Comparison of four Mycoplasma pneumoniae IgM-, IgG- and IgA-specific enzyme immunoassays in blood donors and patients.

Mycoplasma pneumoniae antibodies were studied in 504 blood donors and 102 patients with infections not caused by M. pneumoniae with the use of enzyme immunoassay kits from ThermoLabsystems (L), Savyon (S), Bio-Rad (B) and Novitec (N). Detection frequencies of M. pneumoniae IgM in blood donors were 14.9% (L), 16.0% (S), 2.8% (B) and 3.8% (N), and in patients were 40.2% (L), 42.2% (S), 9.8% (B) and 16.7% (N). Detection frequencies of M. pneumoniae IgA were 68.5% (L) and 22.8% (S), and in 65 respiratory disease patients were 100% (L) and 53.8% (S). Thus, use of some kits may lead to overdiagnosis of M. pneumoniae infections.

Respiratory tract infection due to Chlamydia pneumoniae in military personnel.

The objective of this investigation was to determine whether Chlamydia pneumoniae was involved in an outbreak of respiratory disease among military recruits, 92 patients (average age 20.1 years) were included in the study if they had a sore throat or cough for more than 1 week. In addition to sore throat and cough, fatigue, headache, dyspnoea and vertigo were the most frequent symptoms. The patients received standard treatment with 100 mg of doxycycline b.i.d. for 14 days. In 38.8% of cases symptoms were alleviated after 1-2 weeks of treatment, and in 22.4% of cases after 2-3 weeks of treatment. Pretreatment throat washings and sera were sampled for Chlamydia. Sera were drawn for Chlamydia, Mycoplasma and adenovirus serology. Cell culture (Hep-2) and 3 different serological methods-microimmunofluorescence (MIF), enzyme immunoassay with a recombinant glycoconjugate antigen (r-EIA) and immunoperoxidase assay (IPA)-were used. Cell culture was found to have too low a sensitivity to be of diagnostic value. Acute infection was demonstrated in 13% by MIF IgM and in an additional 21% by MIF IgG (titre rises). Enzyme immunoassay IgM was found in 17% and IPA IgM in 19% of individuals without MIF IgM antibodies. Microimmunofluorescence was found to be the most useful test for serodiagnosis. The combination of serological methods showed that 40 out of 52 (76.9%) had an acute infection with possible chlamydial aetiology. In conclusion, methodological improvements are necessary for the aetiological diagnosis of chlamydial respiratory infections.

[Invasive ventilation. Classification, technique and clinical experiences with BiPAP/APRV (Biphasic Positive Airway Pressure/Airway Pressure Release Ventilation)]. / Invasiv ventilation. Klassifikation, teknik og kliniske erfaringer med BiPAP/APRV.

BiPAP (bilevel or biphasic positive airway pressure) and APRV (airway pressure release ventilation) are new, and from a technical viewpoint closely related techniques recently introduced to the field of invasive ventilatory support. BiPAP/APRV can be described as a pressure controlled continuous high flow positive airway pressure system with a time-cycled change between a high inspiratory pressure level and a lower expiratory pressure level. Due to highly sensitive valves placed in the inspiratory and expiratory part of the system, unrestricted spontaneous breathing is possible at any moment of the mechanically supported ventilatory cycle. During invasive ventilation BiPAP offers potential advantages by allowing unrestricted spontaneous breathing thus reducing the need for sedation and facilitating weaning. APRV has primarily been investigated in conditions of moderate to severe acute lung injury and it seems that APRV is associated with less detrimental effects on the cardiopulmonary system compared to conventional ventilatory strategies. Apart from a review of the literature the article gives a classification and a technical description of the systems and focuses on the practical approach to BiPAP/APRV, e.g. the initiation and adjustment of respiratory support and the weaning from ventilatory support when applying these techniques.

[Weaning from respirators via biphasic positive airway pressure]. / Respiratoraftrapning via bifasisk positivt luftvejstryk.

Weaning procedures during the course of intermittent positive pressure ventilation are often difficult. A case is presented in which biphasic positive airway pressure (BiPAP) seemed to be superior to other well known ventilator weaning regimens. The course of the weaning procedure is described.

