Varicella vaccine

The varicella vaccine developed by Takahashi and cols. in 1974, in Japan, shows outstanding features. Its development, site and route of administration and final results are reviewed in this article.The varicella vaccine is highly effective in normal children (with almost 100% seroconversion rate), and with good protective responses in immunocompromised children (82% to 90% seroconversion rate). This is the first attenuated live virus vaccine that may be recommended for these patients. Its indications and side effects, along with needed precautions and contraindications are reviewed. Simultaneous administration of varicella vaccine with other vaccines can be done, each vaccine should be injected at different sites. New studies are ongoing for the association of the varicella vaccine with others vaccines. Several countries licensed this vaccine for administration in selected high-risk individuals. Probably, in the future, the varicella vaccine will be included in the preventive immunization schedule.     

Giant epignathus in the newborn: report of a case and review of the literature

Epignathus is a congenital teratoide tumor in the oral cavity. It is extremely rare and usually lethal. The authors present a case treated successfully. Important aspects of the diagnosis, clinical management and surgical procedures are discussed. Extensive review of the literature is presented.     

A capture enzyme-linked immunosorbent assay for species-specific detection of Bothrops venoms

A direct sandwich enzyme-linked immunosorbent assay (ELISA), employing affinity purified antivenom antibodies specifically recognizing the homologous venom, was developed for species-specific detection of bothropic venom. The method is based on a two-step affinity purification of the specific antibodies. A species monovalent antivenom is adsorbed onto a venom adsorbent containing heterologous venoms from the Bothrops, Crotalus and Lachesis genera. The species-specific antibodies obtained, are then adsorbed onto a second venom adsorbent containing only the homologous venom for the removal of non antivenom antibodies. Venom concentrations of 0.1 and 1,000 ng/ml were specifically identified for Bothrops jararacussu and B. alternatus venom respectively.     

Diagnosis and surgery of brachial plexus injuries

The surgical outcome of traumatic injuries of the brachial plexus (BP) depends on the following parameters: 1) accurate preoperative diagnosis of cervical root avulsion; 2) time interval between injury and surgery; 3) delicate handling of the nerve tissue; and 4) postoperative physiologic training. This report is based on a 15-year experience in brachial plexus surgery and is supported on the grounds of two major studies. In a prospective study, the authors controlled for the reliability of preoperative radiologic diagnosis by myelo-CT and MRI scans for 40 patients, to evaluate the integrity of the intraspinal cervical roots after brachial plexus injury. Surgical inspection via a cervical hemilaminectomy proved the accuracy of 85 percent and 52 percent of CT myelography and MRI, respectively. Retrospective statistical analyses were carried out of the long-term surgical results of 54 patients with traumatic injuries of the BP who received a grafting procedure between cervical roots C5 or C6 and the musculocutaneous nerve. Patients operated on up to 6 months after trauma showed a better result than patients operated on later than 12 months after trauma (p<0.05). In contrast, grafting between cervical root C5 or C6 and the use of different sural-graft sizes to reconstruct the musculocutaneous nerve demonstrated no statistically significant difference in the final outcome.     

Platelet function abnormalities in a family with recurrent arterial thrombosis

Three young family members with recurrent arterial thrombosis underwent investigation for lipid or coagulation abnormalities. Lipoprotein electrophoresis, cholesterol, triglyceride levels, and routine coagulation studies were unremarkable. By contrast, testing of platelet function showed enhanced platelet aggregability to epinephrine and collagen in two of the subjects. In addition, release of 14C-serotonin by adenosine diphosphate and epinephrine was increased over control values in these same two patients. The third subject demonstrated decreased platelet aggregation and lowered 14C-serotonin release, but was symptomatic with rest pain at the time of testing. The ongoing in vivo thrombosis in the third subject may account for hypocoagulable platelets by in vitro testing. These abnormally sensitive platelets identified by platelet function testing may be associated with a familial "hypercoagulability" syndrome. Definition of the hemostatic abnormality in these individuals provided a rational basis for pharmacological therapy with antiplatelet drugs, which appeared to be successful.     

Quinoxaline derivatives: structure-activity relationships and physiological implications of inhibition of N-methyl-D-aspartate and non-N-methyl-D-aspartate receptor-mediated currents and synaptic potentials.

The inhibitory potencies at excitatory amino acid (EAA) receptors of 11 quinoxaline derivatives were evaluated in two-electrode voltage-clamp recordings of Xenopus oocytes injected with rat cortex mRNA. Currents activated by kainate or (RS)-alpha-amino-3-hydroxy-5-methyl-4-isoxazole-propionic acid (AMPA) in Xenopus oocytes were inhibited competitively by all the quinoxaline derivatives, with apparent Ki values ranging from 0.27 to 300 microM against kainate and from 0.25 to 137 microM against AMPA. An excellent correlation was observed between inhibitory potencies of the quinoxaline derivatives against kainate and AMPA currents, in support of the contention that in this preparation these two agonists act at a single site. All 11 quinoxaline derivatives also inhibited current activated by the combination of glycine and N-methyl-D-aspartate (NMDA), apparently acting at the glycine site, and did so over a narrower range of apparent Ki values (0.37-8.1 microM). The correlation between the quinoxalines' kainate/AMPA potencies and their glycine/NMDA potencies was relatively weak. Thus, the quinoxaline derivatives were all good antagonists of glycine/NMDA currents and displayed a greater range of potencies against kainate and AMPA. The inhibitory effects of the six quinoxaline derivatives most potent in the Xenopus oocyte experiments were also tested against the excitatory postsynaptic field potential (EPSFP) recorded in the pyramidal cell dendritic field of the CA1 region of hippocampal slices after stimulation of the Schaffer collateral-commissural pathways. In slices superfused with "normal" medium (containing 1 mM Mg2+), in which the EPSFP is mediated primarily by non-NMDA receptors, IC50 values correlated closely with the Ki values against kainate/AMPA obtained in oocyte experiments but were approximately 8-fold higher. Similarly, in slices superfused with nominally Mg(2+)-free medium, in which the EPSFP is amplified due to a relief of the Mg2+ block of NMDA receptors, IC50 values correlated closely with the Ki values against glycine/NMDA obtained in oocyte experiments but were 60-fold higher. This comparison of results from the two experimental systems lends further support to the argument that hippocampal synaptic transmission is mediated postsynaptically by kainate/AMPA-type and NMDA/glycine-type EAA receptors that are pharmacologically indistinguishable from those expressed in mRNA-injected Xenopus oocytes. Furthermore, it suggests that EAA receptors in situ may be nearly saturated by high local concentrations of the endogenous ligands, a condition that would contribute substantially to the apparent non-NMDA receptor selectivity of certain quinoxaline derivatives.