[Development and validation of assessment instruments for shared decision making]. / Entwicklung eines Fragebogens zur Partizipativen Entscheidungsfindung.

The German Ministry for Health and Social Security is funding ten projects to introduce shared decision making into clinical practice. The medical problems the projects are focussing on were chosen from among various diseases (e. g. depression, multiple sclerosis, cancer). The ten projects achieved consensus on a core set of instruments for the measurement of process and outcome of the shared decision making. Instruments developed in German-speaking countries are currently not available. Thus, linguistic and cultural validation had to be performed for the core set instruments. The results of the data analysis as well as patient interviews demonstrate the need for improving these instruments. Therefore, the members of the methodological working group concentrated on the integration of these results in a new instrument. In a first step the construct of "shared decision making" was defined, followed by a definition of the process elements characterising shared decision making. Thereafter, items were developed on the basis of the process elements. The new instrument will now be validated for different diseases.

[Movement and its significance: natural healing physiotherapy and modern pharmacological therapy of osteoporosis in the semantic differential. A quantitative study of a self-help group and two comparison groups]. / Bewegung und Bedeutung: Naturheilkundliche Physiotherapie und moderne Pharmakotherapie der Osteoporose im semantischen Differential. Quantitative Untersuchung einer Selbsthilfegruppe und zweier Vergleichsgruppen.

BACKGROUND: Physiotherapy is a frequently applied concomitant therapy for patients with osteoporosis. Compared to modern pharmacological therapy physiotherapy appears to receive sustained high regard, which should be further examined in view of the attribution pattern of the patients. OBJECTIVE: Elements of physiotherapy and Kneipp therapy were quantitatively examined in terms of their semantic content in a three-dimensional space of meaning. This was done in comparison with elements of modern pharmacological therapy. The questions regarding possible patterns of the attributions and a possible hierarchy of the therapy forms were analyzed by a survey of a self-help group for osteoporosis patients and two control groups. MATERIAL AND METHODS: According to the methods of semantic differentials, a self-help group for osteoporosis patients and two control groups (high-school female pupils, breast carcinoma patients) were queried about the individual elements of physiotherapy and modern pharmacological therapy in a polar profile of a questionnaire. The results were arranged onto a numerical matrix and by means of factor analysis, a location in a three-dimensional space of meaning was calculated for each element questioned. For purpose of illustration, the results were transferred to a succession of diagrams so that the assessments for the three axes of meaning became more distinct. The results are discussed on the background of a current neurolinguistic theory of meaning: Sensomotoric experience generates meaning in form of 'primary metaphors'; if reactivated e.g. by physiotherapy, these metaphors can give fundaments for an emergent and salutogenic system of meaning, which helps to reconstruct the patient's 'subjective anatomy' and helps to create new values of living one's life. HYPOTHESES: If sensomotoric experience has a central function in generating meaning, the axis of 'motion' and therapies stressing on sensomotoric experience (e.g. exercise group) will show a corresponding profile of evaluation throughout the three groups. RESULTS: For the axis 'motion' the interventions examined in all three groups show a harmonious profile. The most stable position for all three axes is reflected by 'exercise group', followed by 'whole-body pack'. This stability concerning the axis 'motion' as well as 'exercise group' is discussed in terms of a neurolinguistic theory of meaning, giving sensomotoric experiences the central function for generating meaning. CONCLUSIONS: The results allow conclusions concerning the concrete 'meaning-oriented' combination of physiotherapy with modern pharmacotherapy. Moreover, sensomotoric experiences in physiotherapy are possible reasons for an emergent system of meaning reconstructing the patient's 'subjective anatomy' from basic 'primary metaphors' of bodily experiences up to a whole salutogenetic system of meaning.

Homeopathic remedies as metaphors in family therapy. A narrative-based approach to homeopathy.

OBJECTIVE: To examine a metaphorical, narrative model to explain the outcome of an homeopathic, encounter involving the patient, practitioner and the homeopathic medicine. MATERIAL AND METHODS: The transcript of a videotaped doctor-patient interaction from a European doctor-patient communication study (EUROCOM) was analysed using qualitative methods. RESULTS: Analysis demonstrates a narrative relationship between the protagonists in the therapeutic interaction, with the homeopathic medicine performing a metaphorical role. DISCUSSION: The results justify further investigation of the narrative and metaphorical properties of the therapeutic encounter in homeopathy.