[Inhalation of levopromazine (Nozinan) in the treatment of status asthmaticus]. / Inhalation af levomepromazin (Nozinan) i behandling af status asthmaticus.

Levomepromazine reduces histamine-induced bronchial hyperresponsiveness in asthmatics without significant sedation. We present two patients with acute asthma refractory to conventional therapy, who were treated with inhalation of 2.5 mg levomepromazine. Until controlled studies have been done, we suggest that inhalation of levomepromazine be restricted to patients with asthma refractory to conventional therapy.

Oropharyngeal and esophageal pressure during mono- and binasal CPAP in neonates.

Oropharyngeal and esophageal pressures were measured via a tip-transducer during mono- and binasal CPAP in 30 neonates. During nasal CPAP, increasing flows are followed by an increase in oropharyngeal pressure, although there were great variations among the pressures recorded. On the other hand, no increase in the esophageal pressure could be registered during nasal CPAP. It is advisable to use the lowest flow which ameliorates the respiratory status in neonates. To achieve an appropriate pressure in the oropharynx it is advisable to close the mouth during nasal CPAP in the neonate.

Analysis of early and late deaths on RTOG non-small cell carcinoma of the lung trials: comparison with CALGB 8433.

UNLABELLED: In a major study that showed a treatment advantage for induction chemotherapy followed by radiation therapy (CALGB 8433), there was a significantly (P = 0.02) lower proportion of patients dying within 105 days of registration in the chemotherapy/radiation arm than the radiation therapy arm; without this difference, the overall survival was marginally better (P = 0.059) for the chemotherapy/radiation group. A retrospective analysis of RTOG trials sought explanations for the phenomenon. MATERIALS AND METHODS: Patients who fit the CALGB eligibility criteria and received radiation therapy alone in four prospective trials of the RTOG conducted between 1983 and 1989 were analyzed to determine factors that distinguished patients dying within 105 days from longer survivors. Two were trials of altered fractionation and two used standard fractionation. Of 683 patients identified, 107 (15.7%) died within 105 days after registration. The log linear model was used to evaluate relationships between death within 105 days and known prognostic factors. Karnofsky performance status (KPS), < 90 vs. > or = 90, was the only factor significantly related to death within 105 days (P = 0.0052). A Cox model with the same factors plus fractionation and total dose found KPS and T-stage associated with overall survival (P = 0.0005 and 0.025, respectively). The choice of the hyperfractionation arm (HFX) for Phase III study (69.6 Gy at 1.2 Gy b.i.d.) was based in part on comparison with standard fractionation (STD) from a concurrent RTOG protocol, 8321. Review of early deaths showed that this HFX arm had a lower proportion of patients dying within 105 days (7.9%) than STD in 8321 (21.0%).(ABSTRACT TRUNCATED AT 250 WORDS)

[CPAP treatment of newborn infants. A historical review]. / CPAP-behandling af nyfødte. En historisk oversigt.

Treatment of new-born infants with continuous positive air pressure (CPAP) is reviewed historically on the basis of the available literature. CPAP treatment for this group of patients was introduced just over 20 years ago. Advantages and disadvantages of different methods of use are discussed.

Halothane 2% for caesarean section.

During the induction-delivery interval for Caesarean section delivery, 2% halothane in pure oxygen was administered. The technique was compared to a 0.5% halothane in 50% oxygen/50% nitrous oxide anaesthesia. When a continuous infusion of oxytocin was administered, no excessive haemorrhage was seen. No maternal reminiscence was seen using 2% halothane, but awareness was recorded using 0.5% halothane in 50% nitrous oxide in 15% of the mothers. When there were no signs of preoperative fetal distress, the neonates were unaffected by the halothane concentration provided the induction-delivery interval was short. In cases of fetal distress, the administration of 2% halothane further aggravated the condition of the neonates, as indicated by lowered 1-min Apgar scores, umbilical oxygen tensions, pH and base excess values.

Iridium-192 brachytherapy in the treatment of cancer of the prostate.

