplemented with micronutrients, including zinc, vitamin A and iron, when consumed 3 times/day for 28 weeks by healthy 1- to 4-year-old children was associated with fewer episodes of allergic manifestations in the skin and the respiratory tract. TRIAL REGISTRATION: registration number: NCT01431469.

Investigation of sodium insertion into tetracyanoquinodimethane (TCNQ): results for a TCNQ thin film obtained by a surface science approach.

In this contribution, we investigate the insertion of sodium into tetracyanoquinodimethane (TCNQ) and its effect on the electronic structure by means of a surface science experiment. We exposed a TCNQ thin film stepwise to sodium vapour and monitored the electronic structure by X-ray photoelectron spectroscopy (XPS) and ultra-violet photoelectron spectroscopy (UPS). During the insertion experiment three stages were observed, which can be related to three different phases, predominantly consisting of TCNQ(0), TCNQ(1-) and TCNQ(2-). With increasing sodium content the Fermi level shifts upwards and new electronic states appear in the band gap. For phases with high sodium content the sodium diffusion seems to be inhibited which we attribute to closed diffusion pathways in the molecular structure of TCNQ(1-).

Melanopsin signalling in mammalian iris and retina.

Non-mammalian vertebrates have an intrinsically photosensitive iris and thus a local pupillary light reflex (PLR). In contrast, it is thought that the PLR in mammals generally requires neuronal circuitry connecting the eye and the brain. Here we report that an intrinsic component of the PLR is in fact widespread in nocturnal and crepuscular mammals. In mouse, this intrinsic PLR requires the visual pigment melanopsin; it also requires PLCß4, a vertebrate homologue of the Drosophila NorpA phospholipase C which mediates rhabdomeric phototransduction. The Plcb4(-/-) genotype, in addition to removing the intrinsic PLR, also essentially eliminates the intrinsic light response of the M1 subtype of melanopsin-expressing, intrinsically photosensitive retinal ganglion cells (M1-ipRGCs), which are by far the most photosensitive ipRGC subtype and also have the largest response to light. Ablating in mouse the expression of both TRPC6 and TRPC7, members of the TRP channel superfamily, also essentially eliminated the M1-ipRGC light response but the intrinsic PLR was not affected. Thus, melanopsin signalling exists in both iris and retina, involving a PLCß4-mediated pathway that nonetheless diverges in the two locations.

Functional role of TRPC proteins in vivo: lessons from TRPC-deficient mouse models.

In order to elucidate the functional role of TRPC genes, in vivo, the targeted inactivation of these genes in mice is an invaluable technique. In this review, we summarize the currently available results on the phenotype of TRPC-deficient mouse lines. The analysis of mice with targeted deletion in three TRPC genes demonstrates that these proteins represent essential constituents of agonist-activated and phospholipase C-dependent Ca2+ entry channels in primary cells. Furthermore, from the deficits observed in these TRPC-deficient mouse lines a striking number of biological functions could already be ascribed to TRPC2, TRPC4, and TRPC6, not only on the cellular level but also for complex organ functions and integrative physiology. Accordingly, TRPC2 proteins are critically involved in pheromone sensing by neurones of the vomeronasal organ and, thereby, in the regulation of sexual and social behavior of mice, TRPC4 proteins are essential determinants of endothelial-dependent regulation of vascular tone, endothelial permeability, and neurotransmitter release from thalamic interneurones, and TRPC6 proteins are supposed to have a fundamental role in the regulation of smooth muscle tone in blood vessels and lung.

[Xanthinuria with xanthine lithiasis in a patient with Lesch-Nyhan syndrome under allopurinol therapy]. / Xanthinurie mit Xanthin-Lithiasis bei einem Patienten mit Lesch-Nyhan-Syndrom unter Allopurinol-Therapie.