Homeopathic remedies as metaphors in family therapy. A narrative-based approach to homeopathy

Objective: To examine a metaphorical, narrative model to explain the outcome of an homeopathic encounter involving the patient, practitioner and the homeopathic medicine. (AU)

[Literature review of the latest research results concerning the positive effect of exercise therapy in chronic heart insufficiency]. / Literaturübersicht zu aktuellen Forschungsergebnissen zum positiven Effekt von Bewegungstherapie bei chronischer Herzinsuffizienz.

Scientific investigations indicate similarities in the pathophysiology of heart insufficiency and that of physical inactivity: similar changes in peripheral hemodynamics (increased peripheral vascular resistance, worsening of oxygen utilization during exercise), in autonomic control (activation of neurohumoral compensatory mechanisms, e.g. the renin-angiotensin system, overactivation of the sympathicus, reduction of vagal tonus, reduced pressosensitivity), in functional activity (reduced exercise tolerance and reduced maximum oxygen uptake), in skeletal muscle (decrease in mass, changes in structure), and in the psychological state (reduction in activity and feeling of well-being). In several, although small-scale studies it could be shown that patients with advanced left ventricular failure were able to take part in training programs without experiencing any ill effects, and that there was a positive shift in the usual typical effects of physical training, such as increase of heart rate, change in respiratory frequency, and maximum oxygen uptake. It could be shown that exercise therapy can result in a shift in the balance between the sympathetic and the parasympathetic tonus in the low- and high-frequency maxima of the R-R interval variability. The pre-training general predominance of the sympathetic tonus over the vagal tonus was changed dramatically by the training, leading to a predominance of the vagal tonus. Recent controlled studies with a randomized and controlled cross-over design and the application of a training program which was carried out regularly and independently have confirmed the positive effect of aerobic fitness training in cases of heart disease. At the end of the exercise phase, the patients experienced a significant improvement of the symptoms of left ventricular failure and of their capacity for exercise; furthermore, the training altered parts of the neurohumoral activation, which count as the main factors in the progression and death rate of patients with chronic cardiac disease.

[Cerebral hemodynamics in carbon dioxide applications]. / Zerebrale Hämodynamik bei Kohlendioxidapplikationen.

INTRODUCTION: We compare the effect of carbon dioxide (CO(2)) dry and wet applications on cerebral hemodynamics. METHODS: On 22 volunteers measurements were taken during CO(2) application. 10 probands were examined in CO(2) wet application (1,100-1,300 mg/l) and 12 probands in CO(2) dry application (500 g in a 800 l bathtub). The cerebral blood flow velocity (CBFV) in the middle cerebri artery (MCA) was measured as a parameter of cerebral hemodynamics by means of transcranial doppler sonography. Furthermore were recorded CO(2) expiratory concentration (CO(2)et), blood pressure, and sublingual temperature. RESULTS: At CO(2) wet application the CBFV increased during therapy phase by 15% (p = 0.001), parallel to the rise of the CO(2)et by 18% (p = 0.01). During CO(2) dry application CBFV decreased by 11% (p = 0.007), body temperature increased significantly by 0.2 degrees C. CONCLUSION: CO(2) applications have influence on cerebral hemodynamics. Assuming constant diameters of the great brain vessels, CO(2) wet application shows a raising and CO(2) dry application a reducing influence on cerebral blood flow. This influence will attain therapeutic relevance.

[General medicine malpractice cases]. / Allgemeinmedizinische Behandlungsdefizite.

During the last five years legal proceedings about alleged treatment mistakes in Germany more than doubled. Using a standardized questionnaire about legal proceedings in general medicine, involving liability, an anonymous survey with the members of the workgroup law medicine of the Deutsche Anwaltsverein (DAV) was carried out. The questions included among other things the number and reasons of legal proceedings involving liability. Of 322 questioned lawyers who focused on medicine law 122 (38%) answered. 69.9% of the lawyers think poor information is the main reason for legal proceedings involving liability in general medicine. Three disease groups were mentioned more frequently: diseases of the digestive system (22 mentions), diseases of the circulatory system (21) and diseases of the muscles, skeleton and connective tissue (15). 40 mentions of injections as treatment mistakes build the most frequent therapeutic reason for legal proceedings involving liability. Most of the lawyers think that guidelines do not reduce legal proceedings involving liability. The most common reasons for legal proceedings involving liability such as poor information and insufficient medical examination may point out that the budgetary standards for consultation cannot guarantee enough time for firstly giving a sufficient individual information to the patient and secondly for developing a decision satisfactory for both sides.

