Bacterial colonization of intravascular catheters and anergy to recall skin antigens.

The skin reactivity of 46 ICU patients was tested against recall antigens: mumps, candidin, streptokinase-streptodornase, and purified protein derivative of tuberculin. At the same time, the intravascular catheters used in these patients were cultured with a semiquantitative method. Twelve patients did not react to any of the antigens. There was a statistically significant association between anergy in skin testing and lethal outcome of the current illness. Catheter cultures from 11 patients yielded over 15 colony-forming units of bacteria. No association was found between positive catheter cultures and skin reactivity to any of the antigens. This indicates that catheter colonization is independent of host factors reflected by skin testing and supports the view that transmission of microorganisms into catheters is more important than poor host defense in the initiation of catheter-related infections.

Palmar erythema in rheumatoid arthritis.

Palmar erythema ("liver palms") was seen in 32/100 consecutive patients with classical rheumatoid arthritis and in 10/100 patients with various other internal diseases (p less than 0.001). Age of the patients, sex, duration of disease, titer of rheumatoid factor, stage of disease, erythrocyte sedimentation rate and frequency of volar tenosynovitis of the hands did not differ between patients with and those without palmar erythema. Ulnar deviation of the fingers was less common and the hemoglobin content of the blood was higher in patients with palmar erythema.

Effect of cardiopulmonary resuscitation-induced stress on cell-mediated immunity.

Functions of cell-mediated immunity were studied from 11 patients after cardiovascular resuscitation and from matched controls who were simultaneously under observation. The resuscitated patients were anergic to recall skin antigens (93% negative) as compared to the controls (62%) (p less than 0.01). The anergic state correlated with the outcome of the patients. Lymphocyte numbers did not differ between these groups, but the number of T cells was significantly decreased, and B cells and granulocytes was increased in resuscitated patients. Lymphocytes from resuscitated patients responded to mitogenic stimulation although the responses were lower than those of the controls. Decreased lymphocyte responses were partly due to serum factor(s) which were not attributable to serum cortisol concentration. In addition the findings favour a change in the compartmentalization of lymphocyte subsets resulting in increased number of suppressor cells and/or increased sensitivity of lymphocytes to suppressive humoral factor(s) in the circulation. The anergy in skin evidently represents the final outcome of the dysfunction of several arms of cell mediated immunity.

Graft-versus-host reaction in 3 adult leukaemia patients after transfusion of blood cell products.

We describe 3 cases of acute graft-versus-host (GVH) disease in patients with acute myeloid leukaemia following transfusions taken from non-HLA-identical healthy donors. The leucocyte transfusions were given because of severe bone marrow aplasia and granulocytopenia following leukaemia induction treatment. The first patient had an acute GVH reaction with an erythrodermia-like skin reaction all over and associated with severe abdominal cramping, enlarged liver and pathological liver function tests. The second patient had a relatively mild skin reaction and enlarged liver. Both died of severe pulmonary infection. The third patient also had a mild skin reaction and enlarged liver. He died of pulmonary embolism. The diagnosis of GVH of the latter 2 cases was made on skin biopsy. The autopsy samples revealed in all cases a heavy lymphocytic infiltration of the kidneys and liver portal area. Until more precise guidelines can be established, irradiation of blood cell products given to patients with neutropenia due to leukaemia induction treatment should be considered.

Yersinia antibodies in inflammatory joint diseases.

The occurrence of IgM, IgG and IgA class Yersinia antibodies was studied at the beginning of an inflammatory joint disease and one year later in 354 adult patients using an ELISA technique. The control groups consisted of age and sex matched healthy persons living in the same geographical area as the patients, and of 64 patients with chronic rheumatoid arthritis. Yersinia antibodies of any Ig class were found in 9.0% of all the patients at the beginning of the disease, in 4.0% of the healthy controls and in 1.6% of the patients with chronic rheumatoid arthritis. Patients with ankylosing spondylitis, Reiter's disease or other reactive arthritis showed the highest prevalence (19.4%) of Yersinia antibodies, but in the whole material one half of the patients with Yersinia antibodies were clinically classified as rheumatoid or nonspecific arthritis. The elevated prevalence of Yersinia antibodies in patients with probable rheumatoid or nonspecific arthritis may indicate a reactive etiopathogenesis of arthritis also in some cases without previous evidence of gastrointestinal infection. Quantitation of IgG and IgA antibodies to Yersinia is important in the diagnosis of Yersinia arthritis. These antibodies may not be detected by the generally used agglutination test.

Coxsackie B virus antibodies in myocardial infarction.

Evidence for the association between Coxsackie B virus infections and myocardial infarction was studied in a prospective follow-up examination. Using the micro neutralization test, 9 (15%) of 59 patients with acute myocardial infarction and 1 (2.6%) of 38 control patients showed a fourfold, or higher, antibody increase in paired serum samples against Coxsackie B1-5 viruses. This difference is significant (p less than or equal to 0.05). None of the patients or controls revealed symptoms of a viral infection during the blood sampling. Virus isolation from throat and feces was negative in all patients and controls. This finding agrees with some previous studies suggesting that the Coxsackie B group may in some cases have a causal role in myocardial infarction, or may act as a triggering factor.

Antibodies to measles virus in ankylosing spondylitis.

