unless certain conditions prevail. The organism must be introduced into the uterus, dead tissue must be present at the time, and the injured tissue must remain in the uterus for long enough to permit incubation. In our patient probably the organism was introduced into the uterus from bowel during the unsuccessful attempt at amiocentesis, because the high vaginal swab taken before the abortion was negative for clostridia. Cl welchii septicaemia, especially when haemolysis is present, is regarded as an indication for total abdominal hysterectomy. The improved survival rates of the early 1970s were attributed to this aggressive surgical approach.2 In the absence of haemolysis, however, prompt and adequate antibiotic treatment with immediate curettage will often effect a cure if coupled with good supportive care.3 We are grateful to Mr M E Pawson and Dr J Curtis for permission to publish this case report. Douglas GW. Toxic effects of Welch bacillus in post abortal infection. NY StateJa Med 1956;56:3673-7. 2 Decker WH, Hall W. Treatment of abortion infected with Clostridium welchii. AmJ Obstet Gynecol 1966;95:394-9. 3Pritchard JA, Whalley PJ. Abortion complicated by Clostridium perfringens infection.

A study was performed in infants under the age of 12 months born during 1974 and admitted to St. Göran's Children's Hospital with symptoms suggestive of cow's milk allergy (CMA). The aims of the study were to determine the role of early exposure to cow's milk formulas as a predisposing factor to CMA and to estimate the incidence of CMA in infancy. Twenty-five infants fulfilled the criteria for CMA. Available records were reviewed and a careful history was obtained from the mothers on two occasions. The patient group was compared with a control group. Sixteen of the 25 infants were exposed to cow's milk protein during their first week in the nursery for newborns, 6 were exposed before the end of the fourth week of life, and 3 infants were apparently not exposed. All infants were breast fed 3 to 26 weeks before re-exposure and occurrence of symptoms. Infants with CMA were given cow's milk formulas during their first 4 weeks of life significantly more often than infants in the control group (p less than 0.01). The incidence of CMA was approximately 1 : 200. The first 4 weeks after birth seem to be a particularly vulnerable period. Hence, in order to prevent CMA, infant formula should not be given--even occasionally--during this period.

Heat-labile enterotoxin (LT)-producing Escherichia coli and other enteric bacteria isolated from diarrheal Ethiopian children were studied for O and K antigen, production of heat-stable enterotoxin (ST), stability of LT production, properties of mannose-resistant hemagglutination (MRHA) (indicative of adhesive properties), and colonization factor antigen (CFA). Of the E. coli strains, 33% possessed O6, O8, or O78; 93% of these were stable producers of LT, and 86% produced both Lt and ST. O78 strains possessed CFA/I, whereas O6 and O8 strains possessed CFA/II. The E. coli with O antigens other than O6, O8, or O78, as well as the non-E. coli bacteria tended to lose their ability to produce LT; only 16% produced ST, and they only occasionally showed MRHA properties. The former group of E. coli strains might be considered as true enteropathogenic bacteria (enterovirulent E. coli), which may be identified serologically, while the pathogenic significance of the diversified latter group remains less certain.

Penicillin was given to 104 children with different nutritional status, normal, underweight, marasmus and kwashiorkor. Penicillin was given either intravenously, intramuscularly or orally and the plasma concentration was followed at regular times after administration. There was a significantly decreased plasma clearance of penicillin in all malnourished groups compared to the normal weight-for-age group. The half-lives of penicillin were, however, not significantly different between the nutritional groups. This was explained by the fact that also the volume of distribution was decreased in the malnourished group with a net result that the half-life was unchanged. The bioavailability was decreased if penicillin was given to non-fasting individuals. The greatest difference between fasting and non-fasting was seen in the severely malnourished children with marasmus and kwashiorkor. Therefore, it is advised that, if penicillin is given orally to very sick and undernourished children, the dose should be increased and preferably be given in the fasting state.

A human IgA-radioimmunoprecipitation assay (IgA-RIPA) utilizing the galactose-binding lectin jacalin from the jack-fruit Artrocarpus integrifolia was developed. Among the human immunoglobulins, jacalin binds specifically to immunoglobulin A. The IgA-RIPA was used to characterize the serum IgA response to individual rotavirus polypeptides in nine paired sera from children (8-34 months of age) with an acute rotavirus infection. In acute sera the IgA response was mainly directed against the inner capsid proteins VP2 and VP6, with VP2 surprisingly being the most immunogenic protein while in the convalescent sera, the IgA response was directed not only against structural but also against non-structural proteins.

The permeability properties of the small intestinal mucosa was investigated in nine previously healthy children with acute diarrhoea due to rotavirus. The investigation was performed after intake of a mixture in water of polyethyleneglycol molecules (PEG 400 and 1000) ranging from 282 to 1250 dalton in molecular weight. The 6-h urinary recovery of the PEGs was determined with high performance liquid chromatography and used to assess the permeability characteristics of the intestine. The patients served as their own controls and were investigated in the same manner after recovery 3-5 weeks later. A significantly lower urinary recovery of PEG was noted for all molecular sizes (326-1206 dalton) during acute diarrhoea in comparison with the results obtained after recovery (p less than 0.001-0.1). There was also a relatively lesser change in the urinary recovery of larger PEG molecules during infection, as reflected by a higher recovery ratio between 1074 and 370 dalton PEGs. The results indicate profound changes in the permeability characteristics of the intestine during acute rotavirus diarrhoea.

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