The ross ice shelf project.

A hole was drilled through the Ross Ice Shelf 450 kilometers from the barrier. Scientific sampling through this hole revealed a sparse population of crustaceans, fish, and microbial biomass. The seabed consists of mid-Miocene glaciomarine mud. Geothermal heat flow is average. Oceanographic data indicate an active circulation and melting at the base of the ice.

Continuous infusion versus daily injections of growth hormone (GH) for 4 weeks in GH-deficient patients.

Endogenous GH secretion is pulsatile. Animal studies indicate that GH administered in a pulsatile manner induces growth and insulin-like growth factor I (IGF-I) generation more effectively than continuous administration. Short term human studies, however, have reported similar metabolic effects with constant and pulsatile GH delivery. This study was carried out to compare the metabolic effects of longer term continuous infusion vs. daily injections of GH. Thirteen GH-deficient patients were studied in a cross-over design. The patients were randomized to receive GH as a continuous sc infusion by means of a portable pump for 1 month and as daily sc injections (at 1900 h) for another month. An average daily GH dosage (+/- SEM) of 3.15 +/- 0.27 IU was administered during both periods. Steady state 24-h profiles of GH, IGF-I, IGF-binding proteins (IGFBPs), insulin, glucose, lipid intermediates, and other metabolites were monitored after each treatment period. At the end of each study period (at 0800 h), an oral glucose tolerance test was performed. The mean (+/- SEM) integrated levels of serum GH (micrograms per L) were higher after GH injection [2.51 +/- 0.54 (injection) vs. 1.77 +/- 0.35 (infusion); P < 0.02]. Continuous infusion induced higher nighttime than daytime GH levels (P = 0.01), indicating a diurnal variation in the absorption or clearance of GH. Serum IGF-I levels (micrograms per L) were slightly higher (P < 0.05, by analysis of variance) after continuous GH infusion [312.5 +/- 50.2 (injection) and 334.6 +/- 46.6 (infusion)]. Similarly, constant GH delivery induced higher IGFBP-3 levels (P < 0.05, by analysis of variance). Serum IGFBP-1 levels were similar on the two occasions. Daily GH injections increased daytime insulin levels (P < 0.05), whereas 24-h levels were similar (P = 0.14). The trend toward increased insulin levels after GH injections was also found during the oral glucose tolerance test (P = 0.07). Blood glucose levels were identical on the two occasions. Nocturnal levels of nonesterified fatty acids were higher (P < 0.05) after GH injection. We conclude that continuous sc infusion of GH induced serum IGF-I and IGFBP-3 levels more effectively than daily sc injections. The constant appearance of GH in the circulation did not impair glucose tolerance, but resulted in a less physiological diurnal pattern of nonesterified fatty acids. Our data do not support the concept that a pulsatile GH pattern is of critical physiological significance.

Production of monospecific antibodies to varicella zoster virus antigen in rabbits tolerant to human IgG and immunized with antigen immunoprecipitated with human IgG from zoster reconvalescent sera.

A method for production of antisera specific to a single antigen of a human infectious agent is described with varicella zoster virus (VZV) as a model. Microisolation of immunochemically pure antigen contained in defined immunoprecipitates was achieved by crossed immunoelectrophoresis of a crude antigenic preparation (detergent solubilized, VZV infected cells) into agarose gel containing zoster reconvalescent immunoglobulin. Immunization of rabbits made tolerant to human IgG with immunoprecipitates resulted in the production of antibodies to the antigen part of the immunoprecipitate. The method represents a short cut to the production of heterologous diagnostic antisera to defined antigens of human infectious agents.

Autoantibodies in sera from patients with multiple sclerosis directed against antigenic determinants in pituitary growth hormone-producing cells and in structures containing vasopressin/oxytocin.