PURPOSE: It is the intention of this report to identify appropriate analytical tests which allow for the monitoring of allopurinol treatment of patients with Lesch-Nyhan syndrome and the prevention of uric acid or xanthine lithiasis. MATERIALS AND METHODS: A 12 year old boy with Lesch-Nyhan syndrome presented with signs of compulsive automutilation, motoric and mental retardation and cerebral palsy. Paraclinical patient showed hyperuricemia and significant hyperuricosuria. During administration of allopurinol (200 mg/d) he developed fever, an urinary tract infection and dilatation of pelviureteric junction which was suspected of being nephrolithiasis. During hospitalisation, the purine metabolism was intensively monitored. The allopurinol treatment was adjusted according to clinical and laboratory data. RESULTS: The renal scanning diagnostic showed the develepment of a functionally impaired left kidney. Later this kidney had no part in tubulo-secretorical function. It was necessary to remove surgical two renal stones. The composition of the stones was exclusively xanthine. Serum concentration and urinary excretion of xanthine and hypoxanthine were massively enlarged. The elimination of uric acid in urine was normal. But subsequently, the left kidney had to be removed despite intensive care. CONCLUSION: Lesch-Nyhan syndrome is a disorder caused by congenital absence of the enzyme hypoxanthineguanine phosphoribosyltransferase and an increase of the enzyme activity of adenine phosphoribosyltransferase. Treatment should be adjusted to patient's age and weight. An adapt treatment with allopurinol and optimal fluid intake reduce the risk of uric acid or xanthine lithiasis. Laboratory monitoring includes testings for serum concentration and urinary excretion of uric acid, xanthine and hypoxanthine. Sole a normal concentration of uric acid is not sufficient for therapy control. Assessment of the urine sediment by microscopy or infrared spectroscopy will enable early detection of uric acid or xanthine lithiasis.

[Bilateral testicular masses in the scope of adrenogenital syndrome]. / Beidseitige testikuläre Raumforderungen im Rahmen des adrenogenitalen Syndroms.

Testicular masses in male individuals with the adrenogenital syndrome (AGS) are a clinical and pathological diagnostic dilemma. The major differential diagnosis of gonadal nodules in this setting includes interstitial Leydig cell tumors and secondary benign tumors possibly of adrenal origin. We report a case of adrenogenital syndrome occurring in a 14-year-old boy. Examinations to clarify the cause of his dwarfism and bilateral testicular masses revealed 21-hydroxylase deficiency. The testes were not tender and were firm and nodular on palpation. The serum levels of adrenocorticotrophic hormone (ACTH), 17 alpha-hydroxyprogesterone (17-alpha-OHP), testosterone, and aldosterone were found to be elevated. Under corticosteroid therapy the serum marker abnormalities were corrected and there was gradual regression of the tumor lesions in both testes. Testicular tumors with adrenogenital syndrome are typically bilateral and develop in untreated or inadequately treated males with AGS.

Fatty acid ketodienes and fatty acid ketotrienes: Michael addition acceptors that accumulate in wounded and diseased Arabidopsis leaves.

Physical damage and disease are known to lead to changes in the oxylipin signature of plants. We searched for oxylipins produced in response to both wounding and pathogenesis in Arabidopsis leaves. Linoleic acid 9- and 13-ketodienes (KODEs) were found to accumulate in wounded leaves as well as in leaves infected with the pathogen Pseudomonas syringae pv. tomato (Pst). Quantification of the compounds showed that they accumulated to higher levels during the hypersensitive response to Pst avrRpm1 than during infection with a Pst strain lacking an avirulence gene. KODEs are Michael addition acceptors, containing a chemically reactive alpha,beta-unsaturated carbonyl group. When infiltrated into leaves, KODEs were found to induce expression of the GST1 gene, but vital staining indicated that these compounds also damaged plant cells. Several molecules typical of lipid oxidation, including malonaldehyde, also contain the alpha,beta-unsaturated carbonyl reactivity feature, and, when delivered in a volatile form, powerfully induced the expression of GST1. The results draw attention to the potential physiological importance of naturally occurring Michael addition acceptors in plants. In particular, these compounds could act directly, or indirectly via cell damage, as powerful gene activators and might also contribute to host cell death.

Prevention of central venous catheter-related bloodstream infection by use of an antiseptic-impregnated catheter. A randomized, controlled trial.

