Bernard Portnoy

Los Angeles student nurse study. Daily symptom reporting and photochemical oxidants.

Student nurses in Los Angeles completed daily symptom diaries throughout the period of their training. Average daily symptom rates were compared to daily pollutant data recorded at a nearby monitoring station. Eye discomfort, cough, and chest discomfort all increased with maximum hourly oxidant levels. Headache also increased when symptoms were adjusted for intercurrent morbidity. The relative increase of adjusted symptoms on highest oxidant days ( ≥ 0.40 ppm) ranged from 1.4 for headache to 6.1 for eye discomfort. Temperature, carbon monoxide, and nitrogen dioxide did not explain these associations. Nor were cigarette smoking, a history of allergies or bias in symptom reporting likely confounding factors. Headache and eye discomfort frequently interfere with work and personal habits. Excess cough and chest discomfort attributable to oxidant exposure may easily impose additional physiologic hardships upon high-risk population subgroups.

Fatal myocarditis associated with ECHO virus, type 22, infection in a child with apparent immunological deficiency.

A 14-month-old boy succumbed to fulminating myocarditis. ECHO virus, type 22, was recovered in high titer from the myocardium, and in lower titer from pericardial fluid, liver, and lung. The diagnosis of congenital agammaglobulinemia was supported at autopsy by the absence of plasma cells, abnormal organization of lymphoid tissue, and absence of immunoglobulins in all tissues examined by fluorescent antibody techniques. This is believed to be the first isolation of an ECHO virus from the heart. Fatal virus infection in a child with non-lymphopenic agammaglobulinemia, with the exception of hepatitis, appears to be a very rare event.

Acute Infantile Hemiplegia Secondary of Spontaneous Carotid Thrombosis

IN RECENT YEARS there has been increasing interest in the recognition and pathogenesis of spontaneous thrombosis of the carotid vessels in adults. The possibility that this syndrome may also occur in infants or children has not received the same attention. We believe this case represents the first reported instance of spontaneous thrombosis of the internal carotid artery in a n infant. The histologic findings suggest one of the possible etiologic mechanisms involved.

Serum transaminase elevations in infants with rotavirus gastroenteritis.

Over a 6-week period, 35 (41%) of 86 infants admitted with diarrhea and dehydration were found to have human rotavirus (HRV) gastroenteritis, using the Rotazyme (RTZ) test. Serum transaminase levels were measured on 44 infants on admission and 72 infants during the first 3 days of hospitalization. On admission, RTZ-positive (RTZ +) infants had higher mean and median alanine aminotransferase (ALT) levels [mean 87.5 U/L in RTZ+ vs. 50.0 U/L in RTZ-negative (RTZ-), p = 0.001; median 60 U/L in RTZ+ vs. 41 U/L in RTZ-infants, p = 0.002], and higher mean and median aspartate aminotransferase (AST) levels (mean 64.3 U/L in RTZ+ vs. 44.0 U/L in RTZ- infants, p = 0.008; median 67.5 U/L vs. 42.0 U/L, respectively, p = <0.05). On admission, 72% of RTZ+ vs. 19% of RTZ- infants had ALT levels > 50 U/L (p = 0.0004). Maximum ALT levels from the first 3 days were also higher in the RTZ +group (67.7% of RTZ + vs. 34.1% of RTZ- having levels > 50 U/L, p = 0.005). Transaminase elevations did not correlate with dehydration or any electrolyte abnormalities. These findings suggest that transaminase elevations are common in infants hospitalized with HRV enteritis.

Encephalitis associated with herpes simplex infection presenting as a temporal‐lobe mass: Report of 2 cases with survival

CENTRAL NERVOUS SYSTEM disease associated with herpes simplex infection includes aseptic meningiti~,l-~ acute encephalitis, and a fatal syndrome designated “acute necrotizing encephalitis,” “acute hemorrhagic encephalitis,” or “acute inclusion encephalitis.”4-14 These latter terms refer to an illness with several unusual, perhaps unique, characteristics. Cases reported previously have been uniformly fatal with few individuals surviving beyond the first three weeks. Several reports3v9J0J2J4 have stressed the unique, focal nature of the brain involvement with areas of hemorrhagic softening and edema. This has been associated with a variety of focal neurological deficits and, on occasion, radiographic evidence of vascular or ventricular shift suggestive of a space-occupying lesion. The radiographic abnormalities have been most common with temporal-lobe involvement. All the cases included in this syndrome4-14 have been associated with the isolation of herpes simplex virus from brain obtained at autopsy or demonstration of Cowdry type A intranuclear inclusions in involved portions, or both.l5 Six cases of acute necrotizing encephalitis with radiographic evidence of temporal-lobe involvement have been reported.335 Herpes simplex virus was not isolated from hraiu tissue in any of the 6, but intranuclear inclusions were found in brain tissue at autopsy. This paper describes 2 nonfatal cases of acute necrotizing encephalitis associated with herpes simplex infection. Each patient had

H. INFLUENZAE MENINGITIS: A CONTROLLED STUDY OF TREATMENT WITH AMPICILLIN.

gitis, however, the drug was found in brain almost exclusively in animals with intensive signs of meningitis. Ampicillin, particularly in large doses, had a distinct therapeutic effect in experimental Hemophilus meningitis The pathological changes in the meninges corresponded to the clinical picture. In experiments with /3-streptococci and Haemophilus influenze, however, milld changes were discernible even before signs of meningitis had appeared.

Clinical rubella with arthritis resulting from reinfection.

Abstract A 50-year-old woman with a history of clinical rubella and corroborating serologic evidence of this previous experience was inadventently exposed to Brown strain rubella virus in a control...

The peripheral white blood count in respirovirus infection

The peripheral white blood counts and differentials of 246 infants and children with lower respiratory disease and 96 asymptomatic patients with similar viral infections were analyzed and compared. The median white blood count (WBC) for patients with lower respiratory disease was 14,465 per cubic millimeter. The median WBC for the asymptomatic group was 9,000 per cubic millimeter. Patients with lower respiratory disease had significantly more immature forms than asymptomatic patients. Differences in segmented neutrophils and lymphocytes were not as great. The degree of leukocytosis in patients with lower respiratory disease was not influenced by day of disease, age, or specific viral, etiologic agents. These data indicate that leukocytosis may also be associated with viral disease of the lower respiratory tract and that “infection” alone is insufficient to call forth the response. It is recommended that the classic concepts concerning the leukocytic response to infection be modified.

Agglutinin response to pertussis vaccine. I. Effect of dosage and interval.

An attempt has been made to evaluate pertussis agglutinin response to pertussis antigenas presently marketed. The evidence is clear that 2 individual 0.5 ml. doses of the antigen, when given at widely spaced intervals, will result in levels of agglutinin similar to those achieved following 3 doses given at approximately monthly intervals. Since the initial dose of vaccine failed to elicit an agglutinin response and since early protection against this disease is desirable, the data indicate that immunization schedules should be carried out as currently recommended. For infants whose series of diphtheria-pertussis-tetanus (DPT) immunizations has been interrupted, it is suggested that a single additional dose may be adequate to establish immunity regardless of whether 1 or 2 doses had been given earlier or regardless of the time that may have occurred between the initial and subsequent doses.

Hepatitis and Pneumonia Associated with ECHO Virus, Type 9, Infection in Two Adult Siblings

Abstract Two reports of pneumonia associated with ECHO virus type 9, infection in two adult siblings are presented. Other manifestations of this infection consisted of aseptic meningitis in the bro...