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The treatment of prolonged, severe relapses in multiple sclerosis (MS) patients who respond poorly to high-dose intravenous corticosteroids is not yet established. Plasma immunoadsortion (IA) removes immunoglobulins (IgG), immune complexes, and complement from plasma. It may bear some advantages compared to plasmapheresis, a nonselective procedure that requires substitution of patient plasma by colloids solutions or plasma, which may carry a potential risk for viral infections.Three relapsing-remitting MS patients with a malignant course received IA. All they were experiencing a prolonged relapse unresponsive to high-dose intravenous corticosteroids, causing a locked-in state in two of the patients and severe pseudobulbar impairment in the third one. Five to six IA consecutive sessions were administered along a 7-10 days course.IA was followed by a prompt and unequivocal clinical response in all three patients, which paralleled a decrease in IgG, fibrinogen, and C3 complement serum levels. IA administration was followed by immunosuppressor therapy, either with cyclophosphamide and intravenous ACTH (2 cases) or mitoxantrone (1 case). Improvement has been sustained along a mean follow-up of 7.6 years (range: 7-8.5 years), only one of the patients suffering two mild clinical relapses.We believe that IA may be useful, either as a coadyuvant or alternative treatment in severe relapses in MS patients that do not respond to high-dose intravenous corticosteroid therapy.

Branisella boliviana, from the Late Oligocene of Salla, Bolivia, is the oldest fossil platyrrhine monkey discovered. To date, several fossil specimens of Branisella have been obtained, but most of them are fragmentary dentitions, so the animals craniodental morphology is still obscure. During the 1996 field season a pair of upper and lower jaw fragments and another nearly complete mandible were recovered. These new fossil materials reveal the following morphological features in Branisella: 1) P(2) is much smaller than P(3,4), whereas P(2) is relatively small but probably sexually dimorphic; 2) the zygomatic arch protrudes smoothly posterolaterally from the maxillary bone, as in extant Callicebus; 3) the mandibular arcade is nearly V-shaped and the symphysial angle, which is formed by the horizontal plane and the anterior face of mandibular symphysis, is about 40 degrees, i.e., it neither leans as far anteriorly as in callitrichines nor does it stand as vertically as Cebus; 4) upper and lower molars wore down rapidly in life, suggesting a herbivorous diet and the possibility of terrestriality; and 5) dental eruptive sequence is the same as in extant Aotus. As a whole, the dentition of Branisella is very similar to that of Proteopithecus from the Late Eocene of Fayum, Egypt, except in the lower canine morphology, suggesting a close phyletic relationship between them. The origin and early diversification of platyrrhine monkeys might have occurred on the African continent before crossing the Atlantic Ocean.

We analyzed the function and outcome of 16 kidney transplants performed in our hospital from non-heart-beating donors who were harvested at other hospitals. The cold ischemia times were longer and the delayed graft function rates higher. However, graft function was no different from that of kidneys from heart-beating donors. This experience has encouraged us to use this type of donor to reduce the transplant waiting list.

Five patients with a family history of hypercholesterolemia were treated for one year with double filtered technique of LDL-apheresis: heterozygotic in four patient and homozygotic in one. All patients presented documented cardiovascular disease and had been treated unsuccessfully with lipid lowering drugs.Plasmatic cholesterol was significantly reduced from 463.8 +/- 60.9 mg/dl to 326.36 +/- 36 mg/dl at 6 months after treatment and 347.56 +/- 68.1 mg/dl at 12 months (p0.05). LDL was also reduced from 407.92 +/- 69.39 mg/dl to 294.04 +/- 62.02 mg/dl and 296.6 +/- 82.42 mg/dl respectively (p0.05) and Apo B was reduced from 291.84 +/- 28.97 mg/dl to 224.5 +/- 47.11 mg/dl at 6 and 12 months respectively, without significant modifications of other lipidic parameters and without adverse events.LDL-apheresis is a therapeutic approach effective in the reduction of total plasmatic cholesterol, in conjunction with to LDL and APO B in patients refractory to lipid lowering agents.

During the 1992 and 1993 field seasons, several new specimens of Branisella boliviana, the oldest fossil platyrrhine, were discovered in the late Oligocene deposits at Salla, northwestern Bolivia. The new materials are two maxillary fragments and seven mandibular fragments, including P3 and P2, neither of which have previously been recovered. All new and previously reported materials, including the holotype and referred specimens, were apparently recovered from the same horizon, called the Branisella zone (MacFadden et al. [1985] J. Geol. 93:223-250; MacFadden [1990] J. Hum. Evol. 19:7-21. The crown morphology of the newly discovered upper and lower premolars suggests that Branisella has a close affinity with callitrichines. A detailed examination of all molar specimens suggests that "Szalatavus attricuspis," which was recovered at Salla in 1981 and described as a new genus by Rosenberger et al. (1991), is a junior synonym of Branisella. The Branisella-like upper molar, in which a small hypocone is preserved on the poorly developed distolingual cingulum, is a shared-derived character with callitrichines and does not correspond to the primitive state for platyrrhine phylogeny. The ancestral upper molar morphotype for platyrrhines should have a moderate to large hypocone and a well developed talon area.

