A clinical trial with pre- and post-treatment manometry comparing pneumatic dilation with bouginage for treatment of Chagas' megaesophagus.

The physiologic similarities between the megaesophagus of Chagas' disease and idiopathic achalasia are well documented. Therefore, it would seem reasonable that comparisons of controlled trials of therapy for the more common Chagas' megaesophagus could be applied to idiopathic achalasia, where the paucity of cases makes such a controlled comparison difficult. We had the opportunity to study 18 patients with achalasia secondary to Chagas' disease. All of the patients were from the mid central states of Brazil, all had symptoms of dysphagia and radiographic documentation of dilated esophagus and abnormal peristalsis (Rezende Groups II and III), as well as positive serologic evidence of Chagas' disease. Perfused intraluminal manometric studies were performed on all patients. Resting sphincter pressures ranged from 20-35 mm./Hg., mean of 25 (normal 5-12 mm./Hg.) with aperistalsis. Patients were randomly dilated with either bouginage (44-55 ff catheter) or pneumatic dilator (4-4.5 kg./6.5 cm.2 x 2 min.). Although all patients reported symptomatic improvement several days after either procedure, repeat manometric tracings demonstrated no change in the sphincter pressure in the bouginage group. The pneumatically dilated group, however, demonstrated a decrease in sphincter pressure to normal levels (mean 12 mm./Hg.). Follow-up studies one year after the procedure confirmed the persistence of normal sphincter pressure in the pneumatically dilated group but no change, as well as return of initial symptoms, in the bouginage group.

Giardiasis: an overview for the clinician.

Since the clinician confronting a case of giardiasis may find the current literature confusing and weighted towards rare immunoglobulin deficiency syndromes, a classification is proposed to answer questions pertinent to understanding and managing this infection. Current thinking of giardiasis must involve the realization that (1) asymptomatic carriers exist; (2) that the majority of symptomatic patients have no structural disease explaining their symptoms; and (3) that those patients with anatomic lesions and giardiasis probably have an underlying predisposing condition. A short review of the association of giardiasis and immunodeficiency will then be presented, along with current concepts of diagnosis and therapy.

Detection of circulating antigen in acute experimental infections with Toxoplasma gondii.

Although many serologic tests are available for determination of antibody to Toxoplasma gondii, circulating antigen has not been studied in infections with this organism. Presence of circulating antigen was sought by immunologic methods in experimental infections (Rh strain) of mice and rabbits. In mice, which succumbed to infection within four days; circulating antigen was detectable in serum by counter-current immunoelectrophoresis and agar gel diffusion on days 2-4 of infection. In rabbits; which succumbed to infection within eight days; serum antigen could not be detected by countercurrent immunoelectrophoresis or agar gel diffusion; Affinity chromatography, with use of cyanogen bromide-activated Sepharose and binding of the antigen to hyperimmune rabbit antiserum to Toxoplasma, permitted isolation of serum antigen on days 3, 5, 7, and 8 of infectionmalthough infected micce and rabbits may have parasitemia of 10-2--10-4 organisms/ml of blood, this concentration did not produce precipitin reactions with antiserum that detected antigenemia. Preliminary characterizations of the column-extracted antigen revealed heat inactivation by 56 C for 30 min, complete inactivation by trypsin, and a molecular weight of greater than 100,000 daltons, as determined by chromatography on a Sephadex column.