Spatial risk assessment for Lyme borreliosis in Denmark

A study of nymphal and adult Ixodes ricinus density was performed in well-defined spruce and beech forest habitats with different levels of roe deer abundance and soil water capacity. In 35 habitats, a total of 489 larvae, 1,611 nymphs and 193 adult I. ricinus ticks were collected. Tick density was found to be influenced by roe deer abundance and soil water capacity. Based on this evaluation, a model predicting increasing number of ticks with increasing roe deer abundance and soil water capacity was suggested. A total of 1,045 nymphs and 106 adult ticks were tested for infection with Borrelia burgdorferi sensu lato Of these, 53 nymphs and 6 adults were found to be infected, leading to an general infection rate of 5% and 6% for nymphs and adults, respectively. Prevalences of Borrelia burgdorferi sensu lato in nymphal I. ricinus were found to be independent of roe deer abundance and soil water capacity. The correlation between human neuroborreliosis incidence and the estimated number of I. ricinus based on roe deer abundance and soil water capacity was examined. Differences in human neuroborreliosis incidence were found to correspond with the expected spatial differences in tick density in 12 counties in Denmark.

Temporal risk assessment for Lyme borreliosis in Denmark

The prevalence of Borrelia burgdorferi sensu lato in Ixodes ricinus nymphs in Denmark was found to be approximately 5%. The mean abundance of infected nymphs varied from 0.3 to 4.4 per 100 m2 according to site. The seasonal occurrence of infected nymphs in a beech forest coincided with seasonal distribution of neuroborreliosis cases. In order to establish a working hypothesis, it was assumed that the availability of habitats and human habitat preferences is one of the factors leading to low number of neuroborreliosis cases in the spring. In addition, this paper gives a description of the neuroborreliosis cases in Denmark in the period 1985-97 and offers a possible explanation for the variation in cases. The explanation is based on an assessment of tick density, which by comparison with the number of neuroborreliosis cases provides information on the infectivity of ticks. The model suggests that high temperatures and low precipitation in the autumn is essential for the transmission of B. burgdorferi sensu lato to reservoir hosts or development of B. burgdorferi sensu lato within ticks, which secures high tick infectivity in the following season.

Differentiation of cuticular structures during the growth of the third-stage larva of Ascaris suum (Nematoda, Ascaridoidea) after emerging from the egg

In order to monitor the early phases of the development of Ascaris suum from domestic pigs, third-stage larvae, retrieved from the liver and the lungs, were studied by analyzing worm growth and length increase of individual transverse annuli in the cuticle. Material for study using light and scanning electron microscopy was obtained from experimental infections. The results show that the third-stage larva (not the second-stage) after emergence from the egg grows continuously, without an ecdysis in the liver. During growth, each annulus is split into a complex of 2 subannuli, each of which attains a bimodal appearance and is a prominent feature during a late phase of the third-stage larva. The results suggest that the first 2 molts occur inside the egg, a synapomorphic feature of the Ascaridoidea. The third-stage larvae of ascaridoids, with some functional similarities of the dauer-larva stage of Caenorhabditis sp., facilitate transmission of these parasitic worms to the digestive tract of the vertebrate final host (utilizing the tracheal route in A. suum), where the third and the fourth molts take place.

Prevalence of gastrointestinal helminths in different poultry production systems

A cross-sectional prevalence study of gastrointestinal helminths in Danish poultry production systems was conducted on 268 adult chickens selected at random from 16 farms in Denmark from October 1994 to October 1995. The trachea and the gastrointestinal tract of each bird was examined for the presence of helminths. In the free-range/organic systems the following helminths were found: Ascaridia galli (63.8%), Heterakis gallinarum (72.5%), Capillaria obsignata (53.6%), Capillaria anatis (31.9%) and Capillaria caudinflata (1.5%). In the deep-litter systems: A. galli (41.9%), H. gallinarum (19.4%) and C. obsignata (51.6%). In the battery cages: A. galli (5%) and Raillietina cesticillus or Choanotaenia infundibulum (3.3%). Exact identification of the cestodes was not possible because of missing scolexices. In the broiler/parent system: C. obsignata (1.6%), and finally for the backyard system: A. galli (37.5%) H. gallinarum (68.8%), C. obsignata (50.0%), C. anatis (56.3%) and C. caudinflata (6.3%). The results confirm the higher risk of helminth infections in free-range and backyard systems but prevalence may also be high in deep litter systems.

