The importance of pigs' castration strategy on carbon footprint of feed intake, nitrogen and phosphorus efficiency under different management conditions.

The environmental impact of livestock production is under scrutiny nowadays and is being situated both on a global level and local level. On a global level, the global warming potential (GWP) of meat production is criticised. On a local level, the excretion of nitrogen (N) and phosphorus (P) is of concern as excess nutrients may lead to water eutrophication and soil acidification. The ERA-NET project SuSI evaluated if immunocastration may act as an ecologically, socially and economic more sustainable alternative compared to pork production with surgical castrates (SCs) and boars (BOs). Here, we report the environmental impact of immunocastrates (ICs) vs SC and BO, based on four trials carried out by European SuSi partners. More specifically, we aimed to compare IC with SC and BO in terms of GWP, N and P excretion per kg of pork production and test if this differed between experiments. There was an interaction between trial and sex category (PTrial × Sex category < 0.005) for all environmental sustainability parameters. Surgical castrates performed worse (higher carbon footprint of the feed intake, N and P excretion, lower N and P efficiency) compared to IC and BO, but the size of the effect was trial dependent. Immunocastrates scored intermediate, with mostly no significant differences from BO in most trials, but with significantly better values compared to SC. Over trials, the carbon footprint of the feed intake (land use change inclusive) per kg lean meat gain in the growing-finishing phase was 9-16% lower for IC vs SC and 9-22% lower for BO vs SC. Nitrogen efficiency of IC and BO was 7-10% and 9-14%, respectively, higher compared to SC. Phosphorus efficiency of IC and BO was higher than that of SC by 6-14% and 9-17%, respectively. Per kg of lean meat gain in the growing-finishing phase, IC excreted between 14 and 19% less N and between 14 and 24% less P than SC. For BO, it was between 14 and 27% less N and between 14 and 31% less P than SC. Differences between trials were larger than differences between castration strategies and trial design may have amplified the observed effects. Improving feed efficiency, adapting the feed to the needs of the animal (avoiding excess nutrients) and choosing low-impact ingredients are key for improving the environmental sustainability of pig production. Ending physical castration is another step to attain this goal.

Effect of dietary energy level in finishing phase on performance, carcass and meat quality in immunocastrates and barrows in comparison with gilts and entire male pigs.

Immunocastration, a technique consisting of two vaccinations against gonadotropin-releasing hormone (GnRH), can be used as alternative to surgical castration of piglets. It reduces boar taint and allows higher economic and ecological efficiency compared to barrows. The feeding strategy of immunocastrates, however, can still be improved. After second vaccination, when immunisation becomes fully effective, feed intake of immunocastrates increases sharply. This study aimed to investigate whether energy intake of immunocastrates after second vaccination could be reduced by lowering the dietary energy level of the finishing phase, without negatively affecting animal performance and quality of pork production. We hypothesised that immunocastrates already reach their limits in voluntary feed intake after second vaccination, and therefore would not be able to compensate the lower dietary energy level, in contrast to barrows. Therefore, this study aimed to assess the effect of high-energy diet (HE, net energy (NE) = 10.2 MJ/kg) compared to low-energy diet (LE, NE = 8.8 MJ/kg) in barrows and immunocastrates and as a reference, gilts and entire male pigs on a standard high-energy diet were included. CP and standardised ileal digestible amino acid levels were similar in both diets. For each treatment, eight pen replicates of six pigs per pen were evaluated on performance, carcass quality, meat and fat quality, digestibility, economic and ecological sustainability, behaviour and effectiveness of immune response. No difference in feed intake of immunocastrates between LE and HE could be demonstrated. As a result, daily energy intake of immunocastrates was higher on HE compared to LE, which resulted in a higher daily gain on HE. Feed conversion ratio (FCR) of immunocastrates on HE did not differ significantly with FCR of entire males. Barrows did not show higher average daily gain on HE compared to LE. Nitrogen efficiency was better in HE compared to LE, without negative effects on digestibility, carcass quality, economic parameters, behaviour or immune response. Small positive effects on the palatability of the meat of immunocastrates on HE were observed, although consumers did not prefer one of both feeds. Immunocastration was successful in reducing sexual and aggressive behaviour as well as in lowering the prevalence of boar taint from 15% in EM to 0% in immunocastrates. However, in two out of 96 immunocastrates (one on HE and one on LE), the immunocastration was not fully effective. In conclusion, this study did not show advantages of feeding immunocastrates or barrows a low-energy diet.

