Delayed graft dislocation after thoracic aortic endovascular repair.

BACKGROUND: Endograft dislocation in thoracic aorta has not been widely studied. OBJECTIVES: The purpose of this study is to analyze the incidence and predisposing factor in a single centre experience after 117 procedures. METHOD: Between November 2000 and December 2011, all consecutive patients undergoing endovascular repair for descending thoracic or thoraco-abdominal aortic disease were identified. Follow-up imaging protocol included triple-phase CT-angiography at 1, 4, and 12 months, and annually thereafter. Migration was defined as proximal/ distal movements >10 mm relative to anatomical landmarks or any movement leading to symptoms or reintervention. RESULT: We identified 117 patients. Mean follow-up was 32 months (range, 1-144). Overall, five (4.3%) patients with thoracic EG dislocation were identified. Dislocation was classified as collapse/infolding in 3 cases and migration in 2. Mean delay of the dislocation was 12.7 months. Only one patient developed symptoms and required an additional endograft. In the group of dislocated endografts, mean age (53 ± 20 vs. 68 ± 15, P = .032) and the diameter of the aortic lesion were lower (4.1 cm ± 1.6 vs. 5.6 cm ± 1.8, P = .069), and the proximal landing zone at "zones 2 and 3" were more frequently used (5 vs. 65, P = 0.81). All but one patient with collapse/infolding are still alive and doing well at a mean follow-up of 80 months. CONCLUSION: Dislocation is an infrequent complication, but not so rare. Young age, small aortic diameter , and proximal sealing at the distal arch were the most important data associated with this complication.

Development of an analytical platform for the affinity screening of natural extracts by SEC-MS towards PPARα and PPARγ receptors.

BACKGROUND: Peroxisome proliferator-activated receptors (PPARs) belong to the superfamily of nuclear receptors and represent the targets for the therapeutical treatment of type 2 diabetes, dyslipidemia and hyperglycemia associated with metabolic syndrome. Some medicinal plants have been traditionally used to treat this kind of metabolic diseases. Today only few drugs targeting PPARs have been approved and for this reason, the rapid identification of novel ligands and/or chemical scaffolds starting from natural extracts would benefit of a selective affinity ligand fishing assay. RESULTS: In this paper we describe the development of a new ligand fishing assay based on size exclusion chromatography (SEC) coupled to LC-MS for the analysis of complex samples such as botanical extracts. The known PPARα and PPARγ ligands, WY-14643 and rosiglitazone respectively, were used for system development and evaluation. The system has found application on an Allium lusitanicum methanolic extract, containing saponins, a class of chemical compounds which have attracted interest as PPARs ligands because of their hypolipidemic and insulin-like properties. SIGNIFICANCE: A new SEC-AS-MS method has been developed for the affinity screening of PPARα and PPARγ ligands. The system proved to be highly specific and will be used to improve the throughput for the identification of new selective metabolites from natural souces targeting PPARα and PPARγ.

Mid-term clinical and radiographic outcome of metal-on-metal hip resurfacing through an anterolateral approach.

PURPOSE: The aim of this retrospective study was to evaluate the medium-term clinical and radiographic results of current generation metal-on-metal resurfacing prostheses performed through anterolateral approach. MATERIALS AND METHODS: Fifty-seven hips in 52 patients underwent resurfacing arthroplasty. Two patients died from unrelated causes, leaving 55 hips in 35 males (3 bilateral) and 15 females (2 bilateral), with a mean age at surgery of 56.2 years (range, 27-70 years). Clinical and radiographic assessment was carried out preoperatively and at follow-up in all the survived cases. The cumulative survival rate was determined according to the method of Kaplan-Meier. RESULTS: At a mean follow-up of 5.2 years (range, 1.8-9.1 years), 2 HRs of the same female patient were revised because of early loosening of the acetabular component. Deep venous thrombosis and transient femoral nerve palsy occurred both in 1 case. No specific complications of HR were observed. Average Harris hip score improved significantly from 59.8 points (range, 30.4-90.6) preoperatively to 93.7 points (range, 53-100) at the latest examination. Neck narrowing showed an average of 3.27%, but it never exceeded 10%. Nonprogressive acetabular radiolucencies and osteolysis were detected both in 2 hips. A high rate of patients (32, 60.4%) developed heterotopic ossifications, although low-grade in most cases (27, 84.4%). The cumulative survival rate at 9.1 years with revision for any reason as the end point was 93.0%. CONCLUSIONS: The early clinical and radiographic results of modern metal-on-metal hip resurfacing performed through an anterolateral approach are promising, but longer-term follow-up studies are necessary.