Centrids, a pair of asymmetrically arranged sense organs in Ascaris suum (Nematoda, Ascaridoidea)

Two prominent, asymmetrically placed cuticular somatic sensilla, called centrids, are reported in Ascaris suum Goeze, 1782, the pig roundworm. The right centrid is situated much more anteriorly on the body than is the left one. The centrids are globular in the fourth-stage larva and obviously void of an apical pore, suggesting at least a tactile function. In adult worms, the centrids are platelike, lacking a globular expansion. The observation on the presence of asymmetrically placed centrids in A. suum gives further impetus to the importance assigned to sense organs in the classification and identification of nematodes. The name centrid was originally chosen to indicate the placement of the papillae in the midbody region of worms. The name centrid, rather than, e.g. postdeirid, is proposed to be used when denoting asymmetrically oriented midbody sensilla among the Ascaridida and papillae, when shown homologous to these, of species within the Rhabditea generally. This proposal is in line with the name "Mittelkörperpapillen" originally adopted to denote homologous sensillae in Cucullanidae (Seuratoidea) by Törnquist in 1931.

Ascaridia galli infections in free-range layers fed on diets with different protein contents

1. One hundred and twenty 17-week-old Lohman Brown hens were divided into 4 groups. Groups 1 and 3 were given a diet with 180 g protein/kg and groups 2 and 4 were given a diet with 140 g protein/kg. Groups 1 and 2 were orally infected with 500 (+/- 50) embryonated Ascaridia galli eggs. 2. Marked differences in mean weekly weight gain for the 4 groups were observed. 3. Hens given 140 g protein/kg had a significant lower mean worm burden of adult A. galli worms and a significant lower weight gain compared to the group given 18 g protein/kg. 4. There was no significant difference in faecal egg counts between the 2 parasitised groups. 5. The egg production did not differ significantly between any of the groups. 6. The results of this study indicate that the amount of dietary protein in the diet has an effect on the establishment of A. galli infections in the gut of layers kept under free range conditions.

Growth and structural features of the adult stage of Ascaris suum (Nematoda, Ascaridoidea) from experimentally infected domestic pigs

For studying the morphogenesis of the adult stage of Ascaris suum, worms were obtained from experimentally infected domestic pigs. Structural and morphometric features of A. suum are analyzed by light and scanning electron microscopy. It was shown that the increase in length of the worm from days 35 to 56 is based on a region-specific lengthening of individual transverse annuli in the cuticle. An increased worm size also results in an increased diameter of different cuticular sense organs. It is shown that a pair of lateral midbody papillae, the centrids, are prominent sensilla in the adult male and female worm. The centrids have an asymmetric placement, the right centrid being more anterior on the worm than the left.

Ixodes ricinus strains in Europe

An analysis of cuticular hydrocarbons (CH) of unfed adult Ixodes ricinus ticks collected throughout Europe showed that there are 10 distinct I. ricinus groups. Studies on the seasonal and annual consistency of CH composition and possible effects of host and environmental factors suggested that CHs may be used as a genuine genetic marker for I. ricinus. Preliminary studies compared the vector competence of ticks from three of the most separated I. ricinus groups and the results suggested that there may be significant differences in tick susceptibility to Borrelia afzelii.

European reservoir hosts of Borrelia burgdorferi sensu lato

Existing knowledge on reservoir hosts of Borrelia burgdorferi sensu lato was collated and reviewed and several species, particularly birds, were identified as reservoir competent. At the present time, 9 small mammals, 7 medium-sized mammals and 16 bird species, including passerines, sea birds and pheasants, appear to be capable of transmitting spirochaetes to ticks and thus of participating in the natural circulation of B. burgdorferi s.l. in Europe. The house mouse, Mus musculus is strongly suspected of reservoir competence and many other small rodent species, particularly in eastern Europe and Russia, have been implicated. Ungulates are not thought to play a major role as reservoir hosts, though co-feeding transmission may permit some tick infection. The criteria for establishment of reservoir status are outlined and a method for identification of host blood meals of previous instars of unfed ticks, developed in a participant laboratory, is briefly described.