The effect of immunocastration on adipose tissue deposition and composition in pigs.

Immunocastrated pigs (IC) exhibit intensive fat deposition after immunisation, but the underlying mechanisms of intensified fat metabolism and deposition are not yet fully understood. Moreover, there is also a lack of comparative studies performed on IC, entire males (EM) and surgical castrates (SC). The main objective of our research was, therefore, to characterise the adipose tissue from the quantitative, histo-morphological and biochemical perspectives in IC 5 weeks after their immunisation in comparison to EM and SC. Immunocastrated pigs had an intermediate position in carcass fatness traits between EM (the leanest) and SC (the fattest). The histo-morphological traits of the subcutaneous adipose tissue of IC were similar to those of SC and differed from those of EM; i.e., they exhibited larger adipocytes in the outer backfat and a larger lobulus surface area in both backfat layers than EM. Intensive fat tissue development in IC was corroborated with higher activities of lipogenic enzymes (i.e., fatty acid synthase, malic enzyme, glucose 6-phosphate dehydrogenase, citrate cleavage enzyme), which was especially pronounced in the subcutaneous adipose tissue of IC (1.5- to 2.7-fold higher activity than in EM or SC). The fatty acid composition of the backfat in IC was similar to that in EM pigs. Both IC and EM exhibited less saturated and more polyunsaturated fatty acids than SC. In contrast, the fatty acid composition of the intramuscular fat of longissimus dorsi muscle in IC pigs was more similar to SC than to EM (higher monounsaturated and lower polyunsaturated fatty acid content in IC and SC than EM). In this study, it was demonstrated that immunocastration notably influenced lipid metabolism. This was shown by increased quantity of lipid depots and with changes in adipose tissue cellularity compared to EM, with changes in the fatty acid composition of the intramuscular fat and enhanced lipogenic activity compared to both EM and SC. These results provide new insights into the specificity of adipose tissue development and deposition in IC compared to EM and SC.

Prolonged high-pressure treatments in mammalian skeletal muscle result in loss of functional sodium channels and altered calcium channel kinetics.

Activation and inactivation of ion channels involve volume changes from conformational rearrangements of channel proteins. These volume changes are highly susceptible to changes in ambient pressure. Depending on the pressure level, channel function may be irreversibly altered by pressure. The corresponding structural changes persist through the post-decompression phase. High-pressure applications are a useful tool to evaluate the pressure dependence as well as pressure limits for reversibility of such alterations. Mammalian cells are only able to tolerate much lower pressures than microorganisms. Although some limits for pressure tolerance in mammalian cells have been evaluated, the mechanisms of pressure-induced alteration of membrane physiology, in particular of channel function, are unknown. To address this question, we recorded fast inward sodium (I(Na)) and slowly activating L-type calcium (I(Ca)) currents in single mammalian muscle fibers in the post-decompression phase after a prolonged 3-h, high-pressure treatment of up to 20 MPa. I(Na) and I(Ca) peak amplitudes were markedly reduced after pressure treatment at 20 MPa. This was not from a general breakdown of membrane integrity as judged from in situ high-pressure fluorescence microscopy. Membrane integrity was preserved even for pressures as high as 35 MPa at least for pressure applications of shorter durations. Therefore, the underlying mechanisms for the observed amplitude reductions have to be determined from the activation (time-to-peak [TTP]) and inactivation (tau(dec)) kinetics of I(Na) and I(Ca). No major changes in I(Na) kinetics, but marked increases, both in TTP and tau(dec) for I(Ca), were detected after 20 MPa. The apparent molecular volume changes (activation volumes) deltaV(double dagger) for the pressure-dependent irreversible alteration of channel gating approached zero for Na+ channels. For Ca2+ channels, deltaV(double dagger) was very large, with approx 2.5-fold greater values for channel activation than inactivation (approx 210 A3). We conclude, that in skeletal muscle, high pressure differentially and irreversibly affects the gating properties and the density of functional Na+ and Ca2+ channels. Based on these results, a model of high pressure-induced alterations to the channel conformation is proposed.

