Isolation and characterization of a monoclonal anti-P30 antibody resistant mutant of Toxoplasma gondii

Of the possible iodine-labelled Toxoplasma gondii surface proteins, P30 (apparent Mr 30,000) is the principal one recognized by acute and convalescent anti-toxoplasma sera. This protein which comprises from 3 to 5% of the total parasite protein was used to raise a panel of parasiticidal monoclonal anti-P30 antibodies. One of these monoclonal antibodies was able to select a resistant mutant from a large population of chemically mutagenized wild-type P strain parasites. This mutant retained the wild type sensitivity to other non-P30 parasiticidal monoclonal antibodies as well as polyclonal anti-P30 rabbit sera. Analysis of surface radioiodinated wild type and mutant parasites showed that the mutant had a quantitative reduction in the amount of P30. A comparison of surface biotin labelled wild type and resistant parasites by two dimensional electrophoresis showed that the mutant lacked one and possibly two of several proteins that make up wild type P30. Western blot analysis indicated that the mutant was devoid of antigenically reactive P30. These findings further support the hypothesis that antigenic variants of T. gondii can be induced and may involve the major surface membrane antigens of the parasite.     

Problem Drinkers in Medical Wards: consumption patterns and disabilities in newly identified male cases

One hundred and sixty-one male medical inpatients were identified as problem drinkers according to criteria previously defined. This paper describes the pattern of their drinking and the associated medical and psychosocial problems. Over half had been admitted with an illness not typically related to alcohol and a similar proportion reported levels of consumption which have previously been considered safe. Classical symptoms of dependence were uncommon but specific enquiry revealed a broad range of social problems related to alcohol. Recognition of this profile is necessary if problem drinkers are to be identified at an early stage and to benefit from counselling.     

Pityriasis alba: a study of pathogenic factors

BACKGROUND: The aetiology of pityriasis alba (PA), a common dermatosis in childhood, is still controversial. The objective of this study was to assess the possible aetiopathogenic factors of this disease in infants. METHODS: Forty-four patients with PA and 31 healthy children were examined and compared. Personal hygiene habits, sun exposure, presence of Staphylococcus aureus in nasal fossae and presence of major or minor signs of atopy were assessed during anamnesis and physical examination. Susceptibility to ultraviolet (UV) B radiation was measured by the onset of a contact hypersensitivity reaction to diphenylcyclopropenone in individuals sensitized in previously irradiated areas. RESULTS: The prevalence of PA was higher in individuals with darker skin, in high phototype categories, as well as in males. The number of daily baths and sun exposure between 10.00 h and 15.00 h were significantly higher in the PA group when compared with controls (P = 0.03 and P = 0.0015, respectively). The presence of atopy signs was more common in pityriasis patients (P = 0.002). Susceptibility to UVB radiation was 29.6% in the PA group vs. 29.0% in the control group; nevertheless, important differences were found after stratification in order to control possible confounding factors. The presence of S. aureus in the nostrils was equal in both groups. CONCLUSIONS: Our results confirm that PA, in our population, is more prevalent in males and in individuals in higher phototype categories. In those with inadequate personal hygiene and sun exposure habits the disease is more accentuated, demonstrating that the xerosis presenting in individuals with atopic diathesis is an important element in the development of the disease. S. aureus is not an important aetiopathogenic factor in PA. Susceptibility to UVB becomes important when related to the patient's phototype.     

Nucleolar organizer regions in benign and malignant prostatic disease

A modified silver stain technique for visualizing nucleolar organizer regions (AgNOR counting) was applied to 24 benign and 23 malignant prostatic biopsies. Marked inter-observer variation was found, particularly in sections with high AgNOR counts. After averaging the AgNOR counts of both observers, there was no significant difference in counts between the benign and the malignant biopsies. The AgNOR count appeared to be increased in tumours up to Gleason histological grade 6, but not in tumours of Gleason histological grade 7 or more.     