A cross-sectional study of helminths in rural scavenging poultry in Tanzania in relation to season and climate

A cross-sectional study on the prevalence of helminths in rural scavenging poultry on six hundred adult chickens selected randomly from six villages in the Morogoro Region, Tanzania during the wet and the dry seasons, was conducted. The trachea and gastrointestinal tract of each bird were examined for the presence of parasites. All chickens were infected with one or several species of helminths, the average being 4.8 +/- 1.7 helminths per chicken during the wet season and 5.1 +/- 1.8 during the dry season. A total of 29 different helminth species were shown in the trachea or the gastrointestinal tract. The following species were identified: Syngamus trachea (0.7% (wet season), 2% (dry season)); Gongylonema ingluvicola (6.3%, 17.7%); Tetrameres americana (54.3%, 60.3%); Dispharynx nasuta (0%, 2.7%); Acuaria hamulosa (8.3%, 19.3%); Ascaridia galli (28.3%, 32.3%); Heterakis gallinarum (74.0%, 78.7%); H. isolonche (18.7%, 5.0%); H. dispar (25.7%, 6.3%); Allodapa suctoria (40.0%, 52.0%); Subulura strongylina (3.3%, 1.0%); Strongyloides avium (0.3%, 3.0%); Capillaria annulata (2.0%, 0.0%); C. contorta (9.0%, 1.0%); C. caudinflata (2.0%, 4.3%); C. obsignata (8.7%, 25.0%); C. anatis (4.0%, 9.0%); C. bursata (1.0%, 2.7%); Raillietina echinobothrida (41.3%, 46.3%); R. tetragona (25.3%, 21. 3%); R. cesticillus (8.7%, 2.7%); Choanotaenia infundibulum (0.0%, 3. 7%); Hymenolepis carioca (9.0%, 18.0%); H. cantaniana (48.0%, 43. 0%); Amoebotaenia cuneata (39.3%, 36.0%); Metroliasthes lucida (1.0%, 0.3%); Davainea proglottina (5.7%, 0.3%) and Polymorphus boschadis (0.3%, 0.0%). No trematodes were found. No correlation was found between season and prevalence, or season and mean worm burdens. Twelve helminths of the species recovered represent new local records.

Ascaridia galli populations in chickens following single infections with different dose levels

In all, 3 groups of 20 Lohman Brown chickens aged 1 day were orally infected with doses of 100, 500, or 2,500 embryonated Ascaridia galli eggs, respectively. After 8 weeks, egg counts (eggs per gram of feces, EPG) were determined for all animals prior to slaughter. The gastrointestinal tracts were examined for the presence of adult and immature stages of A. galli. All groups had roughly similar worm burdens and, hence, significantly different establishment rates of 14.2%, 2.9%, and 0.5%, respectively. A significantly lower mean female worm burden was seen in the high-dose group (P = 0.02), which also showed a significantly lower level of egg excretion (P = 0.01). However, fecundity (EPG per female) did not significantly differ between the groups (P = 0.55). The mean lengths of adult worms as well as the weight of the mean worm burdens were significantly smaller in the high-dose group. This study demonstrated that single infections with varying doses of A. galli eggs influenced the establishment rate, sex ratio, egg excretion, and worm size and weight but not the worm fecundity.

Ultrastructure and development of the body cuticle of Oesophagostomum dentatum (Strongylida, Nematoda)

The ultrastructure, development, and morphogenesis of the body cuticle of adult and juvenile Oesophagostomum dentatum (Strongylida, Nematoda) were investigated by light microscopy, scanning electron microscopy, and transmission electron microscopy. The cuticle of the first 3 juvenile stages consists of a trilaminate epicuticle, an amorphous layer, and a radially striated layer. In the last juvenile stage and the adult worm, the radially striated layer is replaced by a fibrous layer with 3 sublayers of giant fibers and a basal amorphous layer. The new forming cuticle of the 3rd juvenile stage exhibits the epicuticle and amorphous material and, at a later time, the epicuticle and the radially striated layer; finally, amorphous material appears between these layers. Our finding of a structural change in the cuticular morphology between the 3rd and 4th juvenile stage harmonizes with earlier reports about the Strongylida. Such a change occurs at different ontogenetic stages or seems to be missing in other nematodes. Morphogenetic events such as the formation of the radial striation layer from amorphous precursor material agrees with previous observations on strongylids.