[Health situation of homeless in a health care home in Hannover]. / Gesundheitliche Situation von Wohnungslosen in einer Krankenwohnung für Wohnungslose.

BACKGROUND AND AIM: Extension of the medical health care system for social fringe groups by means of a special 'Health Care Apartment' for homeless people with an ambulatory nursing service. Between 55-70 % of the homeless people in Germany are in-patients for medical treatment nearly once a year. Only 10-20 % have a family doctor. METHOD: : The pilot experiment of a special Health Care Apartment for homeless people was scientifically evaluated for approximately one and a half year under socio-medical and socio-economic viewpoints. Every patient passes a standardized interview at admission and discharged with one validated systematic setup and one specifically developed questionnaire. RESULTS: : The mean age of the 36 investigated persons was 48.7. 36.1 % (13) of the patients lived in divorce. About 86.1 % (31) of the patients had secondary school qualifications, 69.4 % (25) had learnt a profession. All were unemployed. Two-thirds of them stated they had been found guilty of a criminal offence within the last few years. 44.5 % (16) had been homeless for 3 or more years. Approximately x of the homeless were addicted to alcohol, according to the employees entrusted with looking after the inmates. The main reasons for the average 8-week stay in the medical department were diseases of the skin and skeletal system, which had caused several hospital admissions in the past. The satisfaction of their own health status improved by 66 % from the day of their admission to the day of their discharge. 72.2 % (26) said they could get easier medical support in the Health Care Apartment. Supported by intensive socio-pedagogical care, 55.5 % (20) of the homeless people could be discharged from the special Health Care Apartment to other arrangements for homeless people, respectively to own apartments. CONCLUSION: : The pilot study of the special Health Care Apartment for homeless people in Hannover closes a gap in the provision of medical care which exists in many major cities. Moreover, hospital admissions for homeless people can be prevented and their social reintegration promoted.

[Effects of active and passive movement stimuli on cerebral hemodynamics and the cerebral metabolism]. / Wirkungen kinetischer Stimuli auf die zerebrale Hämodynamik und den zerebralen Stoffwechsel am Beispiel von aktiven und passiv ausgeführten Bewegungen.

INTRODUCTION: In contrast to the well-examined cardiovascular changes during movement stimuli, up to now changes of cerebral hemodynamics and cerebral metabolism have rarely been studied. We investigated the question if active and passive movement stimuli cause changes in the cerebral hemodynamics and the cerebral metabolism. METHOD: Active and passive repetitive movement stimuli on 14 volunteers (8 females, 6 males, age 35 +/- 8 years) were examined. As a parameter of cerebral hemodynamics the mean and the peak blood flow velocity (mCBFV(MCA), pCBFV(MCA)) in the middle cerebral artery (MCA) were recorded by transcranial Doppler sonography. At the same time the noninvasive blood pressure (Penaz method) and the CO(2) expiration concentration were investigated on 8 volunteers of the collective. As cerebral metabolic parameters we examined in 4 volunteers additionally the cerebral respiratory chain enzyme cytochrome aa3 (ccytaa3) and the cerebral oxygen saturation (cHbO(2)) by the transcranial near infrared spectroscopy. With each volunteer 4 measurement series were carried out with a special active and passive exercise program for the right upper as well as the right lower extremity. Each measurement series was formed according to the evoked flow test (R. Aaslid): Exercises were carried out for 20 s, followed by a break of 20 s; this was repeated 10 times for each series. RESULTS: During active exercises of the right lower extremity we found an increase of 13.6% (p < 0.001) of pCBFV(MCA) and an increase of 3.8% (p = 0.003) of mCBFV(MCA). During passive exercises of the lower extremity the increases ran up to 12.3% (p < 0.001) for pCBFV(MCA) and 3.4% (p = 0.004) for mCBFV(MCA). The increases of pCBFV(MCA) came up to 12.5% (p < 0.001) at active exercises of the right upper extremity, those of mCBFV(MCA) to 3.5% (p = 0.15). During passive exercises of the upper extremity the pCBFV(MCA) increased by 12.2% (p < 0.001) and the mCBFV(MCA) by 4.6% (p = 0.007). Significant increases of ccytaa3 were measured during active exercises of the upper extremity (1.6%; p = 0.04) and of the lower extremity (2.7%, p = 0.007). We also found an increase of ccytaa3 during passive exercises of the upper extremity (1.5%, p = 0.04). Significant changes of cHbO(2) were measured with 2.5% (p < 0.05) at active exercises of the lower extremity. CONCLUSION: These studies show that active as well as passive clinical exercises cause an increase of cerebral blood flow velocity. We attribute the increase of cerebral hemodynamics and cerebral metabolism to cerebral activation and autoregulative mechanisms.