[Working memory in healthy subjects and schizophrenics: studies using BOLD fMRT]. / Das Arbeitsgedächtnis bei Gesunden und bei Schizophrenen: Untersuchungen mit BOLD-fMRT.

Functional magnetic resonance imaging uses the blood oxygen level-dependent effect (BOLD MRI) for noninvasive display of cerebral correlatives of cognitive function. The importance for the understanding of physiological and pathological processes is demonstrated by investigations of working memory in schizophrenics and healthy controls. Working memory is involved in processing rather than storage of information and therefore is linked to complex processes such as learning and problem solving. In schizophrenic psychosis, these functions are clearly restricted. Training effects in the working memory task follow an inverse U-shape function, suggesting that cerebral activation reaches a peak before economics of the brain find a more efficient method and activation decreases.

Plasma amisulpride levels in schizophrenia or schizoaffective disorder.

The atypical antipsychotic drug amisulpride is a benzamide with specific antagonistic properties, which target dopamine D(2) and D(3) receptors, preferentially in the limbic system. Amisulpride is readily absorbed from the gastrointestinal tract, distributed to all body systems with little binding to plasma proteins. Elimination occurs mainly through the kidneys as unchanged drug. In contrast, hepatic metabolism is of minor significance and primarily yields two inactive metabolites. Very little is known about the plasma concentrations of amisulpride in patients at varying oral doses or about clinically relevant interactions with co-medication. The aim of the present investigation was to elucidate the factors, which affect amisulpride levels in schizophrenic patients. The plasma amisulpride levels of 85 patients with schizophrenia or schizoaffective disorder (mean age: 34.0+/-11.4 years; 40 women, 45 men) were assessed by high-performance liquid chromatography (HPLC) with fluorometric detection. The average daily dose of amisulpride was 772.3 mg (S.D. 346.7 mg) and the mean amisulpride plasma concentration was 424.4 ng/ml (S.D. 292.8 ng/ml). The interindividual variance of the amisulpride plasma concentration was high; furthermore, the plasma concentration increased linearly with the daily oral dose (r=0.50, p<0.001). Age and gender showed a significant effect on the dose-corrected amisulpride plasma concentrations-older patients and women had higher dose-corrected amisulpride plasma concentrations than younger patients and men. However, cigarette consumption had no effect on the amisulpride plasma concentrations. Regarding co-medication with lithium and/or clozapine, significantly higher amisulpride plasma concentrations were found as compared to monotherapy, whereas other co-medications such as benzodiazepines and various conventional antipsychotics had no effect on the amisulpride plasma concentrations. The results, the possible pathomechanisms and the clinical relevance are discussed. The findings need to be confirmed in larger patient samples and with a wider range of co-medications.

Membrane ion conductances of mammalian skeletal muscle in the post-decompression state after high-pressure treatment.

