Discrepancy between haemagglutination and radioimmunological techniques for measurement of serum thyroglobulin autoantibodies

Recently, it has been suggested that in some patients with autoimmune thyroid diseases the tanned red cell (TRC) method for detection of thyroglobulin autoantibodies (TgAb) is negative where TgAb measured by radioimmunoassay (RIA) show positive values. To investigate this further, patients with thyroid diseases, pernicious anaemia and a control group were studied for serum concentrations of TgAb by TRC and by quantitative RIA, calibrated against MRC Standard A65/93. Antibodies for microsomes (MAb) were measured immunofluoretically. There was in all patient groups (Hashimoto's thyroiditis (n = 41), Graves' disease (n = 50), idiopathic myxoedema (n = 12), euthyroid Graves' disease (n = 7), pernicious anaemia (n = 81) a discrepancy between TgAb measured by TRC and RIA, respectively, whereas there was a reasonable correlation between the presence of TgAb by RIA and the presence of MAb. A possible interference from antinuclear antibodies and rheumatoid factors was ruled out. There was no increased frequency of TgAb measured by RIA in the control group. Fractionation of TRC negative sera revealed macromolecular TRC-activity, whereas TgAb positive sera by both methods had almost exclusively RIA and TRC activity corresponding to IgG. Based on these results and others it seems that the TRC method for measurement of serum TgAb is of limited diagnostic value. Furthermore, the TRC method is in many cases not sensitive enough for screening for TgAb prior to measurement of serum Tg, which is of importance as this method shows false values in the presence of TgAb due to methodological interference.

CdTe-detector registration of 99mTc-DTPA clearance. An assessment of kidney function without blood sampling

Since the most essential function of the kidneys is to regulate the composition and volume of the extracellular fluids the ratio of the extracellular volume (ECV) to the glomerular filtration rate (GFR) seems to be a relevant index of kidney function. This ratio is equal to the mean transit time (t) of an injected ECV-distributed tracer that is exclusively eliminated from the body by glomerular filtration. In 26 patients t was estimated by means of standard methods after an intravenous injection of 99mTc-DTPA and was found to be correlated (r = 0.98) to the reciprocal final slope of the time-activity curve obtained by means of small CdTe-detectors pasted laterally on the crus, 10-12 cm below the knee joint. It is concluded that this external measurement of kidney function, without blood sampling, may shorten the usual procedure from 4 to 1 h. Furthermore, due to the constant detection geometry throughout the investigation it may provide the means for prolonged continuous monitoring of the kidney function at steady state and when rapid changes are expected.

Cerebral abscess. Aetiology and pathogenesis, symptoms, diagnosis and treatment. A review of 200 cases from 1935-1976

From 1935-1976 a total of 200 patients with cerebral abscesses were referred to the University Clinic of Neurosurgery, Rigshospitalet, Copenhagen. The primary source of infection could be established in 169 cases (85%). Bacteria could be cultured in 58% of the cases. From 1935-1957 nearly all patients were subjected to ventriculography (107/129). Cerebral angiography was the dominating diagnostic method from 1958-1974. Since then, 30 patients with a suspected intracranial abscess have been examined by computed tomography. The overall mortality has been 40%, but for the period 1958-1976 17%.

Defective monocyte chemotaxis in pulmonary tuberculosis

Because mononuclear phagocytes are crucially involved in the host resistance to mycobacterial challenge, various functions of human monocytes (i.e. pinocytosis, phagocytosis and chemotaxis) were studied in 15 patients with active, untreated pulmonary tuberculosis and in 32 controls. There was no difference in the pinocytic and phagocytic activity of tuberculous and control monocytes. In contrast, tuberculosis monocytes showed depressed chemotaxis compared with control monocytes (P = 0.000001). This defect may be related to a plasma factor, since tuberculous plasma inhibited the chemotaxis of control monocytes as well as the activity of chemotactic agents.

A quantitative and qualitative study of blood monocytes in patients with bronchogenic carcinoma

Absolute circulating number and functions of blood monocytes (i.e., pinocytosis, phagocytosis, and chemotaxis) were studied in 25 patients with untreated bronchogenic carcinoma and in 28 control subjects. The absolute circulating monocyte count was increased in 20 (80%) of the patients. There was no difference in the pinocytic and phagocytic activity of patient and control monocytes. In contrast, patient monocytes showed depressed chemotactic responsiveness. This defect was more severe in small cell anaplastic carcinoma than in the other histologic types of bronchogenic carcinoma (P = 0.0001), and may explain the difference in macrophage infiltration seen in solid tumours of the lung. There was no correlation between chemotaxis and clinical stage. Depressed chemotaxis may be related to a plasma factor, since patient plasma inhibited the chemotaxis of control monocytes as well as the activity of chemotactic agents. The defective chemotaxis and the presence of plasma inhibitory activity may interfere with the ability of blood monocytes to accumulate as macrophages in tumour sites.

Normalization of defective monocyte chemotaxis during chemotherapy in patients with small cell anaplastic carcinoma of the lung

Monocyte chemotactic responsiveness (MCR) in 14 patients with small cell anaplastic bronchogenic carcinoma was depressed before treatment compared with the MCR in 28 normal controls (P = 0.00004). MCR was subsequently monitored during combination chemotherapy and after 6 months the MCR had become normalized compared with pretreatment values (P = 0.00006). In addition, chemotactic factor inhibitor (CFI) activity in plasma was measured before treatment and after 6 months. When incubated with plasma before treatment casein had 62% of normal activity and when incubated with plasma after chemotherapy, 81% of normal activity (P = 0.0009). CFI activity decreased by greater amounts in patients in complete remission than in patients in partial remission or in non-responders (P = 0.01). This study supports the concept that cancer patients have depressed monocyte function. Chemotherapy seems to enhance monocyte chemotaxis in vitro and to decrease CFI activity in plasma.