Prevalence of antibodies to Borrelia burgdorferi in Danish rodents

Six rodent species from six Danish localities were examined for antibodies to Borrelia burgdorferi by immunofluorescence assay (IFA). A total of 1097 specimens were tested using a serum titre of 1:8. The wild mice Apodemus sylvaticus and A. flavicollis had high prevalences of B. burgdorferi antibodies of 42.1% and 27.9% respectively, but the vole Microtus agrestis also showed an exceptionally high prevalence of 32.7%. Clethrionomys glareolus had a low average prevalence of 17.4%. The lowest and highest prevalences of rodents seropositive for B. burgdorferi of 6.5% and 100% were found for Micromys minutus and Mus musculus respectively. Twice as many of the Microtidae voles (M. agrestis and C. glareolus) as of the family Muridae were caught, and in Denmark the actual number of seropositive Microtidae was 1.6 times higher than for Muridae. The results indicate that in Denmark the family Microtidae species plays an important role as an animal reservoir host for B. burgdorferi. The prevalence of antibodies against B. burgdorferi varied from locality to locality, but seropositive rodents were found at all localities examined, indicating that the spirochete was widely present in Denmark.

Entomopathogenic fungi associated with Ixodes ricinus ticks

The objective of this study was to demonstrate the occurrence of entomopathogenic fungi on Ixodes ricinus ticks in relation to the tick stage, engorgement and season. Ticks were collected from the vegetation, from small rodents and from deer. All entomopathogenic fungi found belonged to the Hyphomycetes. Paecilomyces farinosus and Verticillium lecanii were the predominant species. Other species, found only on engorged females were: Beauveria bassiana, B. brongniartii, P. fumosoroseus and V. aranearum. Eight out of 1833 ticks collected from the vegetation and three out of 269 engorged nymphs were infected with fungi. Thirty-three out of 149 engorged females were infected, whereas males and engorged larvae were not infected. Throughout the season, a significantly higher proportion of ticks collected in autumn were infected. Entomopathogenic fungi may have a significant impact on the size of the I. ricinus population, since females were the most frequently infected stage.

Prevalence of antibodies to Borrelia burgdorferi in Danish deer

To estimate the prevalence of antibodies to Borrelia burgdorferi in the most common species of Danish deer, blood samples were collected from roe deer (Capreolus capreolus), fallow deer (Dama dama), and red deer (Cervus elaphus). A total of 156 blood samples were collected primarily from hunts in three areas of Denmark from November 1990 to December 1991. Presence of deer IgG antibodies to the Borrelia burgdorferi strain DK ECM 1 were shown by an indirect immunofluorescence assay at serum titre 1:64. Antibodies to spirochaetes were detected in 52% of roe deer, 38% of fallow deer, and 27% of red deer. There were significant differences between the number of seropositive animals in the three areas of Denmark examined, but no differences could be shown for age, sex or season. The high antibody prevalence indicates that deer are exposed to tick-borne Borrelia burgdorferi throughout Denmark.

The common frog (Rana temporaria) as a potential paratenic and intermediate host for Angiostrongylus vasorum

Common frogs (Rana temporaria) were exposed either to third-stage larvae (L3) or to first-stage larvae (L1) of Angiostrongylus vasorum. Following exposure to L3, viable larvae could be detected in the frogs for at least 2 weeks. Following exposure to L1, the frogs developed viable L3 in their tissues within 30 days. In a test of the infectivity of these larvae, one fox was fed frogs previously infected with L3 and another fox was fed frogs previously infected with L1. On autopsy it was found that adult A. vasorum populations had been established in both foxes. Thus, it could be concluded that frogs can act not only as paratenic hosts but also as intermediate hosts for A. vasorum.

[Asymptomatic benign mediastinal teratoma]

A case of asymptomatic benign mediastinal teratoma is presented. The necessity for definite diagnosis of mediastinal tumours is stressed together with the need for conferences involving several specialties.

[Cost-benefit analysis of electric stimulation of the spinal cord in the treatment of angina pectoris]

Since August 1988, in Odense Hospital, electric spinal cord stimulation (SCS) has been employed for the treatment of pain in patients with confirmed ischaemic heart disease who suffer from incapacitating angina pectoris despite maximal medical/surgical treatment. The object of the present investigation was to assess not only the social economic consequences of SCS treatment (cost-utility analysis) but also altered quality of life in SCS patients (perception of pain, mobility, function in daily life and physical activity). Sixteen consecutive SCS patients all of whom were resident in the County of Funen and who were submitted to implantation of an SCS system during the period August 1988 to December 1989, participated in this investigation. The results are based on data from the year prior to SCS implantation compared with the subsequent time with SCS treatment. Saving was found at hospital level (reduction in number of admissions) og 40,200 Danish crowns/annum/patient (approximately IJ 3,000) (1989 prices), and for non-hospital related expenses a corresponding saving of 16,289 Danish crowns/annum/patient (approximately IJ 1,600) was found mainly on account of reduction in the amount of home nursing required. The total saving was found to constitute 56,489 Danish crowns/annum/patient (approximately IJ 5,600). In addition, improvements were registered in all respects which constituted assessment of the quality of life of the patients.