Functional cloning and characterization of a UDP- glucuronic acid decarboxylase: the pathogenic fungus Cryptococcus neoformans elucidates UDP-xylose synthesis.

UDP-xylose is a sugar donor required for the synthesis of diverse and important glycan structures in animals, plants, fungi, and bacteria. Xylose-containing glycans are particularly abundant in plants and in the polysaccharide capsule that is the major virulence factor of the pathogenic fungus Cryptococcus neoformans. Biosynthesis of UDP-xylose is mediated by UDP-glucuronic acid decarboxylase, which converts UDP-glucuronic acid to UDP-xylose. Although this enzymatic activity was described over 40 years ago it has never been fully purified, and the gene encoding it has not been identified. We used homology to a bacterial gene, hypothesized to encode a related function, to identify a cryptococcal sequence as putatively encoding a UDP-glucuronic acid decarboxylase. A soluble 47-kDa protein derived from bacteria expressing the C. neoformans gene catalyzed conversion of UDP-glucuronic acid to UDP-xylose, as confirmed by NMR analysis. NADH, UDP, and UDP-xylose inhibit the activity. Close homologs of the cryptococcal gene, which we termed UXS1, appear in genome sequence data from organisms ranging from bacteria to humans.

[Guideline development for general medicine: the problem of dichotomized algorithm development]. / Allgemeinmedizinische Leitlinien-Entwicklung: Problematik der dichotomisierenden Algorithmenbildung.

Development of clinical guidelines in Germany is based on two divergent principles. One is the clinical position of individuality and clinical experience. The other is the strong adherence to the principles of evidence-based medicine and the scientific method, as demonstrated by the clear, algorithmic methodology of critical pathway development. We discuss the pros and cons of both concepts and try to find some sort of practical middle ground between the two extremes.

Spatial and temporal sequence of capsule construction in Cryptococcus neoformans.

The pathogenic yeast Cryptococcus neoformans is distinguished by an extensive polysaccharide capsule, which impedes host defences and is absolutely required for fungal virulence. Despite the biological importance of the capsule, nothing is known about how it is assembled. Substantial capsule growth occurs in two distinct situations relevant to cryptococcal pathogenesis: formation of new buds and induction of capsule on mature cells. We developed pulse-chase protocols to examine these events in a dynamic way using a variety of microscopy techniques. We show that the capsule overlying buds is newly synthesized and differs physically from the corresponding parental material. New capsule formed by mature cells upon induction of synthesis is added at the inner aspect of the existing structure, displacing pre-existing material outwards. Surprisingly, new polysaccharide material is also deposited throughout the capsule, yielding a progressively denser structure. These results yield the first model of capsule synthesis and open new lines of investigation into the underlying mechanisms.

[Changes of cognitive brain functions in the elderly by Kneipp therapy]. / Veränderung kognitiver Hirnleistungen im Alter Durch Kneipp-Anwendungen.

