Schick Test Research Articles

Морфологічні зміни головного мозку при діабетичній енцефалопатії

Метою наведеної роботи було вивчення морфологічних характеристик змін головного мозку у хворих із діабетичною енцефалопатією (ДЕ) на підставі дослідження аутопсійного матеріалу. Матеріали та методи. В роботі наведено результати 14 секційних спостережень. Середній вік хворих становив 51,0 ± 3,4 року. Шматочки мозку фіксували в розчині IHC Zink Fixative, виготовляли серійні парафінові зрізи товщиною 10 ± 1 мкм. Препарати фарбували гематоксиліном і еозином, конго рот, тіоніном за методом Ніссля, ставили ШИК-реакцію, імпрегнували нітратом срібла за методом Більшовського і хлоридом золота за Кахалем, проводили морфометричне дослідження за Г.Г. Автанділовим. Препарати досліджували на мікроскопі Olympus AX70 з цифровою камерою Olympus DP50. Мікрофотографування препаратів здійснювалося з використанням програми AnalysisPro 3.2. Результати. Основними цито-ангіоархітектонічними проявами ДЕ є дифузна альтерація базальних мембран і ендотелію судин мікроциркуляторного русла, меншою мірою — артеріол, внутрішньомозкових артерій і вен. Висока щільність (питомий обсяг) капілярної мережі при ДЕ морфологічно відображає картину капілярного паралітичного застою. Капілярний застій супроводжується стазом крові, збільшенням навколосудинного капілярного простору (простір Вірхова — Робіна), ширина якого є морфологічним еквівалентом лімфатичної дисциркуляції. Ранні морфологічні ушкодження стінок капілярів — потовщення і розщеплення основної мембрани з накопиченням ШИК-позитивних речовин, вогнищева проліферація ендотеліоцитів. До пізніх пошкоджень відносяться капілярний фіброз і гіаліноз, проліферація перицитів, що супроводжується різким порушенням транскапілярного транспорту. Порушення стріарної і радіарної цитоархітектоніки в I–IV шарах головного мозку, випадіння нейронів (нейрональні спустошення) проявляються вогнищевим випадінням гангліозних і пірамідальних клітин. Висновки. Ранніми зворотними морфологічними змінами нейронів є набухання нейронів (гідропічна дистрофія нервових клітин), вогнищевий гіперхроматоз. Незворотними структурними ушкодженнями нейронів є лізис ядра і ядерця з гомогенізацією цитоплазми, формування клітин-тіней, вакуолізація цитоплазми, перицелюлярний набряк, лізис відрост­ків у поєднанні з нейрофагією. Є характерним поєднання гострих альтернативних ушкоджень нейронів із хронічними (ішемічного характеру) — пікноз, зморщування ядер з вираженою атрофією цитоплазми.

Gialiniziruyushchaya trabekulyarnaya opukhol' shchitovidnoy zhelezy

The paper describes a case of thyroid hyalinizing trabecular tumor in a 55-year-old woman. Cytological examination of her fine-needle biopsy specimen showed separately lying tumor cells with intracellular cytoplasmic inclusions. Its cytological study determined the trabeculoalveolar structures formed by tumor cells, the intercellular space exhibited a homogenous eosinophilic matter that yielded a positive Schick's test, laminated calcinates that mimick psammoma bodies. Immunophenotyping of the neoplasm revealed a positive reaction with antibodies to thyroglobulin, a negative reaction to galectin-3 and cytokeratin-19, and membrane Ki-67 expression, which suggests the low malignancy potential.

Gialiniziruyushchaya trabekulyarnaya opukhol' shchitovidnoy zhelezy

The paper describes a case of thyroid hyalinizing trabecular tumor in a 55-year-old woman. Cytological examination of her fine-needle biopsy specimen showed separately lying tumor cells with intracellular cytoplasmic inclusions. Its cytological study determined the trabeculoalveolar structures formed by tumor cells, the intercellular space exhibited a homogenous eosinophilic matter that yielded a positive Schick's test, laminated calcinates that mimick psammoma bodies. Immunophenotyping of the neoplasm revealed a positive reaction with antibodies to thyroglobulin, a negative reaction to galectin-3 and cytokeratin-19, and membrane Ki-67 expression, which suggests the low malignancy potential.

