Morphology of experimentally denervated and reinnervated rat facial muscle. I. Histochemical and histological findings

The morphological changes in rat facial muscles were evaluated after permanent denervation and were compared with findings after immediate reinnervation. Thirty rats underwent transection of the left and right facial nerves immediately followed by hypoglossal-facial nerve anastomosis on the right side (muscular reinnervation) and removal of 8-10 mm of the facial plexus on the left side (permanent muscular denervation). Levator labii muscle samples of both sides were collected sequentially at 2, 6, 7, 10, 20, and 24 weeks after surgery and submitted to routine histological and enzyme histochemical staining procedures. In normal levator labii muscles a typical "chessboard" pattern was found, with type I fibers being smaller than type II fibers. These latter fibers also were more prevalent than the type I fibers. Among the type II fiber subtypes, the type IIB fibers were larger and more frequent. Two weeks after surgery, there were no differences between denervated facial muscles and those undergoing reinnervation. Both showed atrophic myofibers among normal-sized fibers and slight fibrosis. Those muscles denervated for more than 2 weeks displayed increasing fiber atrophy with frequent loss of typability, as well as proliferation of connective tissue and fat cells in perimysial and endomysial sites. After denervation for 20 weeks only a few atrophic fibers were found in wide areas of fibrosis and fat cells. Following nerve anastomosis the reinnervated levator labii muscle showed much less fiber atrophy. Regrowth to normal fiber diameters was found with only a few atrophic myofibers 10 weeks after anastomosis although a moderate fibrosis predominated at perimysial sites.(ABSTRACT TRUNCATED AT 250 WORDS)

Induction of nitric oxide synthase protects against malaria in mice exposed to irradiated Plasmodium berghei infected mosquitoes: involvement of interferon gamma and CD8+ T cells

Exposure of BALB/c mice to mosquitoes infected with irradiated Plasmodium berghei confers protective immunity against subsequent sporozoite challenge. Immunized mice challenged with viable sporozoites develop parasitemia when treated orally with substrate inhibitors of nitric oxide synthase (NOS). This suggests that the production of nitric oxide (NO) prevents the development of exoerythrocytic stages of malaria in liver. Liver tissue from immunized mice expressed maximal levels of mRNA for inducible NOS (iNOS) between 12 and 24 h after challenge with sporozoites. Intraperitoneal injection of neutralizing monoclonal antibody against interferon gamma (IFN-gamma) or in vivo depletion of CD8+ T cells, but not CD4+ T cells, at the time of challenge blocked expression of iNOS mRNA and ablated protection in immunized mice. These results show that both CD8+ T cells and IFN-gamma are important components in the regulation of iNOS in liver which contributes to the protective response of mice immunized with irradiated malaria sporozoites. IFN-gamma, likely provided by malaria-specific CD8+ T cells, induces liver cells, hepatocytes and/or Kupffer cells, to produce NO for the destruction of infected hepatocytes or the parasite within these cells.

Azithromycin prophylaxis against a chloroquine-resistant strain of Plasmodium falciparum

Azithromycin has antimalarial activity and favourable pharmacokinetic properties for a prophylactic antimalarial agent. We investigated the ability of azithromycin to prevent malaria in volunteers infected with a chloroquine-resistant strain of Plasmodium falciparum. 4 volunteers received oral azithromycin 500 mg followed by 250 mg daily for 7 further days. Subjects were infected on the third day of azithromycin. 3 subjects were protected compared with none of 15 controls. The volunteer not protected by azithromycin had unquantifiable plasma levels of azithromycin, probably because of poor absorption. Azithromycin could be a promising prophylactic agent for P falciparum malaria.

Correlation of phosphoinositide hydrolysis with exflagellation in the malaria microgametocyte

Cellular responses to growth factors, hormones, and other agonists have been shown in many animal cell systems to be mediated by the signal transduction cascade controlled by phospholipase C. One such response, calcium mobilization, is regulated by the concerted effect of several specific inositol (poly)phosphates. Another response, protein phosphorylation, is regulated by other phospholipase C (PLC) hydrolysis products. Mature gametocytes are specialized cells primed for transformation into gametes immediately upon removal from the vertebrate bloodstream, thereby initiating the sexual cycle in a vector mosquito. This study showed that PLC hydrolysis products, inositol (1,4,5)triphosphate and diacylglycerol, are correlated with the initial events of flagellar development; they are implicated in synchronizing this crucial transformation for the parasite and hence the continued transmission of the parasite, which leads to this debilitating disease.

