Macrophage spreading inhibition test as an alternate method for in vitro assessment of cell-mediated immunity against Entamoeba histolytica

During cellular immune responses sensitized lymphocytes release a number of mediators collectively known as 'lymphokines'. The assaying of macrophage spreading inhibition (MSI) factor released by sensitized lymphocytes was employed as an alternative procedure for in vitro detection of cell-mediated immunity (CMI) in animals immunized with amoeba antigen preparation. The MSI test was compared with macrophage migration inhibition test. A well defined CMI was detectable in animals immunized by amoebic antigen in combination with Freund's complete adjuvant (FCA). Macrophage spreading was found greatly inhibited when peritoneal exudate cells from these animals were cultured in the presence of specific antigen. The optimal time for the development of typical reaction was 30 min. Incubation for a longer time resulted in macrophage clumping.

Echocardiographic studies during stress testing using cold pressor test combined with hand grip exercise in asymptomatic patients with severe aortic regurgitation

The aim of this study was to evaluate stress combining a cold pressor test and hand grip exercise during echocardiographic investigation of predominantly young asymptomatic patients with severe aortic regurgitation. Thirty five patients were catheterised and divided into two groups. Group A (16 cases) with abnormal ejection fraction by angiocardiography (less than 50%) and Group B (19 cases) with normal ejection fraction (greater than or equal to 50%). The above stress test altered significantly the blood pressure and heart rate in both groups. However, echocardiographic end systolic diameter, end diastolic diameter and fractional shortening were significantly worse during stress test only in Group A but not in Group B. In addition when an end systolic diameter greater than or equal to 48 mm is used as a predictor of abnormal ejection fraction, its sensitivity (100%) and specificity (83%) during stress is only marginally superior to the results obtained at rest. Similarly fractional shortening decrease of 10% or more during stress was no better than resting end systolic diameter parameter. The modified peak systolic pressure-end systolic volume slope demonstrated diminished systolic function in Group A in comparison to Group B. In conclusion, in young asymptomatic patients with severe aortic regurgitation, stress testing altered the echocardiographic parameters significantly in group A patients with abnormal ejection fraction but not in group B patients with normal ejection fraction. However, echocardiographic data during stress testing is not significantly superior to resting end systolic diameter in predicting abnormal ejection fraction.

Asymptomatic severe aortic regurgitation in the young. Hemodynamic and angiographic data in 37 patients with echocardiographic correlation

The aim of this study was to evaluate from hemodynamic and angiocardiographic (ACG) data the extent of left ventricular (LV) systolic dysfunction in a group of predominantly young (mean age 29 years) asymptomatic patients with severe aortic regurgitation (AR). In addition, echocardiography was performed and these data were correlated with ACG data and the value of these parameters in predicting LV dysfunction was tested. Thirty-seven patients were catheterized and 18 demonstrated LV dysfunction with an ejection fraction (EF) of less than 50%. These patients were classified as group A and the remaining 19 patients with EF greater or equal to 50% formed group B. While there was no difference between the 2 groups with regard to age or regurgitant fraction, the end-diastolic pressure was raised (p less than 0.01) and cardiac index depressed (p less than 0.05) significantly in group A. Of the echocardiographic parameters, the end-systolic diameter (ESD) correlated best with the EF (coefficient of correlation = -0.7 and p less than 0.001). In addition, the ESD was significantly higher in group A (p less than 0.001). When an ESD greater than or equal to 48 mm was used as a predictor of an EF less than 50% (group A) the sensitivity was 89% and the specificity 79%. In conclusion, many young asymptomatic patients with severe AR may have severe LV systolic dysfunction and an ESD greater than or equal to 48 mm is a good predictor of such a subgroup.

The natural history of acute rheumatic fever in Kuwait: a prospective six year follow-up report

One hundred and twenty-six children with the initial attack of acute rheumatic fever were followed up prospectively for 6 years. Sixty-six children maintained regular secondary prophylaxis (regular group) and 60 were irregular (irregular group). Two recurrences developed in the regular group with a recurrence rate of 0.005/patient/year follow-up, and 71 recurrences developed in the irregular group with a recurrence rate of 0.2/patient/year follow-up. These findings demonstrate the effect of secondary prophylaxis in reducing the frequency of recurrences. The prevalence rate of rheumatic heart disease in children who had carditis in the initial attack was 42% in the regular group vs 70% in the irregular group (p less than 0.05). These findings demonstrate the deleterious effect of recurrences in the evolution of rheumatic heart disease. The prevalence rate of rheumatic heart disease in children who maintained regular secondary prophylaxis, was 42% in those children who had carditis in the initial attack and 6% in those who had no carditis (p less than 0.05). These findings demonstrate the prognostic significance of presence or absence of carditis during the initial attack, in the subsequent evolution of rheumatic heart disease. The prevalence rate of rheumatic heart disease in the 66 children who maintained regular prophylaxis was 23%. Comparison of these data with those of similarly designed studies shows that the evolution of rheumatic heart disease following the initial attack of acute rheumatic fever, seems to behave similarly in the tropics and subtropics as it did in temperate climates.

Experimental infection of rhesus monkeys with Entamoeba histolytica mimics human infection

Experimental infection of Entamoeba histolytica was successfully established in rhesus monkeys (Macaca mulatta). Parasites of proven pathogenicity maintained through liver passage in hamsters were used in this study. Laparotomized monkeys were inoculated intracecally/intrahepatically with trophozoites, or by oral administration of cysts (2000 cysts/ml). The cysts were isolated from an infected human stool sample. Formation of typical amebic lesions in the inoculated tissues along with alterations in hematologic indices were studied in the infected monkeys. All the experimentally inoculated monkeys showed leukocytosis and mild neutrophilia, while the hemoglobin content and levels of blood sugar and blood urea remained unaltered during the post-infection period. Specific antiamebic antibodies were readily detectable in post-infected sera.