Exposure of excitable tissues to hyperbaric environments has been shown to alter membrane ion conductances, but only little is known about the state of the membranes of intact cells in the post-decompression phase following a prolonged high-pressure treatment. Furthermore, almost nothing is known about high-pressure effects on skeletal muscle membranes. Therefore, we investigated changes to the input resistances, membrane potentials and voltage-gated membrane currents for sodium (INa), potassium (IK) and calcium (ICa) ions under voltage-clamp conditions in enzymatically isolated intact mammalian single fibers following a 3-hr high-pressure treatment up to 25 MPa at +4 degrees C. After a 3-hr 20 MPa treatment, the input resistance was increased but declined again for treatments with higher pressures. The resting membrane potentials were depolarized in the post-decompression phase following a 20-MPa high-pressure treatment; this could be explained by an increase in the Na+- over K+-permeability ratio and in intracellular [Na+]i. Following a 10-MPa high-pressure treatment, INa, IK and ICa amplitudes were similar compared to controls but were significantly reduced by 25 to 35% after a 3-hr 20-MPa high-pressure treatment. Interestingly, the voltage-dependent inactivation of INa and ICa seemed to be more stable at high pressures compared to the activation parameters, as no significant changes were found up to a 20-MPa treatment. For higher pressure applications (e.g., 25 MPa), there seemed to be a marked loss of membrane integrity and INa, IK and ICa almost disappeared.

Integrating evidence-based practices and the recovery model.

Consumer advocacy has emerged as an important factor in mental health policy during the past few decades. Winning consumer support for evidence-based practices requires recognition that consumers' desires and needs for various types of treatments and services differ significantly. The authors suggest that the degree of support for evidence-based practices by consumer advocates depends largely on the degree of disability of the persons for whom they are advocating. Advocates such as members of the National Alliance for the Mentally Ill, who focus on the needs of the most seriously disabled consumers, are most likely to be highly supportive of research that is grounded in evidence-based practices. On the other hand, advocates who focus more on the needs of consumers who are further along their road to recovery are more likely to be attracted to the recovery model. Garnering the support of this latter group entails ensuring that consumers, as they recover, are given increasing autonomy and greater input about the types of treatments and services they receive. The authors suggest ways to integrate evidence-based practices with the recovery model and then suggest a hybrid theory that maximizes the virtues and minimizes the weaknesses of each model.

Reversibility of high pressure effects on the contractility of skeletal muscle.

High pressure application has been extensively used to thermodynamically influence complex physiological processes such as membrane ion conductances and the mechanism of muscle contraction. However, little is known about the reversibility of high pressure effects on intact cells. Therefore, we studied the reversibility of 3 h pressure applications up to 25 MPa at +4 degrees C to intact murine skeletal muscle. Functional mechanical properties were tested in extensor digitorum muscle fibres skinned following a high pressure exposure. Calcium activated force and stiffness were nearly unchanged following pressure applications up to 20 MPa, whereas for higher pressures we found a marked reduction of peak force, a decline of activation kinetics, an increase of relaxation stiffness but still unchanged peak stiffness. The rigor kinetics showed a similar behaviour as the activation kinetics. pCa-force relations remained unchanged up to 20 MPa but were shifted towards smaller pCa values for higher pressures. In conclusion there is a rather sharp high pressure limit of 20 MPa above of which pressure application results in a substantial irreversible loss of contractile functionality in differentiated muscle which may at least partly be explained by changes in the Ca2+ regulatory process. This is supported by a degradation of the 37 kDa band, i.e. Troponin T, shown by SDS gel electrophoresis. However, the general stability of the other bands does not indicate a substantial increase of unspecific protease activity following a high pressure treatment up to 25 MPa.

Results of decompression of peripheral nerves in diabetics: a prospective, blinded study.