BACKGROUND: Bloodstream infection related to short-term use of noncuffed central venous catheters is a common and serious problem. Technologic innovations to reduce the risk for these infections are needed. OBJECTIVE: To determine 1) the efficacy of a novel antiseptic catheter in preventing central venous catheter-related infection, 2) patient tolerance of this catheter, and 3) the sources of bloodstream infection originating from noncuffed, multilumen central venous catheters. DESIGN: Randomized, controlled clinical trial. SETTING: Medical-surgical intensive care unit of a 450-bed university hospital. PARTICIPANTS: 158 adults scheduled to receive a central venous catheter; 403 catheters were studied. INTERVENTION: Participants received either a standard triple-lumen polyurethane catheter or a catheter that was indistinguishable from the standard catheter and was impregnated with chlorhexidine and silver sulfadiazine. MEASUREMENTS: Catheters were studied for colonization and catheter-related bloodstream infection at removal; local and systemic effects of catheters were assessed. The origin of each catheter-associated bloodstream infection was sought by culturing all potential sources (skin, catheter segments, hubs, and infusate) and confirmed by restriction-fragment DNA subtyping. RESULTS: Antiseptic catheters were less likely to be colonized at removal than control catheters (13.5 compared with 24.1 colonized catheters per 100 catheters; relative risk, 0.56 [95% CI, 0.36 to 0.89]; P = 0.005) and were nearly fivefold less likely to produce bloodstream infection (1.0 compared with 4.7 infections per 100 catheters; 1.6 compared with 7.6 infections per 1000 catheter-days; relative risk, 0.21 [CI, 0.03 to 0.95]; P = 0.03). In the control group, 8 catheter-related bloodstream infections were caused by Staphylococcus aureus, gram-negative bacilli, enterococci, or Candida species; no infections with these organisms occurred in the antiseptic catheter group (P = 0.003). No adverse effects from the antiseptic catheter were seen, and none of the 122 isolates obtained from infected catheters in either group showed in vitro resistance to chlorhexidine-silver sulfadiazine. Cost-benefit analysis indicated that the antiseptic catheter should prove cost-beneficial if an institution's rate of catheter-related bacteremia with noncuffed central venous catheters is at least 3 infections per 1000 catheter-days). CONCLUSIONS: The chlorhexidine-silver sulfadiazine catheter is well tolerated, reduces the incidence of catheter-related infection, extends the time that noncuffed central venous catheters can be safely left in place for the short term, and should allow cost savings.

A prospective, randomized trial of gauze and two polyurethane dressings for site care of pulmonary artery catheters: implications for catheter management.

OBJECTIVES: To compare the safety of a conventional polyurethane transparent dressing and a novel highly permeable polyurethane dressing, as compared with standard gauze and tape, as site dressings for pulmonary artery catheters; and to rigorously determine the sources of bloodstream infections deriving from these catheters. DESIGN: Prospective, randomized, clinical trial. SETTING: General adult intensive care units (ICUs) in a university hospital. PATIENTS: A total of 442 adult patients with pulmonary artery catheters were studied. Two thirds of the catheters had been inserted in the operating room and one third had been inserted in an ICU. INTERVENTIONS: Patients were randomized at the time of pulmonary artery catheter insertion to have one of three dressing regimens: a) sterile gauze and tape (control), replaced every 2 days; b) a conventional polyurethane dressing, replaced every 5 days; or c) a highly permeable polyurethane dressing, also replaced every 5 days. MEASUREMENTS AND MAIN RESULTS: The origin of each catheter-associated bloodstream infection was sought by quantitatively culturing the skin of the insertion site and all potential sources on the catheter, including the hub and infusate from each lumen of the introducer sheath and the pulmonary artery catheter, and intravascular segments of the introducer sheath and pulmonary artery catheter. Bloodstream infection was confirmed by demonstrating concordance between isolates from the device and blood cultures by pulsed-field electrophoresis of genomic DNA, digested with low-frequency-cleavage, restriction endonucleases. One hundred thirty catheters were randomized to be dressed with sterile gauze and tape (control), 127 with the conventional polyurethane dressing, and 185 with the highly permeable polyurethane dressing. Patients and catheters in the three dressing groups were very comparable. Ninety-six (21.7%) of the 442 catheters studied showed colonization of the introducer sheath or the pulmonary artery catheter, and five (1.1%) catheters caused bloodstream infection. Catheter-related bloodstream infections were associated with concordant cutaneous colonization of the insertion site (n = 2), a contaminated catheter hub or infusate (n = 3), contamination of the extravascular segment of a repositioned catheter beneath the external protective plastic sleeve (n = 1), or hematogenous colonization of the catheter (n = 1). All pulmonary artery catheter-related bloodstream infections occurred with catheters (introducers) in place for > or = 5 days (p < .001). Cutaneous colonization under the dressing at catheter removal was lowest with gauze (10(1.3) colony-forming units), intermediate with the new highly permeable polyurethane dressing (10(1.8) colony-forming units; p < .01), and highest with the conventional polyurethane dressing (10(2.0) colony-forming units; p < .001). There were no significant differences in catheter colonization (20.0 to 25.2 cases per 100 catheters) or catheter-related bloodstream infection (0.8 to 1.6 cases per 100 catheters) between the three groups. CONCLUSIONS: The incidence of pulmonary artery catheter-related bloodstream infection has decreased over the past 5 yrs. Pulmonary artery catheter-related bloodstream infections originate from multiple sources, indicating that measures to prevent bacteremic infections of these devices must focus both on reducing cutaneous colonization at the insertion site and averting contamination of infusate and catheter hubs. Efforts should be made to limit the duration of catheterization with pulmonary artery catheters (including the introducer) to no longer than 4 days. The polyurethane dressings studied appear to be safe for use with pulmonary artery catheters and may be left on for up to 5 days between dressing changes.

