Circulating filarial antigens for monitoring the efficacy of ivermectin in treatment of filariasis.

Seventy-three asymptomatic bancroftian filariasis patients with positive microfilaria in their blood films were included. The patients were randomly divided into 2 groups: ivermectin group (50 cases) given 2 doses each of 100 ug/kg body weight, 3 months apart, and 23 cases had 2 doses of placebo. The study was run blindly for one year. The initial mean microfilaria (MF) count was 111/ml. At 3 months after ivermectin therapy, mean MF became 7.8/ml and 24% of ivermectin treated cases had no detectable MF (P <0.05). At 6, 9 and 12 months, the mean MF count became 4.1, 6.5 and 11/ml with amicrofilaria in 54%, 42% and 40% of treated cases respectively (P <0.05). On the other hand, no statistically significant change in the mean MF count in placebo group was detected. The routine laboratory investigations were unchanged or slightly improved at 3 and 6 months. Side effects after the first dose of ivermectin were mild fever in 16% and weakness in 20%. None was recorded after the second dose. Circulating filarial antigens could be detected in 66% of cases before treatment, as all cases with high microfilaremia had positive antigenemia. The mean antigen level started to decline significantly after 9 months post treatment. At the end of the study (one-year), all negative microfilaremic cases had negative antigen levels, indicating that detection of antigen in-patients sera is a very good indicator of cure and efficacy of the drug.

Value of estimating intraocular antibody production in diagnosis of typical and atypical lesions of ocular toxoplasmosis.

Serum and aqueous humor (AH) samples were collected from 45 patients: 20 with typically active or reactivated retinal lesions of Toxoplasma (Group I), 16 with atypical lesions (Group II) and 9 with old quiescent scars (Group III). Also, serum and AH samples were collected from 10 patients with chronic toxoplasmosis without any ocular manifestation (Group IV). T. gondii specific IgG, IgA and IgM antibodies were measured by ELISA in AH and serum and the intraocular (local) antibody production was determined by calculating Goldman-Witmer coefficient (G.W.C.). IgG antibodies were the only class detected in all sera of patients with ocular and nonocular toxoplasmosis. An intraocular IgG antibody synthesis was confirmed in 95% and 37.5% of patients with typical (Group I) and atypical (Group II) posterior uveitis respectively and in none of either patients with quiescent scars (Group III) or the ophthalmologically free patients (Group IV). As regard the typical active lesions, the sensitivity of the IgG assay (95%) was higher than that of IgA (60%) and IgM (5%) assays. Beside the conclusion that AH analysis to detect local antibody production is more reliable than the estimating of serum antibodies for the diagnosis of ocular toxoplasmosis, the detection of AH specific antibodies in 6 atypical cases, who were treated successfully by antitoxoplasmic therapy, represent a help to increase the number of uveitis cases in which specific treatment can be established.

Evaluation of the role of Ancylostoma caninum in humans as a cause of acute and recurrent abdominal pain.

Ancylostoma caninum is responsible for cases with eosinophilic enteritis (EE) and unexplained abdominal pain with peripheral eosinophilia in man. Ninety-five patients with obscure acute or recurrent abdominal pain and ten asymptomatic healthy parasite free were subjected to thorough history taking, clinical examination, sonography, routine laboratory investigations and serotesting by IgG ELISA to detect antibodies to excretory/secretory (ES) antigens of adult A. caninum and by IgG and IgG4 Western blot (W.B.) to detect antibodies to Ac68 antigen. Eleven male patients (11.6%) (5 with acute abdomen, 3 diagnosed as appendicitis and 3 had recurrent mild to moderate abdominal pain) fulfilled the criteria of case definition of human enteric infection with A. caninum (G.I). The study also detected human hookworm infection in 14 patients (G.IIb) other parasites in 34 patients (GIIc) and 36 patients had no parasites (G.IIa). Although 3 patients from group I were diagnosed as appendicitis and were dealt with surgically, the pain recurred and mebendazole only put an end to the patient's complaints. The obtained appendices of these operated cases showed marked eosinophilic infiltration but no adult canine hookworms were detected. IgG ELISA was positive in 72.7%, 8.3%, 100%, 23.5% and 0% in groups and control respectively. IgG and IgG4 W.B. did not increase the sensitivity but IgG4 W.B. elevated specificity to 100% excluding those with HH infection (Group Iib) who showed 100% cross-reactions. Stool analysis was the only differentiation between these two types of hookworms. These findings confirmed the presence of human enteric infection with A. caninum as clinical entity in the study community and referred to its value in differential diagnosis of the obscure abdominal pain.

Tissue reaction to prosthetic materials in human temporal bones.

We studied tissue reaction to polymeric silicone (Silastic), polyethylene, tantalum wire, and polytetrafluorethylene (Teflon) in temporal bones and to Silastic in removed shunt tubes. A purpose of this study was to determine which synthetic material is best for insulation of cochlear implant electrodes. We found fibrous tissue around all shunt tubes and in all bones, giant cells in some specimens, and lymphocytic infiltration in a few. We consider none of these findings to indicate bioincompatibility, except in one case with a presumed idiosyncratic reaction to Silastic. We conclude that all four materials are well tolerated by the human ear. Our finding that Silastic is well tolerated for long periods of time leads us to conclude that it is good choice for insulation for implanted wires.

The effect of stapedectomy on hearing of patients with otosclerosis and Meniere's disease.

To determine new guidelines for stapedectomy in patients with both Meniere's disease and otosclerosis, we studied the position of the saccular membrane and Reissner's membrane in relation to the stapes footplate in eight temporal bones from patients with Meniere's disease. We also reviewed charts of four patients with both otosclerosis and Meniere's disease who had stapedectomy. Histologic and clinical findings were compared with preoperative bone conduction levels at 500 Hz and at high frequencies. We found that the saccular and Reissner's membranes did not contact the stapes footplate ain bones of patients with preoperative bone conduction levels of 35 dB or better at 500 Hz and no high-frequency loss. We also found that stapedectomy was successful in patients with the same criteria. We therefore conclude that stapedectomy does not increase the risk of sensorineural hearing loss for patients with otosclerosis and Meniere's disease who have bone conduction levels of 35 dB o better at 500 Hz and no high-tone loss, but it is contraindicated for patients with 45 dB at 500 Hz or worse and with high-tone loss.