IL-5 is essential for vaccine-induced protection and for resolution of primary infection in murine filariasis

The pathways conferring immunity to human filariases are not well known, in part because human-pathogenic filariae do not complete a full life cycle in laboratory mice. We have used the only fully permissive infection of mice with filariae, i.e., infection of BALB/c mice with the rodent filarial nematode Litomosoides sigmodontis. Our previous results showed that worm development is inversely correlated with Th2 cytokine production and eosinophilia. The scope of the present study was to directly elucidate the role of interleukin-5 (IL-5) and eosinophils in controlling the development of L. sigmodontis after vaccination and in primary infection. BALB/c mice immunized with irradiated third-stage larvae (L3) were confirmed to have elevated IL-5 levels as well as high subcutaneous eosinophilia and to attack and reduce incoming larvae within the first 2 days, resulting in 70% reduction of worm load. Treatment of vaccinated mice with anti-IL-5 antibody (TRFK-5) suppressed both blood and tissue eosinophilia and completely abolished protection. This demonstrates, for the first time in a fully permissive filarial infection, that IL-5 is essential for protection induced by irradiated L3 larvae. In contrast, in primary-infected mice, anti-IL-5 treatment did not modify filarial infection within the 1st month, most likely because during primary infection IL-5-dependent mechanisms such as subcutaneous eosinophilia are induced too late to disturb worm establishment. However, there is a role for IL-5 late in primary infection where neutrophil-dependent worm encapsulation is also under the control of IL-5. Received: 30 March 2000     

161. Das asymptomatische Bronchialcarcinom

Zusammenfassung Indikationen und Komplikationen von 291 Bronchoskopien, 149 Mediastinoskopien und 28 Thoracoskopien werden vorgestellt. Es wird neben der diagnostischen insbesondere auf die therapeutische Indikation und die Lokalanaesthesie bei der Bronchoskopie hingewiesen. Die Mediastinoskopie hat keine ernsthaften Komplikationen. Die Thoracoskopie ist eine risikoarme Methode zur Erkennung von Pleuraerkrankungen in örtlicher Betäubung und wird in Intubationsnarkose zur thorakalen Vagotomie beim Asthma bronchiale eingesetzt.     

Resequencing microarray method for molecular diagnosis of human arboviral diseases

BackgroundResequencing DNA microarray (RMA) technology uses probes designed to identify a panel of viral sequences. It can be used for detecting emerging viruses by revealing the nucleotide polymorphisms within the target of interest.Objectives/study designAs a new tool for molecular diagnosis of arbovirus infection, high density PathogenID v2.0 RMA (PID2-RMA) was assessed for the detection and genetic analysis of dengue, West Nile, and Chikungunya viruses in spiked blood samples or sera from individuals infected with dengue virus. Viral RNAs extracted from biological samples were retrotranscribed into cDNA and amplified using the Phi 29 polymerase-based method. This amplified cDNA was used for hybridization on PID2-RMA.ResultsA good specificity of RMA-based detection was demonstrated using a panel of arboviruses including Dengue, West Nile and Chikungunya viruses. This technology was also efficient for the detection and genetic analysis of the different serotypes of dengue virus in sera of infected patients. Furthermore, the mixing of dengue, West Nile and Chikungunya prototype viruses within a single sample of human blood did not interfere with the sensitivity of PID2-RMA.ConclusionsOur data show that high density PID2-RMA was suitable for the identification of medically important arboviruses. It appears to be particularly adapted to the genetic analysis of dengue, West Nile, and Chikungunya viruses in urgent clinical situations where the rapid identification and characterization of the pathogen is essential.     

276. Standardisierte Cholecystektomie und Choledochusrevision

Zusammenfassung An der Chirurgischen Klinik, Krankenhaus Nordwest, Frankfurt/M., wurden in den letzten 15 Jahren mehr als 8000 Eingriffe an der Gallenblase und den Gallenwegen durchgeführt. Die Gesamtletalität betrug 0,7%, bei reiner Cholecystektomie 0,4%. Es wird detailliert die standaridisierte Taktik und Technik gezeigt, nach der alle Operationen durchgeführt wurden. Die Komplikationsrate konnte so auf ein Minimum gesenkt werden, und die Verweildauer betrug nur 8 Tage. Durch den von uns gewählten kleinen Transrectalschnitt sind Narbenbrüche und ausgedehnte Verwachsungsbeschwerden ausgesprochen selten.     