Diabetic neuropathy traditionally is considered progressive and irreversible and will result in lower extremity ulceration and amputation in a segment of the diabetic population, despite the best efforts to control serum glucose levels. Restoration of sensation to the diabetic may prevent these complications of neuropathy. The present study was designed to evaluate whether decompression of a peripheral nerve at a known site of anatomic narrowing can restore sensibility to that nerve in the diabetic. Twenty diabetic patients ( 14 type I, 6 type II, with a mean duration of diabetes of 14.8 years) had surgical decompression of a median nerve at the wrist and an ulnar nerve at the elbow, or a decompression of the posterior tibial nerve at the ankle (total of 31 nerves). A therapist, in a manner blind to the operative site, evaluated two-point discrimination in the pulp of the appropriate digit. The postoperative sensibility was compared with that of the nontreated, contralateral extremity. At a mean of 23.3 months, 69 percent of the lower-extremity nerves and 88 percent of the upper-extremity nerves (79 percent overall) had improvement in sensibility. In comparison, 32 percent of the control (not decompressed) contralateral nerves had measurable progression of neuropathy. The hypothesis that decompression of a peripheral nerve in the diabetic will improve sensibility was confirmed at the p < 0.001 level.

Myosin binding protein C, a phosphorylation-dependent force regulator in muscle that controls the attachment of myosin heads by its interaction with myosin S2.

Myosin binding protein C (MyBP-C) is one of the major sarcomeric proteins involved in the pathophysiology of familial hypertrophic cardiomyopathy (FHC). The cardiac isoform is tris-phosphorylated by cAMP-dependent protein kinase (cAPK) on beta-adrenergic stimulation at a conserved N-terminal domain (MyBP-C motif), suggesting a role in regulating positive inotropy mediated by cAPK. Recent data show that the MyBP-C motif binds to a conserved segment of sarcomeric myosin S2 in a phosphorylation-regulated way. Given that most MyBP-C mutations that cause FHC are predicted to result in N-terminal fragments of the protein, we investigated the specific effects of the MyBP-C motif on contractility and its modulation by cAPK phosphorylation. The diffusion of proteins into skinned fibers allows the investigation of effects of defined molecular regions of MyBP-C, because the endogenous MyBP-C is associated with few myosin heads. Furthermore, the effect of phosphorylation of cardiac MyBP-C can be studied in a defined unphosphorylated background in skeletal muscle fibers only. Triton skinned fibers were tested for maximal isometric force, Ca(2+)/force relation, rigor force, and stiffness in the absence and presence of the recombinant cardiac MyBP-C motif. The presence of unphosphorylated MyBP-C motif resulted in a significant (1) depression of Ca(2+)-activated maximal force with no effect on dynamic stiffness, (2) increase of the Ca(2+) sensitivity of active force (leftward shift of the Ca(2+)/force relation), (3) increase of maximal rigor force, and (4) an acceleration of rigor force and rigor stiffness development. Tris-phosphorylation of the MyBP-C motif by cAPK abolished these effects. This is the first demonstration that the S2 binding domain of MyBP-C is a modulator of contractility. The anchorage of the MyBP-C motif to the myosin filament is not needed for the observed effects, arguing that the mechanism of MyBP-C regulation is at least partly independent of a "tether," in agreement with a modulation of the head-tail mobility. Soluble fragments occurring in FHC, lacking the spatial specificity, might therefore lead to altered contraction regulation without affecting sarcomere structure directly.

Therapeutic jurisprudence and the resolution of value conflicts: what we can realistically expect, in practice, from theory.

This article assesses the criticisms of therapeutic jurisprudence that it cannot resolve value conflicts, especially between autonomy rights and therapeutic values, or, less radically, that it has not provided a general method for resolving conflicts. Grounded in general jurisprudential principles about conflict resolution, including novel developments respecting the meaning of weighing and balancing, the article rejects the criticisms as unfounded. The article also develops and critiques arguments maintaining that therapeutic jurisprudence cannot resolve certain value conflicts because the values are incommensurable. The argument is illustrated by examples concerning the right to refuse treatment, and jurisprudential analyses of that right.

The effect of ionic strength on the kinetics of rigor development in skinned fast-twitch skeletal muscle fibres.