Prevention of sporogony of Plasmodium falciparum and P. berghei in Anopheles stephensi mosquitoes by transmission-blocking antimalarials

The sporontocidal activity of three 8-aminoquinolines, a 1,4-naphthoquinone, and three dihydroacridine-diones was determined against the ANKA clone of Plasmodium berghei and both chloroquine-sensitive (NF54) and chloroquine-resistant (7G8) P. falciparum. Anopheles stephensi mosquitoes previously fed on P. berghei--infected mice or P. falciparum--infected cultures were refed on uninfected mice treated previously with a given drug. Sporontocidal activity was determined by assessing both oocyst and sporozoite development. Neither primaquine nor menoctone exhibited sporontocidal activity against P. berghei or either strain of P. falciparum at a dose of 100 mg base drug/kg mouse body weight, whereas the other five compounds each effectively interrupted the sporogonic development of all three parasite strains at this dose. These data clearly demonstrate that experimental dihydroacridine-diones and 8-aminoquinolines are capable of interrupting the sporogonic development of P. berghei and chloroquine-sensitive and chloroquine-resistant P. falciparum. These data also suggest that the P. berghei model may be used to accurately predict sporontocidal activity against P. falciparum.

Failure of doxycycline as a causal prophylactic agent against Plasmodium falciparum malaria in healthy nonimmune volunteers

OBJECTIVE

To determine whether doxycycline, 100 mg administered as a single daily oral dose, is effective as a causal prophylactic agent, an agent active against the pre-erythrocytic liver stage of Plasmodium falciparum malaria parasites, in healthy nonimmune persons. If effective, the recommendation by the Centers for Disease Control and Prevention (CDC) that doxycycline be continued for 4 weeks after returning from malaria-endemic areas could be shortened to 1 week.

DESIGN

Randomized, double-blind, placebo-controlled trial.

SETTING

Medical ward at the U.S. Army Research Institute of Infectious Diseases, Fort Detrick, Maryland.

PARTICIPANTS

18 nonimmune, healthy, adult male volunteers, age 21.7 +/- 2.9 (SD) years, were enrolled in two groups, one of 8 persons and one of 10 persons. Six participants in the first group and 7 in the second group received doxycycline. The remaining participants received placebo. Two volunteers were dropped from the study, leaving 16 participants for analysis.

INTERVENTION

Each participant received doxycycline, 100 mg, or placebo in a single daily oral dose starting 3 days before exposure to P. falciparum-infected mosquitoes and ending 6 days after exposure.

MEASUREMENTS

Monitoring for parasitemia, plasma doxycycline concentrations, and mosquitoes' salivary-gland sporozoite grade.

RESULTS

6 of 6 (100% [95% Cl, 54% to 100%]) participants on doxycycline in the first group and 2 of 6 (33% [Cl, 4% to 78%]) in the second group were protected from malaria. No differences were found between protected and nonprotected participants in the doxycycline elimination half-life (T1/2) (20.8 +/- 5.0 h compared with 21.9 +/- 5.2 h), the steady-state average plasma concentration (1626 +/- 469 ng/mL compared with 1698 +/- 651 ng/mL), or other pharmacokinetic parameter estimates. The mean mosquito salivary-gland sporozoite grade was significantly higher (P = 0.02) in protected (3.5 +/- 0.3) than in nonprotected persons (3.1 +/- 0.1). Overall, 8 of 12 persons on doxycycline were protected from malaria, yielding a causal prophylactic efficacy rate of 67% (Cl, 35% to 90%).

CONCLUSIONS

A dosing regimen of doxycycline, 100 mg once daily, administered as a causal prophylactic agent against P. falciparum malaria in healthy, nonimmune volunteers, had an unacceptably high failure rate. Therefore, the CDC recommendation that doxycycline should be taken daily starting 1 to 2 days before travel, during travel, and for 4 weeks after travel should still be followed.

[Pharmacology of colchicine and its use in dermatology]

This study provides a summary about an old drug, colchicine, which has been used in medicine for two thousand years. It emphasizes the importance of this agent in the treatment of dermatologic diseases, especially in vasculitis. One of the aims of the study to spread the application of colchicine in the therapeutic management.

Utilization of side-chain precursors for penicillin biosynthesis in a high-producing strain of Penicillium chrysogenum

Utilization of the side-chain precursors phenoxyacetic acid (POA) and phenylacetic acid (PA) for penicillin biosynthesis by Penicillium chrysogenum was studied in shake flasks. Precursor uptake and penicillin production were followed by HPLC analysis of precursors and products in the medium and in the cells. P. chrysogenum used both POA and PA as precursors, producing phenoxymethylpenicillin (penicillin V) and benzylpenicillin (penicillin G), respectively. If both precursors were present simultaneously, the formation of penicillin V was blocked and only penicillin G was produced. When PA was added at different times to cells that were induced initially for POA utilization and were producing penicillin V, the POA utilization and penicillin V formation were blocked, whereas the cells started utilizing PA and produced penicillin G. The blocking of the POA turnover lasted for as long as PA was present in the medium. If POA was added to cultures induced initially for PA utilization and producing penicillin G, this continued irrespective of the presence of POA. Utilization of POA increased concomitant with depletion of PA from the medium. Analysis of cellular pools from a growing cell system with POA as precursor to which PA was added after 48 h showed that the cellular concentration of POA was kept high without production of penicillin V and at a concentration comparable to the concentration in the medium. The cellular concentration of POA was higher than the concentration of PA that was utilized for penicillin G production.