Reference values for bicycle exercise tests in patients with various degrees of ischaemic heart disease

This investigation was carried out in an effort to analyze the influence of various degrees of ischaemic heart disease (IHD) on cardiovascular and physical performance. Assessment of the severity of IHD was based on observations obtained routinely during exercise tests (ST segment response and systolic blood pressure response). The study group included 926 subjects with known or suspected IHD, who were referred for an exercise testing; 268 females, mean age 54 years (range 19-89 years), and 658 males, mean age 52 years (range 16-88 years). We found that increasing IHD severity was associated with significant reductions of cardiovascular performance. The mean maximum work-load (MWL) was lower in females than in males, and MWL as well as mean maximum heart rate (MHR) and mean maximum change in systolic blood pressure (M delta SBP) decreased with increasing IHD and age. The present results may be used to assess the cardiovascular response to exercise in patients with IHD so that altered responses due to causes other than IHD may be identified. Furthermore the result may prove useful in the adjustment of rate responsive pacemakers (RRP) in patients with IHD.

[Clinical trial of an ergometry bicycle with automatic blood pressure registration]

Automatic blood-pressure registration on a computerized ergometer cycle was compared with simultaneous manually registered blood-pressure employing a standard mercury sphygmomanometer during performance of maximal ergometer exercise testing on 50 consecutive patients. The difference in blood-pressure registered by the automatic and the manual methods, respectively, was, on an average +0.2 mmHg with a 95% confidence interval of +/- 20 mmHg. By means of linear regression analysis, a correlation coefficient of 0.97 (p less than 0.001) with an uncertainty of approximately 6% with automatic blood-pressure registration was found. Simultaneously, the uncertainty was independent of the degree of work performed. The apparatus was found to be of practical clinical use.

Evaluation of intensified prehospital treatment in out-of-hospital cardiac arrest: survival and cerebral prognosis. The Odense ambulance study

During a period of 3 years three different types of emergency medical service (EMS) systems were evaluated in a city with about 238,000 inhabitants/population density of 570/km2. Included were 393 out-of-hospital cardiac arrest patients in whom prehospital cardiopulmonary resuscitation was provided by personnel on basic, intermediate, or advanced care training. When ordinary ambulances (basic EMS) were used, 8 (5%) patients were discharged alive. When ambulances with specially trained paramedics (intermediate EMS) were used, 2 (1%) patients were discharged. Finally medically staffed ambulances with doctors collaborating (advanced EMS) were used, and 11 (13%) patients were discharged. The intermediate EMS system was used in another area with 45,000 inhabitants/population density of 340/km2, and in this area 20 (18%) patients were discharged. Among the survivors a psychological assessment in form of a test for dementia was assessed in long-term survivors (n = 30) together with 28 patients surviving acute myocardial infarction and 11 control persons. The results of the investigation demonstrate that the more intensive the prehospital treatment of out-of-hospital cardiac arrest, the more patients survive and the more patients survive with good cerebral function. However, the ambulances with specially trained paramedics were only effective in the area with 340 inhabitants/km2.

[Temporary pacemaker treatment in Denmark]

The employment of temporary pacing (TP) in Denmark in 1986 is illustrated by means of a questionnaire investigation. Seventy-four out of 77 Danish hospitals with a medical-cardiological specialist returned usable replies. Facilities for temporary pacing were available in 39 (53%) of the hospitals. The method of pacing most extensively employed was the transvenous method which was used in 33 hospitals while external transcutaneous pacing by Zoll's method was available in 13 hospitals. In transvenous pacing, the subclavian vein was employed routinely in 24 hospitals while a cubital vein was used primarily in eight hospitals. More than 85% of the pacing catheters employed were of disposable type. Only one hospital always employed a permanent pacing lead which could be utilised if permanent pacing should be required. A total of 486 patients with or without acute myocardial infarction (AMI) were submitted to temporary pacing. Employment of temporary pacing in patients with AMI was 0-8.3% (average 3.7%). In general, it was found that hospitals with cardiac laboratory facilities showed the greatest temporary pacing activity. The indications for temporary pacing are assessed on the basis of two case reports. The greatest employment of temporary pacing was found in patients with AMI with third degree atrioventricular block and ventricular escape rhythm (anterior wall 74%, posterior wall 56%). Employment of temporary pacing was least in symptomfree patients with anterior wall AMI and bifascicular block (9%).