INTRODUCTION: Pharmacological and nonpharmacological treatment of brain syndrome is multifarious. Until now, plain external applications of physical stimuli, as used daily in geriatric care, were not explored regarding their influence on cognitive brain function. The aim of this randomized cross-over study was to examine the influence of dermatoreceptive stimuli on cognitive brain function of healty geriatric volunteers. METHODS: 24 healthy volunteers (23 women, 1 man) were randomized into 2 groups (cross-over design). Group A (mean age +/- SD: 68.8 +/- 6.2 years) was treated according to the following regime: at first a 10-12 degrees C cold stimulus for 10 s (a so-called Kneipp face shower) and afterwards a cold wet pack of 10-12 degrees C at the neck for 1 min. Group B (age 69.8 +/- 5.3 years) was subjected to an identical procedure but with warm thermoindifferent temperatures of 34-36 degrees C. After 1 week the two groups were interchanged. The parameters of interest were the critical flicker frequency (CFF) and the latencies of the event-related P300 potentials of the visually evoked potentials (VEP), which can be considered the electroencephalographic substrate of the cognitive functional ability. The CFFs and the P300 latencies and amplitudes were measured directly before and 10 min after the application of the above-mentioned stimuli. Furthermore, the CFFs were recorded a second and third time 30 and 60 min later. RESULTS: Following application of cold-water stimuli, the CFF increased from (mean +/- SE) 32.55 +/- 0.44 s(-1) to 33.06 +/- 0.44 s(-1) (p = 0.003) 10 min after the stimulus. 30 min later the CFF was still elevated at 32.95 +/- 0.47 s(-1) (p = 0.043). The P300 latencies decreased by 4.8% (p < 0.001) after cold-water application from 266.5 +/- 5.28 to 253.7 +/- 4.22 ms. After warm stimuli they increased from 258.69 +/- 3.71 to 266.17 +/- 5.03 ms (p = 0.01). The P300 amplitudes were elevated by 5% only with the cold stimuli (p = 0.004). CONCLUSION: Cold water applied locally to face and neck region is able to provoke significant improvements of cognitive abilities.

[Metaphorical aspects of mistletoe therapy in patients' experiences--a qualitative study]. / Metaphorische Aspekte der Misteltherapie im Patientenerleben--eine qualitative Studie.

OBJECTIVE: Mistletoe therapy is an item of research because of its immunological features. Nevertheless, mistletoe should be also an item of research because of its semiotics. Long before R. Steiner proposed mistletoe as an anticancer drug, this plant seemed to have its meaning not by pharmacodynamics but by pharmacosemiotics and magic. Thus, metaphorical aspects of mistletoe therapy should be described by processing the transcript and paintings from a therapeutic group session of cancer patients. Especially the relation between individually and historically coded metaphors should be looked at. MATERIAL AND METHODS: Sample of this qualitative study is the transcript of a therapeutic session of 12 female malignoma patients getting mistletoe infusions (Isorel(r)) since 1.5 years in a general practitioners' practice. Sequential coding of the transcript, inventory of themes, and structural hypothesis are the first steps. The structural hypothesis is triangulated by a textual corpus containing anthroposophic and ethnographic material; then a grounded theory is made. RESULTS: The material is divided. On the one hand, there is a huge amount of historically coded, stereotypic metaphors (sun, cancer, ritual). On the other hand, 'ritual' seems not only a stereotypic metaphor but also a container of individually coded metaphors concerning body experiences (proprioceptive etc.). Metaphors from anthroposophy are rare - the metaphors seem to stem from a deeper level of ethnographic sources. The whole session has a polyphone narrative structure. Categories of semiotics such as icon, index and symbol are only by the context of interaction a suitable description for mistletoe's metaphoric function. CONCLUSIONS: Problems of bias (denominator problem, valid but not reliable) are discussed, and a proposal is made for further forms of generalization of the results (semantic differentials). Moreover, it has to be asked if different preparations of mistletoe (e.g. lectine standard, draft from planta tota) make different halos of metaphors.

Detection of glycophospholipid anchors on proteins.

Many eukaryotic proteins are tethered to the plasma membrane by glycosyl phosphatidylinositol (GPI) membrane anchors. This unit provides a general approach for detecting GPI-anchored proteins. First, the detergent-partitioning behavior of a protein of interest is examined for characteristics of GPI-linked species. The partitioning of total cellular and isolated proteins with Triton X-114 is described in this unit, and precondensation of Triton X-114, which is necessary to remove hydrophilic contaminants before partitioning, is outlined in a Support Protocol 1. The protein may also be subjected to specific enzymatic or chemical cleavages to release it from its GPI anchor. Phospholipase cleavage (starting with intact cells or membranes, or with isolated protein) is detailed, and chemical cleavage with nitrous acid is also described. If GPI-anchored proteins are radiolabeled with fatty acids, it facilitates the detection of the GPI protein products following the cleavage reactions. A protocol for separation of lipid moieties released from proteins is provided and base hydrolysis of proteins is also presented.

Detection of glycophospholipid anchors on proteins.