Hereditary benign telangiectasia

Multiple familial cutaneous telangiectases occurring over 3 generations are reported. The morphology of the lesions, the absence of haemorrhagic episodes and the pattern of inheritance are consistent with the diagnosis of hereditary benign telangiectasia described by Ryan and Wells. The differential diagnosis and a possible association with other mesodermal anomalies are discussed.

Treatment of dysfunction of the cricopharyngeal muscle with botulinum A toxin: introduction of a new, noninvasive method

Botulinum toxin is known as a relatively safe and efficacious agent for the treatment of various neurologic and ophthalmologic disorders. Since dysphagia and deglutition problems combined with aspiration are often caused by spasticity, hypertonus, or delayed relaxation of the upper esophageal sphincter (UES), conventional treatment including lateral cricopharyngotomy was replaced by localized injections of botulinum toxin into the cricopharyngeal muscle (CM) in a series of 7 patients. The study comprised patients with slight dysphagia caused by isolated hypertonus of the UES, as well as patients with severe deglutition disorders, complete inability to swallow, and aspiration problems. Preoperative diagnostic evaluation included careful history-taking, physical examination, cineradiography, and esophageal manometry to exclude other causes of dysphagia. For precise localization, injections were performed under general anesthesia after location of the CM by direct esophagoscopy and electromyographic guidance. Injections were administered into the dorsomedial part and on both sides into the ventrolateral parts of the muscle. Depending on the severity of symptoms and the intraluminal pressure of the UES, the dose varied between 80 and 120 units (botulinum toxin A from Dysport). The treatment outcome was evaluated by a disability rating score: patients' complaints were scored by subjective and objective parameters before and after injection. All but 2 patients experienced complete relief or marked improvement of their complaints. There were no severe side effects or postoperative complications. Local botulinum toxin injection proved to be an effective alternative treatment to invasive procedures for patients with isolated dysfunction of the UES, and also for patients with more complex deglutition problems combined with aspiration.

Maturation of auditory evoked potentials in young guinea pigs with binaural conductive hearing loss

A reversible conductive hearing loss produced during the first 4 weeks post partum caused marked alterations in the development of click-evoked auditory brainstem (ABR) and middle latency (MLR) responses in guinea pigs. The early component PI in the ABR in controls showed adult-like latencies at the time of birth, while the later ABR components PIII and PV and all components investigated in the MLR showed postnatal development characterized by a shortened latency that persisted for the whole period of investigation. The course of the ABR latencies showed the sharpest decrease during the first 2-3 weeks of life, while that for the MLR took place during the first 5 weeks. In addition to the increased ABR thresholds and lengthened ABR latencies due to the conductive hearing loss, development of the ABR inter-peak latencies (IPL) and MLR latencies was retarded. The IPL reached control values 1 week after the end of the deprivation phase, while the delay in MLR started later (4th week) and lasted longer than did that in the ABR. These findings showed that a long-lasting postnatal conductive hearing loss does not generate sustained impairment at the level of the brainstem but can evoke longer-lasting deficiencies at higher stations of the auditory pathway.

Inhibition of dihydrofolate reductase by mofebutazon

Mofebutazon, in contrast to phenylbutazon, inhibits dihydrofolate reductase in a concentration-dependent manner. An apparent Ki for mofebutazon and dihydrofolate reductase in the presence of NADPH as electron donor and dihydrofolate as electron acceptor of approximately 0.2 mM was calculated.

Humoral immune responses in volunteers immunized with irradiated Plasmodium falciparum sporozoites

Volunteers immunized with gamma-irradiated Plasmodium falciparum sporozoites serve as the gold standard for protective immunity against mosquito-borne malaria transmission and provide a relevant model for studying protective immune effector mechanisms. During a 7-12 month period, we immunized four volunteers via the bites of irradiated, infected mosquitoes. Following these exposures to attenuated sporozoites, all four volunteers developed antibodies to sporozoites as measured by an immunofluorescence assay and by an enzyme-linked immunosorbent assay using the circumsporozoite (CS) protein repeat-based molecule R32LR as capture antigen. Three volunteers also developed antibodies against the nonrepeating (flanking) regions of the CS protein; the level of these antibodies paralleled the serum activity to inhibit sporozoite invasion of hepatoma cells in vitro. These three volunteers were protected against malaria transmitted by the bites of five infected mosquitoes. Two of these protected volunteers received additional immunizing doses of irradiated sporozoites and were subsequently protected against challenge with a heterologous P. falciparum clone. No detectable fluctuations were observed in circulating levels of tumor necrosis factor, interferon-gamma, or interleukin-6 during the course of this study. Analysis of the humoral and cellular immune responses of these protected volunteers is expected to yield important clues to additional targets of immunity against the pre-erythrocytic stages of malaria parasites.