IgG antibodies to measles virus were measured by a solid-phase radio-immunoassay in serum specimens from 31 patients with confirmed ankylosing spondylitis (AS), from 8 patients with symptoms and signs resembling AS and from 39 patients hospitalized for various non-rheumatological disorders. The patients with AS and without iritis/uveitis had a 4-fold increased amount of measles antibodies in their serum specimens compared with the control patients (p less than 0.01). The AS patients with iritis and the patients with symptoms and signs resembling AS were, in this respect, similar to the control patients.

Sensory neuropathy in rheumatoid arthritis: an electroneurographic study.

In a selected series of twenty-three RA patients, aged from 23 to 56 years, mean 41, the neurophysiological functions of six sensory nerves were measured and the results were correlated with clinical and laboratory data. Significant changes in the functions of one or more nerves were found in 10 patients, 2 of whom had no symptoms of clinical neuropathy. There was a highly significant correlation between neurophysiological symptoms and clinical neuropathy symptoms, although the combination of the clinical and electrophysiological findings was variable. On the other hand, there was no significant correlation between neurophysiological/neurological findings and clinical/laboratory data (age, sex, duration of disease, stage of disease, rheumatoid factor and erythrocyte sedimentation rate). Manifest or sub-clinical mono-neuropathies in n. medianus were found in 5 patients. In the light of these results it would seem in order to recommend the inclusion of an electro-neurophysiological examination of the medianus nerves of RA patients in routine diagnostic procedures.

Men evacuated after the Second World War from the Carelian Isthmus to Southwest Finland: risk group for myocardial infarction?

More myocardial infarctions occurred and the prevalence of diabetes mellitus and hypercholesterolemia (greater than 9.5 mmol/l) was higher among men evacuated in 1944 from Metsäpirtti (Carelian Isthmus) to Vehmaa (Southwest Finland) than among men of the same age native to Vehmaa. Blood pressure, smoking habits, fat intake, physical activity at leisure and mental stress were - according to the questionnaires - equal in both groups. Metsäpirtti and its surroundings was a genetic isolated as compared to Vehmaa. The population of Vehmaa is more mixed and has been influenced by the Germanic (Swedish) race for a long time.

Follow-up studies of joint complications in yersiniosis.

In 1971-73, 60 patients were hospitalized for an infectios disease caused by Y. enterocolitica serotypes III and IX or Y. pseudotuberculosis serotype I. In the spring of 1977 a follow-up study was carried out with 52 of these patients, one patient having died from intestinal perforation evidently resulting from yersiniosis-induced amyloidosis and colitis. The follow-up study showed that two patients had symptoms of sacroilitis, one had developed an apparent rheumatoid arthritis after yersiniosis and one had joint plans and a high serum rheumatoid factor titer with no objective joint changes. All results from kidney and liver studies were normal. No brucellosis antibodies were found in the follow-up study. Twelve patients had antibody titers against Y. enterocolitica serotype III.

Determination of human immunoglobulin M rheumatoid factor by a solid-phase radioimmunoassay which uses human immunoglobulin G in antigen-antibody complexes.

A solid-phase radioimmunoassay for the rapid determination of human immunoglobulin M (IgM) rheumatoid factor (RF) has been developed. Preparation of the solid phase for the assay involved the formation of complexes between respiratory syncytial virus-specific human IgG antibodies and virus antigen on the surface of polystyrene balls. Binding of serum RF to IgG in the immune complex was subsequently detected by 125I-labeled mu-chain-specific antibodies to human IgM. The amount of radioactive indicator antibody bound was converted to units of RF by comparison to the standard curve for an RF reference-serum pool. This assay should prove useful in studies of the physiological role of RF, since it can effectively measure low levels of circulating RF.

Is group-specific meningococcal vaccination resulting in epidemics caused by groups of virulent meningococci?

In 1976 routine vaccination against Neisseria meningitidis serogroups A and C was started in the Finnish Armed Forces. A case of fulminant, complicated pneumonia caused by group-Y meningococcus in a vaccinated recruit, prompted a study of the distribution of the meningococcal groups isolated from the recruits in the same unit. 14 (46%) of the 31 isolates from 84 recruits were group Y. Group-Y meningococcus was rarely isolated from unvaccinated controls. These results suggest that widespread vaccination against serogroups A and C may have led to an increase in the frequency of meningococcus group Y.

Inter-relationships of laboratory variables in rheumatoid arthritis.

The inter-relationships of 25 variables in 140 rheumatoid patients were studied. One group, consisting mainly of hematologic variables, was differentiated on the basis of its high correlation with disease activity. The second group consisted of CRP and rheumatoid factor, which had highly significant positive correlations with each other. The third group consisted of serum aspartate aminotransferase, serum creatinine, antistreptolysin titre and blood eosinophils. These relationships are discussed.

Serum sulfhydryl groups in rheumatoid arthritis.

The sulfhydryl groups are chemically active parts of the protein molecule and participate in many important biochemical and metabolic processes. The present material comprised 132 patients with rheumatoid arthritis, 104 patients with other diseases and 44 controls. The patients with rheumatoid arthritis had decreased serum sulfhydryl group levels, the decrease being greater in patients with active disease. Changes in the activity of rheumatoid arthritis were correspondingly followed by changes in the serum sulfhydryl group levels. The serum sulfhydryl group levels diminished significantly with advancing age. Similarly decreased serum sulfhydryl group levels could also be observed in many other diseases.