Microscopic laminotomies for degenerative lumbar spinal stenosis.

In this retrospective study, we investigated 50 patients who had undergone primary lumbar microsurgical multiple laminotomy without spinal fusion for degenerative spinal stenosis. There were 31 men and 19 women with a median age of 66 years (35-85 years). Thirteen patients had grade I spondylolisthesis, most at L4-L5 levels (11 of 13). Single-level laminotomy was done in 13 patients, two levels in 30, and three levels in 7. The median follow-up period was 27 months (range, 15-48 months). A standardized self-reported questionnaire was used for clinical outcome study. The demographic data and clinical features of these patients were analyzed for the prognostic factors. The analysis showed excellent results in 18 patients, good in 16, fair in 8, and poor in 8, whereas 30 patients reported that they were very satisfied with the surgery results, 10 were somewhat satisfied, 2 were somewhat dissatisfied, and 8 were very dissatisfied. Therefore, the satisfactory rate of the surgery was higher if judged by patient satisfaction. Among the parameters analyzed, the presence of neurogenic claudication (p = 0.008), coexisting disease (p = 0.04), and the absence of motor deficit (p = 0.03) were associated with lower total scores. In addition, longer duration of symptoms (p = 0.04) was associated with less improvement of back pain score, whereas the absence of motor deficit (p = 0.004) was associated with less improvement of leg pain score. The presence of spondylolisthesis did not affect outcomes.

An ultrastructural study of the exoerythrocytic schizonts of Plasmodium cynomolgi and P. knowlesi in Macaca mulatta.

Exoerythrocytic schizonts of Plasmodium cynomolgi and P. knowlesi were examined by electron microscopy in biopsy samples of primate livers. With maturity the parasitophorous vacuole membrane becomes highly sculptured by the addition of a discontinuous dense thickening, the distribution of which can be a distinguishing character between these two species. The parasitophorous vacuole membrane follows the contours of the parasite faithfully with a minimal surrounding vacuole. The marked destruction of the cytoplasm of the host hepatocyte by most of the parasites studied however gave the distinct, but erroneous, appearance of a large parasitophorous vacuole at the light microscope level. The mature parasite often exhibited a highly invaginated surface contour with the result that the cytoplasm of the host cell and parasite became intimately interdigitated, this interweaving is unlikely to be recognized in light microscopic studies.

Clinical experience with a continuous monitor of intracranial compliance.

Intracranial compliance, as estimated from a computerized frequency analysis of the intracranial pressure (ICP) waveform, was continuously monitored during the acute postinjury phase in 55 head-injured patients. In previous studies, the high-frequency centroid (HFC), which was defined as the power-weighted average frequency within the 4- to 15-Hz band of the ICP power density spectrum, was found to inversely correlate with the pressure-volume index (PVI). An HFC of 6.5 to 7.0 Hz was normal, while an increase in the HFC to 9.0 Hz coincided with a reduction in the PVI to 13 ml and indicated exhaustion of intracranial volume-buffering capacity. The mean HFC for individual patients in the present study ranged from 6.8 to 9.0 Hz, and the length of time that the HFC was greater than 9.0 Hz ranged from 0 to 104.8 hours. The mortality rate increased concomitantly with the mean HFC, from 7% when the mean HFC was less than 7.5 Hz to 46% when the mean HFC was 8.5 Hz or greater. The length of time that the HFC was 9.0 Hz or greater was also associated with an increased mortality rate, which ranged from 16% if the HFC was never above 9.0 Hz to 60% if the HFC was 9.0 Hz or greater for more than 12 hours. In 12 patients who developed uncontrollable intracranial hypertension or clinical signs of tentorial herniation during the monitoring period, 75% were observed to have had an increase in the HFC to 9.0 Hz or more 1 to 36 hours prior to the clinical decompensation. The more rapid the increase in the HFC, the more likely the deterioration was to be caused by an intracranial hematoma. Continuous monitoring of intracranial compliance by computerized analysis of the ICP waveform may provide an earlier warning of neurological decompensation than ICP per se and, unlike PVI, does not require volumetric manipulation of intracranial volume.

