Differential diagnosis of dementia and depression in the elderly using neuropsychological methods

This study examined the utility of the Halstead-Reitan Neuropsychological Battery in the differential diagnosis of dementia, major depression, and general neurological impairment. Orthogonal contrasts between groups showed superior performance for depressives on most Halstead-Reitan subtests. Contrasts between organically impaired groups showed that these groups did not differ significantly (p >.05) on any of the Halstead-Reitan subtests. A step-wise discriminant analysis indicated that on the basis of neuropsychological variables alone, demented patients were differentiated from elderly depressed with clinical levels of accuracy. However, when neurologically impaired and demented patients were considered together in a single group reflecting organic impairment, hits increased dramatically. The results were discussed in terms of their implications for differentially diagnosing dementia and depression in the elderly.     

Xanthogranulomatous salpingitis and oophoritis: a case report and review of the literature

A case of xanthogranulomatous salpingitis and oophoritis in a 47-year-old woman is presented. Xanthogranulomatous inflammation is an uncommon form of chronic inflammation that is destructive to affected organs; it is characterized by the presence of lipid-filled macrophages with admixed lymphocytes, plasma cells, and neutrophils. Only a few cases of xanthogranulomatous salpingitis and oophoritis have been reported to date. The case presented here is associated with Escherichia coli infection, endometriosis, and an intrauterine device.     

Serological Cross-Reaction between Legionella pneumophila and Citrobacter freundii in Indirect Immunofluorescence and Rapid Microagglutination Tests

We describe the first case in which a diagnostic rise in titers of antibody to formalinized Legionella pneumophila serogroup 1 yolk sac antigen was shown to be caused by a cross-reaction between L. pneumophila and another organism, Citrobacter freundii.     

Rethinking globally relevant vaccine strategies to human immunodeficiency virus type-1

According to the latest UNAIDS figures for 1999 there were an estimated 30.6 million people living with HIV-1, with 16,000 new HIV infections per day. The only global strategy of combating new HIV infections is to make a vaccine that is affordable to developing countries, where greater than 90% of new infections occur, and that has enough efficacy to interrupt high rates of transmission. This review critically examines: 1) important immune parameters that should be considered which will allow an understanding of preventative vaccine design and 2) the mechanisms underlying immune destruction during HIV-1 infection that will facilitate design of therapeutic vaccines. A realistic goal of a preventative vaccine is to elicit protective immune responses in vaccinees that would prevent HIV-1 from replicating extensively in the host. Components of protective immunity are thought to include neutralizing antibodies (NAB) and cytotoxic T lymphocytes (CTL). Rethinking vaccine strategies has to take into account that HIV-1 vaccines must elicit primary cellular and humoral immunity via dendritic cell and Langerhan cell priming. It is only under these conditions that boosting immunity with subsequent vaccinations will allow high enough CTL effector cells and NAB titres to impede or to prevent HIV-1 replication. Success of therapeutic vaccine strategies, has to take into consideration the pathology of persistent immune stimulation by chronic HIV-1 infection. To re-stimulate immunity and re-direct immune responses, chronic immune stimulation by HIV-1 has to be alleviated by reducing high levels of viral antigen presentation by suppressing virus with antiretroviral agents. Such treatment courses may only have to be transient, long enough for immunity to respond to an immunogenic stimulus. Short-course drug therapy may then be an affordable option for many countries already carrying a high burden of HIV-1/AIDS.     

Rabbit corneal damage produced by Pseudomonas aeruginosa infection.

Gross, light microscopic, and electron microscopic examination of the rabbit corneal destruction produced by experimental Pseudomonas aeruginosa infections revealed a combination of acute inflammation and liquefaction necrosis of the cornea. Degeneration of the epithelial cells and the start of polymorphonuclear leukocyte infiltration of the cornea occurred initially. These changes were followed by loss of the epithelium, degeneration and loss of the keratocytes and endothelium, loss of the characteristic weblike pattern of the proteoglycan ground substance, dispersal of ultrastructurally normal collagen fibrils, extensive accumulation followed by degeneration of polymorphonuclear leukocytes, and accumulation of plasma proteins and fibrin in the necrotic cornea. Histochemical examination of the cornea suggested a loss of the proteoglycan ground substance but not of collagen. Rabbit corneas injected with Clostridium histolyticum collagenase showed gross and cellular changes similar to those observed during the pseudomonal infections; however, histochemical examination suggested a loss of collagen, and electron microscopy revealed ultrastructurally abnormal collagen fibrils. The results support the idea (i) that a bacterial or host-derived collagenase is not required for extensive corneal damage during a P. aeruginosa corneal infection, and (ii) that a P. aeruginosa corneal infection may severly damage the cornea by producing extensive corneal edema and by causing the loss of the corneal proteoglycan ground substance, thus resulting in dispersal of undamaged collagen fibrils, weakening of the cornea, and subsequent descemetocele formation and corneal perforation by the anterior chamber pressure.     

Immunological features of idiopathic Addison''s disease: an antibody to cells producing steroid hormones

Antibodies to adrenocortical cells, occurring in the serum of patients with idiopathic Addison's disease, were investigated by the indirect immunofluorescence technique. With selected human adrenal tissue obtained post mortem, staining was brightest in the innermost cells of the adrenal cortex. Strongly positive sera were observed to react with all thirty specimens of adrenal tissue examined, but lipid-depleted adrenocortical tissue provided the most suitable reagent for detecting weak antibody.     

An epidemiologically valuable typing method for Neisseria meningitidis by analysis of restriction fragment length polymorphisms.

A restriction fragment length polymorphism (RFLP) typing method was developed for Neisseria meningitidis. A cloned EcoRI fragment from a Neisseria meningitidis Group B serotype 15P1.16 sulphonamide-resistant strain was used to probe Southern blots of total chromosomal DNA restriction fragments (enzyme AvaI). A group of 75 apparently unrelated organisms gave rise to 26 different restriction fragment length patterns and two different groups of epidemiologically related strains had RFLP patterns that were distinct for each group. The technique was highly reproducible and discriminatory. The RFLP data were compared with the results of serotyping and subtyping and isoenzyme electrophoretotyping. The RFLP data were consistent with those from the alternative typing methods; clones defined by isoenzyme analysis were subdivided by this technique. The use of RFLP typing by cloned probes should be of considerable epidemiological value.