Use of polymerase chain reaction for accurate follow-up of Loa loa experimental infection in Mandrillus sphinx

Mandrills (Mandrillus sphinx) experimentally infected with human Loa loa usually remain microfilaremic for a long period of time. Nevertheless some control their microfilaremia while still harboring adults worms, and therefore become occult-infected. A nested polymerase chain reaction (PCR) assay, targeted on the repeat 3 region of the gene coding for the L. loa 15-kD protein (15r3-PCR), has been evaluated in mandrills infected with third-stage larvae (L3) of L. loa. The results of this assay were negative during the prepatency period (4 months after inoculation), but became positive when microfilariae appeared in the blood, and remained positive in all mandrills, even in those that became amicrofilaremic. These results show that the positivity of the 15r3-PCR assay is linked to the appearance of microfilariae in peripheral blood and demonstrated that L. loa-specific DNA can be detected in blood from occult-infected mandrills.     

Pohl's track screw for the surgical treatment of femoral neck fracture. Reliable surgical principle or obsolete method?

Pohl's hip screw--the classic form of a dynamic osteosynthesis--is an approved method in the treatment of the fracture of the femoral neck (lateral and pertrochanteric fractures). Between 1963 and 1983 over 200 patients were treated with Pohl's hip screw. At an averaged stay of 29 days in hospital half of them were rehabilitated. The mortality rate was 9.3%. More recent methods--e.g. the dynamic hip screw, propagated by AO--present more technical improvements but they are only variations of an old therapeutic principle proved over a generation.     

Prospective evaluation of the use of endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy.

Preoperative cholangiography and subsequent removal of bile duct stones may increase the efficacy of laparoscopic cholecystectomy and reduce the rate of conversion to open cholecystectomy. Since there is little data on the incidence of choledocholithiasis in this group of patients, we undertook a prospective study on the routine performance of ERC in 288 patients selected for laparoscopic cholecystectomy. ERC succeeded in 264 of the 288 patients (91.7%) and showed a normal bile duct system in 227 (86.0%). Atypical bile duct anatomy was seen in eight patients. Open cholecystectomy was performed in seven of them but was judged to be absolutely necessary in only two cases (one patient each with Caroli syndrome and Mirizzi syndrome). ERC also revealed bile duct stones in 29 of 264 patients (11.0%) which had not been suspected on the basis of clinical, laboratory and ultrasonographic findings in nine cases (3.4%). EPT succeeded in all of the 29 patients with choledocholithiasis but open cholecystectomy was subsequently performed in four patients due to incomplete bile duct clearance (n = 3) or temporary bleeding after EPT (n = 1). The rate of ERC/EPT-related morbidity was 2.8%. It is concluded from a risk-benefit analysis in these patients that ERC should be restricted to patients with suspected bile duct stones. Following this strategy, small ductal concrements and bile duct abnormalities will be missed in 6.4% of cases but the clinical relevance of these findings is still unclear. In patients with combined gallbladder and common bile duct stones, preoperative EPT plus subsequent laparoscopic cholecystectomy appears to be an effective and time-saving therapeutic regimen which should be compared with open cholecystectomy plus common bile duct exploration in future studies.     

224. Langzeitergebnisse nach portocavalen Anastomosen bei Patienten mit massiver Oesophagusvaricenblutung

Zusammenfassung Vom 1.5.1977 bis 31.12.1978 wurden 21 Warren-Shunts angelegt. Unselektiertes Krankengut mit 4 Child A-, 14 Child B-, 3 Child C-Fällen. Postoperative Letalität 23,8%. (n = 5), jedoch nur ein technischer Fehler. Postoperative Komplikationen: Rezidivblutung in 19,04%; keine Pankreatitis. Kontrollangio (100%.) : nur bei 1 Patienten hepatofugale Strömung; Splenomegalieabnahme in 66,6%. Nur bei 1 Patienten klinische Zeichen einer Encephalopathie. 87,5%. postoperativ arbeitsfähig. Conclusio: keine negative Beeinflussung der Letalitätsrate durch diese Shunt-Variante. Portale Leberperfusion bleibt erhalten. Encephalopathierate nur 6,25 %. Spätthrombosen selten (6,25 %). Umwandlungsmöglichkeit in einen PC-Shunt bleibt erhalten.