[Lymphangitis carcinomatosa]

The authors present a 86 years old male patient with gradually developing upper right arm swelling. There were several hyperaemic papules, vesicles and teleangiectases on his arm. The histology revealed a lymphangitis carcinomatosa. There were no signs of any tumor, but multiple isotope accumulations in the bones. Anaplastic thyroid gland carcinoma with multiple metastases were found at autopsy.

[Progressive circumscript lentiginosis--phakomatosis pigmentovascularis III/A]

The case of a young woman with circumscribed lentiginosis on certain parts of her body with nevi flammei on face, neck and trunk is reported. This patient's condition was significant in two ways: she had a progressive circumscribed lentiginosis or lentiginosis syndrome, and it was associated with lentigo, nevus spilus and nevus flammeus, so that it was suggestive of phakomatosis.

[Acrokeratoelastoidosis]

The differential diagnosis and classification of acrokeratoelastoidosis, a relatively rare disorder, may cause difficulties. The authors therefore report the case of a 25-year-old male patient with characteristic clinical and histological signs of the disorder.

Laser action with (F(2)(+))(A) centers in additively colored lithium-doped KI

Laser action has been achieved with lithium (F(2)(+))(A) centers in additively colored KI. In preliminary measurements, this material has been tuned continuously between 2.72 and 3.67 microm. The material was coaxially pumped with a pulsed 1.73-microm Er:YLF laser, and (F(2)(+))(A) centers were produced by using a selective, two-step photoionization technique, These additively colored crystals have the practical advantage of being reusable after cycling between liquid-nitrogen and room temperature.

[Clinical aspects and pathogenesis of the "on-off" phenomenon in Parkinson syndrome]

It was the aim of our study based on a group of 460 patients suffering from Parkinson's disease to find out possible pathogenetic linkups for the so-called "on-off" phenomenon. The method was based on two questionnaires of different structure, and in 90 cases we also called personally on the patient in his home. The patients were either known from neurological treatment they received at the Department of Neurology of the University of Essen, or were approached on-target via their membership in the German Parkinson Association. After evaluation, 43 patients with an on-off phenomenon and 81 with end-of-dose akinesia, as well as 336 patients without fluctuations of motility, could be classified and evaluated further. All patients with an on-off phenomenon or end-of-dose akinesia had received L-dopa treatment for several years; the average treatment period was 8.4 years in a patient with on-off phenomenon and 7.3 years in case of end-of-dose akinesia. Compared therewith, patients without fluctuations had only an average L-Dopa intake period of 5 years. It is a striking fact that in the patient group without fluctuations (n = 336) 51 patients (15.7%) had never taken an L-dopa preparation. 72.1% of the on-off group suffered from hyperkinesia before abrupt onset of the phase, while at the same time a recession of L-dopa efficacy was seen after several years of treatment. In about 40% of the questioned on-off patients we found that end-of-dose akinesia had preceded the on-off condition, and that the time correlation of the akinesia with the intake of the preparation was gradually abandoned. The age of the patients with on-off or end-of-dose patterns was, at the time of diagnosis, 55.6 or 54.2 years respectively. These patients were therefore much younger on the average than those of the comparative group without any disturbance of motility (60.1 years). On-off patients suffered comparatively more often from concomitant cardiovascular disease and their more active smoking habits were very noticeable. Taking the pathological specialities into consideration, it is recommended to critically reconsider the early use of L-dopa in relatively young patients with concomitant cardiovascular diseases, and to give preference in case of an indication for L-dopa to a combination treatment especially with MAO-B inhibitors and dopamin antagnonists in order to keep the daily L-dopa dose low. Arguments against L-dopa to be taken three times daily are discussed, as are the pros and cons of concomitant therapy.