We have reported previously that autoantibodies in sera from patients with multiple sclerosis (MS) were reactive with rat brain, including pituitary, and with swine pituitary in areas thought to contain peptides of the somatotropin family and/or vasopressin/oxytocin. We have now tested the same patient sera for their specificity to antigenic determinants which are common to animal and human peptides. Localization of the binding sites of the MS sera was demonstrated in rat pituitaries and brains using the double immunofluorescence staining method, employing anti-bovine somatotropin (STH), anti-ovine prolactin (PRL), anti-neurophysin I and II, anti-somatostatin, and anti-vasopressin as reference antibodies. In the pituitary, the positive MS sera reacted specifically with cells which were also reactive with anti-bSTH. In the brain, positivity of MS sera was mainly localized in structures reactive with anti-neurophysin I and II and anti-vasopressin. Absorption experiments, immunocytochemical model assays, and radioimmunoassays, however, did not show specific binding of the MS sera to any of the above-mentioned peptides. Therefore, while these data present additional evidence on the localization of the immunocytochemical reaction sites of the MS autoantibodies, they do not enable us to identify the specificity of these antibodies.

Autoantibodies against pituitary peptides in sera from patients with multiple sclerosis.

Autoantibodies against pituitary peptides were demonstrated in sera from multiple sclerosis (MS) patients. Ten patients with lupus erythematosus disseminatus (SLE) and 97 healthy blood donors served as controls. The sera were used as primary antibodies in the indirect immuno-enzyme cytochemical (IEC) method, with fixed, paraffin-embedded rat brains and rat and hog pituitaries as antigen substrates. Eleven of the 33 MS sera reacted with peptides in the neural lobe/hypothalamic nuclei or distal lobe. The MS had a significantly higher incidence of peptide antibodies than sera from controls (11/33 vs 9/97). The mean antibody titers were significantly different (1577 vs 333). Comparison with rabbit reference antibodies specific to each of the 6 distal lobe hormones showed that the 9 distal lobe-positive MS sera reacted with cells harboring peptides of the somatotropin family. The presence of peptide autoantibodies was not related to clinical status or medical treatment. No antibodies against pituitary peptides were found in the SLE sera. One of the 11 positive MS sera showed antibodies against gastric parietal cells. None of the 11 sera showed antibodies against muscle, mitochondria, thyroid, adrenal, or parotid antigens. We propose that in a proportion of patients with MS, these autoantibodies might be involved in the demyelinization process by interfering with the peptide/receptor interplay, thus placing MS as a disease in analogy with myasthenia gravis. Alternatively, these autoantibodies might be involved in the altered immunoregulation of MS or be secondary to the disease.

Immunoelectron microscopic localization of herpes simplex virus antigens in infected cells using the unlabeled antibody-enzyme method.

Subcellular localization of viral antigens was demonstrated during viral morphogenesis using herpes simplex virus type 1 (HSV-1) infected monolayers of rabbit cornea cells. The localization was done by immunoelectron microscopy employing the peroxidase-antiperoxidase (PAP) immunocytochemical technique and the postembedding staining method. The localization of viral antigens was followed at time intervals during infection from 2 to 19 hr. After exposure of sections to either polyspecific antibodies against total HSV-1 antigens or monospecific antibodies against HSV-1 antigen No. 8, specific immunological reaction products were identified both in the cytoplasm and nucleus after 2 hr. The distribution and quantity of reaction products varied in the infected cells during the viral morphogenesis. The present results on the subcellular distribution of the HSV-1 antigens are related to current biochemical findings.

Pituitary-cell autoantibody diversity in sera from patients with untreated Graves' disease.

Sera from 22 untreated patients with recently diagnosed Graves' disease (GD) were screened in an immunocytochemical tissue assay for presumptive pituitary IgG autoantibodies, as defined by the presence of immunoreaction with rat and swine pituitary cell types. Forty four patients with Hashimoto's thyroiditis (HT) and 97 healthy subjects were also studied. Anti-pituitary antibodies were found in 14 of the 22 GD sera (64%). Of these, 6 sera reacted with cytoplasmic components of growth hormone (GH) cells, 3 with prolactin (PRL) cells, and 5 with both GH and PRL cells. Yet, none of the immunoreactive sera reacted with human GH, bovine PRL or TSH in dot-blot assays and absorption studies. Anti-pituitary antibodies also occurred in 4 of the 44 HT patients (9.1%) and in 9 of the 97 healthy subjects (9.2%). The frequency of sera revealing anti-pituitary antibodies was significantly higher in patients with GD compared to the groups of HT patients (P less than 0.00005), and healthy subjects (P less than 0.00005). Healthy subjects and patients with HT had a similar frequency of anti-pituitary antibodies (P = 1.0000). These data demonstrate that in thyroid autoimmune conditions antibodies reactive with cytoplasmic components of pituitary GH/PRL cells, may be present in sera from patients with GD. The pathological importance of this observation is at present unknown.