Bio-corrosion characterization of Mg-Zn-X (X = Ca, Mn, Si) alloys for biomedical applications.

The successful applications of magnesium-based alloys as biodegradable orthopedic implants are mainly inhibited due to their high degradation rates in physiological environment. This study examines the bio-corrosion behaviour of Mg-2Zn-0.2X (X = Ca, Mn, Si) alloys in Ringer's physiological solution that simulates bodily fluids, and compares it with that of AZ91 magnesium alloy. Potentiodynamic polarization and electrochemical impedance spectroscopy results showed a better corrosion behaviour of AZ91 alloy with respect to Mg-2Zn-0.2Ca and Mg-2Zn-0.2Si alloys. On the contrary, enhanced corrosion resistance was observed for Mg-2Zn-0.2Mn alloy compared to the AZ91 one: Mg-2Zn-0.2Mn alloy exhibited a four-fold increase in the polarization resistance than AZ91 alloy after 168 h exposure to the Ringer's physiological solution. The improved corrosion behaviour of the Mg-2Zn-0.2Mn alloy with respect to the AZ91 one can be ascribed to enhanced protective properties of the Mg(OH)(2) surface layer. The present study suggests the Mg-2Zn-0.2Mn alloy as a promising candidate for its applications in degradable orthopedic implants, and is worthwhile to further investigate the in vivo corrosion behaviour as well as assessed the mechanical properties of this alloy.

Solid state interactions in the La-Au-Mg system: phase equilibria, novel compounds and chemical bonding.

Gold intermetallic chemistry is very rich, covering different classes of compounds ranging from the Hume-Rothery to Zintl phases to polar intermetallics to quasicrystals. Au's relativistic effects are frequently mentioned as responsible for the peculiar structural and physical properties of its compounds, nonetheless the aspects of chemical bonding are far to be clearly understood. In this work, the La-Au-Mg system was targeted for the discovery of new gold intermetallics and their structural and chemical bonding characterization. Studies on solid state interactions resulted in the construction of a partial La-Au-Mg isothermal section at 400 °C. The high reactivity between the constituents is reflected by the formation of five intermetallic compounds in the concentration range of less than 50 at% of Au. A complete crystallographic study was conducted for four of them, namely La1.82Au3+xMg14.36-x (0 ≤ x ≤ 0.90, hP42-3.64-CeMg10.3), La3Au4-xMg12+x (0 ≤ x ≤ 0.75, hP38-Gd3Ru4Al12), LaAuMg2 (oS16-MgCuAl2) and LaAu1+xMg1-x (0 ≤ x ≤ 0.15, hP9-ZrNiAl). A unifying description based on the different stacking sequences of equal slabs along the c-axis is proposed for these intermetallics. Chemical bonding in LaAuMg2 was studied by following the position space approach and including relativistic effects. Among the peculiarities of this LaMg2Au auride, there are two-atomic La-Au bonds showing a classical polar covalent character and that form distorted hexagonal planar layers and multi-atomic bonds involving Mg species. One of these is interpreted as a Mg-Mg bond supported by the neighbouring La and Au atoms, explaining the Mg reduced oxidation state (close to +1) in this compound.

[Mantova cell factory: a model for skin regeneration]. / Mantova cell-factory: un modello di rigenerazione cutanea.

Chronic wounds, including venous and arteriosclerotic leg ulcers, diabetic foot ulcers, decubitus and trauma-induced wounds, represent a major problem in our society. Because the incidence of chronic wounds is high, the socioeconomic impact is considerable. The problem increases as the average age of the population increases and so the research into wound healing is continuously on the move. The aim of our research was to develop an autologous skin substitute and to verify its efficacy in closing chronic ulcers that do not respond to the currently available wound-healing treatments (topical therapy, antibiotics, surgical cleansing, external compression). Keratinocytes were obtained from the patients' foreskins. All medical procedures were undertaken with the approval of the ethics committee and with the patient's consent. In our survey we evaluated the possibility to grow autologous keratinocytes both with the ''feeder-layer'' method and on a type I collagen substrate. Using the first method, we obtained a two-dimensional strip composed of a few layers of normally arranged keratinocytes; it was, however, very fragile and this may affect the efficacy in clinical use. When cells were grown on an appropriately treated type I collagen substrate, we obtained more layers of normally arranged keratinocytes which were also differentiated into basal, spinous, granular and keratin layers. In addition to keratinocyte reproduction, we obtained reproduction of melanocytes in the correct basal position. The new skin substitute provides a new treatment option for chronic wounds that are refractory to conventional therapies. Adequate cytohistological and immunohistochemical analysis to evaluate the cells' correct morphology and phenotype is important in this technique.