Morphological Assessment of the Safety of Alveolar Opening

Objective: The safety of an alveolar mobilization technique was morphologically evaluated. Materials and methods. Experiments were made on 46 non-inbred albino male rats weighing 280—320 g. Thiopental sodium (15—20 mg/kg animal weight) was intraperitoneally injected for anesthesia. A TSE Animal Respirator was employed for 30—180 minutes. In the first experimental animal group, the ventilation parameters were as follows: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP (during alveolar opening) 40 cm H2O (40 seconds); PEEP (after recruitment) 10 cm H2O (20 minutes). Recruitment was carried out at 20-minute intervals for 1—3 hours. Experimental Group 2 animals underwent artificial ventilation (AV) with the following ventilation parameters: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP (during alveolar opening) 20 cm H2O (20 seconds); PEEP (after recruitment) 10 cm H2O (20 minutes). The control animals had AV with the ventilation parameters: air flow 0.4—0.5 l/min; respiration rate 60 per min; tidal volume 1—5 ml; PEEP 0 cm H2O. Lung pieces were fixed in 10% neutral formalin solution and embedded in paraffin. The histological specimens were stained with hematoxylin and eosin; the Schick test was carried out. Results. Histological study of the lung from the experimental group animals has shown dilated alveoli and bronchioli. The increased alveolar volume at a high air flow and PEEP leads to air-blood barrier damage, alveolar septal infiltration with leukocytes, neutrophils, and macrophages, and to the development of interstitial and alveolar edema. Lung morphological changes were less pronounced in the animals from the second experimental group. Conclusion. The alveolar opening technique improves gas exchange parameters, as evidenced by oxygen utilization. The high PEEP values are attended by more significant lung morphological changes. Key words: alveolar recruitment, open lungs, PEEP.

Adaptive Processes in the Respiratory System and Adrenals in Concomitant Brain Injury

Objective: to study the nature and time of development of pulmonary and adrenal structural changes in early concomitant brain injury. Materials and methods. The lungs and adrenals from 120 persons who had died from severe concomitant brain injury were morphologically studied. Pulmonary and adrenal specimens were embedded in paraffin. Histological sections were stained in hematoxylin-eosin, by using the procedures developed by Weigert, van Gieson, and Mallory. The Schick test and other histochemical methods were used. Morphometric studies were also employed. Statistical processing used Student’s t-test. Results. In injury, the early pulmonary structural changes were ascertained to be circulatory disorders, bronchial and bronchiolar mucosal damage, and the development of atelectases and focal emphysema. The morphological criteria for increased adrenal cortical functional activity are focal delipidization, diminished cortical transparency, the «spotty» appearance of the cortex, boundary-spanning between the cortical and reticular zones, multiple cytolysis, and iron plethora. Conclusion. Severe concomitant brain injury is followed by pulmonary structural changes underlying acute respiratory failure. Adrenal structural and functional changes play an important role in the pathogenesis of lung injury. Key words: severe concomitant brain injury, lung injury, adrenals.

Schick Test Survey At Two Urban Primary Schools Of Kathmandu

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Agammaglobulinemia, by Col. Ogden C. Bruton, MC, USA,Pediatrics, 1952;9:722–728