Regression of outflow tract obstruction subsequent to treatment with verapamil in hypertrophic obstructive cardiomyopathy

A 29-year-old man suffering from hypertrophic obstructive cardiomyopathy was treated with verapamil 240 mg daily for 4.5 years. During this period the symptoms were reduced, and an intraventricular gradient diminished from 80 to 20 mm Hg, possibly due to a decrease in left ventricular ejection fraction combined with an improved diastolic filling.

Entrapment of a tined pacemaker electrode in the tricuspid valve. A case report

A tined pacemaker electrode was entrapped in the tricuspid valve apparatus. Nonresponding, sustained ventricular tachycardia, and cardiac arrest necessitated forcible removal of the electrode causing partial avulsion of the tricuspid valve. Hemodynamically insignificant tricuspid regurgitation developed subsequently.

[Out-of-hospital heart arrest. Prospective study of various types of expanded prehospital treatment in Odense]

During the period 1.2.1988-31.1.1989, a prospective investigation was undertaken of the intensive prehospital treatment in Odense. Comparison was undertaken between a medically staffed ambulance (2 months), a motorized doctor (rendez-vous, model 4 months) and the heart ambulance (recommended by the Danish National Board of Health (6 months]. Out of 28 patients brought in by the medically staffed ambulance, two (7%) were discharged alive. Out of 57 patients brought in the phase with the motorized doctor nine (16%) were discharged alive. Out of 78 patients brought in by heart ambulance one (1%) was discharged alive. The results of this investigation reveal that the prehospital treatment of cardiac arrest in Odense can be improved by participation of a doctor in the treatment, (particularly the rendezvous model). Suggested improvements consist of 1) improved alarm system, 2) intensification of training laymen in treatment of cardiac arrest and 3) increased information to the population.

[First aid in cases of out-of-hospital heart arrest]

In connection with participation of doctors in the emergency ambulance service in Odense, the number of cases of observed cardiac arrest outside hospital was registered during a period of six months. The object was to assess how often primary treatment for cardiac arrest was instituted by passers-by before arrival of the ambulance. Seventy-four cases of observed cardiac arrest occurred. In 11 of these (15%) primary resuscitation was attempted outside hospital. In only three (4%) cases the primary resuscitation was undertaken by lay persons. Treatment of cardiac arrest before arrival of the ambulance increases survival. It is therefore essential to increase the number of courses in the treatment of cardiac arrest for lay persons, if mortality is to be reduced.

[Klinefelter's syndrome associated with primary mediastinal germinal cell tumor]

A case of a man aged 25 year with Klinefelter's syndrome (KS) associated with a primary malignant germinal cell tumour is presented. Echocardiography was of assistance in the diagnosis as a tumour behind the heart was demonstrated. If patients with KS develop cardiopulmonary symptoms, referral for x-ray of the thorax is recommended. If there is enlargement of the heart or increase in width of the mediastinum, echocardiography should be performed. This case history emphasizes further that a negative cytological test does not disprove malignancy.

[Epididymitis caused by amiodarone]

A case of epididymitis developed in a 33 year old man after treatment with the anti-arrhythmic agent, amiodarone, for approximately 18 months. No signs of bacterial infection or anatomical abnormalities were found. Amiodarone as the cause of epididymitis has only previously been described on a few occasions. We stress the importance of considering this adverse effect of amiodarone therapy as a differential diagnosis in the etiology of epididymitis.

Epididymitis caused by treatment with amiodarone

Epididymitis is described in a man aged 33 who had been treated with the antiarrhythmic agent, amiodarone. No signs of bacterial infection or anatomical abnormalities were found. Amiodarone as the cause of non-infectious epididymitis has been reported. This additional case stresses the importance of considering an adverse effect of amiodarone treatment as a cause when making a differential diagnosis of epididymitis.

[Cardiac arrest outside of hospital. A retrospective study in Odense]

During the period 1.10.1986-30.9.1987, all patients with cardiac arrest outside hospital brought to the casualty department in Odense Hospital were registered. Out of 160 patients, 133 (83%) could be primarily resuscitated, 19 (12%) were resuscitated but died later in hospital and eight patients (5%) were resuscitated and could be discharged alive from hospital. Out of the eight patients who were discharged alive, only two (1%) had retained reasonable cerebral function as assessed by dementia testing. Treatment of the cardiac arrest prior to the arrival of the ambulance, duration of the cardiac arrest for less than six minutes and staffing of the ambulance with three first-aid men were factors of decisive importance for survival of the patients. The results of this investigation demonstrate that treatment of cardiac arrest outside hospital is unsatisfactory. Proposals for improvement of treatment include: 1. Information to the population. 2. Training of first-aid staff in treatment of cardiac arrest. 3. Quicker arrival of ambulances and 4. Better staffing and training of ambulance staff in the use of a defibrillator possibly with participation of a doctor.