Surface antimicrobial activity of heparin-bonded and antiseptic-impregnated vascular catheters.

Most Swan-Ganz pulmonary artery catheters have heparin bonded to the surface with benzalkonium chloride, a cationic surfactant, to reduce thrombosis. Since benzalkonium is bactericidal, the antimicrobial activity of heparin-bonded pulmonary artery catheters was investigated in an in vitro assay. Each catheter exhibited activity against a wide variety of potential microbial pathogens, including Candida albicans. The magnitude of activity against individual organisms correlated strongly with their in vitro susceptibility to benzalkonium chloride (r = .94, P < .002). A chlorhexidine-silver sulfadiazine-impregnated catheter exhibited even greater activity than the heparin-bonded catheters (P = .01). When exposed to serum for 24 h, heparin-bonded catheters lost > or = 50% of their antimicrobial activity, whereas the activity of the chlorhexidine-silver sulfadiazine-impregnated catheter was minimally affected. The fortuitous surface antimicrobial activity of heparin-bonded catheters may account for the low incidence of catheter-related bacteremia (mean, 1.0%) compared with Swan-Ganz catheters of the same materials but not coated with benzalkonium-heparin (mean, 2.8%).

Comparative study of cefazolin, cefamandole, and vancomycin for surgical prophylaxis in cardiac and vascular operations. A double-blind randomized trial.

Three-hundred twenty-one adults undergoing cardiac or major vascular operations were randomized to receive intravenous cefazolin, cefamandole, or vancomycin for prophylaxis against surgical infection in a double-blind trial. All three regimens provided therapeutic blood levels throughout operation in patients studied undergoing cardiopulmonary bypass. The prevalence of surgical wound infection was lowest with vancomycin (4 infections [3.7%] versus 14 [12.3%] and 13 [11.5%] in the cefazolin and cefamandole groups, respectively; p = 0.05); there were no thoracic wound infections in cardiac operations in the vancomycin group (p = 0.04). The mean duration of postoperative hospitalization was lowest in the vancomycin group (10.1 days; p < 0.01) and highest in the cefazolin group (12.9 days). Prophylaxis with vancomycin or cefamandole, compared with cefazolin, did not prevent nosocomial cutaneous colonization by methicillin-resistant coagulase-negative staphylococci; colonization or infection with vancomycin-resistant staphylococci or enterococci was not detected. Adverse effects attributable to the prophylactic regimen were infrequent in all three groups. Eight patients given vancomycin became hypotensive during administration of a dose, despite infusion during a 1-hour period; however, slowing the rate of administration and pretreating with diphenhydramine allowed vancomycin to be resumed and prophylaxis completed uneventfully in five of the patients. We conclude that administration of vancomycin (approximately 15 mg/kg), immediately preoperatively, provides therapeutic blood levels for surgical prophylaxis throughout most cardiac and vascular operations, resulting in protection against postoperative infection superior to that obtained with cefazolin or cefamandole. Vancomycin deserves consideration for inclusion in the prophylactic regimen (1) for prosthetic valve replacement and prosthetic vascular graft implantation, to reduce the risk of implant infection by methicillin-resistant coagulase-negative staphylococci and enterococci; (2) for any cardiovascular operation if the patient has recently received broad-spectrum antimicrobial therapy; and (3) for all cardiovascular operations in centers with a high prevalence of surgical infection with methicillin-resistant staphylococci or enterococci. Guidelines for dosing and administration of vancomycin for cardiovascular surgical prophylaxis are provided.

