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Cysticercosis of the nervous system Diagnosis by means of specific radioimmunoscan.

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Cysticercosis of the Nervous System:
Diagnosis by Means of Specific
Radioimmunoscan
Gregorio Skromne-Kadlubik, MD, Cesar Celis, MD, and Antonio Ferez, MD
A new method for diagnosing cerebral cysticercosis by means of specific radioimmunoscan is described. T h e method
has been evaluated in 24 patients with encouraging results. T h e technique involves a single intravenous injection
followed by brain scanning and thus far has been entirely nontoxic. T h e accuracy o f the scan was confirmed in 6
patients by surgical removal of lesions that coincided in location and number with t h e diagnostic scan of the parasites.
Skromne-Kadlubik G , Celis C, Ferez A: Cysticercosis of t h e nervous system: diagnosis by means of specific
radioimmunoscan. Ann Neurol 2:343-344, 1977
Cerebral cysticercosis is a prevalent disease in developing countries, as shown by a 3.6% incidence in
autopsies performed over a six-year period in the
General Hospital, Mexico City. T h e diagnosis in most
cases is difficult because of t h e similarity of symptoms
to those of cerebral tumor. This paper describes a new
diagnostic method for direct visualization of cysticercosis by means of specific radioimmunoscan, together
with the first satisfactory results in humans. We described previously similar studies in experimental
animals [4].
Material and Methods
The radioimmunoscan for cerebral cysticercosis was performed in 24 patients using the following methods.
Satisfactory antibodies have been produced in rabbits in
an empirical form. Immunization is carried out with
moderate amounts (0.2 mgiml) of homogenized cysticercous protein as antigen, mixed with Freund’s adjuvent (1 :
10). Rabbits are injected subcutaneously with 1 ml every
two weeks for three doses and then bled for sera (10 ml).
The antibodies are precipitated and titrated at a concentration of 1 : 100,000 [2] and labeled by the constant-current
electrolytic method reported by Rosa et a1 [31. They are
then purified by ion-exchange chromatography in columns
containing DEAE [ l ] .
Each patient received 10 mCi of antibodies labeled with
indium 113m, and a brain scan was obtained three hours
later by scintillation camera. Twelve subjects had no evidence of cerebral cysticercosis; they were diagnosed as
having brain tumors, vascular disease, and other disorders
instead. The other 12 had signs, symptoms, or laboratory
findings (including complement-fixation test) that indicated
cerebral cysticercosis; in 6, surgical removal of the cyst was
possible. All 24 patients were studied for evidence of toxicity by clinical and laboratory methods.
From the Radionuclide Laborarory, Department of Physiology,
Universiry of Mexico Faculty of Medicine, Mexico City, Mexico.
Results
T h e Figure shows typical human radioimmunoscans
of cerebral cysticercosis. Similar scans were obtained
in 12 patients, and i n 6 they correlated closely with the
surgical findings. N o n e of the control patients had
abnormal scans. No patient developed an untoward
reaction to either the antibody injection o r the brain
scan.
Discussion
Cerebral cysticercosis is an incapacitating disease with
a high mortality. T h e diagnosis is difficult because of the
great variability in clinical findings. This new diagnostic method, requiring only a single intravenous dose,
is simple and safe and gives satisfactory information
about the presence, number, and location of cerebral
cysticercosis. No other isotopic scanning method
gives such information because routine brain scans do
not demonstrate cysticercosis.
Radioimrm~nosi ans JIo ?YZ dzffereri t pal i r n t ~showing cerebral Lyslicercosir in anterior projection (left) and
lateral projection (right).
Address reprint requests to Dr Skrornne-Kadlubik, AP Postal
70250, Mexico, AP 2 0 , DF Mexico.
Accepted for publication May 10, 1977.
343
References
1. Hunter WM: Introduction, in Kirkham KE, Hunter WM (eds):
Radioimmunossay Methods. Edinburgh and London,
ChurchilI/L.ivingstone, 197 1 , pp 3-23
2. Parker CW: Nature of immunological responses and antigenantibody interaction, in Ode11 WD, Daughaday W H (eds): Prin-
344 Annals of Neurology Vol 2 No 4 October 1977
ciples of Competitive Protein-binding Assays. Philadelphia,
JB Lippincott, 1971
3. Rosa u, Pennise F, Bianchi R, et al: Chemical and biological
effects of iodination on human albumin. Biochim Biophys Acta
133~486-489,1967
4. Shomne-Kadlubik G, Celis C: Centelleografia de la cisticercosis experimental. Rev Lat Microbiol (in press)
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nervous, mean, specific, cysticercosis, system, radioimmunoscan, diagnosis
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