Antioxidative properties of phenazone derivatives: differentiation between phenylbutazon and mofebutazon

Both phenylbutazon and mofebutazon inhibit oxidative fragmentation of the methionine derivative, 2-keto-4-methylthio-butyric acid (KMB) by xanthine oxidase--or diaphorase mediated OH radical production. Differentiation of the two non-steroidal antiinflammatory drugs is possible by means of determining oxygen reduction by xanthine oxidase or diaphorase in the presence of the naphthoquinone, juglone, where only mofebutazon shows an inhibitory effect.

[Serum and secretory immunoglobulins in atopic dermatitis]

In 58 atopic dermatitis patients from 93 was determined the total and specific IgE. Majority of the cases (84.5%) were extrinsic in type and it is an evidence for the local (through the body surfaces) crossing route of allergens. Thus the body surfaces are the most important factors in case of host defense in the first line. To investigate the local defending factors, the body fluids (whole saliva and tear taken from patients, n = 11) were examined too (preliminary study). According to amount of IgA and IgA/IgG ratio, the tear proved to be pure glandular secretum. In the further sistemically arranged study the sera and tear samples were simultaneously examined (n = 35). In follows is scheduled the measurement of total and specific IgE not only in sera, but the tear sample of patients.

Apc gene-mutations in familial adenomatous polyposis-coli identified at the DNA and protein level

Peripheral blood cell DNA of patients suffering from Familial Adenomatous Polyposis coli (FAP) were subjected to SSCP screening analyses. Here, we report on a patient, who was diagnosed at the age of 31 years suffering from a severe form of adenomatous polyposis coli. The germline mutation was identified to result from a 5-bp germline microdeletion surrounding Adenomatous Polyposis Coli (APC) codon 1309. Examination of DNA derived from pooled adenomas of the same patient confirmed the inherited mutation. Western blot analysis with an APC N-terminus specific antiserum (anti-APC123) applied to tumor-derived proteins identified a polypeptide chain of 140 kD corresponding to the truncation induced by the APC germline mutation. We further examined DNA isolated individually from eight adenomas of the same patient. The analysis revealed the surprising observation, that three out of eight tumor samples analyzed, gave rise to a predominant PCR-amplified band of normal size, implicating that the allele containing the germline deletion had been lost, and instead hemi-/homozygosity for the somatic, not for the germline mutation had been aquired as a tertiary event. A similar mutational mechanism has been reported for the Rb-1 tumor suppressor gene in the retinoblastoma model.

Immunohistological characterization of the cellular infiltrate in dermatophytosis

The local cell composition of skin infections caused by Trichophyton rubrum (13 cases) and Microsporum canis (2 cases) was examined using monoclonal antibodies and the ABC immunoperoxidase technique. The number of Langerhans cells increased both in the epithelium and in the dermis of the mycotic area. Apart from these, only T cells were found in the dermis, among which helper cells were predominant. The helper/suppressor ratio showed variations depending upon the pathogen.

In vitro culture of the mosquito stages of Plasmodium falciparum

The sporogonic cycle of Plasmodium falciparum was obtained in vitro. Mature gametocytes, from blood-stage cultures, produced gametes that underwent fertilization at elevated pH and ambient temperatures. Wheat germ agglutinin stimulated transformation of zygotes into retorts and ookinetes. Twenty-four hours thereafter, 18-49% mature ookinetes and 10-20% intermediate retort forms were counted. Cultures were seeded onto a basement membrane-like gel (Matrigel) in coculture with Drosophila melanogaster cells. Both ookinetes and retorts attached to Matrigel and transformed into oocysts. Mature oocysts and sporozoites expressed circumsporozoite protein. The entire life cycle of Plasmodium falciparum, the most important malaria pathogen of humans, can now be studied in vitro.

Plasmodium falciparum: stage-specific ribosomal RNA as a potential target for monitoring parasite development in Anopheles stephensi

The transcriptional switch of Plasmodium falciparum ribosomal RNA A gene to the C gene was demonstrated during the developmental transition from the vertebrate blood stage to the invertebrate sporozoite stage. Expression of the sporozoite specific C gene in infected mosquitoes was not detected until Day 10 postinfectious blood meal, the time of mature oocyst formation on the midgut. As a potential target for monitoring malaria parasite development in mosquitoes, oligonucleotide probes based on sequences of small subunit ribosomal RNA were evaluated for specificity and sensitivity by filter blot hybridization against different species and stages of malaria parasites. Probes PfC02 and PfA02 were selected as the most sensitive for sporozoite and blood stage parasites, respectively. Filter blot hybridization using probe PfC02 resulted in sensitivity comparable with microscopic dissection in single mosquitoes, detecting mosquitoes with an average of 1.2 oocysts per gut or as few as 800 salivary gland sporozoites.