Induction of experimental chronic Pseudomonas aeruginosa lung infection with P. aeruginosa entrapped in alginate microspheres.

Alginate-producing, mucoid P. aeruginosa is frequently found in the lungs of patients with cystic fibrosis (CF), where it causes a chronic infection. The importance of alginate in the pathogenesis was demonstrated by the ability to establish chronic P. aeruginosa lung infection in rats if P. aeruginosa entrapped in minute alginate-beads were inoculated transtracheally. Alginate beads containing P. aeruginosa were formed by nebulizing a suspension of seaweed sodium-alginate and P. aeruginosa into a calcium solution. The alginate bead method of establishing infection was compared to an agar-bead method and proved to be quantitatively similar after 4 weeks. The ability of the two methods to induce formation of precipitins, IgA and IgG antibodies against P. aeruginosa antigens, including outer membrane proteins, flagella, exoenzymes and alginate, was assessed by crossed immunoelectrophoresis, enzyme-linked immunosorbent assay and immunoblotting. The two methods of inducing infection were comparable and infected rats had significantly higher antibody response than rats inoculated with sterile beads. We suggest that the alginate bead model closely resembles the later stages of CF-lung infection and that it offers the theoretical advantage of using a substance which is chemically similar to the alginate produced in vivo by P. aeruginosa.

Multidisciplinary approach to pseudoaneurysms complicating pancreatic pseudocysts. Impact of pretreatment diagnosis.

OBJECTIVE: To determine the effectiveness of thin-section, dynamic-contrast computed tomography and angiography in detecting the presence of pancreatic pseudoaneurysms. DESIGN: This case series consisted of 57 patients who were being examined for endoscopic drainage of pancreatic pseudocysts. SETTING: All patients were examined in a tertiary care, teaching hospital. PATIENTS: Fifty-seven consecutive patients were examined for 2 years. Follow-up ranged from 6 months to 2 years. INTERVENTIONS: All patients underwent thin-section, high-speed, dynamic-contrast computed tomography. Those patients with findings that were consistent with the presence of a pseudoaneurysm underwent angiography. Embolization was attempted if a pseudoaneurysm was present. Endoscopic retrograde cholangiopancreatography was used to determine pancreatic ductal anatomy before operation. MAIN OUTCOME MEASURE: No undetected pseudoaneurysm has complicated this series of endoscopically drained pseudocysts. RESULTS: Five patients had findings that were consistent with a pancreatic pseudoaneurysm on computed tomography. Angiographic findings confirmed a pseudoaneurysm in four patients, and angiographic embolization was successful in three. Four patients underwent resection, while one was treated with embolization and endoscopic stenting of a compressed pancreatic duct. There were no mortalities. CONCLUSIONS: Before endoscopic drainage of a pancreatic pseudocyst, a thin-section, high-speed, dynamic-contrast computed tomographic scan is essential. If there are findings consistent with the development of a pseudoaneurysm, angiography must be performed. This allows delineation of the arterial anatomy, as well as the option of performing angiographic embolization. While patients with pseudoaneurysms in the body and tail of the pancreas underwent resection, angiographic embolization alone was an acceptable alternative when the lesion was located in the head of the pancreas.

Out-of-hours service in Denmark: the effect of a structural change.