Cholestasis and changes in the microcirculation of perfused rat liver caused by the calcium ionophore A23187 and type I antiarrhythmic drugs

The calcium-ionophore A23187 causes a reversible increase of the hydrostatic pressure in the portal vein of perfused rat liver. Concomitantly, hepatic functions like the production of bile and the transhepatic movement of the bile acid taurocholate are diminished, mainly due to decreased uptake. These phenomena are partly explained by changes in the microcirculation of the liver, visualized by Trypan blue staining. Both the increase in portal pressure and the major part of the decrease of biliary excretion of taurocholate and bile flow are prevented by the addition of the vasodilator papaverine. The type I antiarrhythmic drugs quinidine and N-propylajmaline bitartrate (NPA), at high concentrations, also induce a rise in portal pressure and act as a cholestatic agent. The rise in portal pressure caused by NPA requires the presence of extracellular calcium and is counteracted by papaverine. In contrast to A23187, the cholestasis caused by NPA is not influenced by papaverine. While NPA decreases the hepatic uptake and biliary excretion of taurocholate, papavarine is able to restore only the uptake and not the excretion. The concentration of taurocholate in the bile is not significantly changed by NPA.

The theory and practice of movie psychiatry

The depiction of psychiatry in the movies has been a source of concern over the years to many in the profession who feel that a false picture of psychiatrists' work has been presented to the public. In fact, psychiatry in the movies has developed its own characteristics, which only occasionally intersect with those of the real-life profession. This paper outlines the methods and theories of the invented profession of movie psychiatry.

Safety and efficacy of a recombinant DNA Plasmodium falciparum sporozoite vaccine

A recombinant DNA Plasmodium falciparum sporozoite vaccine produced in Escherichia coli (FSV-1) was tested in doses of 10 micrograms to 800 micrograms protein in fifteen volunteers. No serious adverse reactions occurred. Antibodies that reacted with P falciparum sporozoite antigens by enzyme-linked immunoassay developed in twelve of the volunteers. The highest antibody titres induced were similar to those resulting from lifelong natural exposure to sporozoite-infected mosquitoes. Postimmunization serum samples from a majority of volunteers mediated the circumsporozoite (CS) precipitation reaction and inhibited sporozoite invasion of hepatoma cells in vitro. Serum from the three volunteers who received 800 micrograms doses reacted with the surface of sporozoites in an immunofluorescence assay. Six immunised volunteers receiving a fourth dose of FSV-1 and two non-immunised controls were challenged by bites of mosquitoes infected from cultured P falciparum gametocytes. Parasitaemia did not develop in the volunteer with the highest titre of CS antibodies, and parasitaemia was delayed in two other immunised volunteers. This study confirms that human beings can be protected by CS protein subunit vaccines and provides a framework for the further development and testing of more immunogenic sporozoite vaccines.

Efficacy of murine malaria sporozoite vaccines: implications for human vaccine development

As part of a study of potential vaccines against malaria, the protective efficacy of sporozoite subunit vaccines was determined by using the Plasmodium berghei murine malaria model. Mice were immunized with recombinant DNA-produced or synthetic peptide-carrier subunit vaccines derived from the repetitive epitopes of the Plasmodium berghei circumsporozoite gene, or with radiation-attenuated sporozoites. Immunization with subunit vaccines elicited humoral responses that were equivalent to or greater than those elicited by irradiated sporozoites, yet the protection against sporozoite challenge induced by either of the subunit vaccines was far less than that achieved by immunization with attenuated sporozoites. Passive and adoptive transfer studies demonstrated that subunit vaccines elicited predominantly antibody-mediated protection that was easily overcome whereas irradiated sporozoites induced potent cell-mediated immunity that protected against high challenge doses of sporozoites. These studies indicate that new strategies designed to induce cellular immunity will be required for efficacious sporozoite vaccines.

Plasmodium falciparum: immunogenicity of circumsporozoite protein constructs produced in Escherichia coli

The immunogenicity of Plasmodium falciparum recombinant circumsporozoite protein constructs R16tet32, R32tet32, and R48tet32 in mice was examined by measuring antibody responses by enzyme linked immunosorbent assay, immunofluorescence, circumsporozoite precipitation, and inhibition of sporozoite invasion. All three constructs were found to be immunogenic when administered alone, but antibody responses were greater for the larger constructs, R32tet32 and R48tet32. Increased dose, boosting, and the use of adjuvants further augmented antibody responses. R32tet32 was found to be the most immunogenic of the three constructs, and high levels of protective antibodies were found to persist for at least 44 weeks when the construct was given with alum. Clinical trials with alum adjuvanted R32tet32 have now begun.