Observations on early and late post-sporozoite tissue stages in primate malaria. V. The effect of pyrimethamine and proguanil upon tissue hypnozoites and schizonts of Plasmodium cynomolgi bastianellii.

Two rhesus monkeys were each infected with 2.1 x 10(6) sporozoites of Plasmodium cynomolgi bastianellii; one was treated with 1.0 mg of pyrimethamine base per kg body weight for 5 d after sporozoite inoculation. A further 2 monkeys were each infected with 9.75 x 10(6) sporozoites of the same parasite; one was treated with 10 mg of proguanil per kg body weight for 4 out of 5 d after inoculation. The treated monkeys showed a delayed primary parasitaemia and relapses. In sections of liver biopsies taken 7.5 d after sporozoite inoculation, all monkeys showed numerous hypnozoites. However, there were no full grown schizonts and only rare retarded schizonts in the treated monkeys, in contrast to the untreated monkeys which had many mature or nearly mature schizonts. Later biopsies confirmed the continued presence of hypnozoites in all monkeys.

Note on the history of cutaneous leishmaniasis in the Mediterranean and Middle East area.

There exist records of what seems to be cutaneous leishmaniasis at least as far back as 650 BC, and possibly much earlier in the Tigris/Euphrates basin. It was described by Avicenna in the 10th century AD, and was well-known in Aleppo and Baghdad by the 18th century AD. Cutaneous leishmaniasis due to Leishmania infantum may have occurred in Crete in the 18th century. Artificial transmission was effected in Algeria and Aleppo in the 18th century.

Management of neurosurgical problems in pregnancy.

The effects of pregnancy on neurosurgical disease are complex and require a detailed knowledge of physiology, anatomy, and pharmacology. The following article details the pathophysiology and treatment of the more common disorders of the nervous system seen during pregnancy.

The correlation between delayed hypersensitivity, lymphocyte activation and protective immunity in experimental murine leishmaniasis.

The growth of Leishmania major and Leishmania mexicana lesions and the concomitant development of delayed-type hypersensitivity (DTH) to homologous or heterologous soluble antigen was studied in BALB/c and CBA/Ca mice. Although CBA/Ca mice are highly susceptible to L. mexicana, developing non-healing lesions, they are resistant to L. major; while BALB/c mice develop non-healing lesions when infected with either species. The development of resistance was associated with the acquisition of DTH which peaked at 48 h (L. major infected CBA/Ca mice). Non healing lesions were associated with either negative DTH (L. major infected BALB/c mice) or DTH that peaked at 24 h but had significantly subsided by 48 h (L. mexicana infected CBA/Ca and BALB/c mice). The latter response was associated with basophilic infiltration of the skin test site. Pre-irradiating (600 rad) CBA/Ca and BALB/c mice induced resistance against L. mexicana and L. major respectively in conjunction with the appearance of 48 h DTH to the homologous antigen. There was clear dissociation in the skin reactivity produced by the heterologous antigen. Thus L. major-derived antigen failed to produce DTH in L. mexicana infected mice of either strain. L. mexicana-derived antigen on the other hand produced a quicker response and of greater magnitude than the homologous antigen in L. major infected CBA/Ca mice. This correlated well with the strong cross-immunity induced by L. major in these mice to L. mexicana infection.

[In vitro cultivation of Plasmodium cynomolgi bastianelli in hepatocytes of the Macaca rhesus]. / Obtention in vitro de schizontes de Plasmodium cynomolgi bastianelli dans des hépatocytes de Macaca rhesus.

Primary cultures of Rhesus monkey were infected with sporozoites of P. c. bastianelli. Despite a high level of contamination, two schizonts were seen at days 6 and 11.

Observations on early and late post-sporozoite tissue stages in primate malaria. IV. Pre-erythrocytic schizonts and/or hypnozoites of Chesson and North Korean strains of Plasmodium vivax in the chimpanzee.

