R. Lagercrantz

CHRONIC REGIONAL ENTEROCOLITIS (MB CROHN) IN CHILDREN AND ADOLESCENTS

A series of 36 children and adolescents with chronic regional enterocolitis is presented. An apparent increase in the occurrence of the disease is noted. Clinical and roentgenological findings are reported. A high incidence of colonic localization was found and is probably typical of a paediatric series. There were difficulties in establishing an early diagnosis, mainly due to the common occurrence of nonspecific symptoms in the early stages of the disease. The guiding principles for the differentiation between regional enterocolitis and ulcerative colitis are discussed. The results of conservative treatment were poor. The majority of patients (31) were subjected to surgical therapy; the main indication being chronic, progressive disease. The immediate results of surgery were good. In respect of late results, a recurrence rate of about 50% was encountered. Extensive disease, especially when treated with resection and ileorectal anastomosis seemed to have an unfavourable prognosis. The importance of radical resections is stressed.

Follow-up Investigation of Children with Ulcerative Colitis With Special Reference to Indications for Surgical Therapy

One hundred and thirty‐seven patients who fell ill with ulcerative colitis before fifteen years of age have been followed for two to twenty‐six years (Tables 2 and 3). Of these 78.8 % had the chronic intermittent type of disease. Nineteen patients died after varying periods (Table 2), seventeen (12.4%) of ulcerative colitis or its complications. Of those surviving 8.8 % were found to be severely incapacitated on follow‐up examinations. Those who had had symptoms for more than nine years seldom recovered (Table 2). Even patients who had been free from symptoms for several years ran the chance of developing cancer of the colon at an early age and in this series the total frequency was 4.4 %.

Extra‐Colonic Manifestations in Chronic Ulcerative Colitis

The various extra‐colonic manifestations observed in 24 out of 48 children with ulcerative colitis have been described. Most of these changes may most likely be the result of hyperergic reactions, probably due to hyperimmunisation. Such a view is supported from the occurrence of very high serum‐levels of gammaglobulin in patients with u.c. The extracolonic manifestations seen in u.c. are similar to those seen in such connective tissue disorders as systemic lupus erythematosus and periarteritis nodosa. The extra‐colonic manifestations disappear after colectomy (and if necessary rectum extirpation) and their occurrence does not seem to contraindicate surgical intervention.

Tuberculin‐Sensitivity and Antibodies (Agglutinins) after BC G‐Vaccination

1. Twohundred and fortyeight healthy school‐children, who had been BCG‐vaccinated 3 months to 5 years previously were tuberculin‐tested and blood‐samples were drawn for hemagglutination‐tests. (MIDDLEBROOK‐DUBOS.)

Infections and Staphylococci in Maternity Wards. II

In an earlier investigation hospital infections probably caused by Staphylococcus aureus (S. aureus) were registered in 11%of mothers and infants in the maternity wards of Karolinska Hospital [l]. S. aureus were cultured from 82 % of the infants, 64 % of the mothers and 54 ‘>A of the staff. Phagegroup I11 strains (particularly those of phage type 47) seemed to cause infection more often than other strains (including strains of phage-type 8OjSl). The frequency of probable hospital infections and of carriers was considered relatively high. In an attempt to lower this, ordinary soap for hand washing for mothers and staff was replaced with pHiseHex (Winthrop), as this has been reported a valuable hand desinfectant [Z, 31. To evaluate the effect of pHiseHex it was introduced only in the delivery rooms and in one ward while ordinary soap for handwashing was still used in the other wards. The result of a study of rates of infections and carrier states is presented in this paper.

Antibodies to Tubercle Bacilli and Tuberculin Response after BCG Vaccination in Infants of Mothers with Tuberculosis

The antibody against the polysaccharide‐fraction of the tubercle bacillus, as measured by the Middlebrook‐Dubos hemagglutination reaction apparently does not pass the placenta. Accordingly, it cannot explain the considerably more retarded tuberculin allergy after BCG vaccination in infants of tuberculous niothers than in other children, as shown in large series.

STAPHYLOCOCCI AND INFECTION IN MATERNITY WARDS IV. Studies on A Partial Rooming‐in System

Infections and colonization with Staphylococcus aureus were studied in 159 mothers and their newborns. The patients were observed when in hospital, and the mothers were given questionnaires to report symptoms of infection in themselves or their babies during the first weeks after discharge from the hospital. The infection rate measured in this way was high, 27% among the children and 16% among the mothers. Interviews with mothers and reports from child welfare centres that were attended by all children showed, however, that anxious and insecure mothers over‐reported infection symptoms. Such a re‐evaluation reduced the infection rates to 8% among the children and 7% among the mothers.

Fatal Bacterial Infections in the Antibiotic Era

Summary and Conclusions