BACKGROUND: In Denmark, the provision of out-of-hours care by general practitioners (GPs) was reformed at the start of 1992. Rota systems were replaced locally by county-based services. The new out-of-hours service resulted in a considerable reduction in the total number of GPs on call. AIM: To describe how the patients experienced the change from a satisfaction point of view, and how the pattern of patient contact and the fee for GPs changed with the new system. METHOD: The county of Funen was chosen as the geographical area where data were collected. A questionnaire measuring patient satisfaction was posted before the change, immediately after the change, and three years later to a random selection of patients who had been in contact with the out-of-hours service within two weeks before the mailing date. All primary care services for the Danish population are stored in a database (National Health Service Registry). From this continuously updated database, the contact pattern and the fee for GPs were extracted for 1991, 1992, and 1995. RESULTS: The total number of patient contacts was reduced by 16% in the first year, but by only 6% three years later. Three years after the change, there were more than twice as many telephone consultations as before the change, and there were only a third as many home visits. After three years, the GPs' fees were reduced by 20%. There was a significant decrease in patient satisfaction, although the overall level remained high. This decrease was lower three years after the change than immediately after the new system was introduced. CONCLUSION: The new service had a major cost-effectiveness benefit, but there was a price to pay in patient satisfaction.

A health education booklet for young families--its need, use and effect.

The objective was to describe the effect of a mailed health education booklet for families with children in relation to parents' need for health education. It was a randomized controlled trial. The parents' anxiety and use of doctors were registered in a questionnaire, together with selected psychosocial conditions, during a retrospective period of six months. An age-stratified random sample of 3913 families--1953 study families and 1960 control families was drawn in the county of Ringkjøbing, Denmark. The booklet was used a lot; it reduced parents' anxiety and use of doctors in children's illnesses. The effect was most pronounced in those parents who had least need for health education. This method of health education was not very efficient. The possibilities and value of combining written health education with personal individual instruction by the general practitioner are discussed.

Immunohistochemical detection of epidermal growth factor receptor in laryngeal squamous cell carcinomas.

Laryngeal squamous cell carcinomas from 15 consecutive preoperatively irradiated patients were investigated for the expression of epidermal growth factor receptor (EGF receptor). The study was performed on frozen sections by means of the 5-layer APAAP technique employing an antibody recognizing the extracellular part of the EGF receptor. In sections from 9 of the patients with laryngeal squamous cell carcinoma, normal differentiated epithelia were included. Sections from 6 of these patients, in addition, contained dysplastic epithelia. Expression of EGF receptor-like material was demonstrated in the basal cell layer of normally differentiated laryngeal epithelial and in dysplastic epithelia. Fourteen of the squamous cell carcinomas proved EGF receptor positive. Nearly all cells in the poorly differentiated carcinomas showed positive staining with the antibodies. In moderately to well differentiated carcinomas a reduction in the extent of staining was seen in certain areas. Especially for the epithelial pearls, the staining reaction was localized to the undifferentiated cells in the periphery. This finding corresponds to the staining pattern observed in the basal cell layers of normal epithelial. The present investigation confirms the expression of EGF receptor-like material in normal laryngeal epithelial, dysplastic epithelial and squamous cell carcinoma. The staining pattern was similar to that observed in oral squamous cell carcinomas, predominantly varying inversely with cellular differentiation.

Hypertension is not a complication in cyclosporine-A monotherapy.

The course of blood pressure and antihypertensive treatment (AHT) was studied in 27 renal transplant recipients immunosuppressed with cyclosporine-A (CyA) as monotherapy. At the time of transplantation 13 patients received AHT and 14 were normotensive. The final outcome of transplantation and CyA immunosuppression was 19 patients without AHT, 4 with reduced AHT and 3 with unchanged doses of AHT, while in 1 case a de novo mild hypertension necessitated diuretic treatment.

The Preventive Use of the Anderson Knee Stabler in Football.