In a continuing reexamination of plasmodial tissue stages within the context of the hypnozoite theory of malarial relapse, 2 strains of Plasmodium vivax with distinct and disparate relapse characteristics in humans were studied in chimpanzees. Following intravenous inoculation of massive numbers of salivary gland sporozoites, both the frequently relapsing Chesson strain and a North Korean strain characterized by predominantly delayed relapses exhibited relapse patterns and antimalarial sensitivity in the splenectomized chimpanzee essentially indistinguishable from those seen in humans. Examination of hepatic biopsies obtained at 7 and 10 days after infection revealed both pre-erythrocytic (pre-e) schizonts and hypnozoites in tissue obtained from the animal infected with the Chesson strain, but only rare hypnozoites (no pre-e schizonts) at 7 days in the animal infected with the North Korean strain. These findings, combined with the comparability of relapse behavior--which indicates the suitability of the chimpanzee as a model for the natural (human) host-parasite relationship--are essentially as predicted by the hypnozoite theory, despite the small numbers of tissue forms seen. Pre-erythrocytic schizogony of the Chesson strain in the liver was essentially indistinguishable from that of other strains studied, also underlining the suitability of this model system for tissue stage studies of P. vivax.

Zoonotic cutaneous leishmaniasis in Saudi Arabia: the incrimination of Phlebotomus papatasi as the vector in the Al-Hassa oasis.

Surveys of the phlebotomine fauna in a focus of zoonotic cutaneous leishmaniasis (ZCL) in the Al-Hassa oasis, Eastern Province, Saudi Arabia, revealed only one species of Phlebotomus (P. papatasi) and three of Sergentomyia (S. antennata, S. clydei and S. fallax). 11 specimens of P. papatasi from six sites in the oasis were found with promastigotes in the midgut. An isolate from one of the sandflies was typed by the examination of isoenzymes and identified as Leishmania major, zymodeme LON-4 (= Montpellier zymodeme 26), the principal zymodeme of L. major isolated from patients with ZCL in the oasis. Three isolates from leishmanial lesions at sites of the bites of wild caught specimens of P. papatasi were also identified as the same zymodeme of L. major as the isolate from the sandfly. The findings show that P. papatasi is the vector of ZCL in the Al-Hassa oasis and probably in other ecologically similar foci in the Kingdom.

Observations on early and late post-sporozoite tissue stages in primate malaria. III. Further attempts to find early forms and to correlate hypnozoites with growing exo-erythrocytic schizonts and parasitaemic relapses in Plasmodium cynomolgi bastianellii infections.

Rhesus monkeys were heavily infected with sporozoites of Plasmodium cynomolgi bastianellii in an attempt to demonstrate the site of invasion of sporozoites into tissue cells and their growth there. Further attempts were made to correlate the appearance and loss of hypnozoites with parasitaemic relapses. Hypnozoites were demonstrated and once again shown to decrease in numbers over 229 days during which time the infection showed parasitaemic relapses. Liver biopsies taken at two-day intervals for 12 days showed that hypnozoites decreased in numbers over-all and growing schizonts were demonstrated in the liver. At this time a parasite the size of a hypnozoite was seen with two nuclei and another was seen with an elongate, possibly dividing nucleus in one monkey. an attempt to find the location of the early intracellular exoerythrocytic forms in the liver at various times less than 40 hours after infection using smears and immunological staining with newly prepared anti-sera failed. Large numbers of sporozoites of P. knowlesi were also injected into a rhesus monkey the liver of which on the fifth day after infection showed no hypnozoites among 157 sections of growing schizonts and no parasites at all on the 42nd day after infection. In P. cynomolgi bastianellii infections parasites, mostly hypnozoites, were found in the liver up to 229 days after infection.

Ecology of leishmaniasis in the south of France. 19. Determination of the hosts of Phlebotomus ariasi Tonnoir, 1921 in the Cévennes by bloodmeal analyses.