A hitherto unrecognized entity manifested by complete absence of gamma globulin with otherwise normal serum proteins and recurrent pneumococcal sepsis is described in an 8-year-old male. The patient appeared to be normal in other respects and, after extensive study, no structural or functional change could be demonstrated in any body system. He was unable to produce antibody to the pneumococcus with the four antigenic substances used; a positive Schick test persisted despite numerous attempts to reverse it with diphtheria toxoid. No antibody could be demonstrated following administration of typhoid vaccine in the usual manner, and his serum was negative for complement-fixing antibodies of epidemic parotitis after he experienced a typical clinical picture of that disease.Gamma globulin could be demonstrated in his serum after concentrated immune human serum globulin was administered subcutaneously, and its gradual disappearance could be followed by electrophoretic analysis over a period of approximately six weeks. Concurrently, and following administration of human gamma globulin (3.2 gm. gamma globulin) at monthly intervals, he had been free of pneumococcal sepsis for more than a year, whereas he had experienced clinical sepsis at least 19 times in the previous four years. Eight different types of pneumococci had been recovered from blood cultures during 10 different episodes of sepsis.In the Discussion, [the author] concluded that there was a cause-and-effect relationship between the absence of gamma globulin and the repeated infections, based on the child's dramatic improvement after beginning gamma globulin therapy. [The author] proposed two possible causes–congenital or acquired. While [he] felt that the patient's good health for the first 4.5 years of life argued against a congenital cause, the persistence of the defect supported it.

The Three Ps: Unabridged

The circumstances and coincidences of life often lead us down strange and circuitous routes as we travel on this journey. How well I remember, as a fledgling first year medical student, having a Schick test placed on my arm as part of a laboratory exercise in an immunology course. The results, a large slough on my forearm, indicated that I was susceptible to diphtheria. Little did I realize then the importance of that name, nor was I aware of his contributions to the definition of serum sickness and anaphylaxis. But even more removed from the realm of possibility was to have imagined that I would one day have the privilege of standing before this distinguished body to honor the memory of Dr. Bela Schick. As I began searching for information about Dr. Schick, my secretary pulled from the shelf in our own office library a volume, published by Schering, that contains the first five Bela Schick lectures. Dr. Murray Peshkin delivered the first Bela Schick lecture to this body in 1968, followed by Howard Rapaport, John McGovern, Jerome Glaser, and Susan Dees. Most of them knew Bela Schick and had worked under him or had been inspired by him. Dr. John McGovern who spoke in 1970 began with these words of Dr. Schick: “First, the patient, second, the patient, third, the patient, fourth the patient, fifth the patient, and then maybe comes science. We first do everything for the patient; science can wait, research can wait.”1 Dr. McGovern noted that these are strange words for a great scientist. They become much less strange when we recognize the fact that Dr. Schick was also a great humanitarian with a particular genius to combine these two cultures in medicine in perfect harmony. The title of this presentation is “The three Ps: Unabridged.” These Ps could represent pollens, pets, and pests or providers, payors, and politicians, but instead they represent the three most important elements in our lives and work: PATIENTS, PHYSICIANS, AND PROFESSION. The word unabridged, which means to be whole, complete, uncut, leaving nothing out, suggests to us the way in which we should approach the three Ps. I hope to develop this theme as it pertains to us and our acknowledgment of these most important areas.

Quantitative estimation of diphtheria and tetanus toxoids. 6. Use of different antibody titration methods for evaluation of immunogenicity in animals during potency assay of diphtheria toxoid

Two diphtheria toxoid preparations were compared in potency assays in guinea-pigs using different methods for evaluation of the responses to vaccination. The methods used were the direct skin challenge (Schick test) and ELISA and VERO cell titration of antibodies. The different evaluation methods resulted in the same relative potencies between the toxoids. It was observed that when first-vaccination sera were compared with a second-vaccination serum, the relative antibody concentration depended on whether ELISA or VERO cell titration was used.

The effect of Schick testing on diphtheria antitoxin status

Twenty-nine healthy persons were Schick tested as part of their occupational health examination. All but three of them had been previously immunised against diphtheria. One unimmunised person had a history of diphtheria. Blood samples were taken before and at varied intervals after the Schick tests in order to determine whether the Schick test antigen was immunogenic. Of the 29 persons tested, 21 were Schick-negative, three were Schick-positive. Four pseudoreactors were Schick-negative, one pseudoreactor was Schick-positive. Only four of the 29 had any significant rise in antitoxin titre after Schick testing. Three of these were Schick-negative, while one was a pseudoreactor who was negative at a later reading. We conclude that Schick testing is not reliably immunogenic and that, contrary to expectation, it cannot be assumed to elicit a useful booster response in previously immunised persons.