PEHPS medium, developed for axenic cultivation of Entamoeba histolytica and E. invadens, was also capable of supporting the growth of a Trichomonas vaginalis strain, with an inoculum of 1 to 100 trichomonads/ml. The logarithmic growth phase in PEHPS or in TYI-S-33 medium lasted 72 h; yield (3.33 +/- 0.56 x 10(6) trichomonads/ml), duplication time (4.27 h), number of duplications (16.85), or increase ratio (33,328) in PEHPS medium showed no significant differences with those obtained in TYI-S-33 under similar culture conditions. Accordingly, PEHPS medium might be used for the axenic cultivation of T. vaginalis.

The objective of this investigation was to quantitatively evaluate, by using light and transmission electron microscopy, the intracellular digestion of human erythrocytes (HE), ingested by Entamoeba histolytica trophozoites in vitro. Amebas fed 10 min with HE were postincubated 3-12 h at 36.5 degrees C without HE, and fixed with glutaraldehyde. After staining by the benzidine reaction, HE per ameba, and percent of amebas containing at least one HE were determined by light microscopy. Trophozoites ingested an average of eight HE per ameba and 92% of them contained HE after the 10 min pulse. Erythrocytes were clearly observed as reddish-brown corpuscles in the amebic cytoplasm. During postphagocytosis incubations progressive loss of HE staining, as well as changes in size of food vacuoles, were observed, thus proving the intracellular digestion of HE. The hydrolysis of HE was corroborated with the electron microscope, the HE cytoplasmic matrix being the first structure catabolized and later the plasma membrane. Quantitative analysis demonstrated decrease of 56% of ameba containing HE, and 1.35 HE per ameba on average, after 3 h postphagocytosis. Afterwards, both parameters decreased at a slow rate until HE disappeared. The t1/2 of HE within amebas was 2 h.

The effect on amebal virulence of Escherichia coli, Clostridium symbiosum and a mixture of lactobacilli was investigated. Amebas from HM1 and HK axenic strains were incubated with a single bacterial strain or lactobacilli for short, intermediate, or long periods and analyzed for their erythrophagocytosis, hemolytic activity and cytotoxicity in vitro and hepatic abscesses formation in vivo. It was found that in vitro virulence was enhanced by all studied bacteria in HK9 but not in HM1 strains, which only showed an increase in cytotoxicity. The virulence in vivo was solely increased in trophozoites of HM1 strain by all tested bacteria.

8 cases of membranous glomerulonephritis (MG) after renal transplants (RT) are presented; one being a recurrence of the original disease and the other 7 due to a different cause of renal insufficiency. The total incidence of MG after transplantation was 1.63%; 1.39% being the incidence of MG of new cases. Only 1 patient showed decrease of renal function and in this case the MG was accompanied by chronic rejection lesions. There was no sign of neoplasias nor drugs producing MG. As far as chronic infections are concerned, only one patient showed B antigen and it was not observed during the immunofluorescent test in the biopsy. 6 patients had urological complications after the renal transplant (3 cases of urinary fistula; 2 cases of obstructive uropathy; 1 case of short ureter). 2 patients experienced the start of hemodialysis due to focal and segmentary glomerulosclerosis. The beginning of proteinuria commences between 2 and 23 months after the RT (median 13,0 +/- 7,5 moths); with a range of between 2.0 and 12.0 gr/day (median: 6.8 +/- 3,2 Z gr/day), this being nephrotic in 4 cases. Proteinuria improved 1 case, and persisted in the other patients at the same level registered previous to the diagnosis. MG is a non-frequent complication or RT and is usually benign. Patients with post-transplant urologic complications could be considered to have a higher risk of developing a MG "de novo".

From 1974 to 1987 we have diagnosed thirty three patients with rheumatic fever. The age of onset ranged from three to sixteen years with a mean age of nine years and six months. Carditis was the most frequent major criteria (27/33) followed by arthritis (14/33) and Sydenham's chorea (6/33). All the patients with carditis had the mitral valve affected. The usual treatment in the acute phase was penicillin and aspirin. The prophylaxis recommended to the patients was penicillin G benzatine every 21 days if they had carditis and every 28 days if they didn't. Two patients allergic to penicillin are receiving erythromycin. We have observed that the incidence of rheumatic fever has remained unchanged that the age of onset increased and that the antiinflammatory drug of choice in most patients with carditis is aspirin.