The spread of freshwater snails including those of medical and veterinary importance

The present paper discusses the spread of freshwater snails that act as intermediate hosts for various trematodes that cause diseases in man and in cattle. Examples of snail species which have spread across natural barriers are reviewed as well as the mechanisms involved in this transport. Focus is put on the extensive trade in freshwater aquatic plants and aquarium fish, and the need for better control of this trade is emphasized in order to minimize the risk of unintended import of potentially harmful snails.

Seasonal patterns in the transmission of Schistosoma haematobium, S. mattheei and S. mansoni in the highveld region of Zimbabwe

The pattern of fluctuation in the population size of Bulinus globosus and Biomphalaria pfeifferi, in their infection rates with Schistosoma haematobium/S. mattheei and S. mansoni, respectively, and in the cercarial population size as monitored using hamster immersions, was elucidated in streams in the temperate highveld region of Zimbabwe over a 27-month period during 1982-1984. The results revealed that transmission of S. mansoni was erratic and unpredictable without a clearcut seasonal transmission pattern. In contrast, transmission of S. haematobium and S. mattheei exhibited a marked seasonal pattern, being most intensive during the hot, dry season (September-November) and markedly reduced during the cold, dry season (June-August). During the rainy (December-February) and warm, post-rainy (March-May) seasons transmission was moderate and variable, but occasionally intensive. The results also showed that rodent immersion is to be preferred to measurements of snail population size and snail infection rate in elucidating seasonality of transmission of schistosomiasis.

[Morphology of the tegument of Schistosoma intercalatum; comparison of three stocks from Cameroon, Zaire and Gabon]

The study of the teguments of male Schistosoma intercalatum with SEM shows two different morphological types: a) Type Cameroon (Edea) (consistent with the previous studies by Kuntz et al.). b) Type Zaïre (Kisangani) similar to type Gabon (Libreville).

A study of the biological characteristics of a hybrid line between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun)

The viability of a hybrid between male Schistosoma haematobium (Dar es Salaam, Tanzania) and female S. intercalatum (Edea, Cameroun) was studied for up to the F7 hybrid generation and the biological characteristics of the hybrid were compared with those of each of the parental species. Using the total cercarial production/100 exposed snails/5 weeks value (TCP) as an index the hybrid miracidial infectivity to Bulinus forskalii (Kinshasa, Zaire), the host snail for S. intercalatum, remained comparable to that of S. intercalatum for up to at least the F5 generation and the TCP values for the hybrid/B. wrighti combination remained for up to the F7 generation intermediate between those of the parental species in B. wrighti. The hybrid also retained the infectivity for up to at least the F5 generation to B. globosus (Mazeras, Kenya), the host snail for S. haematobium, but the TCP values for the hybrid/B. globosus combination remained consistently lower than that of the S. haematobium/B. globosus combination. The hybrid cercarial infectivity to hamsters was for up to the F7 generation comparable to that of both parental species and the egg production capacity/worm pair/day of production of the F1 hybrid generation exceeded in both hamsters and mice that of both parental species. However, the egg production capacity subsequently decreased with that of the F3 to F6 generations in hamsters and with that of the F2 and F5 generations in mice being comparable to that of S. intercalatum. The pattern of distribution of eggs in tissue of hamsters of the F1 and F2 generations resembled that of S. haematobium and S. intercalatum, respectively, but the distributional pattern of the F3 to F6 generations deviated markedly from that of both the parental species and the preceding hybrid generations. The hybrid cercarial infectivity to mice and the pattern of egg distribution corresponded to that of S. intercalatum. The egg morphology of the P1 generation corresponded to that of S. intercalatum while that of the F1, F2 and F3 hybrid generations exhibited great polymorphism with a range of shapes through those of the parental species but with most eggs being intermediate in shape. However, the eggs of the F4 to F7 hybrid generations exhibited less polymorphism and resembled those of S. bovis in both size and shape.