Many eukaryotic proteins are tethered to the plasma membrane by glycosyl phosphatidylinositol (GPI) membrane anchors. This unit provides a general approach for detecting GPI-anchored proteins. First, the detergent-partitioning behavior of a protein of interest is examined for characteristics of GPI-linked species. The protein may also be subjected to specific enzymatic or chemical cleavages to release the protein from its GPI anchor. Protocols for phospholipase cleavage and chemical cleavage with nitrous acid are provided for this purpose. If GPI-anchored proteins are radiolabeled with fatty acids, it facilitates the detection of the GPI protein products following the cleavage reactions. Separation of lipid moieties and base hydrolysis of proteins are detailed herein.

How does Cryptococcus get its coat?

During the past few decades, increasing attention has focused on pathogenic fungi both as fascinating research subjects and as the agents of serious illness in diverse patient populations. In particular, opportunistic fungi such as Cryptococcus neoformans command notice as the ranks of their immunocompromised victims grow. C. neoformans is unique among fungal pathogens for its major virulence factor, a complex polysaccharide capsule. In this article, our current understanding of the structure and biosynthesis of the capsule is reviewed, as are the many questions that remain to be answered about how Cryptococcus gets its coat.

Normal ultrastructure, but altered stratum corneum lipid and protein composition in a mouse model for epidermolytic hyperkeratosis.

Recently, we established keratin 10-deficient mice, serving as a model for the hyperkeratotic skin disorder epidermolytic hyperkeratosis. The considerable ichthyosis in these mice suggested alterations in terminal differentiation and in the formation of a functional epidermal barrier. Here, we report on the ultrastructural organization and composition of the stratum corneum lipids and on the expression of two major cornified envelope proteins. Electron microscopy of ruthenium tetroxide postfixed skin samples demonstrated a normal extrusion and morphology of lamellar bodies as well as the formation of bona fide lamellar layers in neonatal keratin 10-deficient mice. When we studied the composition of the major stratum corneum lipids, however, we found significant changes. Most importantly, the analysis of ceramide subpopulations revealed that the total amount of ceramide 2 was elevated in keratin 10-deficient mice, whereas ceramides 1, 3, 4, and 5 were decreased among total stratum corneum lipids. The amount of the ceramide precursors sphingomyelin and glucosylceramide was reduced in the stratum corneum without accompanying changes in the mRNA coding for acid sphingomyelinase. Notably, we found an increased mRNA and protein content for involucrin in neonatal keratin 10-deficient mice, whereas the expression of loricrin was not changed. Our data demonstrate that, although the formation of lipid layers in the stratum corneum appeared to be normal, its lipid composition is significantly altered in keratin 10-deficient mice.

The glycosphingolipidoses-from disease to basic principles of metabolism.

The glycosphingolipidoses are a set of diseases that are caused by defects in the lysosomal degradation of glycolipids derived from the plasma membrane. By investigating the molecular bases of the diseases, basic principles of storage disease pathology and of membrane digestion were discovered. The generation of mouse models has facilitated the development of new and promising therapeutic strategies for these diseases, most of which are not treatable at present. Lately, the discovery of the importance of glycosphingolipid metabolism for skin development has opened a new and interesting field.

A unique alpha-1,3 mannosyltransferase of the pathogenic fungus Cryptococcus neoformans.

The major virulence factor of the pathogenic fungus Cryptococcus neoformans is an extensive polysaccharide capsule which surrounds the cell. Almost 90% of the capsule is composed of a partially acetylated linear alpha-1,3-linked mannan substituted with D-xylose and D-glucuronic acid. A novel mannosyltransferase with specificity appropriate for a role in the synthesis of this glucuronoxylomannan is active in cryptococcal membranes. This membrane-associated activity transfers mannose in vitro from GDP-mannose to an alpha-1, 3-dimannoside acceptor, forming a second alpha-1,3 linkage. Product formation by the transferase is dependent on protein, time, temperature, divalent cations, and each substrate. It is not affected by amphomycin or tunicamycin but is inhibited by GDP and mannose-1-phosphate. The described activity is not detectable in the model yeast Saccharomyces cerevisiae, consistent with the absence of a similar polysaccharide structure in that organism. A second mannosyltransferase from C. neoformans membranes adds mannose in alpha-1,2 linkage to the same dimannoside acceptor. The two activities differ in pH optimum and cation preference. While the alpha-1,2 transferase does not have specificity appropriate for a role in glucuronoxylomannan synthesis, it may participate in production of mannoprotein components of the capsule. This study suggests two new targets for antifungal drug discovery.