Comparative testing of monoclonal antibodies against Plasmodium falciparum sporozoites for ELISA development

Ten monoclonal antibodies developed against Plasmodium falciparum sporozoites at four institutions were evaluated for use in an enzyme-linked immunosorbent assay (ELISA). Four of the antibodies were eliminated because of their low sensitivity or requirement for high concentrations of capture antibody, while an additional four were rejected because they exhibited cross-reactivity with P. berghei sporozoites. Of the two remaining monoclonal antibodies, that designated 2A10 had the highest sensitivity, a requirement for lower concentrations of capture antibody, and had been tested successfully against sporozoites from a wider range of geographical areas than the others. Use of this monoclonal antibody in a standardized ELISA method gave a test ten times more sensitive than previously reported for P. falciparum sporozoites and its detection limit was less than 100 sporozoites per mosquito.

Selective two-step photoionization of F-aggregate centers using 1.06-microm radiation

A two-step photoionization of several potentially laser-active F-aggregate centers is observed in additively colored crystals by using high-intensity 1.06-microm pulses from a Q-switched Nd:YAG laser. The centers produced include the lithium (F(2)(+))(A) center in KI, which has lased with tunability from 2.4 to 4.0 microm, and N(1) (+) centers in KBr, which show promise of lasing. Steady-state concentrations of ionized (F(2)(+))(A) and N(1) (+) centers are found to be considerably larger than those produced by using blue or near-ultraviolet excitation.

Immunity to malaria and naturally acquired antibodies to the circumsporozoite protein of Plasmodium falciparum

A candidate Plasmodium falciparum sporozoite vaccine, R32tet32, which includes 32 tetrapeptide repeats derived from the circumsporozoite protein of P. falciparum, has been developed on the basis of the hypothesis that antibodies to the repeat region of this protein will protect against sporozoite infection. The results of two in vitro assays, the circumsporozoite precipitation reaction and the inhibition of sporozoite invasion into hepatoma cells, are thought to indicate protective immunity. We therefore tested serum samples from persons living in a hyperendemic malarious area of Indonesia for antibodies against R32tet32 and for their ability to produce circumsporozoite precipitation and to inhibit sporozoite invasion of hepatoma cells. The prevalence and mean titer of antibody against R32tet32 increased with the age of the subjects, whereas the prevalence of P. falciparum infection in the community decreased. Only serum samples with IgG or IgM R32tet32 antibody titers greater than or equal to 1/800 had precipitation activity and invasion-inhibiting activity of more than 75 percent. When the serum samples were fractionated by affinity chromatography, only the fractions containing purified human antibody to R32tet32 were found to contain this activity. These data support the hypotheses that antibodies to the circumsporozoite protein are important in reducing the prevalence of malaria with increasing age among persons in areas in which malaria is endemic and that vaccine-elicited antibody to the circumsporozoite repeat region will protect against infection with P. falciparum sporozoites.

Simple method for obtaining exact nonrelativistic formulas for two-photon (n, l, m) continuum dipole transitions for hydrogenic atoms

The Kramers-Heisenberg matrix element for two-photon transitions between a bound (n, l, m) state and a continuum is obtained in terms of the Coulomb Green's function matrix element for the ground-state ? continuum transition. The number of the F(1) Appell functions involved is minimized. The analytical results for the ns ? continuum transitions are given, and both the resonant behavior and the transparency region of the two-photon cross section are predicted.

[Scleromyxedema]

In a 51-year-old man scleromyxedema developed gradually from mucinosis papulosa over 13 years. Paraproteins of the type IgG-lambda were discovered in this patient.