9-acridinyl and 2-methoxy-6-chloro-9-acridinyl derivatives of aliphatic di-, tri-, and tetraamines. Chemistry, cytostatic activity, and schistosomicidal activity

9-acridinyl derivatives of 1,6-hexanediamine, 1,8-octanediamine, bis(3-aminopropyl)amine, N,N'-bis(3-amino-propyl)piperazine, and N-ethyl-1,6-hexanediamine in the form of their hydrochlorides were prepared in high yields and converted into potential hetero bis DNA intercalating diacridines. The corresponding potential homo bis DNA intercalating reagents were prepared by heating the above amines with 9-chloroacridines. The chemical stability of the acridines was examined. Their cytostatic activity against Cloudman melanoma cells, in vitro, has been determined. The strongest cytostatic activity was observed for the acridine derivatives of the tri- and tetraamines. The schistosomicidal activity of selected acridine and diacridine derivatives against Schistosoma mansoni in mice was found to be insignificant. The S. mansoni egg development was apparently suppressed by this treatment.

Studies on the relationship between Schistosoma and their intermediate hosts. V. The genus Bulinus and Schistosoma bovis from Iringa, Tanzania

The relationship between an isolate of Schistosoma bovis from Iringa, Tanzania, and various species of the host snail genus Bulinus from East Africa was studied using the total cercarial production per 100 exposed snails over a period of 4 weeks following patency as an index of the compatibility. All populations of Bulinus forskalii and B. africanus tested exhibited a high level of susceptibility while the populations of B. truncatus and B. globosus tested were either refractory or of low to moderately low susceptibility. All populations of B. abyssinicus, B. canescens, B. nasutus and B. tropicus tested were refractory. It is suggested that B. africanus is the most important host snail for S. bovis in East Africa, that B. forskalii at least locally may contribute significantly to the transmission and that B. truncatus and B. globosus only play a limited role in the transmission.

A review of the biology and transmission ecology of African bovine species of the genus Schistosoma

The present paper reviews the information available concerning the biology and transmission ecology of the African bovine species Schistosoma bovis, S. mattheei, S. margrebowiei and S. leiperi. Criteria for species identification (egg morphology, intermediate host spectra, definitive host-parasite relationships, etc.) are listed and the geographical distribution of the four species and factors determining the relative occurrence within their overall distributional ranges are described. S bovis and S. mattheei occur north and south of 10 degrees S, respectively, and S. margrebowiei occurs mainly, and S. leiperi only, in southern central Africa. Definitive host-related factors (susceptibility, water contact pattern, ect.) providing the background for being a primary definitive host and the primary definitive host spectra for the four schistosome species are described. The primary definitive host spectrum for S. margrebowiei and S. leiperi comprise lechwe, puku and waterbuck, for S. mattheei lechwe, puku, waterbuck plus cattle, and for S. bovis cattle and possibly also some of the listed antelope species. In addition, wild bovines and cattle may provide a reservoir of S. mattheei and S. margrebowiei in humans, but wild bovines and domestic stock play no major role in the transmission of other human species of schistosomes. The intermediate snail host spectra of S. mattheei and S. leiperi only comprise members of the Bulinus africanus species complex; S. bovis is transmitted by members of the B. truncatus, B. africanus and B. forskalii species groups, and S. margrebowiei is transmitted by members of the B. forskalii species group and possibly also by members of the B. tropicus and B. truncatus species groups. Factors determining the transmission ecology of the four schistosome species, and thereby the epidemiology of bovine schistosomiasis, are discussed. Influential factors comprise environmental conditions mediated via the effect of these on the size of the snail host population and on the rate of the intramolluscan development, behavioural patterns of the definitive host population and the course of the infection in the definitive host as related to aspects of susceptibility and level of endemicity. The epidemiological pattern (prevalence and intensity of infection, seasonality of transmission, etc.) is described and exemplified, and it is finally concluded that the increasing water conservation and changing methods of husbandry may result in bovine schistosomiasis becoming a major veterinary problem in Africa.

Clinical pathology of Schistosoma bovis infection in sheep

The clinical pathology of Schistosoma bovis infection in sheep was studied for a period of 16 weeks. The length of the prepatent period was 10 weeks, and reduced haemoglobin and packed cell volume values and increased serum gammaglutamyl-transpeptidase levels were observed from eight to 10 weeks after infection and onwards. The bromsulphalein clearance rate was significantly reduced 16 weeks after infection. Eosinophil counts were increased six and eight weeks after infection and towards the end of the experiment.