Anisakis, anisakiasis and IgE-mediated immunity to Anisakis simplex.

Anisakis simplex is a common parasite in fish and cephalopods and is not only capable of causing anisakiasis in humans through visceral invasion of the third-stage larvae but can also cause anaphylactic reactions, as has recently been demonstrated. We present the clinical case of a 56-year-old man who initially presented anaphylactic reactions related to eating fish. Shortly afterwards, he began to experience self-limiting recurrences of very intense epigastric pain, nausea and vomiting. Skin tests for immediate hypersensitivity (prick tests) with a commercial extract as well as the determination of specific IgE in the patient's serum were clearly positive for A. simplex. The hemogram did not show eosinophilia. Copro-cultures and parasites in the patient's feces were repeatedly negative. Gastroscopy was normal. The intestinal tract showed contrast flocculation and dilation of ansas in the distal duodenum and proximal jejunum. Biopsy samples of gastric and distal duodenum mucous showed an active process of chronic inflammation with a predominance of eosinophils in the lamina propria. After subjecting the patient to a fish and cephalopod-free diet and treating him with thiabendazole 350 mg every 12 hours for 6 days, he showed no sign of symptoms while awaiting new tests. Even though the diagnosis of IgE-mediated allergy caused by A. simplex offers no room for doubt, we are unable to present a firm diagnosis of anisakiasis as no larva has been seen. Nevertheless, the clinical pattern, the image of the intestinal tract, the eosinophilic infiltrate in the biopsies and the good response to thiabendazole all lead to the suspected existence of anisakiasis in this patient coexisting with IgE-mediated allergy to this parasite.

[User satisfaction with primary care teams: related to doctor's training in the field of physician-patient relations]. / Satisfacción de usuarios de equipos de atención primaria: relación con la formación del médico en el área de la relación médico-paciente.

OBJECTIVE: To find the satisfaction level of health users attended by Bizkaia primary care teams (PCT) with 5 or more permanent doctors and to determine whether there is any relationship between satisfaction and doctors being trained in doctor-patient relationships (DPR). SETTING: Primary Care. Towns in the 2 health areas out of the 6 in which Bizkaia is divided. TARGET POPULATION: the users of PCTs with 5 or more doctors in the 2 health areas. The randomly selected sample had 323 patients, to which we had earlier added 30% (n = 420) due to the probable non-repliers. INTERVENTION AND RESULTS: Satisfaction was measured using the questionnaire composed by J.M. Moreno et al; and training in DPR, using a questionnaire composed by the authors. Satisfaction scored on average 73 points out of 80 (range 34 to 80). 36.7% of the doctors had low or nil training in DPR (< 10 hours); 16.7% had average training (10 to 40 hours); and 46.7% stated they had a high level of training (> 40 hours). Data analysis showed that satisfaction increased in line with the user's age and the length of the user's relationship with the doctor. CONCLUSIONS: 1) The satisfaction found is high, which corroborates other authors' results. 2) The most determinant variable of user satisfaction is age. 3) We found no statistically significant association between patient satisfaction and doctor training in the field of DPR.

Immunization against porcine cysticercosis in an endemic area in Mexico: a field and laboratory study.