[Clinical picture, immunology and pathogenesis of recurring erysipelas]

Immunodeficiency is an important factor in RE besides chronic local trauma. We observed RE in patients suffering from hematological disorders. A Candida-killing activity, the chemotactic response and other functions of the neutrophil leucocytes, were found impaired.

[Recurrent disseminated infundibulofolliculitis]

A white male patient with disseminated, pruritic, follicular papules on the skin is reported. Histologically, an inflammatory infiltration around the infundibulum, perifollicular oedema and spongiosis of the follicular epithelium were demonstrated. The lesions failed to respond to therapy. On the basis of the clinical and histological findings, we suggest that this is a case of disseminated and recurrent infundibulofolliculitis, which was first described by Hitch and Lund in 1968.

[Seborrheic pemphigoid]

A 67-year-old male patient is reported whose clinical manifestations and histological and immunofluorescence features corresponded to seborrheic pemphigoid. This male patient is in contrast with the few cases previously described in the literature, as they were all females. Clinical remission was achieved with azathioprine and low-dose steroid therapy.

Malaria transmitted to humans by mosquitoes infected from cultured Plasmodium falciparum

Malaria was transmitted to six normal human volunteers by mosquitoes infected from cultured gametocytes of Plasmodium falciparum. This method, which offers advantages over other methods of infecting volunteers, will be useful for evaluating the efficacy of human malaria vaccines.

[Alloimmune neonatal neutropenia: clinical observations and therapeutic results]

Alloimmune neonatal neutropenia is a rare disease. A family with four affected newborns is described in which the course of the disease aggravated from the first to the third child. The third child died from generalized infection. In the mother's serum specific antibodies against neutrophils (anti-NA 1) were detected which reacted with cell suspensions from the father and the other children. In the fourth child no neutrophils were present even immediately after birth. In this child the diaplacental transferred antibodies were detectable in falling concentrations over 8 weeks. The number of neutrophils normalized when the antibodies disappeared. Infection in the newborn was prevented by care in an environment poor in bacteria and by antimicrobial prophylaxis. Repeated exchange transfusions with NA 1-free blood only lowered the antibody titer. Transfusions of white blood cell concentrates had only shortlived effects on the neutropenia.

Immunogenicity of synthetic peptides from circumsporozoite protein of Plasmodium falciparum

In a study of recombinant proteins that might be useful in developing a vaccine against malaria, synthetic peptides from the circumsporozoite (CS) protein of Plasmodium falciparum were found to be immunogenic for mice and rabbits. Antibody to peptides from the repeating region of the CS protein recognized native CS protein and blocked sporozoite invasion of human hepatoma cells in vitro. Antibodies to peptides from regions I and II had no biologic activity, although antibody to region I recognized processed CS protein by Western blot analysis. These data support the feasibility of developing a vaccine against the sporozoite stage of the malaria parasite by using synthetic peptides of the repeating region of the CS protein conjugated to a carrier protein.

Broadly tunable oscillator-amplifier system using lithium (F(2)(+))A centers in KCl

An oscillator-amplifier system has been constructed using (F(2)(+))(A) centers in KCl:Li crystals and a 1.41-microm laser pump generated by Raman shifting a 1.06-microm Nd:YAG line in liquid nitrogen. Output energies of 2.3 mJ and peak powers exceeding 0.4 MW were achieved. The system was tuned continuously over the 2.0-2.4-microm spectral wavelength range.

Identification of Plasmodium falciparum-infected mosquitoes by a double antibody enzyme-linked immunosorbent assay

A double antibody micro enzyme-linked immunosorbent assay (ELISA) for identifying Plasmodium falciparum sporozoites in mosquitoes is described. Using monoclonal antibodies made against South American P. falciparum sporozoites, the ELISA was able to detect and identify sporozoite antigens of South American and Asian origins in extracts of dried infected mosquitoes.

