We have used electron microscopy to examine purified intact variable surface glycoproteins (VSGs) from clones derived from two distinct stocks of Trypanosoma brucei. The VSG molecule from MITat 1.2 has a large elongated domain consistent with the shape of the dimeric N-terminal domain determined by X-ray analysis (see preceding paper), and a heretofore unseen short, thin fibrous tail presumed to be the C-terminal domain. Electron microscopy on DiTat 1.3, however, indicates a morphology quite distinct from that of MITat 1.2. Analysis of four VSG amino acid sequences reveals 7-fold periodicities (heptad repeats) which indicate that alpha-helical coiled-coil secondary structure elements occur in all of these VSGs, consistent with the observation of helical bundles in one VSG. These results suggest the possibility that VSG antigenic diversity may be related to a diversity in length and disposition of alpha-helical bundles and coiled-coil domains.

Animals↗

PubMedDate not supplied

[Therapy of osteoid osteomas -- always surgically?].

Osteoidosteomas are common bone tumours in childhood. Frequently they occur in the long bones of the lower extremities, less frequent in the humeri, phalanxes or the axial skeleton. The tumour is benign and noninfiltrative. Metastases do not occur. Typical complaints are nightly pain attacks, which are relieved by nonsteroidal antiinflammatory drugs. On X-ray, the classic finding is a small radiolucent area surrounded by sclerotic bone in the cortex. Surgical excision is often recommended, providing the possibility for a histological diagnosis. Therapeutic alternatives are percutaneous coagulation of the nidus by alcohol or laser, thermo-coagulation or high-frequency radioablation. Spontaneous remissions are well documented. Therefore the decision to wait and see and to treat with antiinflammatory medication is a considerable therapeutic option. We present two patient with an ostoidosteoma in the proximal femur. One of them underwent an unsuccessful trial for surgical extirpation and histological examination but afterwards developed a severe hip contraction with scoliosis. In the case of the other patient a primary operation was abandoned. Pain was completely controlled upon treatment with nonsteroidal antiinflammatory drugs in both patients. The contractions also disappeared completely upon physiotherapy. Serial MRI showed a significant regression of the inflammatory reaction in one case and the disappearance of the tumour in the other one. In conclusion, pharmacomedical therapy can be recommended, if the diagnosis is doubtlessly and a close follow up is established. The risk of anaesthesia and surgical treatment should be weighted against the risk of nonsteroidal antiinflammatory drug treatment.

Anti-Inflammatory Agents, Non-Steroidal↗

PubMedDate not supplied

The concept of the GPOH-HD 2003 therapy study for pediatric Hodgkin's disease: evolution in the tradition of the DAL/GPOH studies.

Today it is possible to cure more than 90 % of children and adolescents with Hodgkin's disease with a combination of radiotherapy and chemotherapy. Since the DAL-HD 82 study, the main scientific focus has been on avoiding late effects such as the OPSI syndrome, late complications involving the heart, lungs, thyroid and/or gonads particularly sterility in men and premature onset of menopause in women, and the prevention of secondary malignancies. The GPOH-HD 2003 study will introduce FDG-PET to the initial diagnostic program and the assessment of response to therapy in order to evaluate further possibilities for reducing therapy. In this context, the central review of all clinical and radiological findings, systematically done since the DAL-HD 90 study, will be increasingly relevant in maintaining standardised stage classification and therapy group assignment which was established by the preceding studies. Continuing in the direction of the earlier studies, the indications for radiotherapy will be restricted even further. In the early stages (treatment group 1) patients with CR or a negative FDG-PET at the end of chemotherapy will receive no radiotherapy in order to reduce the risk of a secondary malignancy. In a randomized comparison, procarbazine will be replaced by dacarbazine in the COPP cycles to determine whether sterility in men and premature onset of menopause in women can be avoided by elimination of procarbazine while retaining the same clinical efficacy. Finally, relapse therapy is to be tailored according to the time of relapse, the initial therapy group, and the patient's response to the relapse therapy with more patients receiving autologous transplantation in order to further improve the results of relapse treatment.

Antineoplastic Combined Chemotherapy Protocols↗

PubMedDate not supplied

[Rare case of an epidemiologically important tuberculosis in childhood].

BACKGROUND: Tuberculosis is an infectious disease which is nearly forgotten in Germany because of its low incidence. CASE REPORT: We report on a 14-year-old german girl who was disregarded when active case-finding of her uncle's active pulmonary tuberculosis was carried out three years before. As a result she herself developed a severe infectious pulmonary tuberculosis. The delay between onset of symptoms and diagnosis gives cause for concern and led to active tuberculosis in her brother and her girl friend as well. The lack of information about tuberculosis in population and delay of medical detection in this case led unnecessarily to the continuing chain of infection. CONCLUSIONS: This case report shows that there are severe infectious courses of tuberculosis even in childhood which might get epidemiologically important. For earlier diagnosis and successful interruption of chains of infection tuberculosis in the German population even today has to be taken into account. Case detection through contact investigation of adults is of great importance in childhood and adolescence.

Adolescent↗

PubMedDate not supplied

[Color coded Doppler ultrasound in diagnosis of gastroesophageal reflux].

We report the possibility to detect small gastro-oesophageal refluxes by means of colour coded Doppler(CD)ultrasonography. The choice of an adequate pulse repetition frequency, which coded velocities up to 30 cm/s into colour without aliasing phenomenon, is an important premise for a colour coded proof of reflux. The sensitivity has been increased from 87% to 94% in sonographically detection of reflux, if the results are compared with the pH metry, measured about 24 hours. It is shown by comparison of the three methods (B-mode-, CD-ultrasonography and 24 hours pH-monitoring), that there are in each case equal false negative and false positive results. So the over all agreement was just 83% of all three methods. In our opinion it should be performed an additional ultrasonography in completion to the customary pH metry, which can detect even short term and pH neutral refluxes. If it is used supplementary, the colour coded Doppler ultrasonography improves the diagnostic sensitivity especially in trifle refluxes.

Child↗