Elevation in anti-Proteus antibodies in patients with rheumatoid arthritis from Bermuda and England.

OBJECTIVE: To determine whether patients with rheumatoid arthritis (RA) from Bermuda and England have an increased anti-Proteus antibody titer when compared to healthy Bermudian and English controls, and to ascertain whether any increase in antibody titer is specific by testing 4 other microbes, Escherichia coli and 3 normal anaerobic bowel bacteria. METHODS: Antibody titers were measured by ELISA and indirect immunofluorescence (IIFA) under coded conditions. RESULTS: Elevated titers of anti-Proteus antibodies were demonstrated in 34 patients with active RA from Bermuda when compared to 33 healthy Bermudian controls by ELISA (p < 0.001) and IIFA (p < 0.001). An elevation of anti-Proteus antibodies was also observed in 34 patients with RA from England when compared to 30 healthy English controls again by ELISA (p < 0.001). A similar antibody elevation in 31 patients with RA from England was observed when compared to 30 healthy controls when measured by IIFA (p < 0.001). However, there was no significant elevation in antibody titers against E. coli or the 3 normal bowel flora isolates in the patients with RA from both countries compared to their respective controls, when measured by ELISA. CONCLUSION: A specific elevation in the immune response to Proteus mirabilis has been demonstrated in patients with RA from both Bermuda and England. However, this study cannot distinguish between antibody association with disease per se and association with disease activity. The role of Proteus in RA and the effect of anti-Proteus therapy in patients with RA merits further study.

Recognition of microclimate zones through radon mapping, Lechuguilla Cave, Carlsbad Caverns National Park, New Mexico.

Radon concentrations range from less than 185 to 3,515 Bq m-3 throughout Lechuguilla Cave, Carlsbad Caverns National Park, New Mexico. Concentrations in the entrance passages and areas immediately adjacent to these passages are controlled by outside air temperature and barometric pressure, similar to other Type 2 caves. Most of the cave is developed in three geographic branches beneath the entrance passages; these areas maintain Rn levels independent of surface effects, an indication that Rn levels in deep, complex caves or mines cannot be simply estimated by outside atmospheric parameters. These deeper, more isolated areas are subject to convective ventilation driven by temperature differences along the 477-m vertical extent of the cave. Radon concentrations are used to delineate six microclimate zones (air circulation cells) throughout the cave in conjunction with observed airflow data. Suspected surface connections contribute fresh air to remote cave areas demonstrated by anomalous Rn lows surrounded by higher values, the presence of mammalian skeletal remains, CO2 concentrations and temperatures lower than the cave mean, and associated surficial karst features.

Neonatal transport: a controlled study of skilled assistance. Mortality and morbidity of neonates less than 1.5 kg birth weight.

To attempt to demonstrate the need for skilled care of sick neonates in transport, a modified randomized controlled study of infants being transported to this institution was carried out. Although special equipment was used, ambulances were not modified. Results of the first phase reported here show that infants weighing less than 1.5 kg at birth, transported by a trained physician and nurse, were significantly warmer, less hypotensive, and less acidotic on admission to the NICU. Mortality was significantly reduced, first week morbidity somewhat lessened, and duration of stay in hospital reduced by more than one third (P less than 0.01).

Idiopathic hypoparathyroidism and pseudoparathyroidism: case reports and review of the literature

2 case of idiopathic hypoparathyroidism and 1 case of pseudohypoparathyroidism are reported. The rarity of these syndromes is stressed. The action of parathyroid hormone as applied to these conditions is briefly discussed, and the etiology, pathology, main clinical features, differential diagnosis and treatment of both types of hypoparathyroidism are reviewed (AU)