Saliva as an analytical tool to measure occupational exposure to toluene.

OBJECTIVE: To describe a sensitive and rapid method for the determination of toluene in saliva. Biomonitoring of toluene exposure is commonly performed by determination of urinary hippuric acid, o-cresol or toluene itself. The analysis of blood toluene has been verified as another method for biomonitoring. However, drawing blood is invasive and can often not be performed at the workplace for hygienic reasons. Sampling of saliva may be non-invasive, easy to perform and a viable alternative for biomonitoring in the workplace. METHODS: We measured the solvent concentration in saliva specimens of 5 healthy volunteers studied in the laboratory and a group of 36 workers exposed to toluene in the synthetic leather industry. Saliva was collected into Salivette (Sarstedt, Germany) devices by sterile cotton rolls placed in the mouth and then squeezed into pre-weighted vials. Environmental toluene was collected for the duration of a work-shift by Radiello (FSM, Italy) passive samplers. Toluene in urine and saliva (head space analysis) and in environmental samples was measured by GC-MS. RESULTS: Environmental toluene levels ranged from 0.22 to 57.20 mg/m(3), while the concentrations of the solvent in saliva and urine ranged from 0.12 to 18.30 microg/L, and from 0.47 to 26.64 microg/L, respectively. The correlation coefficients (r) between biological and environmental levels of toluene were 0.77 and 0.93, respectively, for saliva and urine samples. CONCLUSION: This preliminary study suggests that saliva may offer many advantages over 'classical' biological fluids such as blood as it is readily accessible and collectible: therefore saliva toluene may be considered as a possible biomarker of exposure to toluene.

[Characteristics, use and toxicity of fluorochemicals: review of the literature]. / Caratteristiche, uso e tossicità dei fluorurati: revisione della letteratura.

Perfluorooctane sulfonate (PFOS) and perfluorooctanoic acid (PFOA) are perfluorinated surfactants used to produce polymers and telomers whose carbon chain can be differently long. Polytetrafluoroethylene (PTFE), namely Teflon, is the chief fluoropolymer and it has been widely utilised over the last decades and all over the world. Indeed, its particular physical and chemical properties make it difficult to replace this substance in several industries (textile, paper, chemical, fire-fighting foam industry). Perfluoroalkyl-compounds may be considered ubiquitous and, in particular, it has been shown that PFOS may be concentrated in the food chain. Concerns about possible toxic effects of these chemicals date back to seventies, but only in 2000 the Environmental Protection Agency (EPA) stated PFOA and PFOS withdrawal to avoid environmental pollution. In 2002 the Organisation for Economic Co-operation and Development reported that these substances are bio-persistent, tend to accumulate in different tissues of living organisms and are toxic to mammalians. In 2006 EPA established that every PFOA emission will be eliminated not later than 2015. Actually, health effects of perfluoroalkyl-compounds on humans remain controversial, in spite of a number of experimental and epidemiological studies. Research focuses on possible endocrine disruption, thyroid and liver carcinogenicity, and development alteration. Our article reviews the main studies concerning PFOS and PFOA industrial and environmental toxicology.

Long-term outcome of older patients with newly diagnosed de novo acute promyelocytic leukemia treated with ATRA plus anthracycline-based therapy.

Treatment outcome in older patients with acute promyelocytic leukemia (APL) is lower compared with younger patients, mainly because of a higher induction death rate and postremission non-relapse mortality (NRM). This prompted us to design a risk- and age-adapted protocol (Programa Español de Tratamientos en Hematología (PETHEMA)/HOVON LPA2005), with dose reduction of consolidation chemotherapy. Patients aged ⩾60 years reported to the PETHEMA registry and were treated with all-trans retinoic acid (ATRA) plus anthracycline-based regimens according to three consecutive PETHEMA trials that were included. We compared the long-term outcomes of the LPA2005 trial with the preceding PETHEMA trials using non-age-adapted schedules (LPA96&LPA99). From 1996 to 2012, 389 older patients were registered, of whom 268 patients (69%) were eligible. Causes of ineligibility were secondary APL (19%), and unfit for chemotherapy (11%). Median age was 67 years, without relevant differences between LPA2005 and LPA96&LPA99 cohorts. Overall, 216 patients (81%) achieved complete remission with no differences between trials. The 5-year NRM, cumulative incidence of relapse, disease-free survival and overall survival in the LPA2005 vs the LPA96&99 were 5 vs 18% (P=0.15), 7 vs 12% (P=0.23), 87 vs 69% (P=0.04) and 74 vs 60% (P=0.06). A less intensive front-line regimen with ATRA and anthracycline monochemotherapy resulted in improved outcomes in older APL patients.