Structure of the gene encoding the immunodominant surface antigen on the sporozoite of the human malaria parasite Plasmodium falciparum

The gene for the circumsporozoite (CS) protein of Plasmodium falciparum has been cloned and its nucleotide sequence determined. The gene encodes a protein of 412 amino acids as deduced from the nucleotide sequence. The protein contains 41 tandem repeats of a tetrapeptide, 37 of which are Asn-Ala-Asn-Pro and four of which are Asn-Val-Asp-Pro. Monoclonal antibodies against the CS protein of Plasmodium falciparum were inhibited from binding to the protein by synthetic peptides of the repeat sequence. The CS protein of Plasmodium falciparum and the CS protein of a simian malaria parasite, Plasmodium knowlesi, have two regions of homology, one of which is present on either side of the repeat. One region contains 12 of 13 identical amino acids. Within the nucleotide sequence of this region, 25 of 27 nucleotides are conserved. The conservation of these regions in parasites widely separated in evolution suggests that they may have a function such as binding to liver cells and may represent an invariant target for immunity.

[Nevus of the arrector muscle of hair]

We report on a 14-year-old boy who, at the age of 6 months, developed groups of pin head-sized protuberances on a bay leaf-shaped area of the skin above and below the left clavicle. These skin eruptions become more prominent in response to heat and cold, but cause no complaints. The histological picture shows longitudinal and cross sections of mm. arrectorum pilorum in large numbers.

Infectivity to mosquitoes of Plasmodium falciparum clones grown in vitro from the same isolate

In an attempt to produce a line of cultured Plasmodium falciparum parasites consistently infective to mosquites, a Brazilian isolate, IMTM 22, was cloned by the limiting dilution method. Five of the resulting clones were examined in detail. The clones were found to differ in their ability to produce micro- and macrogametocytes, to exflagellate and to infect Anopheles freeborni mosquitoes. The stability of one clone in producing microgametocytes and in its ability to produce oocysts and sporozoites in mosquitoes has been documented through 15 subcultures. This clone should provide a reliable source of infectious gametocytes for genetic studies and vaccine development.

[Anderson-Fabry disease (angiokeratoma corporis diffusum)]

A 49-year-old man with angiokeratoma corporis diffusum is reported. Dermatological, ophthalmological or renal abnormalities have so far been found in 14 of the relatives of the patient. The typical dermal signs of the patient appeared on the distal part of the trunk at the age of 5-6 years, and swelling of the left leg occurred in adulthood. Besides the bicuspidal insufficiency, examination revealed ophthalmological symptoms, signs of renal damage, and the alpha-galactosidase activity deficiency of the leucocytes.

[Ashy-dermatosis--a case with spontaneous disappearance of the cutaneous lesions]

A 14-years-old girl suddenly developed typical dermal signs of ashy-dermatosis at the time of menarche. After one year, the signs began to fade and had disappeared completely two years later. The direct immunofluorescence and the ultrastructure resemble lichen planus. Endocrine factors may have played a part in the presented case, considering the sudden onset at the time of menarche.

Color-center laser continuously tunable from 1.67 to 2.46 microm

Laser action is reported for a KCI crystal containing both sodium and lithium (F(2)(+))(A) centers. The laser is continuously tunable from 1.67 to 2.46 microm and is pumped with the 1.3-microm lines of a Nd:YAG laser.

Thermodynamic and kinetic studies of silver ion complexes with cyclic and open chain diaza-polyethers including cryptands in acetonitrile + water mixtures