Maturation of binaural interaction components in auditory brainstem responses of young guinea pigs with monaural or binaural conductive hearing loss

Reversible conductive hearing loss created during the first 4 weeks post partum caused marked alterations in the maturation of binaural interaction components in the auditory brainstem responses of guinea pigs. In untreated control animals all three components investigated demonstrated postnatal development in terms of latency shortening that was completed during the first 3 weeks of life. Plugging of both external ear canals caused a significant delay in the maturation of the late component DN2, where latency values of the controls were reached only 2 weeks after the end of the treatment, i.e. after 6 weeks of life. Monaural deprivation likewise led to a retarded development of peak latencies during the phase of imbalanced sensory input. After the end of the one-sided conductive hearing loss the maturation process was markedly enhanced, even resulting in latency values for DN2 and DP1 that were significantly shorter than those of the controls. This phenomenon persisted until the end of the study period and was the case for both plugged and untreated ears in this group of animals. The time course of latencies in two other groups of experimental animals which were deprived in the same way as adults suggests that the effects observed are due to a sensitive period in the maturation process of the auditory pathway.

[A rare metabolic disease: alkaptonuria--ochronosis]

The authors describe the case of a 40-year-old female patient. Since childhood her urine had caused black discoloration on her underwear. For about a year the skin of the axillae and pinnae had been bluish-black without subjective complaints. One year before admission, pain in the thoracic and lumbar spine began, with limitation of motion. Examination of the urine, histological and electron microscopical findings, and X-ray examination of the spinal column confirmed the diagnosis of alkaptonuria and congenital ochronosis.

Plasmodium falciparum and P. berghei: detection of sporozoites and the circumsporozoite proteins in the saliva of Anopheles stephensi mosquitoes

Sporozoites and free circumsporozoite (CS) protein were stained immunoenzymatically in 1-min saliva samples collected from Anopheles stephensi mosquitoes infected with either Plasmodium berghei or P. falciparum. The number of sporozoites in 1-min saliva-streak samples significantly increased as the salivary gland index rose from 3+ to 4+. For P. berghei-infected mosquitoes from which saliva had been collected before 30 days postfeed, the median sporozoite counts for 3+ and 4+ gland indexes were 4.5 and 116, respectively. For P. falciparum-infected mosquitoes, the median counts obtained in two experiments were 4.5 and 14.5 (3+) and 97 and 107 (4+), respectively. The frequency of sporozoite detection in the saliva of mosquitoes containing < 100 salivary-gland sporozoites was low (0.1), whereas that in the saliva of mosquitoes with > 100 sporozoites was high (0.96). In highly infected 4+ P. berghei-infected mosquitoes from which saliva had been collected after 30 days postinfection, both the volume of saliva collected and the median number of sporozoites recovered decreased significantly.

Safety, immunogenicity, and efficacy of a Plasmodium falciparum vaccine comprising a circumsporozoite protein repeat region peptide conjugated to Pseudomonas aeruginosa toxin A

Twenty-one malaria-naive volunteers were immunized with a vaccine consisting of a 22-kDa recombinant peptide (R32LR), derived from the repeat region of Plasmodium falciparum circumsporozoite (CS) protein, covalently coupled to detoxified Pseudomonas aeruginosa toxin A. Nineteen volunteers received a second dose of vaccine at 8 weeks, and eighteen received a third dose at 8 to 12 months. The vaccine was well tolerated, with only one volunteer developing local discomfort and induration at the site of injection which limited function for 48 h. The geometric mean anti-CS immunoglobulin G antibody concentration 2 weeks after the second dose of vaccine was 10.6 micrograms/ml (standard deviation = 3.0 micrograms/ml). Eleven volunteers (52%) developed anti-CS antibody levels of greater than 9.8 micrograms/ml, the level measured in the one volunteer protected against P. falciparum challenge after immunization with the alum-adjuvanted recombinant protein R32tet32 in a prior study. Three separate experimental challenges were conducted with 10 volunteers 2 to 4 weeks after the third dose of vaccine. The four best responders, on the basis of antibody levels (6 to 26 micrograms/ml), were challenged with two infected-mosquito bites, but only one of four immunized volunteers and one of three malaria-naive controls became parasitemic. In a second challenge study using five infected-mosquito bites as the challenge dose, three of three malaria-naive control volunteers and two of three immunized volunteers developed malaria. The third vaccine was apparently completely protected. In the third and last challenge, three of three controls and five of five vaccinees became infected. Sera obtained on the days of challenge inhibited sporozoite invasion of hepatocytes variably in vitro (range, 45 to 90% inhibition), but the degree of inhibition did not correlate with protection. Although antibody against the CS repeat region may protect some individuals against experimental challenge, this protection cannot be predicted from antibody levels by current in vitro assays. The functionality and fine specificity of anti-CS antibody are probably critical determinants.