[Recent prevention strategies and occupational risk analysis: Control Banding and Sobane]. / Recenti strategie per la prevenzione e l'analisi dei rischi in ambito occupazionale: Control banding e Sobane.

Employers are responsible for the prevention of risks and must provide for the safety and health of their workers. They are obliged to apply the general principles of prevention: to avoid, where possible, any risk; to characterize and hence to estimate residual risks; to eliminate risks at the source; to adjust jobs to the needs of workers and not workers to the jobs. When we pass to the practical performance of these shared principles we introduce many problems: problems concerning terminology; problems in estimating the nature of the risks that are faced; coordination problems between the subjects that preside over prevention; problems arising from the different typology of the companies investigated In order to answer these questions the "Industrial Hygienists" have long since created various strategies for the prevention and control of risks. Among different models the methods Control Banding and Sobane-Deparis are undoubtedly the most promising. Control Banding is designed to assist especially Small and Medium Enterprises in complying with the chemical safety regulations, the scheme uses the R phrases that in Europe must be assigned to potentially harmful chemicals by the manufacturer of the chemical. R phrases describe the most important harmful effects of a chemical and have been adopted in many non European countries also. The combination of the hazard classification of the chemical and assessment of the exposure potential will allow understanding of the level of risk thus leading the person carrying out the assessment to an appropriate control method. Occupational hygienists with experience of assessing occupational exposure to chemicals agreed parameters that could be used to give reasonable indications of exposure potential. One of them is quantity being used and three categories--small, medium and large--are defined. The likelihood of the chemical becoming airborne has been addressed by defining solids according to levels of dustiness and liquids according to volatility. A simple graph that uses the boiling point of the chemical and the process operating temperature assigns the chemical a high, medium or low volatility rating. The user now has enough information to identify the control approach required to adequately reduce exposures to the chemical Occupational hygienists agreed on three broad control approaches: General Ventilation; Engineering Control; Containment. However it is recognised that in some cases specialist advice will be needed. The user takes the hazard group, quantity and level of dustiness/volatility and matches them to a control approach using a simple table. The controls are described in control guidance sheets, which comprise both general information and, for commonly performed tasks, more specific advice. The second section of the document describes a risk-prevention strategy, called SOBANE, in four levels. These four levels are: screening, where the risk factors are detected by the workers and their management, and obvious solutions are implemented; observation, where the remaining problems are studied in more detail, one by one, and the reasons and the solutions are discussed in detail; analysis, where, when necessary, an occupational health (OH) practitioner is called upon to carry out appropriate measurements to develop specific solutions; expertise, where, in very sophisticated and rare cases, the assistance of an expert is called upon to solve a particular problem. The method for the participatory screening of the risks, Deparis, is proposed for the first level screening of the SOBANE strategy. The aim of Sobane strategy is to make risk prevention faster, more cost effective, and more effective in coordinating the contributions of the workers themselves, their management, the internal and external OH practitioners and the experts.

The diagnostic value of cytohistological urine analysis and cytokeratin 20 in malignant and atypical urothelial cells.

INTRODUCTION: To determine the ability of cytohistology and cytokeratin 20 (CK 20) expression in malignant and atypical cells (AUC) from urine to serve as a diagnostic tool for assessing urothelial carcinoma (UC). METHODS: Diagnoses from 55 urine cytological samples from 55 patients were analyzed and correlated with subsequent biopsy findings. A total of 50 archived urine slides from patients that received a cytological diagnosis and histological follow-up were selected for immunostaining with monoclonal CK 20 antibodies and elaborated by Z-test for proportions. RESULTS: The majority of all positive or atypical smears (24; 89%) were confirmed through histological analysis. The majority of urinary cytological diagnoses reported as negative (15; 54%) were also confirmed through biopsies. The overall sensitivity, specificity, PPV, and NPV were 65%, 83%, 89%, and 54%, respectively. All 13 smears cytologically determined to contain malignant cells, with subsequent biopsies confirming UC, exhibited strong positive staining with the CK 20 antibody. All cases evaluated as benign both cytologically and histologically had negative CK 20 staining. Of the 15 AUC cases with lesions confirmed through biopsies, 11 (73%) had atypical cells that stained positive for CK 20. DISCUSSION: Our results demonstrate the diagnostic value of urinary cytology and confirm CK 20 as an adjunct marker for the diagnosis of UC and for the triage of AUC.