An Evaluation of Diphtheria — Tetanus (Adult) Vaccine in Unselected Human Volunteers

One hundred unselected adult volunteers received an adult diphtheria (less than 2 Lf)-tetanus (greater than or equal to 40 IU) adsorbed vaccine without prior Schick testing. No volunteer had a moderate or severe reaction although 39% complained of a transient sore arm. Only 10% reported local erythema. Of the study group, 37/43 (86%) patients who were initially seronegative for diphtheria attained levels normally considered as seropositive. The results confirm the safety and efficacy of adult diphtheria-tetanus vaccine and allow its recommendation for use in 'at risk' individuals without the need for prior Schick testing.

Schick test survey in rural children of Jawan Block, District Aligarh, (U.P.), India.

THE PRESENT study conducted in three villages of Jawan block, Aligarh, India on 576 children showed a higher immunity to diphtheria in the age group of 3 months to 5 years. 99.3% children studied were shick negative. Only 4 children below the age of 3 years (0.7%), showed the positive schick test. Each of the 4 children belonged to lower social classes of illiterate Hindu parents and were not previously immunised against diphtheria.

Status of antitoxic immunity against diphtheria in Japan. A report of the National Epidemiological Surveillance for Important Communicable Diseases.

Antitoxic immunity against diphtheria was surveyed during the period from 1962 to 1980. The survey was done by Schick test in the first decade and then by antitoxin titration of sera by the cell culture method in the recent six years. The data show clearly that the successful control of diphtheria has been accomplished in Japan as the result of active immunization. Both single (D) and combined (DP or DPT) vaccines were effective to convert Schick reaction negative. In addition, immunity was greatly improved by the introduction of the combined vaccine and one additional booster injection. However, such subsequent changes in the immunization schedule introduced in 1976 that giving the primary vaccination at older age and the omission of one booster injection at the preschool, has resulted in appearance of a high risk group below three years of age as well as in the lower immunity levels among school children. The data indicate that the continuous surveillance for diphtheria is required in this country.

Immune status of children and responses to DPT vaccination against diphtheria as judged by Schick test and indirect hemagglutination test.

Immune status of 172 children aged between 6 months and two years was studied, using Schick and indirect hemagglutination test (IHA). Schick test was done in all and IHA in 84 of them. Schick negativity rate was found to be 84.3 percent, whereas IHA test showed protective titers in 55.9 percent of subjects. Immunity to diphtheria by IHA could be confirmed only in 68 percent of schick negative children. Response to even a single dose of DPT was significant (p< 0.01) in comparison to unimmunized children. There was no difference in two dose and three dose schedules (75 percent and 80 percent of subjects, had protective titers respectively), of primary immunization against diphtheria as judged by IHA test. Primary immunization followed by a booster provided 100 Percent protection in recently immunized children as judged by IHA test.

The Schick Test

The evaluation of suspected humoral immunodeficiency includes quantitative immunoglobulin levels and specific antibody assays. The Schick test is a simple procedure for measurement of specific diphtheria antibodies that has been overlooked because the availability of Schick test materials has been limited in recent years. We assessed the efficacy of the Schick test in screening for antibody deficiency states in 23 children. Five had positive Schick test reactions. All five had clinical and immunologic findings consistent with a primary immunodeficiency disorder. Each of these patients had at least one other abnormality of antibody formation detected. The Schick test is a simple screening device helpful in the assessment of immunocompetence.