Immune changes induced by electroconvulsive therapy (ECT)

There is a significant increase in the percentage and absolute number of activated lymphocytes (OKT10+, IL2R1+) after ECT treatment of major depressive disorder. There is an acute decrease in the absolute number of total lymphocytes, T8+ and Leu11+ cells one hour after a single ECT.

F-aggregate color centers in sodium-doped KI

Data are presented for additively colored KI:Na, which identifies the (F(2))(A) absorption and emission bands as peaking at 1.03 and 1.62 microm, respectively. These transitions differ from those previously attributed to this defect. (F(2)(+))(A) centers also were produced and found to absorb near 1.52 microm and emit near 2.36 microm. The (F(2)(+))(A) emission would be of interest for use in achieving tunable color-center laser action.

Immunoenzymatic labeling of multiple plasmodial salivary gland sporozoites in a single test

A direct, double- and triple-staining immunoenzymatic method detected and differentiated sporozoites by color in Anopheles stephensi salivary glands and in mixed sporozoite slide preparations. A double-staining method used beta-galactosidase- and alkaline phosphatase-labeled monoclonal antibodies to the circumsporozoite (CS) proteins of Plasmodium berghei and P. falciparum in mosquito salivary glands. The CS proteins were distinguished clearly by the blue-green and red substrate products of beta-galactosidase and alkaline phosphatase, respectively. A triple-staining method differentiated by color among a mixture of P. falciparum and two strains of P. vivax sporozoites. Monoclonal antibodies to the CS proteins conjugated to beta-galactosidase (P. falciparum), alkaline phosphatase (P. vivax variant), and horseradish peroxidase (P. vivax predominant) readily color differentiated sporozoites by the blue-green, purple-blue, and orange-brown substrate products, respectively. This assay may have potential use in malaria transmission studies, genetic crosses of variant strains of plasmodia to determine assortment of CS antigen alleles, and as a technique to determine the fate of the CS antigen in infected mosquitoes.

Homicidal maniacs and narcissistic parasites: stigmatization of mentally ill persons in the movies

The portrayal of mentally ill persons in movies and television programs has an important and underestimated influence on public perceptions of their condition and care. Movie stereotypes that contribute to the stigmatization of mentally ill persons include the mental patient as rebellious free spirit, homicidal maniac, seductress, enlightened member of society, narcissistic parasite, and zoo specimen. The authors suggest that mental health professionals can fight this source of stigma by increasing their collaboration with patient advocacy groups in monitoring negative portrayals of mentally ill people, using public information campaigns such as Mental Illness Awareness Week to call attention to the process of stigmatization, and supporting accurate dramatic and documentary depictions of mental illness.

Papular acrodermatitis of childhood (Gianotti-Crosti disease)

An 11-year-old boy had lentil-sized lichenoid papules, localized to the limbs and trunk, together with acute, nonicteric, hepatitis B surface antigen-positive hepatitis. The clinical picture and course were typical of Gianotti-Crosti disease. Monoclonal antibodies were used to study the lymphocyte subpopulations and surface antigens in the inflammatory infiltrate in frozen sections of a skin biopsy specimen. The results provide data on the pathogenic mechanism of the papular exanthem.

[Experience with Ender nailing in 671 cases]

Between 1976 and 1987 at the Surgical Department of the University of Erlangen-Nürnberg, 671 fractures of the trochanteric region of the femur were treated by Ender nailing. In 54 cases (8.0%) there were intraoperative complications, in 82 cases (12.2%) postoperative complications occurred. Reoperation became necessary at 57 (8.5%) patients. Because of this complication rate we only see indications for Ender nailing in patients with skin lesions over the fracture site, valgus angulation of the proximal fragment and in the palliative treatment of pathological fractures.

[Disseminated cicatricial pemphigoid]

The authors describe a typical case of a rare disease, disseminated cicatricial pemphigoid. At the site of the subepidermal bulla excessive scarring in seen. Electron microscopic examination reveals elastic fibrin deposition and incipient vacuolation under the basement membrane. The indirect immunoperoxidase study shows increased numbers of positive Langerhans cells, which support their antigen-presenting role.

Rapid development of a sensory attribute in young chickens

Development of a consistent pattern in responses to frequency changes is revealed with individual differences scaling. Newborn chicks respond to changes in a background tone to which they have become habituated with momentary delays in their otherwise regular peeping. Durations of these delays are used as measures of perceived difference between all possible pairs of five frequencies between 500 and 608 Hz. Coordinates of five points are calculated to create a map of these frequencies such that distances between points are maximally correlated with delays. A steeply sloped s-shaped curve describes the rapid emergence, from the beginning to the middle of the first postnatal day, of maps that explain significantly more of the input data than expected by chance. This implies that over a few hours birds come to reliably rank different frequencies along a consistent scale. Controlled rearing conditions of decreased external stimulation or early exposure to frequency changes have no effect on this development. In conclusion, scaling is a replicable way to evaluate the development of consistent responses to frequency changes. Similar processes are likely important in other aspects of perceptual development, learning, and memory.