An antigenic extract from Taenia solium metacestodes was evaluated for immunogenicity in pig populations from a large area of endemic porcine cysticercosis in the State of Guerrero, Mexico. A total of 3,295 pigs from 18 villages were immunized with a single dose of 250 micrograms of protein administered intramuscularly. Systematic immunization was also performed on pigs (1,076 immunizations) from two of the villages with the highest percentages of cysticercosis. A year after immunization, porcine cysticercosis decreased from 4.8% and 5.4% to 0%. Immunity against the T. solium metacestode was estimated in vitro by measurements of 3H-thymidine uptake and inhibition of leukocyte migration. Peripheral blood lymphocytes from immunized cysticercotic (pigs that had cysticercosis prior to immunization), cysticercotic immunized (pigs that acquired cysticercosis after immunization), and normal control pigs incorporated 3H-thymidine better than lymphocytes from cysticercotic pigs when stimulated with concanavalin A. A significant inhibition in the leukocyte migration inhibition test was also found in leukocytes from immunized cysticercotic pigs (P < 0.01). Histopathologic studies revealed granuloma formation surrounding the metacestodes of the immunized cysticercotic and cysticercotic immunized pigs. These metacestodes exhibited several stages of destruction. Large numbers of eosinophils were frequently observed in a close association with the degeneration and destruction of parasites. Metacestodes in control cysticercotic pigs were intact and surrounded by a minor inflammatory reaction. Finally, the rate of in vitro evagination of scolices was high in metacestodes obtained from cysticercotic pigs and low or absent in those from immunized pigs (P < 0.01).

Comparison of UV and fluorescence spectrophotometry for the quantification of a potent myotonia inducer: anthracene-9-carboxylic acid, in plasma, urine, and saline perfusion fluids.

UV and fluorescence spectrophotometry were used to establish the analytical profile of a potent myotonia inducer, anthracene-9-carboxylic acid (I). UV spectrophotometry is useful for the determination of I when it is dissolved in physiological solutions (Ringer's, Tyrode's, etc). In these fluids there is a linear relationship between UV absorption and I concentration between 500 and 2000 ng/ml (2.25-9.0 X 10(-6)M). However, in biological fluids there are interferences in the UV absorption due to organic substances. On the other hand, fluorescence spectrophotometry is more sensitive than UV for determinations in plasma and urine. Within the range of 200-1000 ng/ml (0.9-4.5 X 10(-6) M) fluorescence intensity increases linearly with concentration. Furthermore, when both emission and excitation spectra are combined there are no interferences due to organic substances normally present in those fluids. An extraction procedure of I from plasma and urine is also described, and the importance of I determinations in relation to the problem of this myotonia-inducing aromatic monocarboxylic acid is discussed.

Taenia solium: immunity in hogs to the Cysticercus.

Protection was induced in hogs against Taenia solium cysticercosis using an immunogenic complex obtained from its larval "bladder worm" form, Cysticercus cellulosae. Immunoelectrophoresis revealed that this complex contained at least eight antigens. In immunized hogs a total of 71 (mean 11.8) cysticerci were found, whereas in the control animals 397 (mean 74.9) were found. Histopathological studies showed that more than 40% of larvae obtained from immunized hogs were completely destroyed and the others were seen in various stages of degeneration. Eosinophils and mononuclear cells were observed infiltrating the internal structures of the larvae. Intense granulomatous reactions of eosinophils, lymphocytes, macrophages, epithelioid cells, plasma cells, and fibroblasts surrounded the larvae. Larvae from control hogs were intact and surrounded by a small inflammatory reaction. The cellular response was measured by the macrophage migration inhibition test, which was higher in immunized hogs when compared with control animals, either before the infection with T. solium eggs or before slaughter. No significant difference was found in the humoral response of immunized and control hogs.

Angiography in the management of aneurysms of the abdominal aorta. Its value and safety.

The course of 190 patients with aneurysm of the abdominal aorta who underwent preoperative aortography was reviewed to determine the safety and usefulness of that procedure. There were no serious complications; minor problems occurred in only four patients and did not affect operative therapy. In 21 patients, the clinical impression of aneurysm was found to be incorrect. Surgically important findings included suprarenal extension of the aneurysm in nine patients, and demonstration of stenotic lesions in the renal arteries (37 patients) or superior mesenteric artery/celiac axis (17 patients). Helpful findings were associated aneurysms (26 patients), multiple renal arteries (28 patients), and occlusive lesions in the lower extremities or aortocranial system in 82 and eight patients respectively. Such information was found useful in planning operative procedures and minimizing operative time and blood loss. In our experience, angiography in patients with aneurysm of the abdominal aorta is both safe and informative.