Impact of oral immunotherapy on quality of life in children with cow milk allergy: a pilot study.

Quality of life is negatively affected in children with food allergy. Oral immunotherapy is an approach to food allergy that leads to patient desensitization by administering gradually increasing amounts of a given food allergen. The aim of this pilot study is to evaluate how oral immunotherapy affects quality of life in children allergic to cow milk proteins. Thirty children (aged 3-12 years) with cow milk allergy were recruited. Their parents were provided with a validated disease specific quality of life questionnaire (the food allergy quality of life questionnaire -- parent form, FAQLQ-PF) before and again 2 months after completing an oral immunotherapy protocol with cow milk. A significant improvement in all the investigated domains -- emotional impact, food anxiety and social and dietary limitations -- was found. The separate analysis of the different age groups demonstrated that the emotional impact and the food-related anxiety improved in children older than 4, while the social domains improved in each age group. In this pilot experience, oral immunotherapy significantly improves quality of life in children with cow milk allergy. The improvement seems particularly evident in children over 4 years old, who are most likely to benefit from the oral immunotherapy approach. Further placebo-controlled studies are needed to confirm these preliminary results.

Long term prognosis of juvenile absence epilepsy.

INTRODUCTION: Juvenile absence epilepsy (JAE) is a generalized form of epilepsy, characterized by absence seizures (AS) initiated in adolescence, with a typical EEG showing generalized spike-wave discharges. Apart from absences, other seizure types may be observed such as myoclonia and generalized tonic-clonic seizures (GTCS). Its long-term prognosis is uncertain. MATERIAL AND METHODS: We retrospectively selected all patients who met the 1989 ILAE diagnostic criteria for JAE. We analysed clinical variables, pharmacological treatment, and seizure remission with medical treatment and seizure relapse after stopping medical treatment. RESULTS: We identified 21 patients, 17 women and 4 men, 86% of whom had suffered GTCS and 14% myoclonias. Mean age at AS onset was 17 years old (range 10-44), 4 patients debuted with AS in adulthood. Mean follow up duration was 25 years (range 10-43). Ninety per cent of the patients were treated with valproate and 62% needed polytherapy. Currently 43% have achieved seizure freedom under medical treatment. All attempts to stop treatment failed, in some cases after long periods of seizure remission. CONCLUSIONS: Less than fifty per cent of patients with JAE achieve remission, antiepileptic treatment is mandatory during all life, despite having long periods of remission.

Exo-endocytotic recycling of synaptic vesicles in developing processes of cultured hippocampal neurons.

In mature neurons synaptic vesicles (SVs) undergo cycles of exo-endocytosis at synapses. It is currently unknown whether SV exocytosis and recycling occurs also in developing axons prior to synapse formation. To address this question, we have developed an immunocytochemical assay to reveal SV exo-endocytosis in hippocampal neurons developing in culture. In this assay antibodies directed against the lumenal domain of synaptotagmin I (Syt I), an intrinsic membrane protein of SVs, are used to reveal exposure of SV membranes at the cell surface. Addition of antibodies to the culture medium of living neurons for 1 hr at 37 degrees C resulted in their rapid and specific internalization by all neuronal processes and, particularly, by axons. Double immunofluorescence and electron microscopy immunocytochemistry indicated that the antibodies were retained within SVs in cell processes and underwent cycles of exo-endocytosis in parallel with SV membranes. In contrast, another endocytotic marker, wheat germ agglutinin, was rapidly cleared from the processes and transported to the cell body. Antibody-labeled SVs were still present in axons several days after antibody loading and became clustered at presynaptic sites in parallel with synaptogenesis. These results demonstrate that SVs undergo multiple cycles of exo-endocytosis in developing neuronal processes irrespective of the presence of synaptic contacts.

Synapsins: mosaics of shared and individual domains in a family of synaptic vesicle phosphoproteins.

