[Isolated myocardial noncompaction in childhood-case report and review of the literature]. / Isolated myocardial noncompaction als seltene Ursache einer Synkope im KindesalterFallbericht mit Literaturübersicht.

The diagnostic work-up for the first syncopal episode of a 14-year-old female adolescent revealed the morphology of an isolated myocardial non-compaction on echography. Angiography and biopsy of the left ventricle confirmed the diagnosis. Despite a reduced shortening fraction (FS 21%) and frequent premature atrial beats, there were no further cardiac or extracardiac symptoms. After establishment of therapy with beta-blockade, digitalis, angiotensin converting enzyme inhibition and acetylsalic acid, the follow-up over 24 months was good; the implantation of an automatic implantable cardioverter-defibrillator is planned.

Observations on levels of immunoglobulin M in confirmed cases of Trypanosoma rhodesiense infection in the Lambwe Valley.

By means of established single-diffusion techniques, immunoglobulin M (IgM) levels in the blood and cerebrospinal fluid of patients with confirmed Trypanosoma rhodesiense infections were studied at the time of parasitological diagnosis, while the patients were being treated with suramin and melarsoprol, and during post-treatment surveillance. During the 3-year study period the number of diagnosed cases in which there was a raised level of IgM in the blood varied considerably, depending on whether diagnosis was made early or late in the course of the infection. In some cases the blood IgM levels returned to normal during preliminary courses of treatment with suramin and in others by the end of a 1-month course of treatment with melarsoprol, while in some other cases they did not return to normal for about 2 years. Similar results were obtained for IgM in cerebrospinal fluid, except that if IgM could be detected at the start of treatment with melarsoprol it was still detectable at the end of treatment. However, cerebrospinal IgM usually disappeared after 2 years. The results indicate that IgM levels are a useful indicator in the diagnosis of the more chronic cases.

Observations on the patterns of blood IgM levels in the populations of endemic and nonendemic sleeping sickness areas in Kenya.

Increased levels of serum immunoglobulin M (IgM) may be related to a wide range of antigenic stimuli provided by a variety of infections to which people are repeatedly exposed. Most, if not all, of the natural antibodies against bacterial and cellular antigens have been found to belong to the IgM class. It is known that IgM levels in the blood increase in trypanosomiasis but it is not possible to demonstrate trypanosomes in all persons who show raised IgM levels in serological surveys in an endemic sleeping sickness area. Although survey data are limited, this paper discusses the usefulness of IgM tests as an aid to the detection of Trypanosoma rhodesiense infections.

An evaluation of the capillary and latex agglutination and heterophile antibody tests for the detection of Trypanosoma rhodesiense infections.

In a small proportion of persons infected with Trypanosoma rhodesiense the parasitaemia is so slight or so intermittent that a positive diagnosis cannot be made by the routine parasitological examination of blood and glandular fluid. By the time the infection is mature enough to be diagnosed by these methods these persons may not readily have access to a diagnostic centre. Some of these infections could be diagnosed earlier by repeated intensive examinations of blood and cerebrospinal fluid, and by animal inoculation tests. A stimulus for investigators to make these examinations could be provided by the results of a simple, rapid, and highly specific immunological screening test that could be made concurrently with the first parasitological examination of suspected cases. The results of two such tests for detecting circulating trypanosomal antibodies are described. One of the tests, the latex agglutination test, is potentially useful as a screening test for persons whose first parasitological examination is negative but whose clinical or social background suggests that they may be infected. This test could find wide application in hospitals and dispensaries, and in the field. Studies indicate that there is little value in testing suspected cases of trypanosomiasis for heterophile antibodies.

Preliminary observations on the use of the latex agglutination test for detecting circulating trypanosomal antibodies in game animals in the Lambwe Valley.

The first use of the latex agglutination test (LAT) for determining the frequency of circulating trypanosomal antibodies in a sample of game animals collected in the Lambwe Valley, Kenya, is described. The immunological examination of animals belonging to 9 species revealed an incidence of circulating antibody of 25.5%, which was only slightly higher than, and therefore in close agreement with, the results of a concurrent parasitological survey. It is concluded that the LAT is very suitable for determining the overall incidence of trypanosomal infections in wildlife communities.

Estimation of serum immunoglobulin M as a screening technique for trypanosomiasis. A field trial in the Democratic Republic of the Congo.

Field trials in West Africa have shown the value of the estimation of serum immunoglobulin M (IgM) levels as a screening test in endemic trypanosomiasis areas. A further field trial carried out in the Democratic Republic of the Congo is described. The technique used, based on double diffusion on an agar plate, gave consistent results in skilled hands, but the standard required is probably too high for the wide application of the method under normal field conditions. The diameter of the precipitation zones for 200 sera from new patients from a survey population of nearly 10 000 was generally between 8.3 mm and 9.7 mm, while the mean diameter for 210 sera from healthy persons was 6.2 mm. The results for 115 sera from previously treated patients were generally intermediate between these two levels.Duplicate IgM estimations made in the laboratory on dried blood samples collected on filter-paper in the field gave agreement with the serum IgM test in 96% of the cases. The greater simplicity of the filter-paper method might make it suitable for wide-scale IgM estimations.