Nefrosis Lipoidea y alergia por alimentos

A total of twenty children with a diagnosis o\ prymery nephrosis were randomly chosen from the Nephrology Unit of the Area Sur-Oriente of Santiago de Chile. Ages ranged between 1 and 11 years. Diagnostic criteria of nephrosis was; a) Albuminaria greater than 100 mgs/kg/24 h; b) Hipualbuminemia, c) protein electrophoresis with an increase in the alpha 2 fraction, and a compatible renal biopsia. All patients had an Inmunological Prophile performed, which measured celular response (PPD & DNCBj, humoral response (febrile aglutinins 6c Schick test) and intradermal feasting against 13 foods frecuently ingested in Chile. Ten patients were randomly hospitalized and elimination diets performed during nine days. On the tenth day an induction test was performed, Samples for albuminuria, leucocyte counts and absolute eos inophi ls determination were obtained at 1, 2. 6, 24, 71 hours after the induction test was performed. We observed that an allergyc family history predominated when compaired with a renal disease family background, diminished celular response and low sensibilizing potential proteins sensitize these patients, who when subjected to the elimination diets, have remision of their nephrosis or can reduce the therapeutic steroid doses. We conclude that patient's specific proteins sensibility may influence the clinical course of lipoid nephrosis.

Diphtheria immunization in adolescents and adults with reduced doses of adsorbed diphtheria toxoid.

A study was undertaken in Schick-positive university students and schoolchildren to determine the diphtheria antitoxin response to vaccines containing a reduced dose of adsorbed diphtheria toxoid. It was found that the majority of participants, apparently previously sensitized, responded with an increase in antitoxin titre to protective levels after performance of the Schick test, or after the first dose of vaccine. A group of non-immune students required three doses of vaccine to reach adequate antitoxin levels to ensure durable immunity. Only one local reaction was observed in the group of 51 students, and this was attributed to an Arthus-type reaction involving the tetanus toxoid component of a combined adsorbed diphtheria and tetanus vaccine.

Accelerated degradation tests on some immunological products

The accelerated degradation test was applied for predicting the stability of Schick test toxin, fluid-killed Japanese encephalitis vaccine and freeze-dried BCG vaccine. The predicted degradation rate at a given low temperature was calculated on the basis of the hypothesis that the deterioration rate was a monomolecular reaction from the results obtained with experiments at some appropriate elevated temperatures. In both the first two cases the calculated values were fairly equivalent to the empirical ones obtained on actual prolonged storage at the corresponding low temperature. As the degradation rate of BCG vaccine did not necessarily follow the hypothesis of monomolecular reaction, some devices were attempted.

731 PURINE NUCLEOSIDE PHOSPHORYLASE (PNP) DEFICIENCY WITH CELLULAR IMMUNE DEFICIENCY

Inherited deficiencies in purine metabolism can be associated with immunologic abnormalities. We report the 5th family deficient in PNP and cellular immunity. The proband, a 5-yr-old, had .08% of normal erythrocyte PNP. He presented at 3½-yrs with a history of mild increase in frequency of infections. He had a severe autoimmune hemolytic anemia and at 4½-yrs developed severe ataxia and tremor. He was lymphopenic (<300/mm3) had an absolute decrease in T- and B-lymphocytes and was unresponsive to phytohemagglutinin in vitro. Response to allogeneic cells was normal. IgG and IgM were increased and a monoclonal gammopathy (IgG4λ) was present. Other antibody functions were intact (non-reactive Schick test, normal isoagglutinins, and development of influenza antibodies after infection). Erythrocyte adenosine deaminase was normal. Serum uric acid was 1.9 mg/dl and plasma and urine inosine were increased (38 μM, 13.3 mmole/gm creatinine). Urine guanosine was also increased (4.15 mmole/gm creatinine). This patient confirms the role of purine catabolism in T-lymphocyte function. Also, the unusual neurological findings, monoclonal gammopathy and hemolytic anemia suggest that clinical manifestations of PNP deficiency may be more heterogenous than previously appreciated.

SUSCEPTIBILITY TO DIPHTHERIA: A SURVEY BY AN AD-HOC WORKING GROUP

Schick tests and antitoxin titrations have been carried out to investigate what percentage of individuals in each of 9 small groups were susceptible to diphtheria. Overall, 33% were susceptible: 26% among those below and 44% among those above 35 years of age. These results suggest that about 35% of the population of the United Kingdom are susceptible to diphtheria.