Synapsins are neuronal phosphoproteins that coat synaptic vesicles, bind to the cytoskeleton, and are believed to function in the regulation of neurotransmitter release. Molecular cloning reveals that the synapsins comprise a family of four homologous proteins whose messenger RNA's are generated by differential splicing of transcripts from two genes. Each synapsin is a mosaic composed of homologous amino-terminal domains common to all synapsins and different combinations of distinct carboxyl-terminal domains. Immunocytochemical studies demonstrate that all four synapsins are widely distributed in nerve terminals, but that their relative amounts vary among different kinds of synapses. The structural diversity and differential distribution of the four synapsins suggest common and different roles of each in the integration of distinct signal transduction pathways that modulate neurotransmitter release in various types of neurons.

A synaptic vesicle membrane protein is conserved from mammals to Drosophila.

The structure of synaptobrevin, an intrinsic membrane protein of small synaptic vesicles from mammalian brain, was studied by purification and molecular cloning. Its message in bovine brain encodes a 116 amino acid protein whose sequence reveals it to be the mammalian homolog of Torpedo VAMP-1. Antibody probing demonstrates that the protein is also present in Drosophila, and its Drosophila homolog was cloned. Alignment of the sequences of synaptobrevin/VAMP-1 from the three species shows it to contain four domains, including a highly conserved central region of 63 amino acids that contains 75% invariant residues. The finding that a membrane protein from vertebrate synaptic vesicles is conserved in Drosophila points toward a central role of this protein in neurotransmission and should allow a genetic approach to neurotransmitter release.

Neuronal pentraxin, a secreted protein with homology to acute phase proteins of the immune system.

We have identified, by affinity chromatography, a binding protein for the snake venom toxin taipoxin. The sequence of this 47 kDa protein is unique, is characteristic of a secreted protein, and has homology to the acute phase proteins serum amyloid P protein and C-reactive protein of the pentraxin family. We have named this protein neuronal pentraxin (NP), as Northern analysis and in situ hybridization demonstrate high message levels in neurons of cerebellum, hippocampus, and cerebral cortex. Because NP may be released synaptically and has homology to immune proteins potentially involved in uptake of lipidic, toxic, or other antigenic material, we suggest that NP may be involved in a general uptake of synaptic macromolecules.

Colon carcinoma immunoscintigraphy by monoclonal anti-CEA antibody labeled with gallium-67-aminooxyacetyldeferroxamine.

Previous experimental results in nude mice showing that radiolabeling the monoclonal antibody anti-CEA 35 with 67Ga-aminooxyacetyldeferroxamine could give better tumor localization than radioiodination prompted us to initiate the present clinical study. The 67Ga-labeled antibody anti-CEA 35 (185 MBq, 0.7-1.7 mg) was injected preoperatively into 14 patients for colorectal carcinoma imaging. The same antibody labeled with 125I (3.7 MBq, 0.25 mg) was injected simultaneously to compare the 67Ga and 125I dose recoveries in surgical specimens. Twelve of 14 primary tumors gave a positive 67Ga scintigraph. The mean %ID/g recovered in all tumors 3-9 days after injection was significantly higher for 67Ga (0.019%) than for 125I (0.005%) (p < 0.001, paired t test). The tumor-to-normal tissue ratios were generally higher for 67Ga, with the exception of liver. We conclude that 67Ga-aminooxyacetyldeferroxamine improved immunoscintigraphy outside the liver, particularly in the pelvic region. We also show that deferroxamine infusion accelerates the excretion of 67Ga in eight patients and propose that this could lead to further improvement of immunoscintigraphy.

Single coronary arteries: two cases with distinct and previously undescribed angiographic patterns.

Single coronary artery is a rare congenital anomaly, sometimes associated with myocardial ischemia. We present the clinical and angiographic features of two symptomatic patients with documented myocardial ischemia and with distinct and previously undescribed patterns of single right coronary arteries. These cases are new variants of the types R-I and R-II-A, in which the most probable mechanisms of ischemia are the insufficient blood supply, due to the long trajectories of the single arteries and the presence of underdeveloped vessels. Also, our second case presented with a fistulae from the LCX to the left ventricle, which is another determinant of myocardial ischemia.

Transportation in commerical aircraft of passengers having contagious diseases.