Cholestasis and changes of portal pressure caused by chlorpromazine in the perfused rat liver

Chlorpromazine (10 mumol/L) causes a marked increase in portal pressure in perfused rat liver. Simultaneously, oxygen consumption, hepatic clearance of taurocholate and bile flow are diminished. These effects are prevented by the cyclooxygenase inhibitors indomethacin (15 mumol/L), acetylsalicylate (3 mmol/L) or ibuprofen (200 mumol/L). On addition of chlorpromazine the liver releases increased amounts of prostaglandin D2; this increase does not occur in the presence of indomethacin. At higher concentrations of chlorpromazine (100 mumol/L) the inhibition of taurocholate clearance and bile flow is accompanied by only a moderate increase of portal pressure, and indomethacin is without effect. At this high concentration, substantial cell damage, as indicated by the release of lactate dehydrogenase, is present. We conclude that arachidonic acid-derived metabolites, notably prostanoids, are involved in the inhibition of bile flow and of taurocholate clearance observed at low concentrations of chlorpromazine. The data suggest that changes in the microcirculation are responsible for the impairment of the liver functions. At higher concentrations of chlorpromazine the cell toxicity of the drug becomes prominent.

Plasmodium falciparum-infected Anopheles stephensi inconsistently transmit malaria to humans

Malaria was transmitted to only 5 of 10 volunteers bitten by 1-2 Anopheles stephensi carrying sporozoites of the 3D7 clone of the NF54 strain of Plasmodium falciparum in their salivary glands. Parasites were detectable by culture in blood taken 7-10 days following exposure and by thick blood film 14-16.5 days after exposure. Infectivity did not correlate with the numbers of sporozoites in the salivary glands.

[Pemphigus herpetiformis]

We report on the typical case of a 71-year-old male patient suffering from herpetiform dermatitis. Histological investigation and immunofluorescence revealed the characteristic features of pemphigus. The symptom disappeared after therapy with corticoids.

The use of midazolam and flumazenil in locoregional anaesthesia: an overview

Midazolam is useful as an intravenous supplement to local anaesthesia techniques in producing sedation, amnesia and anxiolysis, and has about five times the sedative potency of diazepam. Considerable interpatient variability exists in dose requirements, especially in elderly patients. The combined effects of local anaesthetics and midazolam may contribute to enhanced haemodynamic effects and changes in the respiratory pattern, impairing ventilation and oxygenation. Flumazenil can be titrated in incremental doses to reverse the residual sedative effects of midazolam, without intrinsic haemodynamic or respiratory effects, but may not fully antagonise the decrease in chemoreceptor sensitivity nor the changes in breathing pattern induced by midazolam. Patients treated with epidural or spinal anaesthesia supplemented with midazolam should be monitored to avoid hypoxaemia risks even after the administration of flumazenil.

[Discoid lupus erythematosus beginning on the eyelids]

We report on a 20-year-old women, who suffered from discoid lupus erythematosus (DLE) beginning on her eyelids with dyschromia and cutaneous infiltration. Similar signs appeared on the top of her nose, her nostrils, and her lower lip. Simultaneously with these alterations, we found a superficial exulceration on her hard palate, which histologically proved typical for DLE. After therapy with chloroquine for 3 weeks, the alterations disappeared.

Safety and immunogenicity of a Plasmodium vivax sporozoite vaccine

A recombinant DNA Plasmodium vivax sporozoite vaccine containing the repeating region of the Salvador I strain circumsporozoite (CS) protein was produced in Escherichia coli. This vaccine was tested in 13 naive volunteers at doses of 10-1,000 micrograms. No serious adverse reactions were noted. None of 4 volunteers receiving the 10 micrograms dose developed antibodies measurable by ELISA. Six of 9 volunteers in the other dose groups developed measurable antibodies: 5 of 5 volunteers receiving 100 micrograms and 1 of 4 receiving 1,000 micrograms. Antibody responses measured by immunofluorescence assays paralleled those seen by ELISA. None of the volunteers developed antisera that inhibited sporozoite invasion of human hepatoma cells in vitro. Lack of a classical anamnestic response and lack of a typical dose response to increasing amounts of antigen suggests the possible presence of an immunosuppressive epitope in the repetitive region of the CS protein.