Tricuspid stenosis and regurgitation in rheumatic heart disease: a prospective cardiac catheterization study in 525 patients

Cardiac catheterization (CC) was done in 525 symptomatic patients. Tricuspid regurgitation (TR) was graded from right ventricular (RV) angiography (RVA) and compared with RV indicator curves (IC). Tricuspid stenosis (TS) was diagnosed from the mean diastolic gradient (MDG). Organic (O) disease was diagnosed from TS or from thickening of the tricuspid valve (TV) on angiography. TR was found in 137 patients (26%), of whom 46 (33.5%) had additional TS. All of the patients with TS had significant TR. OTR was more frequent (70.4%) and more severe (p less than 0.0001) than functional TR (FTR). There was no difference in pulmonary artery pressure between FTR and OTR except when associated with TS. The TV was explored in 56 patients. A MDG greater than or equal to 2 mm Hg correctly predicted TS in 91% of the patients and right atrial angiography in 100% of the patients. Organic thickening of the TV was predicted in 84%.

Reye's syndrome

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Acute rheumatic fever during childhood in Kuwait: the mild nature of the initial attack

A prospective clinical study is reported of the initial attack of acute rheumatic fever in 210 children seen in Kuwait over a period of four years. The main presenting feature was pain in the joints, caused by arthritis in 79% of our patients and by arthralgia in 15%. Five per cent presented with chorea alone and 1% with congestive heart failure alone. Carditis was detected in 46.2%, cardiomegaly in 10%, pericarditis in 1.4% and congestive heart failure in 4.8%. The incidence of chorea was 7.6%, of erythema marginatum 1% and of subcutaneous nodules 0.5%. The mortality rate was 0.5%. Data from this study reflect the mild nature of acute rheumatic fever in Kuwait, in contrast to the aggressive nature of the disease described from neighbouring and developing countries.

Long term results of valvar replacement in Kuwaitis

The long term follow-up of 59 Kuwait citizens who underwent valve replacement is presented. There was an early mortality of 12% and late mortality of another 12% with actuarial survival of 76% at five years. These values compare well with earlier Western series. The mean age of 26 is about half that reported in the Western literature. The ratio of mitral valve involvement (pure or mixed) to aortic valve involvement is 2.5:1 indicating that rheumatic heart disease is still prevalent. However, no case was operated during rheumatic activity. Anticoagulation therapy was well tolerated among the Bedouin community with acceptable thromboembolic and bleeding complications. There was high foetal wastage with only two live births out of six pregnancies. Valve malfunctions, haemolysis and subacute bacterial endocarditis complications are also discussed and were little different from other series.

Effect of mebendazole against Echinococcus granulosus and Taenia hydatigena cysts in naturally infected sheep and relevance to larval tapeworm infections in man

The ability of three treatment schedules of mebendazole to kill well-established hydatid cysts was studied. Pregnant sheep, naturally infected with Echinococcus granulosus and/or Taenia hydatigena, were treated daily with mebendazole at a dose rate of 50 mg/kg body weight for either five days, one month, or three months. At autopsy, seven months after the commencement of treatment, no evidence was found that the 5-day treatment schedule had any damaging effect on E. granulosus cysts. The effects of the one month treatment were equivocal. There was evidence of a damaging effect from the 3-month treatment schedule and protoscoleces were not infective to dogs. No T. hydatigena cysts survived the 1- and 3-month treatments, but organisms from the 5-day treatment were infective to dogs. These results for E. granulosus in sheep suggest that long-term treatment with mebendazole may be required in hydatid disease in man. The results obtained for T. hydatigena in sheep are discussed in relation to the treatment of cysticercosis from T. solium in man. Mebendazole showed no untoward effect on the sheep or their lambs.

[Early and late functional hearing results from a modified technique for tympanoplasty (author's transl)]

This paper is a comparative study of the early and late functional results of tympanoplastic operations, as modified by Khan. Following such surgery, we examined 494 patients who had been operated on between 1970--1972 in the ENT Clinic of the Free University of Berlin (Klinikum Westend). Preliminary and final hearing results were recorded with the aid of sound audiograms, which were critically assessed by two different types of evaluations. These included the results of pure-tone changes and speech reception thresholds as achieved by the tympanoplastic operations. On the basis of socially useful hearing improvements, the functional results of cases operated in our clinic are above average. The hearing gain shown from post-operative controls to the final studies is especially satisfactory, since this also includes an improvement in bone conduction.

Estimation of cardiac chamber size by routine chest radiography and echocardiography

The size of the left atrium and both ventricles was estimated by routine chest radiography and compared to echocardiographic single-chamber measurements. Left atrial size correlated well, but echocardiography appeared to be considerably more sensitive in detecting enlargement. Estimates of left ventricular size by radiography and echocardiography showed considerable discrepancy, since the single-dimension echocardiographic technique does not reflect lateral or inferior enlargement, which is readily visible on the radiography; however, ultrasound can distinguish left ventricular hypertrophy from dilatation. Right ventricular size cannot be assessed accurately using the single-diameter technique. The authors suggest that a combination of both techniques would be more accurate than either modality alone and that two-dimensional cardiac studies should prove more reliable than the single-diameter method.