Most airlines refuse to board passengers known or believed to have contagious diseases. Such rigor can scarcely be justified by reference to either laws or regulations. It introduces the risk of arbitrary, mistaken, or prejudiced conduct in areas in which international organizations recommend the greatest liberalization, and it can cause serious harm to certain patients. Finally, it does not seem logical, for airlines learn about only a small fraction of the contagious persons who travel, and public health is much more greatly endangered by unknown contagious persons. Normal hygienic conditions aboard planes suppress the risks of contagion concerning most diseases transmitted by insects or through contact with the skin, with mucuous membranes, with the faeces, or with urine. Airlines should continue to refuse to transport only those passengers having diseases which are characterized by vomiting or serious diarrhoea or which are transmitted through the air if it is impossible by simple means to avoid the risk of contaminating other travellers and any members of the flight crew who might be receptive.

Minisatellite and HPRT mutations in V79 and human cells irradiated with gamma rays.

The induction of mutations at the Hprt locus and minisatellite sequences was studied in V79 cells, peripheral blood lymphocytes (PBL) and lymphoblastoid cells (CCRF-CEM) exposed to gamma rays. In V79 cells the Hprt mutant frequency increased with dose at least up to 6.0 Gy, whereas the number of HPRT mutant lymphocytes increased up to 3 Gy. Clones derived from single irradiated cells were screened for mutations at minisatellite sequences by DNA fingerprint analysis. In V79 cells, a dose-response curve for minisatellite alterations was obtained up to 4.5 Gy. In contrast, very few mutations at minisatellite sequences (2/137) were detected among clones isolated from PBL of two donors irradiated with 1-4 Gy. Similar results were observed in lymphoblastoid CCRF-CEM cells irradiated with 2-3 Gy (4 mutants/180 clones), suggesting that in human lymphoid cells minisatellite DNA is more stable than in other mammalian and human cell lines.

[Homologous and heterologous transcription of the Cry+-plasmid in Bacillus thuringiensis]. / Gomologichnaia i geterologichnaia transtseptsiia Cry+-plazmid Bacillus thuringiensis.

The possibility of homologous and heterologous transception of Cry+ plasmids in Bacillus thuringiensis is demonstrated. Cry+ plasmids from crystal bearing strain of Bacillus thuringiensis were transferred into acrystalline strain belonging to H5 serotype by mutual incubation. The donor strain was previously marked by the transmissive plasmid pAM beta 1 coding for erythromycin and lincomycin resistance. The transcipients having acquired the ability to synthesize delta-endotoxin were referred to H5 serotype due to their phenotype. By analogous method Cry+ plasmid was transferred from Bacillus thuringiensis to Bacillus cereus. Bacillus cereus strain GP7 was used as a recipient strain resistant to tetracycline. The presence of delta-endotoxin in transcipients was confirmed by bioprobes and immunoenzyme assay. To prove the transfer of Cry+ plasmid the plasmid profiles of the parent strains and transcipients have been analyzed. The formation of cellular contacts during mutual incubation of Bacillus thuringiensis and Bacillus cereus strains was demonstrated by electron microscopic study of ultrafine cuts.

Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in Brazil.

Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in Brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.

[The role of mefloquine in the prevention of malaria]. / La place de la méfloquine dans la prophylaxie du paludisme.

The use of Méfloquine in the prophylactic treatment of malaria has, up to now, been hampered by the standpoint adopted by the WHO, the Conseil Supérieur d'Hygiène and some specialists, for whom Méfloquine should be administered only for short stays in areas of strong chloroquine-resistance. This policy, which prevents many travellers and overseas residents from benefitting from one of the most effective prophylactic treatments on the market today, thereby indirectly causing a number of pernicious cases of malaria, is based on the unfounded, unproved premise that wide use of this drug would foster the development of méfloquine-resistance or on side-effects, which are in fact rarely of any consequence and always curable. The efficacity of this drug should ensure that it is used for the basic prophylactic treatment of malaria in chloroquine-resistant areas, whatever the degree of this resistance and the length of stay involved, on condition that care is taken as to the tolerance of this drug in the early stages of treatment.

[Genesis of the pancreatographic manifestations of chronic pancreatitis]. / Genez pankreatograficheskikh proiavlenii khronicheskogo pankreatita.

Processes of transformation of the volume and shape of the major pancreatic duct are responsible for pathological pancreatograms. Restricted motility of the gland lobules disposed on its frontal surface in projection of the major pancreatic duct in chronic pancreatitis underlies the formation of pathological pancreatograms.