Carbon dioxide tensions in manually ventilated, prone patients

The distribution of arterial carbon dioxide tensions (PaCO2) in 288 anaesthetized, healthy patients in the prone position was investigated during non-monitored manual ventilation. Four equal groups of 72 patients were compared employing a conventional anaesthetic system with and without CO2-absorption and a modified Mapleson D rebreathing system using high and low fresh gas flows. No fundamental difference between the Mapleson D system and the circle system without CO2-absorption could be demonstrated. With the Mapleson D system a high fresh gas flow resulted in a loss of rebreathing characteristics, the scatter of PaCO2-values then approaching that of a conventional circle system with CO2-absorption. The results demonstrate that during manual ventilation a CO2-absorption results in unpredictable levels of PaCO2 with unacceptably wide ranges. On the other hand, prevention of hypocapnia could be obtained with the rebreathing systems using a low fresh gas flow. Hypercapnia was modest and similar in all groups, PaCO2 never exceeding 7.3 kPa. In terms of PaCO2-levels it seems, compared to recent literature, of no importance whether the patient is prone or supine or whether or not ventilation is monitored, performed by hand or by means of anaesthetic ventilators. Accurate levels of PaCO2 can probably only be obtained by frequent analyses of PaCO2, or monitoring of the end-tidal CO2 concentration.

Personality correlates of sphenoidal EEG-foci in temporal lobe epilepsy

Patients with unilateral temporal lateral or temporal mediobasal epileptic focus as ascertained by sphenoidal electrode EEG recordings were evaluated using the questionnaire designed by Bear & Fedio (1977). The seventeen traits defined by the items in this questionnaire were also assessed by close observers in an equivalent questionnaire. Patients with medio-basal temporal lobe focus were found generally to exhibit "epileptic" personality traits to a greater extent than patients with lateral focus, and the results indicated that they also, more than patients with lateral focus, were characterized by a schizoid paranoid outlook. The patients with left temporal lobe focus were found to be emotionally labile compared to patients with right temporal lobe focus. Patients with lateral right-sided temporal focus had obviously the most benign psychological prognosis. The main discrepancies between the results of Bear & Fedio (1977) and the present study are briefly discussed.

Human monocyte function in vitro: influence of conditions during transport of blood from patient to laboratory

Monocyte functional tests were carried out on samples of peripheral human blood which had been subjected to 4 different conditions of transport and temperature. There was no difference in cell viability or pinocytic, phagocytic and chemotactic activity of monocytes isolated from blood exposed to these different conditions. However, the yield of monocytes obtained after metrizoate/polysucrose centrifugation was very low when blood samples in transit were kept for 2 h at 0--4 degrees C. It is concluded that a period of transport up to 24 h is acceptable, provided the temperature of the blood sample is kept between 15 and 25 degrees C.

Possible role of histamine in rheumatoid arthritis. Treatment with cimetidine and mepyramine

Basophilocytes from patients with rheumatoid arthritis (RA) responded to leukocyte nuclei from normal persons with histamine release; a similar histamine release induced by the nuclear components RNA and DNA has been demonstrated previously. A role of histamine in RA is also supported by the findings of clinical improvement during treatment with H1 and H2 antihistamines in six of 12 patients with RA in active phase, whereas four showed definite deterioration.

Burkitt's lymphoma mimicking prostatitis

We report on a 24-year-old man who had symptoms suggestive of acute pancreatitis but the diagnosis was Burkitt's lymphoma infiltrating the prostate. He was treated with cytotoxic drugs with a good initial response. Voiding improved and the tumor had disappeared completely on rectal palpation. However, the patient suffered a relapse and, despite intensive chemotherapy, he died a few months later with disseminated tumor infiltration.

Methodological approaches to antigen identification in soluble immune complexes; A model study

The usefulness of different techniques for identification of immune complex-(IC) bound antigen(s) was investigated in two Ab-Ag model systems. The following approaches were used: 1) determination of IC-activity before and after removal of IC by adsorption to antibody-specific solid phase systems. 2) analysis of PEG-insoluble IC by reference line-rocket immunoelectrophoresis and 3) reprecipitation of PEG-insoluble IC in the presence of 125I-labelled antibody to suspected antigens and subsequent analysis of the distribution of the radioactivity. This latter approach, the use of a double PEG precipitation immunoradiometric assay, was found most useful and simple for identification of antigen(s) contained in soluble IC. The technique is most sensitive in demonstrating IC-bound antigen(s) when the IC are formed in slight to moderate antigen excess.

In vitro characterization of synthesized thyroglobulin immune complexes (IC). A model for studies of IC containing an autoantigen

Human thyroglobulin (Tg) immune complexes (TgIC) were preformed at different ratios from purified Tg, and Tg antibodies (TgAb) obtained from six patients with autoimmune thyroid diseases. TgIC were characterized by precipitation with polyethylene glycol, and sedimentation in sucrose gradient. TgIC from one patient were further characterized by concanavalin A (con A), and binding to the complement factor Clq and rheumatoid factor (RF). Tg and TgIC had almost identical binding to con A, no binding to Clq, but could be partially separated by ultracentrifugation and polyethylene glycol. The highest degree of separation was obtained by a RF-coated plastic tube radiometric assay, using 125-I-rabbit TgAb as indicator. Tg showed no binding to RF, and a dose-response curve of TgIC in serum could be established. There was a dependence of the Tg-TgAb ratio, TgIC at equilibrium and in antibody excess being detected most efficiently. The method may serve as an aid in the evaluation of the fate of Tg, TgAb and TgIC following thyroid damage (surgery, radioiodine) and may be extended as a model system in the investigation of immune complexes in connection with autoimmune disorders.