In brief: The Anderson knee stabler restricts the valgus stress to the knee joint, which should decrease the number and severity of collateral ligament injuries and reduce the number of meniscal injuries. The authors reviewed medical records of football players at the University of Southern California (USC) and recorded the number and type of knee surgeries from 1980 to 1984, noting which players wore braces and which did not. Results showed that the Anderson knee stabler is beneficial in preventing collateral ligament and meniscus injuries to the knee. There have been no grade-3 injuries to the collateral ligaments caused by direct contact to the brace. The authors recommend that all USC linebackers and interior linemen wear the Anderson knee stabler during practices and games but say that further longitudinal data are needed.

[Septic arthritis]. / Septisk arthritis.

Septic arthritis (SA) is reviewed in the English literature with reference to registration of localisation of the infected joints, the bacteriological cause, predisposing factors, clinical information and laboratory data related to SA. Seventy-eight publications were available concerning 975 patients with 1086 infected joints caused by 1032 bacteria. Large joints such as the knee and hip were most frequently, however, infected, in recent years, SA in small axial joints has been reported with increased frequency. Gram-positive cocci and especially Staphylococcus aureus are most frequently the cause of infection. High temperatures, elevated sedimentation rate and leucocytosis are often noticed in SA, as is a warm, tender, swollen joint with effusion and painful movements. Investigation of the aspirated fluid from the joint for bacteria and number of leucocytes as well as CT-scanning or scintigraphy are the most important diagnostic tools. With rapid and correct antibiotic treatment the prognosis for good or excellent function of the joint is reported to be from 27-90%, while the mortality is reported as being 7-23%.

[Septic arthritis in intravenous drug abuse]. / Septisk arthritis ved intravenøs stofmisbrug.

Septic arthritis (SA) in intravenous abusers is reviewed in the English literature from 1966-1992 with the purpose of registration of the bacteriological development, localization of the infected joints, clinical information and laboratory data. Eighty-three publications are available for the review. We have registered 270 joint infections caused by 264 bacteria in 257 intravenous drug abusers with SA. Since 1985 there has been a change in joint localization and bacteriology. A possible explanation is considered. Diagnosis and treatment is difficult, because of the unstable life-style and frequent compliance problems in intravenous drug abusers. SA should be considered in patients with known intravenous drug abuse, uncharacteristic pain and symptoms of osteoarticular infection. SA is often accompanied by fever, leucocytosis and elevated sedimentation rate. Bacteriological diagnosis is achieved by joint aspiration and/or blood culture. Tc-99m-MDP-(technetium-99m-methylene diphosphonate)-bone scintigraphy should be performed on joints suspected of infection which are difficult to aspirate. With adequate antibiotic treatment the prognosis is good, and the mortality is insignificant.

[Patients' activity and length of stay after hip arthroplasty with balanced analgesia and early mobilization]. / Patientaktivitet og indlaeggelsestid efter hoftealloplastik med balanceret smertebehandling og tidlig mobilisation.

Thirteen consecutive patients were submitted to hip-replacement by Müller's method under epidural analgesia and were treated for postoperative pain with balanced analgesia by means of continuous epidural infusion of a mixture of bupivaine (0.625 mg/ml) and morphine (0.05 mg/ml) 4 ml hourly for 96 hours and supplemented by 600 mg ibuprofen every eight hour orally. The analgesic treatment was combined with intensive mobilization regime and altered postoperative care as regards early normalization of daily activities and reduced duration of hospitalization. The patients were found to be effectively relieved of pain during rest and also during mobilization and, together with suitable care and rehabilitation, this had the result that more than half of the patients were mobilized from bed for more than eight hours from the second postoperative day and that all of the patients were able to carry out ordinary everyday functions after the fourth postoperative day, with the assistance of the aids which the hip regimen required. Eleven of the patients were ready for discharge on the sixth postoperative day while two patients were not discharged until the eighth and ninth postoperative days on account of slight surgical complications. All of the patients were discharged to their homes and to outpatient rehabilitation for three weeks. Compared with the usual duration of hospitalization of approximately 13 days in corresponding patients, this pilot investigation appears to show that the analgesic regime employed was extremely effective but that traditional attitudes and routines in the postoperative care and mobilization must be revised if this is to be utilized for more rapid restitution and reduced duration of hospitalization.