.The stability constants for Ag+ complexes of several diazapolyether ligands, L = (2,2,1), (2,1), (2,2) and (2) (Scheme 1), have been measured in acetonitrile and water mixtures. Rate constants for formation and dissociation of Ag(2,2,1)+, together with the free energies of transfer, ΔGtr, of (2,2,1) among the mixtures, are also reported, and are compared with corresponding values for the Ag+-(2,1,1) and Ag+-(2,2,2) systems. The solvent dependences of the stability constants and hence of ΔGtr(AgLCIO4) - AG,,(L) are almost identical for all systems, except for small differences at low water content between the behaviour of the bicyclic cryptand ligands [(2,2,2), (2,2,1), (2,1,1)] and the monocyclic and acylic ligands, attributable to effects of NH solvation in the latter group. The preferential solvation of Ag+ by acetonitrile in the mixtures results in a sharp decrease in the stability constants as acetonitrile is added to water, but the effect is partly compensated for by a corresponding decrease in the free energies of the complexes. A strong differentiation in the kinetic behaviour of the bicyclic cryptand ligands is observed. For (2,1,1) the formation rates are almost independent of solvent composition and the free energies of transfer of the activated complex, ΔG‡tr (Ag+. . .(2,1,1),ClO4-) closely parallels that of AgCIO4, whereas for the larger cryptands the formation rates show a stronger solvent dependence, and ΔG‡tr (Ag+. . .L,ClO4-) values much more closely resemble those of the stable complexes, ΔG‡tr (AgLClO4). It is suggested that for the smaller (2,1,1) ligand preferential solvation of Ag+ by acetonitrile still persists in the transition state, but that in the activated complex for (2,2,1) and (2,2,2) the strong interactions between Ag+ and the ligand nitrogens have already replaced the Ag+. . .N≡CCH3 interactions occurring for the uncomplexed Ag+ ion in the mixtures.

[Side effects and contrast medium resorption of iopamidol and iocarmate in lumbar myelography]

Lumbar myelographies were carried out with lopamidol and locarmat of identical concentrations of iodine in 2 groups of 20 patients each. In about one-third of the cases, clinical side effects and EEG changes were found after the examination without difference with the exception of one seizure and one state of confusion which occurred only after locarmat. Resorption of the contrast media was judged by CT examinations of the lumbar spine and the head. There was a more rapid decrease of lumbar contrast density in patients with a narrow lumbar sac which was accompanied by a more rapid intracranial accumulation of the contrast medium. This may be due to a more active transport of cerebrospinal fluid in this group of patients.

Continuous tuning of a color-center laser between 2 and 4 microm

Efficient laser action is reported for the (F(2)(+))(A) center in KI with tunability now extending from 2.38 to 3.99 microm. For the F(2)(+) and (F(2)(+))(A) centers coexisting in KI, the combined lasing range is 1.98-3.85 microm. The 1.73-microm line of a pulsed Er:YLF laser pumped both centers simultaneously.

[Diagnostic importance of CT examination of the lumbosacral region of patients with lumbo-sciatica (author's transl]

In 160 patients with lumbo-sciatic complaints, CT examinations of the lumbo-sacral region were carried out. In 106 of these cases, which were controlled by myelography and/or operation, the CT diagnosis was correct in 74%. In 19%, the CT findings were uncertain, and in 7% they were wrong. A reliable CT diagnosis could be made mainly in the case of a medial or medio-lateral disc herniation of a size above 0.5 cm in diameter if the patient was not operated previously, and in extremely lateral prolapses into the intervertebral foramen without myelographic changes. Small medial protrusions, specially within a narrow spinal canal, or postoperative controls often gave rise to uncertain findings. However, osseous changes as compressions of the lateral recess or the narrow spine syndrome were demonstrated usually better by CT than on routine radiograms. Nevertheless, the indication for the performance of a lumbo-sacral CT should be kept narrow and should be limited to cases with clear-cut radicular signs.

[Actinic reticuloid (author's transl)]

A 39 year old patient had suffered from a dermatitis at his neck, partly affecting the face as well, 11/2 years ago. A temporary improvement had been followed by signs of actinic reticuloid: lichenoid eruptions on the erythematous skin associated with pruritus. Patch and photo-patch tests were negative. Histology revealed innumerable capillaries and several macrophages carrying melanin, apart from so-called "Sézary-like" cells.

Broadly tunable laser action beyond 3 microm from (F(2)(+))(A) centers in lithium-doped KI

Laser action has been achieved by using lithium (F(2)(+))(A) centers in KI. The laser is continuously tunable from 2.59 to 3.65 microm; the 1.73-microm line from a pulsed Er:YLF laser is used as pump source.