Aggressive radiotherapy was used in 170 patients with advanced localized carcinoma of the prostate. After pelvic lymphadenectomy, 192Ir brachytherapy was used to deliver 3500 cGy to the prostate within 2 days. External-beam therapy (4500 cGy) was then given to a total of 8000 cGy. Random biopsies 18 months afterward were negative for residual cancer in 62 of 83 patients (75%), and 37 of 45 patients (82%) with pathologically proved localized disease remain without evidence of disease. Morbidity was significantly reduced in the most recent 70 patients by improvements in technique. The authors believe such therapy should be considered for patients with advanced stage B2 or C disease in particular.

Sensitive and specific radioimmunoassays for opiates using commercially available materials. I: Methods for the determinations of morphine and hydromorphone.

Sensitive and specific radioimmunoassay (RIA) methods for the analysis of morphine and hydromorphone in human plasma samples using commercially available materials were developed. The limit of quantitation was 0.3 ng/mL of plasma for morphine and 50 pg/mL of plasma for hydromorphone. An extraction step preceding the RIA quantitatively removed morphine, leaving 99% morphine-3-glucuronide (M3G) and 95% hydromorphone-3-glucuronide (H3G) in the aqueous phase. The specificity of the morphine RIA method for the analysis of clinical samples was confirmed by HPLC quantitation. The antiserum used in the hydromorphone RIA method cross reacted slightly with H3G at 0.66%. However, analysis of clinical samples using the direct versus the extraction RIA showed that the extraction step was necessary for the specific determination of hydromorphone in pharmacokinetic studies. After extraction, only 0.033% of the H3G present in plasma samples would be observed as interference for the free hydromorphone. The RIA methods were shown to be accurate and reproducible with almost 100% recovery of morphine and hydromorphone. They offer convenient alternatives to chromatographic methods for pharmacokinetic studies.

Real-time signal processing in speech recognition and its potential use within the development of hearing aids.

Acoustic-phonetic features necessary for rule-based speech recognition are described. The selection of feature algorithms is based on their robustness to variability of dynamics in speech signals and to influence of environmental noise, and their suitability for real-time implementation using speech production or speech perception modelling. Features are estimated in real-time, using a 32-bit floating point signal processor DSP32. The features described are pitch, formants, segmentation and labelling. The paper indicates the potential use of these features in connection with future experiments leading to development of new hearing aids.

Real-Time Signal Processing in Speech Recognition and Its Potential Use within The Development of Hearing Aids.

Acoustic-Phonetic features necessary for rule-based speech recognition are described. The selection of feature algorithms is based on their robustness to variability of dynamics in speech signals and to influence of environmental noise, and their suitability for real-time implementation using speech production or speech perception modelling. Features are estimated in real-time, using a 32-bit floating point signal processor DSP32. The features described are pitch, formants, segmentation and labelling. The paper indicates the potential use of these features in connection with future experiments leading to development of new hearing aids.

Haemodynamic steady state via combined infusion of dobutamine and dopamine in the pretransplant phase.

The course of a critically ill patient suffering endstage dilated cardiomyopathy is reported focusing on the use of inotropic support. A steady state haemodynamic condition was achieved using continuous low-dose infusion of dobutamine in combination with dopamine for several days. Thus as a candidate for heart transplantation he was made transportable to a foreign country.

Peroperative buprenorphine: do high dosages shorten analgesia postoperatively?

Fifty-two patients undergoing biliary surgery were investigated in a prospective randomized study, in which they received buprenorphine 10, 20, 30, and 40 micrograms X kg-1, respectively, as sole intravenous analgesic as a bolus 15 min before induction of anaesthesia. The anaesthetic was uneventful in all four groups, although when receiving 10 and 20 micrograms X kg-1 almost two-thirds of the patients needed supplemental analgesics during the operation. When receiving buprenorphine in the dosage of 30 and 40 micrograms X kg-1, 50% of the patients requested an analgesic within 5 min of extubation. In contrast, when receiving 10 and 20 micrograms X kg-1 none of the patients requested an analgesic within 1 h of the operation. These findings accord to a certain extent with the presence of a bell-shaped dose-response curve for buprenorphine in humans.