Recent atomic 3-D reconstructions of the acto-myosin interface suggest that electrostatic interactions are important in the initial phase of cross-bridge formation. Earlier biochemical studies had also given strong evidence for the ionic strength dependence of this step in the cross-bridge cycle. We have probed these interactions by altering the ionic strength (Gamma/2) of the medium mainly with K+, imidazole+ and EGTA2- to vary charge shielding. We examined the effect of ionic strength on the kinetics of rigor development at low Ca2+ (experimental temperature 18-22 degrees C) in chemically skinned single fast-twitch fibres of mouse extensor digitorum longus (EDL) muscle. On average the delay before rigor onset was 10 times longer, the maximum rate of rigor tension development was 10 times slower, the steady-state rigor tension was 3 times lower and the in-phase stiffness was 2 times lower at high (230 mM) compared to low (60 mM) ionic strength. These results were modelled by calculating ATP depletion in the fibre due to diffusional loss of ATP and acto-myosin Mg.ATPase activity. The difference in delay before rigor onset at low and high ionic strength could be explained in our model by assuming a 15 times higher Mg.ATPase activity and a threefold increase in Km in relaxing conditions at low ionic strength. Activation by Ca2+ induced at different time points before and during onset of rigor confirmed the calculated time course of ATP depletion. We have also investigated ionic strength effects on rigor development with the activated troponin/tropomyosin complex. ATP withdrawal at maximum activation by Ca2+ induced force transients which led into a "high rigor" state. The peak forces of these force transients were very similar at low and high ionic strength. The subsequent decrease in tension was only 10% slower and steady-state "high rigor" tension was reduced by only 27% at high compared to low ionic strength. Addition of 10 mM phosphate to lower cross-bridge attachment strongly suppressed the transient increases in force at high ionic strength and reduced the steady-state rigor tension by 17%. A qualitatively similar but smaller effect of phosphate was observed at low ionic strength where steady-state rigor force was reduced by 10%. The data presented in this study show a very strong effect of ionic strength on rigor development in relaxed fibres whereas the ionic strength dependence of rigor development after thin filament activation was much less. The data confirm the importance of electrostatic interactions in cross-bridge attachment and cross-bridge-attachment-induced activation of thin filaments.

Comparison of technetium-99m-sestamibi scintimammography with contrast-enhanced MRI for diagnosis of breast lesions.

UNLABELLED: Scintimammography using 99mTc-sestamibi and contrast-enhanced MRI were performed to determine the diagnostic accuracy of either method in the diagnostic workup of patients suspicious for breast tumors. METHODS: Fifty-six patients (42 with indeterminate mammograms) underwent preoperative prone planar scintimammography and pre- and postcontrast-enhanced MRI. Visually determined signal increase after application of Gd-DTPA was compared with visually scored sestamibi uptake, and the diagnoses of both methods were correlated with the final histopathologic results. RESULTS: Overall, sensitivity and specificity of scintimammography for diagnosing breast cancer were 88% and 83%, respectively. In the subgroup of patients with indeterminate mammograms, sensitivity was 79% and specificity was 83%. MRI readings provided a higher sensitivity (91% with respect to all patients and 89% with respect to patients with indeterminate mammograms), but a considerably lower specificity (52% in both groups) due to contrast-enhancement in different benign lesions. CONCLUSION: Due to its considerably higher specificity, scintimammography rather than MRI may be suitable to reduce the number of breast biopsies which yield benign results. Thus, this method may be suggested as the preferable tool in the diagnostic workup of patients with indeterminate mammographic findings.

Evaluation of mammographic breast lesions with Tc-99m sestamibi scintimammography and contrast enhanced MRI.