Engorged sandflies were collected using 58 CDC light traps set up nightly for 5 weeks at 12 stations in the commune of Roquedur, Gard, France, in the Cévennes focus of leishmaniasis. Of 782 engorged females, 593 were Phlebotomus ariasi, 3 were P. mascittii and 186 were not identified. Using the precipitin ring test and counter-current immuno-electrophoresis, the bloodmeals were tested with antisera to man, leporids, rodents, canids, mustelids, equids, suids, bovids, birds, lizards and amphibia. Of 530 identified bloodmeals, 2 were avian blood, 26 were mixed meals of mammalian blood and 25 were meals taken from unidentified mammals. Of the 477 other sandflies, 211 (44.2%) had fed on canids, 107 (22.4%) on man, 70 (14.7%) on bovids (presumed to be cattle at one station and goats elsewhere), 33 (6.9%) on leporids (probably mostly domesticated rabbits), 26 (5.5%) on mustelids (probably badgers), 17 (3.6%) on horses and 13 (2.7%) on rodents (probably brown rat). The proportions of feeds on different mammals varied according to their availability at each station. When both man and dog were equally available, the dog was preferred. The finding that, away from human habitation, P. ariasi commonly feeds on mustelids suggests the need for a reappraisal of animals of this family as possible reservoirs of leishmaniasis in the Cévennes.

Leishmania mexicana mexicana: attachment and uptake of promastigotes to and by macrophages in vitro.

Promastigotes of Leishmania mexicana mexicana attach to mouse macrophages in vitro in the absence of serum by a wheat germ agglutinin-like ligand on the surface of the promastigote that binds to the N-acetyl glucosamine moiety of a receptor on the surface of the macrophage. The binding is temperature dependent, and the macrophage receptor is trypsin, cytochalasin B, and is assisted or inhibited as for attachment. Treatment of promastigotes with proteolytic enzymes uncovers a receptor for a serum component that binds strongly to a mouse macrophage receptor in vitro. The strain of mice donating the macrophages had little effect upon attachment and uptake except that A strain mouse macrophages attached fewer promastigotes in 10 min than those of outbred mice, but took up as many promastigotes over 90 min as those of outbred mice. Low responder Biozzi mouse macrophages took up more promastigotes than high responder Biozzi mouse macrophages. Normal unheated human, rabbit, and guinea pig sera lysed promastigotes and so inhibited their attachment to macrophages in vitro. Unheated immune serum showed an enhanced inhibition of attachment. Heated normal serum allowed attachment and uptake, while promastigotes treated with heated immune serum showed enhanced attachment to and uptake by macrophages. Treatment of macrophages in vitro with immune serum enhanced their ability to attach promastigotes and to engulf them. Repeated 90-min exposures of a population of promastigotes to uptake by mouse macrophages in vitro did not deplete the population of any sub-population more likely to be taken by macrophages.(ABSTRACT TRUNCATED AT 250 WORDS)

Leishmania: chemotaxic responses of promastigotes and macrophages in vitro.

Promastigotes of Leishmania move progressively up a concentration gradient of: various sugars, specific sugars attracting individual species of Leishmania; serum albumin and another unidentified constituent of serum; hemoglobin; and a factor generated by promastigotes in NNN medium. The movement of promastigotes up a concentration gradient of serum is optimal at a pH of 6.4 to 6.8 and a temperature of 28 degrees C and above. Cholinergic and adrenergic agents did not affect the attraction of serum for promastigotes, and cyclic nucleotides, inflammatory mediators, and macrophage products were not chemotaxic. It is postulated that the sugar chemotaxins influence the movement of promastigotes from the sand fly midgut to the esophagus, and serum chemotaxins may play a part in the entry of promastigotes into the skin of a mammal from the proboscis. Macrophages, the host cell of the obligate intracellular Leishmania species, were not attracted to any product of promastigotes. When, however, promastigotes interact with serum, complement is activated to form C5a which is chemotaxic for macrophages. Activation of complement by promastigotes is, at least partially, by the alternate pathway. Other chemotaxins resulting from promastigote interaction with serum may also be present. Promastigotes may also produce inhibitors of C5a activity.

The effect of parasitization by Leishmania mexicana mexicana on macrophage function in vitro.

Macrophages infected with amastigotes of Leishmania mexicana mexicana as compared to normal macrophages show decreased migration both randomly and through a 5 microns pore in response to a known chemotaxin, an increased ability to pinocytose and an increased bactericidal ability. Unless very heavily parasitized their ability to phagocytose is unaltered. Parasitized macrophages are unaltered in their ability to secrete extracellularly lysosomal enzymes, prostaglandins and lysozyme in response to known stimuli, or to kill target cells in an antibody dependent cell mediated cytotoxicity assay.