ANTERIOR ST SEGMENT DEPRESSION IN INFERIOR MYOCARDIAL INFARCTION: EFFECT ON COMPLICATIONS AND LONG-TERM SURVIVAL

Abstract The effect of anterior ST segment depression in inferior myocardial infarction on early complications and long-term prognosis was studied. A modification of the Minnesota Code was used for grading the extent of ST segment depression in leads V₂ to V₄ on the first hospital electrocardiogram. In 267 patients with acute inferior myocardial infarction, 107 had isoelectric anterior ST segments, 84 had minor ( 0.5 mm) depression, and 76 had major (> 0.5 mm) depression. Patients with anterior ST segment depression had higher serum enzyme levels, higher Norris coronary pronostic indices, and more frequent cardiac failure during the acute stages, but similar 28 day case fatality rate (11.1%) compared with patients without anterior ST segment depression (12.6%). In the subsequent four years total cardiac death rates were not significantly different and the pattern of survival was not influenced, but there was a higher fatal re-infarction rate in patients with major anterior ST segment depression. Thus, anterior ST segment depression in inferior myocardial infarction was associated with more severe infarction in the early phase but was not a reliable marker of high risk after recovery. Selection of patients for further investigation should not be based on this observation alone.     

BOTH INHERITED HLA-HAPILOTYPES ARE IMPORTANT IN THE PREDISPOSITION TO RHEUMATOID ARTHRITIS

The distribution of the HLA-DR allele frequencies of 105 RApatients has been compared with the expected distribution underrecessive and dominant modes of inheritance using control datafrom 2041 controls and the antigen genotype frequency amongpatients methodology. The observed distribution was compatiblewith a recessive mode of HLA-linked inheritance in RA, witha dominant mode rejected, whether HLA-DR4 was considered alone,or HLA-DR4 and HLADRI were combined as if they were behavingas a single predisposing gene. Mean sibship concordance rates(MSCRs) were calculated for categories of proband HLA-DR genotypes.The highest MSCR was seen for HLA-DR4 homozygous probands, andthe lowest for HLA-DR2 or 7/non-4 genotypes. These combinedobservations suggest that interactions between both inheritedHLA-haplotypes are important in the predisposition to RA. KEY WORDS: Rheumatoid arthritis, HLA-haplotypes, HLA-DR, Mode of inheritance     

Challenge of percutaneous nephrolithotomy in patients with spinal neuropathy

OBJECTIVE:To assess the technical difficulties, associated complications and stone clearance rates in patients with spinal neuropathy undergoing percutaneous nephrolithotomy. METHODS: Twenty-nine patients with spinal neuropathy underwent percutaneous nephrolithotomy in the two centers studied between October 1995 and January 2002. They were nine patients with traumatic spinal cord injury, 10 patients with spina bifida and 10 with other heterogeneous causes for their spinal neuropathy. The group included 12 men and 17 women, with an average age of 44 years (14-80). Patients' medical records were reviewed retrospectively for data relating to their renal lithiasis. RESULTS: A total of 39 percutaneous nephrolithotomy procedures were undertaken on 32 kidneys. Thirteen procedures were for staghorn calculi. Preoperatively, eight kidneys required nephrostomy and 5 J stent decompression. The average American Society of Anesthesiologists (ASA) score was 3, and one patient had percutaneous nephrolithotomy performed under local anaesthetic as the risk of general anaesthetic was felt to be too high. The associated morbidity and mortality in this group is significant. There were two postoperative deaths. Major complications were associated with three procedures, and consisted of seizures, aspiration pneumonia and pressure necrosis. Nine patients experienced minor complications including fever, hypotension and nephrostomy site leakage. Nine patients required intensive therapy unit care postoperatively and the average hospital stay for the group was 13.32 days. Only 18 (62%) patients were rendered stone-free from their initial percutaneous nephrolithotomy. Seven patients required a further procedure for stone clearance: four underwent extracorporeal shock-wave lithotripsy, two ureteroscopy and one nephrectomy. CONCLUSIONS: Patients with spinal neuropathy and renal lithiasis pose a significant operative challenge. Technical difficulties and potential complications should be considered carefully before undertaking percutaneous nephrolithotomy in these patients.     

Managing nurses and nursing: short courses as role development

This paper describes the development over a 3-year-period of short management courses for registered nurses offered as part of a professional development educational programme by Oxfordshire Health Authority (OHA) Clinical Education and Practice Team (OXCEPT). The courses were seen as role development for staff nurses, team leaders, sisters, charge nurses and senior sisters, and the content and length of courses were altered, extended and developed in response to evaluation of the courses by tutors and participants. The emphasis is on integrating participants' clinical, managerial and educational roles, as professional practitioners managing nurses and nursing.