Cell-permeable peptide inhibitors of JNK: novel blockers of beta-cell death.

Stress conditions and proinflammatory cytokines activate the c-Jun NH2-terminal kinase (JNK), a member of the stress-activated group of mitogen-activated protein kinases (MAPKs). We recently demonstrated that inhibition of JNK signaling with the use of the islet-brain (IB) 1 and 2 proteins prevented interleukin (IL)-1beta-induced pancreatic beta-cell death. Bioactive cell-permeable peptide inhibitors of JNK were engineered by linking the minimal 20-amino acid inhibitory domains of the IB proteins to the 10-amino acid HIV-TAT sequence that rapidly translocates inside cells. Kinase assays indicate that the inhibitors block activation of the transcription factor c-Jun by JNK. Addition of the peptides to the insulin-secreting betaTC-3 cell line results in a marked inhibition of IL-1beta-induced c-jun and c-fos expression. The peptides protect betaTC-3 cells against apoptosis induced by IL-1beta. All-D retro-inverso peptides penetrate cells as efficiently as the L-enantiomers, decrease c-Jun activation by JNK, and remain highly stable inside cells. These latter peptides confer full protection against IL-1beta-induced apoptosis for up to 2 weeks of continual treatment with IL-1beta. These data establish these bioactive cell-permeable peptides as potent pharmacological compounds that decrease intracellular JNK signaling and confer long-term protection to pancreatic beta-cells from IL-1beta-induced apoptosis.

[The significance of enviromental and biological monitoring in workers employed in service stations after the elimitation of tetraethyl lead from gasoline]. / Il significato del monitoraggio ambientale e biologico nei lavoratori addetti alle stazioni di servizio dopo la eliminazione del piombo tetraetile dalle benzine.

The chemical risk in service stations may be due to toxic compounds present in fuel (particularly benzene and additives) and to the emission of exhausts and fine particulate from vehicles. Owing to the elimination of lead (Pb) from fuel and to the necessity of lowering CO emission, several oxygenated additives have been added to fuel, in particular methyl-tert-butyl-ether (MTBE), whose toxic properties are at present under investigation. The introduction of reformulated gasoline (RFG) and the use of catalytic converters (with possible release of platinum (Pt) in the environment) may have modified the risks for workers employed in service stations. The paper shows data collected from 26 subjects (divided into three specific tasks, namely: fuel dispenser, "self-service" attendant and controller, and cashier) to estimate the actual chemical risk and to compare it with the previous data taken from literature. For this purpose, besides performing the usual medical surveillance, we measured the environmental concentrations of benzene, MTBE and formaldehyde, the urinary levels of benzene metabolites S-phenylmercapturic acid (S-PMA) and t,t-muconic acid (MA) and of unmodified MTBE, and the blood concentrations of Pb and Pt for each subject. Mean values of these compounds were, respectively: 38.81 microg/m3; 174.04 microg/m3; 10.38 microg/m3; 2.36 microg/g creatinine; 96.57 microg/g creatinine; 1.41 microg/L; 7.00 microg/100 mL; 0.0738 ng/ml. The above values were much lower than the corresponding limit values reported by ACGIH and DFG. In particular, after the introduction of vapour recycle systems and the widespread use of "self-service" systems, airborne benzene concentration dropped from 300/400 microg/m3 to lower than 100 microg/m3, without noticeable increasing of exposure to formaldehyde. The disappearing of Pb from gasoline leads to a progressive lowering of its blood levels, while the possible risks due to the very low amounts of Pt released from catalytic converters have still to be defined exactly. Taken all in all, our results seem to indicate that, after the elimination of tetraethyl lead, the chemical risk for workers employed in service stations is now lower than in the past.

Alterations of ocular motility in cerebellar pathology. An electro-oculographic study.

