Demonstration and solubilization of antigens expressed primarily on the surfaces of Candida albicans germ tubes.

Antisera against mycelial-phase, but not yeast-phase, Candida albicans absorbed with yeast-phase organisms preferentially stained germ tube segments of several strains of mycelial-phase C. albicans by the indirect fluorescent-antibody staining technique. Germ tube segment antigens were not found in significant amounts on blastospore segments or on yeast-phase organisms. Absorption of the mycelial-phase reference sera with yeast-phase C. stellatoidea, but not with C. tropicalis, C. guillermondii, or Saccharomyces cerevisiae, resulted in preferential germ tube segment staining of C. albicans. A dithiothreitol extract of mycelial-phase C. albicans organisms blocked staining of the germ tube segment, but a dithiothreitol extract of yeast-phase organisms did not. When dithiothreitol extracts from both phases were reacted against yeast-absorbed reference sera in tandem crossed and crossed line immunoelectrophoresis, a cross-reacting arc and several arcs unique to the mycelial-phase extract were noted. Immunofluorescent staining tests were performed, using appropriately absorbed sera from patients with candidiasis to stain a laboratory strain of C. albicans. Human tissue slices infected with C. albicans were used as targets for appropriately absorbed rabbit antisera. These human data indicated that antigens preferentially expressed on the germ tube in vitro were also expressed on filamentous structures of the fungus in infected human tissues. In vitro and in vivo, the invasive mycelial phase of C. albicans expresses certain antigens that are highly concentrated on the germ tube.     

Continuous venovenous hemofiltration improves cardiac performance by mechanisms other than tumor necrosis factor-alpha attenuation during endotoxic shock.

OBJECTIVE: To assess the effects of continuous venovenous hemofiltration (CWH) on global and regional hemodynamics, plasma lactate, and tumor necrosis factor-oa (TNF-a) levels during endotoxic shock in dogs. METHODS: Thirty pentobarbital-anesthetized and mechanically ventilated dogs were divided into six groups of five dogs each. Group 1 served as a control, undergoing CWH at 3 Uhr without endotoxin. Group 2 served as the endotoxin-alone time-matching group. Group 3 received CWH 1 hr after endotoxin at 3 Uhr for 270 mins. Group 4 received CWH 1 hr after endotoxin at 3 Uhr for 150 mins and at 6 Uhr for an additional 120 mins. Group 5 and group 6 received the ultrafiltrate from group 1 and group 3, respectively. MEASUREMENTS AND MAIN RESULTS: Three hours after endotoxin challenge, dogs treated with CWH at 3 Uhr had a higher cardiac output (4.9 + 0.6 vs. 2.9 + 0.6 Umin; p < .05) and stroke volume (35 + 7 vs. 20 + 4 mL; p < .05) and a lower pulmonary vascular resistance (116 26 vs. 331 + 126 dyne-sec/cm5; p < .05) than the endotoxin-alone group. Five hours after endotoxin, dogs treated with CWH at 6 Uhr also had higher hepatic (464 + 164 vs. 126 + 75 mUmin; p < .05) and femoral (95 + 46 vs. 30 + 34 mL/min; p < .05) blood flow. Moreover, dogs treated with CWH at 6 Uhr had higher mean arterial blood pressure (84 + 24 vs. 40 + 15 mm Hg; p < .05) and left ventricular stroke work index (1.1 + 0.6 vs. 0.2 + 0.2 g/kg; p < .05) than the endotoxin-alone group. Plasma lactate levels were lower in the CWH group at 6 Uhr (2.7 + 1.1 mmol/L) than in the endotoxin-alone group (4.4 + 0.6 mmol/L; p < .05). Plasma TNF-ao levels were unaffected, and only minor amounts of TNF-o were found in the ultrafiltrate. CONCLUSION: In this acute endotoxic shock model, CWH at 3 Uhr improved cardiac performance and decreased pulmonary vasoconstriction. Moreover, CWH at 6 LUhr also increased arterial blood pressure and left ventricular stroke work, increased hepatic and femoral arterial blood flow, and decreased blood lactate levels. These effects were not attributable to TNF-alpha removal.     

Intrathecal baclofen for treatment of spasticity of multiple sclerosis patients

We conducted a retrospective study of the case files of 64 multiple sclerosis (MS) patients presenting severe spasticity, who had received intrathecal (IT) baclofen test injections between 1992 and 2004 in a rehabilitation unit. In almost all cases of our series, IT baclofen was proposed to patients who were no longer able to walk. IT baclofen is a safe and effective treatment to reduce spasticity in MS patients. Despite an advanced stage of the disease at the time of pump placement, the complication rate was low and the efficacy of this treatment was maintained over time.     

P63‐related disorders: Dermatological characteristics in 22 patients

In P63‐related ectodermal dysplasias (ED), the clinical characteristics focus on extra‐cutaneous manifestations. The dermatological phenotype remains incompletely characterized. We report the dermatological features of 22 patients carrying a TP63 mutation. Erosions, erythroderma and pigmentary anomalies are characteristics of P63‐related ED. Our data suggest that patients might be classified into two major P63‐related disorders: AEC and EEC. RHS and ADULT represent mild AEC and EEC forms, respectively.