Treatment of life-threatening primary pulmonary hemosiderosis with cyclophosphamide.

This report describes a five-year-old boy with severe pulmonary hemorrhage caused by primary pulmonary hemosiderosis with cow's milk sensitivity. After failing to respond to corticosteroids and azathioprine, he dramatically improved after being given cyclophosphamide. He worsened after discontinuation of cyclophosphamide on two occasions and improved significantly with its reinstitution. Cyclophosphamide was continued for 14 months without further bleeding or adverse effects. The patient has remained in remission for nearly five years. Cyclophosphamide may be a life-saving alternative therapy for refractory pulmonary hemorrhage with pulmonary hemosiderosis.

Epileptic nystagmus.

Two cases of epileptic nystagmus (EN) are described. The first patient had no history of seizures and experienced attacks of EN associated with oscillopsia and followed by horizontal diplopia and esotropia. These episodes could be triggered by certain visual stimuli and ocular pressure. The second patient had a history of generalized tonic-clonic seizures. He displayed episodes of EN that changed direction in the course of the attacks simultaneously with a shift of the EEG discharge from one occipital region to the other. Cortical blindness followed postictally. On recovery from the postictal state, both patients were neurologically normal. With standard electrodes, the EEG seizures associated with EN involved the occipital, posterotemporal, and parietal areas of the scalp contralateral to the fast phase of the nystagmus. In the first patient, use of supplementary scalp electrodes further localized the seizures to an anterior occipital site intermediate between standard occipital and posterotemporal electrodes. Thirty-six previously reported cases of EN were associated with partial seizures. Horizontal EN most commonly results from seizure activity involving the occipital cortex, although participation of adjoining portions of the parietal and temporal cortexes is possible.

Nosocomial infections from contaminated endoscopes: a flawed automated endoscope washer. An investigation using molecular epidemiology.

Approximately 1 year after purchase of one manufacturer's automated endoscope washing machine, we began to detect heavy contamination of upper gastrointestinal (UGI) endoscopes cultured after cleaning and disinfection in the washer. During the first 6 months of 1988, 77% of surveillance cultures (20-mL flush through the biopsy channel) were positive for gram-negative bacilli (median concentration, 10(5) cfu/mL), most frequently Pseudomonas aeruginosa serotype 10. During the first 19 months of use of the washer, nosocomial post-UGI endoscopy colonization or infections with P. aeruginosa increased 36%. Investigations show that endoscope contamination derives from a flaw in the design of the EW-10 washer: the detergent holding tank, inlet water hose, and air vents cannot be reliably disinfected and contain heavy biofilms that recontaminate the machine after it has been disinfected, as specified by the manufacturer, with glutaraldehyde. Only by rinsing machine-cleansed endoscopes with 70% alcohol followed by forced air drying has reliable disinfection been achieved. Since adaptation of terminal alcohol treatment and drying, post-UGI endoscopy colonization or infection by P. aeruginosa has declined threefold (p less than 0.001). Testing in other centers using the manufacturer's EW-10 or EW-20 washer has shown similar contamination. In three centers, including our own, postendoscopy infections by machine-associated type 10 P. aeruginosa have been confirmed by demonstrating concordance between isolates from contaminated machines or endoscopes and from infected patients by immunoblot of whole cell lysates and by pulsed-field electrophoresis of DraI endonuclease-digested genomic DNA. This problem reaffirms the vulnerability to microbial contamination of water-containing apparatus and equipment in patient care and points up the critical importance of engineering design to prevent contamination.

Nocturnal sleep in Huntington's disease.

Nocturnal sleep was studied in 16 inpatients with Huntington's disease. In comparison with healthy controls, patients exhibited a disturbed sleep pattern with increased sleep onset latency, reduced sleep efficiency, frequent nocturnal awakenings, more time spent awake and less slow wave sleep. These abnormalities correlated in part with duration of illness, severity of clinical symptoms, and degree of atrophy of the caudate nucleus. Patients showed an increased density of sleep spindles.

