Bengt Björkstén

Chronic recurrent multifocal osteomyelitis and pustulosis palmoplantaris

Based on nine patients 4 to 26 years of age, we describe the clinical characteristics of chronic recurrent multifocal osteomyelitis. This disorder was characterized by an insidious onset of fever, local swelling and pain in affected bones, and radiologic findings suggesting osteomyelitis. The lesions were mainly localized to the clavicles and the metaphyses of tubular bones. The clinical course was characterized by intermittent periods of exacerbation and improvement over several years. Six of the patients had recurrent pustulosis palmaris and plantaris, which closely parallelled the exacerbations of the bone lesions. Biopsies from the bone lesions showed nonspecific inflammatory changes with granulocytic infiltration. Repeated bacterial and fungal cultivations from blood, bone biopsies, and pustules were negative. Immunologic investigation revealed no abnormality common to the patients. There was no indications of a genetic etiology. The pathogenesis of the disorder is unknown. Antibiotic treatment had no obvious effect but corticosteroid therapy appeared to be of benefit in some patients. The long-term prognosis appears to be relatively good.

Serum IgE in infants and influence of type of feeding

Serum IgE in healthy infants was followed longitudinally during the first year of life and was related to heredity for allergy and type of feeding. During the first 6 months of life there were no significant differences of serum IgE levels in relation to presence or absence of heredity for allergy and type of feeding. IgE levels determined at the age of 12 months in infants who were weaned after the age of 6 months were significantly higher than in infants weaned before that age (P<0.05). When the time periods had passed, following onset of cows milk‐feeding and complete cessation of breast‐feeding, and were correlated to IgE at the age of 12 months, there were inverse significant correlations; i.e. the earlier the onset of cows milk‐feeding the lower the IgE and the later the cessation of breast‐feeding the higher the IgE. This was particularly obvious as regards infants with heredity for allergy and a long duration of breast‐feeding (r=−0.43; P<0.01). Infants with heredity for allergy subjected to a hypoallergenic diet adhered to for 6 months had significantly higher IgE at the age of 12 months than infants with similar heredity but a normal diet (P<0.05). The results indicate that serum IgE during late infancy is influenced by both genetic factors and the time of introduction of cows milk formula in the diet and the time of cessation of breast‐feeding.

Interaction of E. coli strains with human serum: Lack of relationship to K1 antigen

Twenty-eight strains of E. coli isolated from infants were compared with respect to opsonic requirements, sensitivity to serum, and ability to activate serum chemotactic factors. Six of the strains were isolated from stools of healthy newborn infants; 22 were isolated from the cerebrospinal fluid or blood of infants with meningitis and/or septicemia. Eighteen of the strains had K1 polysaccharide antigen. Fourteen of the strains (seven with K1 antigen) activated complement via the alternative pathway and all of these strains were well opsonized in 4% pooled human serum. A higher concentration of serum was necessary to opsonize 12 of the 14 strains that did not activate the alternative pathway. A wide variation was also found in opsonic requirements of E. coli strains isolated from healthy and sick infants. There was no relationship of the K1 antigen to opsonic requirements, to capacity to activate complement via the alternative pathway, to generation of chemotactic factors, or to sensitivity to serum cidal activity. Therefore, the association of E. coli with K1 antigen and neonatal meningitis did not appear to be related to these bacteria-serum interactions.

Congenital dyserythropoietic anaemia type III: an electron microscopic study.

The morphological features of erythroblasts in congenital dyserthropoietic anaemia (CDA) type III were studied by electron microscopy. Typical findings included clefts and blebs within the nuclear region, autolytic areas within cytoplasm, iron‐filled mitochondria and myelin figures. The findings resembled those reported in other dyserythropoietic anaemias particularly in CDA type I; the main morphologic features which distinguished the two types were lack of spongy appearance of the chromatin, lack of cytoplasmic organelles within the nuclear region and intact nuclear envelope in CDA type III.

METHOTREXATE AND PREDNISOLONE TREATMENT OF A CHILD WITH PSORIATIC ARTHRITIS

ABSTRACT: Björksten, B. and Bäck, O. (Department of Paediatrics and Dermatology University Hospital, Umeå, Sweden) Methotrexate and prednisolone treatment of a child with psoriatic arthritis. Acta Paediatr Scand, 64:664, 1975–A case of severe psoriasis and psoriatic arthritis in a child is presented. Only one detailed report has been published previously. The result of treatment with prednisolone and methotrexate was encouraging.

USE OF THE NITROBLUE TETRAZOLIUM (NBT) TEST IN THE DIFFERENTIATION BETWEEN PYELONEPHRITIS AND CYSTITIS

ABSTRACT: Björkstén, B. and de Chateau, P. (Department of Paediatrics, Umeå University, Umeå, Sweden.) Use of the Nitroblue Tetrazolium (NBT) Test in the differentiation between pyelonephritis and cystitis. Acta Paediatr Scand 64:182, 1975.– NBT tests were performed on blood from 37 patients with urinary tract infections caused by conform bacteria. The level of infections was evaluated by the clinical signs, ESR, renal concentrating capacity and titre of antibodies against the strains of E. coli isolated in their urine. Elevated proportions of NBT‐positive neutrophils were found in 11 of 14 patients with pyelonephritis and in 3 of 23 patients with cystitis or asymptomatic bacteriuria (ABU). The total number of NBT‐positive neutrophils was 1000 or more per mm3 blood in 11 of 13 patients considered to have pyelonephritis, while it was 800 or less in all the patients investigated, evaluated as having cystitis or asymptomatic bacteriuria. The NBT test is recommended as an adjunct in the level diagnosis or urinary tract infections in children. The utility of the test in smouldering pyelonephritis is presently being investigated.