Scintimammography using Tc-99m sestamibi and contrast enhanced MRI were performed in order to determine the accuracy of both methods in the diagnostic work up of patients with suspicious or indeterminate preliminary diagnosis. 25 controls and 56 patients (14 with suspicious and 42 with indeterminate preliminary diagnoses), in whom physical examination and/or mammography warranted breast biopsy, underwent prone planar scintimammography. Sestamibi uptake was scored visually and measured using the ROI technique to enable semiquantitative evaluation. The patient group additionally underwent plain and contrast enhanced MRI. Visually determined signal increase following application of Gd-DTPA was compared with scintigraphic findings and final histopathologic results. Sensitivity and specificity of semiquantitative scintimammography for diagnosing breast cancer was 88% and 87%, respectively. Based on ROC analysis a target/non target ratio R > 1.3 was shown to be the optimal threshold for separating benign from suspicious scintigraphic diagnoses. MRI reading provided a slightly higher sensitivity (91%), but a considerable lower specificity (52%) due to contrast enhancement of different benign lesions. In the clinically important patient subpopulation with indeterminate results from previous diagnostic procedures, sensitivity of scintimammography fell to 79%, while specificity remained at 87%. MRI revealed a higher sensitivity of 89% and a lower specificity of 52%. Our data indicate that semiquantitative scintimammography using Tc-99m sestamibi provides a comparable sensitivity to contrast enhanced MRI in the assessment of breast cancer. The latter does not reduce the number of biopsies yielding benign results due to the high number of false positive diagnoses. Therefore, scintimammography seems to be the preferable tool in the diagnostic work-up of patients with indeterminate mammographic diagnoses.

Treatment of nonunions about the knee utilizing custom total knee arthroplasty with press-fit intramedullary stems.

Juxta-articular nonunion about the knee is infrequent but may be a troublesome problem, especially if it is about a total knee arthroplasty or associated with an arthritic joint. This technique of total knee arthroplasty with an uncemented press-fit intramedullary rod and bone grafting achieved union in all nine nonunions about the knee. Radiographic review indicated all nonunions to be healed by an average of 2 months, with none taking longer than 6 months to heal. The average postoperative Hospital for Special Surgery knee score was 78 (range, 50-91), with 4 excellent, 4 good, and 1 poor result. This study demonstrated that this is a successful salvage procedure for juxta-articular nonunions in the face of either arthritis in the adjacent joint, severe articular incongruency, or an ipsilateral total knee arthroplasty.

Diagnosis of pathogenic Entamoeba histolytica infection using a stool ELISA based on monoclonal antibodies to the galactose-specific adhesin.

Monoclonal antibodies (MAbs) directed against pathogen-specific epitopes of the galactose adhesin of Entamoeba histolytica were used in an ELISA to detect antigen from pathogenic E. histolytica. Single stool specimens from 74 patients in Bangladesh were used. The ELISA for pathogenic E. histolytica was positive in all 12 stool specimens with pathogenic amebae subsequently cultured, in no stool specimens with nonpathogenic E. histolytica and in 2 of 40 stools with other or no intestinal parasites detected. Specificity and sensitivity of the assay for pathogenic E. histolytica were 97% and 100%, respectively. These preliminary data offer promise for an ELISA using MAbs to the galactose adhesin as a rapid and sensitive means to detect the presence of pathogenic E. histolytica infection in stool specimens.

Osteochondritis dissecans of the lateral femoral condyle in the adult.

In osteochondritis dissecans, 15% of the lesions occur in the lateral condyle. In order to understand the significance of these lesions, 27 were studied prospectively from 1983 to 1990 and compared with 20 consecutive cases of lesions of the medial femoral condyle. Lesions of the lateral femoral condyle were larger, and often comprised the entire width of a condyle and resulted in deformation of a significant segment of the femoral condyle. They lay further posteriorly and commonly were associated with mechanical symptoms including buckling or locking. A discernible clunk was unique to these lesions. In addition, lateral lesions were more fragile, often having multiple bony islands that were prone to fragmentation, making replacement difficult if not impossible. Lateral lesions occurred directly within the main force-bearing areas of the condyle, disrupting normal contact areas and possibly leading to more rapid joint deterioration once segments are lost. This has prompted concern for reinsertion of articular fragments or reconstruction with osteochondral allografts.