Nosocomial Pseudomonas pickettii bacteremias traced to narcotic tampering. A case for selective drug screening of health care personnel.

Three patients in a university hospital developed nosocomial infusion-related Pseudomonas pickettii bacteremia. Investigation identified six additional patients who had received intravenous fluid contaminated by P pickettii but did not become ill. All nine patients had had surgery, and each of these patients but only nine of 19 operated-on control patients had received intravenous fentanyl citrate in the operating room; the mean dose given to the nine case patients was far greater than that given to control patients. Fentanyl in 20 (40%) of 50 predrawn 30-mL syringes was shown to be contaminated by P pickettii. Contamination was caused by theft of fentanyl from predrawn synringes and replacement by distilled water contaminated by P pickettii. Narcotic theft by health care personnel may cause patients to suffer pain needlessly and can also result in dire unanticipated consequences, such as nosocomial bacteremia. Whereas drug testing in the workplace is highly controversial, we believe that testing of health care personnel is indicated when drug abuse or theft is suspected.

Development of serum antibody to toxic shock toxin among individuals with toxic shock syndrome in Wisconsin.

The presence of Staphylococcus aureus producing toxic shock toxin (TST) and the absence of antibody to TST (anti-TST) in acute-phase sera are markers for toxic shock syndrome (TSS). We used radioimmunoassay methods to examine 133 acute-phase and 277 convalescent-phase serum specimens from 181 patients with TSS for anti-TST. Among confirmed menstrual cases, nine (9.5%) of 95 patients had demonstrable anti-TST in acute-phase sera obtained during the first seven days of illness; patients with probable or non-menstrual TSS had a higher prevalence of anti-TST in acute-phase sera. Five (33.3%) of 15 individuals with confirmed menstrual TSS developed anti-TST as early as seven to nine days after TSS onset; 32 (62.7%) of 51 patients had demonstrable anti-TST in sera obtained more than one year after their episode of TSS. This study demonstrates a gradual rate and low magnitude of development of anti-TST after TSS and supports the diagnostic usefulness of measuring anti-TST levels in sera from patients suspected of having TSS.

Prevalence of serum antibody to staphylococcal enterotoxin F among Wisconsin residents: implications for toxic-shock syndrome.

Staphylococcal enterotoxin F (SEF) has previously been shown to be a marker for toxic-shock syndrome (TSS)-associated strains of Staphylococcus aureus, whereas the serologic absence of antibody to SEF (anti-SEF) has been shown to be a marker for susceptibility of persons to TSS. In this study, anti-SEF was measured by radioimmunoassay in 689 banked sera obtained from Wisconsin residents during 1960, 1970, and 1980. The prevalence of anti-SEF as estimated by logistic regression analysis was 47%, 58%, 70%, 88%, 96%, and 99% at ages one, five, 10, 20, 30, and 50 years, respectively. Evidence for the transplacental transfer of anti-SEF is also presented. Despite the reported increased incidence of TSS occurring during the past five years, with a preponderance of cases occurring among women, no significant differences in the prevalence of anti-SEF were noted between sexes or longitudinally between the years 1960, 1970, and 1980. These data enhance our understanding of the epidemiology of TSS and further identify the population that may be susceptible to TSS.

Toxic shock syndrome: relation to catamenial products, personal health and hygiene, and sexual practices.

In 1980, the discovery of an association between vaginal tampon use and toxic shock syndrome affected the lifestyles of menstruating women and the catamenial products industry. It made both the general public and the medical community more aware of all aspects of menstruation. The relation between developing toxic shock syndrome and tampon use is unclear; tampon fluid capacity (absorbency) remains the best predictive measure of that risk. No unique aspect of tampon use other than absorbency seems to increase the risk of developing toxic shock syndrome, and numerous hygiene and medical history factors do not seem to play a role in the pathogenesis of the disease. Studies in Minnesota, Wisconsin, and Iowa indicate that 70% to 75% of women between the ages of 15 and 24, the group with the highest risk of developing menstrual toxic shock syndrome, continued to use tampons after news media attention in 1980 on the association of the syndrome with tampon use. This rate of use is higher than the rate found for the general population by recent tampon market research.