An estimation of the number of malaria sporozoites ejected by a feeding mosquito

Restrained Anopheles stephensi mosquitoes infected with Plasmodium falciparum were made to produce time-dependent series of saliva droplets in mineral oil. The relative volume of each droplet and the number of sporozoites each contained were determined microscopically; gland sporozoites were estimated with an enzyme-linked immunosorbent assay. Median gland infection was 8170 and median number of sporozoites ejected was 15 (range, 0-978). Inoculum size was positively correlated to the number of sporozoites in the salivary glands. Most mosquitoes ejected sporozoites only at the beginning of salivation; this suggests that only those parasites in the common and secondary salivary ducts at the time of feeding can be ejected. The small size of inocula may explain some aspects of malaria transmission, including the often observed discrepancy between inoculation and incidence rates.

Optically induced reorientational aggregation and the stability of F(2)(+) color-center lasers

Spectroscopic evidence is presented showing that F(2) centers in KCI optically convert to an array of higher Faggregate centers at temperatures as low as 40 K. This aggregation occurs through random diffusion of F(2)(+) centers by means of repeated optical reorientation. Stable lasing of the F(2)(+) center has been achieved at a crystal temperature below which this reorientational aggregation ceases.

[Effect of binaural conductive hearing loss on maturation of acoustically evoked potentials (auditory brain stem response, middle latency response) in guinea pigs]

During the early development of the acoustic system a conductive hearing loss may alter the maturation of acoustically evoked potentials and affect the development of hearing. The present experiments were carried out in newborn guinea pigs with binaural conductive hearing loss. The external ear canals were plugged over a period of one month from the first day postpartum. During and after deprivation click-evoked Auditory Brainstem Responses (ABR) and Middle Latency Responses (MLR) were collected to analyze changes in the maturation of these potentials in comparison to untreated animals. This type of deprivation is characterized by threshold elevations of about 40 dB over a wide frequency range. In young deprived animals, ABR Latencies (PIII, PV) and interpeak latencies exhibited a significant delay with a maximum between day 13 and 19, which disappeared within 10 days after the end of the treatment. MLR latencies were also significantly affected after three to four weeks of the deprivation phase. In contrast to the ABR, the recovery of the latencies was completed within four to six weeks. These results therefore indicate that a conductive hearing loss may alter the maturation of the acoustically evoked responses in the sensitive phase after birth. This type of partial deprivation may affect the development of hearing and speech perception in children with chronically occurring otitis media.

[Single-photon emission-computed tomography in the differential diagnosis of dementia]

To assess the value of single photon emission computed tomography (SPECT) in the differential diagnosis of dementia SPECT and conventional computed tomography were performed in 77 patients (50 men, 27 women, mean age 59 [28-90] years) with dementia diagnosed by a battery of psychometric tests. In 13 out of 15 patients with dementia of Alzheimer type SPECT showed a typical Alzheimer pattern (bilateral parietotemporal perfusion defects). Both patients with dementia of Pick type had definite decreases in frontal perfusion. All 21 patients with dementia due to Huntington's chorea showed a typical pattern with absent perfusion of the head of the caudate nucleus, although in three of them conventional computed tomography didn't demonstrate complete atrophy of this structure. Out of 23 patients with multi-infarct dementia there were 17 with focal uptake deficits at various sites, while six displayed an Alzheimer pattern. In Korsakoff's syndrome (n = 11), Down's syndrome (n = 1), Fahr's syndrome (n = 2), senile chorea (n = 1) and HIV encephalopathy (n = 1) no typical distribution patterns were noted. Single photon emission computed tomography can make a contribution to the diagnosis and classification of primary degenerative dementias and can be used to differentiate them from other forms of dementia.

[A case of erythrokeratodermia figurata variabilis successfully treated with tigason]

We report on a young man having suffered from infiltrated, scaly, hyperkeratotic, erythematous skin eruptions since his birth, varying in its course. Histologic examination revealed erythrokeratodermia. Therapy with Etretinate led to rapid regression; on keeping the maintenance dose for a year, we did not observe any recurrences. Light and electron microscopical investigations were carried out both before and 7 weeks after treatment.

ELISA method for detecting Plasmodium falciparum circumsporozoite antibody

An enzyme-linked immunosorbent assay (ELISA) for circulating IgG mouse antibody to Plasmodium falciparum circumsporozoite (CS) protein was modified for use with human sera collected in an area of northern Zambia that was endemic for malaria and from individuals never exposed to malaria. Optimum sensitivity was achieved using Immulon 2 microtitration plates, boiled casein-Tween 20 blocking buffer, and by adding a solution of boiled casein (4 micrograms/ml) to the capture antigen diluent. The results for the detection of anti-CS IgG correlated well with those of sporozoite immunofluorescence antibody assays. Modification of the ELISA method permitted the simultaneous detection of anti-CS IgG and IgM antibody on a single serum sample in the same well of the microtitration plate and the detection of anti-CS IgG antibody in Kenyan dried whole-blood samples collected on filter-paper. The assay has been used to monitor human antibody levels in a phase-I malaria vaccine trial and in longitudinal studies of malaria transmission in Thailand and Kenya.