Saccadic as well as smooth pursuit movements were studied by means of electro-oculograms in a group of 14 patients affected by cerebellar diseases. Ten patients had cerebellar atrophies, and four had undergone surgery for cerebellar tumors. Loss of gain of the pursuit system and metric alteration of saccades were the most striking abnormalities observed. Dysmetria was shown to be related to the amplitude of the movement and to the sector of the perimeter within which the movement occurs (movements occurring in the more eccentric sector were more disturbed). A tendency to produce saccades slower than normal was noted in patients affected by olivopontocerebellar atrophy. The clinical and pathophysiological significance of this finding is discussed with particular reference to Wadia-Swaami hereditary ataxia.

Immunoreactivity of apo B towards monoclonal antibodies that inhibit the LDL-receptor interaction: effects of LDL oxidation.

We studied the immunochemical stability of the epitopes for six monoclonal antibodies to human apolipoprotein B-100 upon Cu(2+)-mediated (20 microM) oxidation of LDL. The antibodies used in this study, some of which are known to interfere with the interaction of LDL with their cellular receptors, recognize epitopes in the amino terminal region (Mb 19), in the middle part (6B, 2A, 7A, and 9A) and near aa 3500 (Mb 47) of native apo B. All antibodies except one (7A) recognized native and oxidized LDL (OxLDL) equally well; the immunoreactivity of the epitope for Ab 7A was markedly reduced upon LDL oxidation. Since antibodies 2A, 7A, 9A, and Mb 47 inhibit the LDL-receptor interaction and OxLDL poorly interact in vitro with the LDL receptor we conclude that: (1) various epitopes for monoclonal antibodies against native apo B are spared upon LDL oxidation; and (2) the epitopes for antibodies 2A, 9A, and Mb 47 do not define a unique domain of apo B directly involved in the binding of LDL to their receptor.

Changes in morphology and infectivity of cell culture-derived trypomastigotes of Trypanosoma cruzi.

Trypomastigotes of Trypanosoma cruzi, obtained from the first burst of infected Vero cells, have only a limited invasive capability for fibroblastic cells. Intracellular amastigotes and epimastigotes do not infect these cells at all. Preincubation of the isolated trypomastigotes with Eagle's minimal essential medium/10% fetal calf serum increases 5- to 15-fold their in vitro infectivity. This increased invasive capability is accompanied, in the case of the EP strain of T. cruzi, by a morphological transformation into an amastigote-like or spheromastigote form, which is similar, but not identical to replicating intracellular amastigotes. Trypomastigotes from another isolate (BEC) also increase their infectivity several fold upon preincubation, but before any morphological differentiation occurs, suggesting that these two events are independent. The phenomenon of increased infective capability of the parasite is expressed similarly in different host cells. Parasite adhesion is stimulated 4- to 12-fold upon preincubation of the trypomastigotes. The type of serum used (fetal calf, calf, human) affects the development of infectivity, as well as the process of cell infection in itself, but not the morphological differentiation. These processes are also temperature-dependent. The highly infective parasitic forms do not synthetize DNA, but are active in RNA and protein synthesis. The results obtained indicate the existence in T. cruzi trypomastigotes of an active system for infecting fibroblastic cells, which is only partially expressed in trypomastigotes recently released from host fibroblasts but which can undergo a further extracellular maturation, thus allowing studies on the mechanism of infection in cell-free media.

Trypanosoma cruzi: polypeptide markers of epimastigotes and trypomastigotes.

We compared the major polypeptides of epimastigotes and trypomastigotes of T. cruzi, by submitting total parasite lysates to electrophoresis in polyacrylamide gels (SDS-PAGE), protein staining with Coomassie brilliant blue, laser densitometry, or immunoblotting with sera derived from infected individuals (Chagas' disease). Epimastigotes and trypomastigotes displayed extensive homology, the differences being quantitative, except for a trypomastigote-specific band of Mr 75,000 which reacted with chagasic sera. Immunoblotting with chagasic sera confirmed the electrophoretic homology of epimastigotes and trypomastigotes. Upon antigenic dilution, a cluster of antigenic bands in the range of Mr 150,000 to 75,000 prevailed in the trypomastigotes, whereas the epimastigotes displayed more abundance of antigenic bands in the range of Mr 72,000 to 36,000.

Alternating myasthenia and myastheniform syndrome in the same subject.

A man of 23 years was affected by myasthenia with amyotrophic patterns. From the neurophysiological viewpoint, there were typical electrophysiological aspects of myasthenia gravis and the Eaton-Lambert syndrome simultaneously. In some instances the various electrophysiological tests were preceeded by the administration of Tensilon, calcium gluconate and sodium benzoate caffeine. It is hypothesized that there are two types of endplates present, or there is a functional variability by which at different moments a block results from a defect in the formation or liberation of acetylcholine.