DNA hybridization probe for clinical diagnosis of Entamoeba histolytica

As an alternative to microscopic identification of Entamoeba histolytica parasites isolated from stool, a sensitive and species-specific DNA hybridization probe was made for rapid diagnosis of E. histolytica parasites in clinical samples directly applied to nylon membranes. The DNA hybridization probe was made by screening a genomic library of a virulent HM-1:IMSS strain of E. histolytica to detect recombinant plasmids containing highly repeated parasite DNA sequences. Four plasmid clones that reacted across Entamoeba species coded for highly repeated rRNA genes of E. histolytica. Four other plasmid clones were E. histolytica specific in that they bound to four axenized and nine xenic strains of E. histolytica but did not recognize closely related E. histolytica-like Laredo, Entamoeba moshkovskii, or Entamoeba invadens parasites. The diagnostic clones detected as few as eight cultured amoebae and did not distinguish between pathogenic and nonpathogenic zymodemes of E. histolytica. The diagnostic clones were sequenced and contained 145-base-pair sequences which appear to be tandemly repeated in the genome. No stable transcript which is homologous to the diagnostic DNA was detected. In a study of stool samples from Mexico City shown by microscopy to contain E. histolytica, Entamoeba coli, Giardia lamblia, Endolimax nana, Trichuris trichiuria, and Chilomastix mesnili parasites, the DNA hybridization probe demonstrated a sensitivity of 1.0 and a specificity of 0.93. We conclude that the DNA hybridization probe can be used for rapid and accurate diagnosis of E. histolytica parasites.

Restoration of wrist extension after paralysis

Loss of active extension of the wrist is a major functional handicap for the affected patient. Restoration of wrist extension, primarily accomplished via tendon transfers, is a fundamental part of surgical treatment after paralysis. The anatomy and physiology of the wrist, the clinical aspects, the history, and restorative treatment of wrist extension after paralysis are discussed.

Aberrant protamine 1/protamine 2 ratios in sperm of infertile human males

Protamines were extracted from the sperm of fertile and infertile human males and the relative proportion of protamines 1, 2, and 3 were determined by scanning microdensitometry following electrophoresis of total protamine in polyacrylamide gels. The proportion of the three protamines was found to be similar in sperm obtained from different normal males. The distribution of protamines in sperm obtained from a select group of infertile males producing an elevated level of large sperm heads, in contrast, was different from that of the fertile males.

Suicide in psychiatric and non-psychiatric populations

An analysis of all 776 suicides reported in Monroe County, New York, from 1966 through 1975 showed that psychiatric patients differ in systematic ways from other individuals who commit suicide. Forty-three percent of the total suicides were committed by patients with recorded contacts in the Monroe County Psychiatric Case Register. While suicide rates by age and sex for the overall population were similar to those reported previously, rates for the subgroup of psychiatric patients yielded little variation by age or sex.

A case of fatal sodium azide ingestion

A fatal case of sodium azide poisoning in which exchange blood transfusions, charcoal hemoperfusion, hemodialysis and potent vasopressor agents failed to prevent the development of circulatory collapse associated with a wide complex cardiac rhythm is presented. The cellular toxin sodium azide resulted in the development of an altered mental status, profound metabolic acidosis, cardiac arrhythmia (atrial fibrillation and terminal wide complex arrhythmias), a relative decrease in cardiac output, hypotension and non-cardiogenic pulmonary edema. Further animal studies are needed to gain new approaches for the treatment of this rare cause of human poisoning.

Assessment and management of asthma in an accident and emergency department

Patients with asthma presenting to the accident and emergency department at Southampton General Hospital during 12 months were reviewed retrospectively to determine how many patients attended, when and how patients were assessed and treated, and what factors appeared to influence whether a patient was admitted to a medical ward or not. Thirty five visits were made by patients requesting a repeat prescription for a metered dose inhaler. A further 193 visits were made by 152 patients (93 male, 59 female); only data on the first visit of any individual were analysed in this study. Patients were more likely to visit in the autumn, at the weekend, and in the evenings. Observations and measurements used to assess the severity of asthma were recorded with variable frequency--heart rate in 84% of examinations, pulsus paradoxus in 13%, and peak flow rate in 11%. Blood pressure was five times more likely to be recorded than peak flow rate. The drugs used to treat asthma were, in order of frequency, a beta agonist (120 patients), intravenous aminophylline (39), and intravenous corticosteroids (30). Sixty (39%) of the patients were admitted to a medical ward. Admission was more likely to occur when patients arrived during the week than at the weekend, when they had cyanosis or pulsus paradoxus, and after receiving parenteral treatment. There was no difference in mean heart rate between patients admitted to the ward and those discharged home. Although there was no specific evidence of inappropriate admission to or discharge from hospital in this retrospective study, the failure to record more objective measurements of the severity of asthma and, in particular, the extent of the airflow obstruction, is cause for concern.