The effectiveness of antibiotic prophylaxis was evaluated in the immediate postoperative period of renal transplantation (RT). Before RT, the patients were randomly assigned to one of the following groups: 1) cefotaxime (intravenous infusion of 1 g one hour before the operation). 2) Ceftriaxone (1 g i.v. given in a similar way). 3) Control (without antibiotics). Patients who required antibiotic therapy during the first 3 postoperative weeks were excluded. 20 recipients of cadaveric renal grafts were included in each group. There were 39 males and 21 females with a mean age of 39.9 years. One patient from the cefotaxime group (5%), 2 from the ceftriaxone group (10%) and 2 from the control group (10%) developed infection of the surgical wound, all due to grampositive organisms. 19 patients had urinary tract infections: 7 from the control group (35%), 7 from the cefotaxime group (35%), and 5 from the ceftriaxone group (25%). The development of wound infection was not correlated with urea, creatinine, hemoglobin or total protein levels, or with urinary tract infection or fistula, diabetes or fever. The mean packed red cell volume of the patients who developed wound infection was 24.7 +/- 1.2 vs 28.6 +/- 6.6 in those who did not (p less than 0.01). All patients with visible hematoma and 3 of 10 with perirenal blood collection had wound infection. It was concluded that antibiotic prophylaxis for renal transplantation was useless in our patients.

The results of five 'en bloc' kidney transplants from 5 anencephalic newborns are reported. The receptors were 8-50 years old. The graft survival 12 months after transplantation was 60%. The average plasma creatinine level the 1st month after transplantation was 4.0 +/- 0.8 mg/dl, after 6 months 1.5 +/- 0.8, and is currently 1.2 +/- 0.6 mg/dl. The follow-up time ranged from 17 to 55 months (mean 30.3 +/- 17.5 months). Two grafts were lost during the early posttransplantation period (due to arterial thrombosis and vascular rejection, respectively); the other grafts are still functioning. Two grafts showed initial oliguria. All of the patients required hemodialysis or peritoneal dialysis for 5-60 days (mean 22.5 +/- 21.4 days). The time of cold ischemia ranged from 15 to 35 h (mean 25.6 +/- 7.7 h). The literature published on the subject is reviewed, and it is concluded that anencephalic donors are an acceptable option for transplantation.

A morphological analysis of an experimental model of invasive intestinal amebiasis was carried out using the washed-closed cecal loop model in hamsters and guinea-pigs. By light microscopy, few amebic trophozoites adhered to the intestinal epithelium, whereas many associated to the mucus blanket. Some trophozoites attached to the interglandular epithelium, during the first 10 to 15 hours of interaction. Hereafter, the parasites destroyed gradually the epithelium and were associated with normal and lysed inflammatory cells. Some amebas have cell debris and erythrocytes in their cytoplasms. Typical amebic ulcer contained abundant trophozoites at the basolateral area. The results suggest that intestinal mucus and muscularis mucosa are temporal barriers to amebic invasion and extension of the ulcer. At the mucosal and submucosal levels, lysis of inflammatory cells produced by amebas seems to play an important role in the extension of the ulcer.

Some strains of mice are known to be relatively resistant to hepatic or intestinal amebic infections. In order to know if the intestinal resistance is expressed few hours after infection, we inoculated axenic amebae in three inbred strains of mice either by direct intracecal injection or by infection of a washed-closed cecal loop. We found that amebae do not survive in conventional animals but they colonize longer in animals with the cecal loop. However, the survival was low after 24 hours postinfection. Balb/c mice were more susceptible and CBA mice more resistant. Our results suggest that genetic resistance to intestinal amebiasis is expressed in mice in the early phases of infection.

Introduction The treatment of prolonged, severe relapses in multiple sclerosis (MS) patients who respond poorly to high-dose intravenous corticosteroids is not yet established. Plasma immunoadsortion (IA) removes immunoglobulins (IgG), immune complexes, and complement from plasma. It may bear some advantages compared to plasmapheresis, a nonselective procedure that requires substitution of patient plasma by colloids solutions or plasma, which may carry a potential risk for viral infections. Patients and methods Three relapsing-remitting MS patients with a malignant course received IA. All they were experiencing a prolonged relapse unresponsive to high-dose intravenous corticosteroids, causing a locked-in state in two of the patients and severe pseudobulbar impairment in the third one. Five to six IA consecutive sessions were administered along a 7-10 days course. Results IA was followed by a prompt and unequivocal clinical response in all three patients, which paralleled a decrease in IgG, fibrinogen, and C3 complement serum levels. IA administration was followed by immunosuppressor therapy, either with cyclophosphamide and intravenous ACTH (2 cases) or mitoxantrone (1 case). Improvement has been sustained along a mean follow-up of 7.6 years (range: 7-8.5 years), only one of the patients suffering two mild clinical relapses. Conclusion We believe that IA may be useful, either as a coadyuvant or alternative treatment in severe relapses in MS patients that do not respond to high-dose intravenous corticosteroid therapy.

To determine the incidence of renal involvement in Schönlein-Henoch syndrome, authors enrolled in a prospective study all children admitted with this diagnoses from 1971 through 1978. They followed-up 112 patients, which represented the 2 per one thousand of the total hospital pediatric admission in the same period; 22 patients (19.6%) developed renal involvement. After two years of follow-up they observe one patient with progressive renal failure, four with minor urinary abnormalities and 17 asymptomatics. The single patient with renal failure represents the 4.5% of the patients with Schönlein-Henoch nephropathy and the 0.9% of the total affected with this syndrome.