Cell mediated immunity in American cutaneous and mucosal leishmaniasis

Cellular immune responses were studied in 35 Brazilian patients with either active cutaneous leishmaniasis (CL), active mucosal leishmaniasis (ML), or healed cutaneous leishmaniasis. The mean age and duration of illness in the two groups were as follows: 14 CL patients, age 28 +/- 13 yr, disease 5 +/- mo; and 16 ML patients, age 34 +/- 15 yr, disease 86 +/- 117 mo. Patients with CL and ML responded well to leishmania antigen in blastogenesis assays. However, the response of ML patients was over three times greater than the response of CL patients. There was a significant correlation between the magnitude of the lymphoproliferative response and the duration of disease activity. There were no significant differences between CL and ML patients in terms of the following parameters: lymphoproliferative responsiveness to mitogens (phytohemagglutinin, concanavalin A, and pokeweed mitogen) and peripheral blood lymphocyte subpopulations (T and B cells, oKT8+ and OKT4+ cells, OKT4:OKT8 ratio). Peripheral blood mononuclear cells from ML patients also generated interferon-gamma containing lymphokine in response to stimulation with leishmania antigen. This lymphokine was capable of inducing macrophages from ML patients to inhibit the intracellular multiplication of leishmania in vitro. These studies have determined that the parameters of lymphocyte and macrophage functions evaluated in ML and CL patients are comparable, except for an enhanced lymphoproliferative response, with leishmania antigen in ML patients. This later finding may be a function of the long duration of active disease in this population and unrelated to the pathogenesis of their mucosal lesions.

Cell mediated immunity in American cutaneous and mucosal leishmaniasis

Cellular immune responses were studied in 35 Brazilian patients with either active cutaneous leishmaniasis (CL), active mucosal leishmaniasis (ML), or healed cutaneous leishmaniasis. The mean age and duration of illness in the two groups were as follows: 14 CL patients, age 28 +/- 13 yr, disease 5 +/- mo; and 16 ML patients, age 34 +/- 15 yr, disease 86 +/- 117 mo. Patients with CL and ML responded well to leishmania antigen in blastogenesis assays. However, the response of ML patients was over three times greater than the response of CL patients. There was a significant correlation between the magnitude of the lymphoproliferative response and the duration of disease activity. There were no significant differences between CL and ML patients in terms of the following parameters: lymphoproliferative responsiveness to mitogens (phytohemagglutinin, concanavalin A, and pokeweed mitogen) and peripheral blood lymphocyte subpopulations (T and B cells, oKT8+ and OKT4+ cells, OKT4:OKT8 ratio). Peripheral blood mononuclear cells from ML patients also generated interferon-gamma containing lymphokine in response to stimulation with leishmania antigen. This lymphokine was capable of inducing macrophages from ML patients to inhibit the intracellular multiplication of leishmania in vitro. These studies have determined that the parameters of lymphocyte and macrophage functions evaluated in ML and CL patients are comparable, except for an enhanced lymphoproliferative response, with leishmania antigen in ML patients. This later finding may be a function of the long duration of active disease in this population and unrelated to the pathogenesis of their mucosal lesions.

Circulating endotoxin-like substance(s) and altered hemostasis in horses with gastrointestinal disorders: an interim report

Twenty-three horses with clinical signs of gastrointestinal disease were evaluated once or serially during the course of the disease for the presence or absence of circulating endotoxin-like substances (ET+ or ET-) and whether the horses were negative, positive, or very positive for serum fibrin/fibrinogen degradation products (FDP-, FDP+, or FDP++). In addition, platelet count, activated partial thromboplastin time (APTT), and 1-stage prothrombin time (OSPT) were measured. When examined initially, 5 horses were ET-/FDP-, 8 were ET-/FDP+, 7 were ET+/FDP-, 3 were ET+/FDP+, and none was ET+/FDP++. Eight horses were evaluated serially and the following changes were noted: 1 ET-/FDP- horse became ET+/FDP++; 1 ET-/FDP- horse became ET-/FDP+; 1 ET-/FDP- horse became ET+/FDP-; 2 ET-/FDP+ horses became ET+/FDP++; 1 ET+/FDP- horse became ET+/FDP+ (++); and 2 ET+/FDP- horses became ET-/FDP-. At the last examination, 4 horses were ET-/FDP- and all survived; 7 were ET-/FDP+ and only 1 was euthanatized; 5 were ET+/FDP- and only 2 were euthanatized; and 7 were ET+/FDP+ or ++, and 5 horses died or were euthanatized. The relationship between ET and FDP is discussed and a working model of endotoxemia and gastrointestinal disease in the horse is presented.

Cholelithiasis in four horses

Four cases of cholelithiasis in horses were reviewed. Two horses were examined because of recurrent abdominal pain. Clinical laboratory data, results of physical examination, and history indicated biliary obstruction. In 1 case, B-mode ultrasonography aided in the diagnosis, which was confirmed at necropsy. In 2 horses, the biliary calculi were incidental necropsy findings.

Failure of human fibroblast interferon to protect against rhinovirus infection

Volunteers were treated with fibroblast interferon or placebo nose drops for four days. On the second day, they received a challenge with rhinovirus type 4. There was no difference in the clinical symptoms or viral shedding between the two groups. The possible reasons for this result are discussed.