[Jevgenij Botkin--personal physician of the tzar--an obituary 80 years after his death]

On 17 July 1998 the remains of Tsar Nicholas II and his family were buried, a historic event extensively covered by the media. The remains of four servants liquidated with the royal family were buried with them. Among the servants was the Tsar's personal physician, Jevgenij Botkin. Not often does a doctor follow his patients not only onto death, but into death--the Hippocratic oath leading to liquidation, so to speak. Who was Dr. Botkin? Did he know what to expect, or was he just a chance victim?

PCR detection of Chlamydia psittaci in faecal samples from passerine birds in Sweden

To investigate to what extent wild passerine birds are carriers of Chlamydia psittaci, 312 faecal samples from 18 bird species were collected. Using the PCR technique and subsequent DNA sequencing, C. psittaci DNA was demonstrated in faecal samples from 9 (2.9%) birds of 6 different species. Sera from 65 bird-ringers, highly exposed to wild birds, were tested by microimmunofluorescence assay for the occurrence of IgG and IgM antibodies to C. psittaci. No such antibodies were found. This results indicate that a significant proportion of wild passerine birds are carriers of C. psittaci, but rarely infectious to humans.

[Refugee or immigrant children in hospital]

The aim of the study was to gain knowledge of the diagnosis, length of hospital stay, and ethnic background of refugee and immigrant children admitted to the Paediatric Ward at Aker University Hospital in Oslo, and to find out how well the staff and families of the children communicated. 347 children, admitted from ten districts in the immediate vicinity of the hospital, were included in the study. 133 (38%) children had parents who were both born in a non-western country. 44 of the children came from a refugee background and 89 from an immigrant background. The median stay on the Paediatric Ward was three days for the immigrant children and two days for the refugee children and children from Western countries. None of the groups was admitted more frequently than the others. Refugee and immigrant children were most often admitted because of respiratory diseases or obscure symptoms. Communication between the staff and more than 40% of the families with refugee or immigrant backgrounds was not satisfactory. Three out of four mothers and one out of two fathers were unable to communicate well in Norwegian. One third of the mothers had less than six years of school education and one quarter of the immigrant mothers had never attended school.

Cloning and characterization of tdhA, a locus encoding a TonB-dependent heme receptor from Haemophilus ducreyi

Haemophilus ducreyi is unable to synthesize heme and must acquire it from its only known host, humans. We cloned and sequenced a gene encoding an outer membrane receptor for heme. It was designated tdhA (for TonB-dependent heme receptor A) since it was related by sequence homology to the family of TonB-dependent receptors. TdhA was strikingly similar to open reading frame HI0113 from the genome of Haemophilus influenzae Rd and also shared homology with five other heme receptors, including HxuC, HemR, HmuR, ChuA, and ShuA, from gram-negative bacteria. An Escherichia coli hemA tonB mutant strongly expressing H. ducreyi tdhA grew on low levels of heme as a source of heme only when an intact H. ducreyi Ton system plasmid was present, formally demonstrating functional TonB dependence. tdhA was expressed poorly in vitro by H. ducreyi and only under conditions of heme limitation. A survey of H. ducreyi revealed that all tested strains but one synthesized small amounts of TdhA in vitro under heme-limiting conditions. Surprisingly, an isogenic mutant of tdhA as well as its parent, 35000, both required the same high levels of heme for growth (50 microgram/ml [77 microM] on agar medium). This result, together with previous findings, suggests that in vitro, the uptake of heme by H. ducreyi is mediated by a TonB- and TdhA-independent mechanism, possibly diffusion.

Enteropathogenic bacteria in migrating birds arriving in Sweden

Birds have been thought to play a role in transmitting infectious agents like influenza, Borrelia and Salmonella. To investigate the role of migrating birds in the dispersal of enteropathogenic bacteria, stool samples from 151 wild birds (50 gulls and 101 passerines) just entering Sweden from their winter grounds were analysed for Salmonella spp., Campylobacter spp. and EHEC O157:H7. The thermophilic isolated enteropathogens found were further analysed by antibiograms. Among the 50 gulls examined, we found 2 isolates of Salmonella typhimurium with multiple antibiotic resistance. Three isolates of C. jejuni were found in the 101 stool samples from passerines. We did not isolate EHEC O157:H7 in any of the bird stools examined.

Role of the Haemophilus ducreyi Ton system in internalization of heme from hemoglobin

By cloning into Escherichia coli and construction of isogenic mutants of Haemophilus ducreyi, we showed that the hemoglobin receptor (HgbA) is TonB dependent. An E. coli hemA tonB mutant expressing H. ducreyi hgbA grew on low levels of hemoglobin as a source of heme only when an intact H. ducreyi Ton system plasmid was present. In contrast, growth on heme by the E. coli hemA tonB mutant expressing hgbA was observed only at high concentrations of heme, was TonB independent, and demonstrated that H. ducreyi HgbA was not sufficient to function as a typical TonB-dependent heme receptor in E. coli. Allelic replacement of the wild-type H. ducreyi exbB, exbD, and tonB loci with the exbB, exbD, and tonB deletion resulted in an H. ducreyi isogenic mutant unable to utilize hemoglobin but able to utilize hemin at the same levels as the parent strain to fulfill its heme requirement. This finding confirms the TonB dependence of HgbA-mediated hemoglobin utilization and suggests that uptake of hemin in H. ducreyi is TonB independent. Additionally, the H. ducreyi Ton system mutant synthesized increased amounts of HgbA and other heme-regulated outer membrane proteins, consistent with derepression of these proteins due to lower intracellular heme and/or iron concentrations in the mutant. Sequencing of the Ton system genes revealed that the arrangement of the genes was exbB exbD tonB. The proximity and structure of these genes suggested that they are transcribed as an operon. This arrangement, as well as the DNA and deduced amino acid sequences of these H. ducreyi genes, was most similar to those from other pasteurellae.

[Murderers in white coats--the physicians' plot against Stalin]

During the Moscow trials in 1936-38 several doctors were sentenced for participating in the murders of party leaders. As others who were accused, the doctors willingly confessed to crimes they could not possibly have committed. A second doctors' plot took place in the autumn of 1952. This time nine doctors, six of them Jews, were arrested for the attempted murder of political leaders. Only the unexpected death of Josef Stalin prevented a new wave of terror. With the single exception of Genrikh Grigorjevitsj Jagoda (1891-1938), head of the NKVD (KGB's predecessor), all those sentenced under the Moscow process are now rehabilitated. The participants of the second doctors' plot were rehabilitated immediately after Stalin's death.

Inhibition of angiogenesis by tissue inhibitor of metalloproteinase-3

PURPOSE

It has been established that Sorsby's fundus dystrophy, a dominantly inherited form of blindness, is caused by mutations in the tissue inhibitor of metalloproteinase-3 (TIMP-3) gene. Because choroidal neovascularization is a prominent feature of Sorsby's fundus dystrophy, the authors have examined whether TIMP-3 protein plays a role in the regulation of angiogenesis.

METHODS

Chemotaxis of endothelial cells toward vascular endothelial growth factor (VEGF) and basic fibroblast growth factor (bFGF) was examined using a modified Boyden chamber assay. Endothelial cells placed in the upper chamber were allowed to migrate through a polycarbonate membrane with 8 microns pores toward VEGF or bFGF present in the lower chamber. Next, the ability of TIMP-3 to inhibit chemotaxis was studied by incubating the cells with varying amounts of TIMP-3 during the assay. Finally, an in vitro angiogenesis assay was performed on collagen gels. Endothelial cells were seeded onto three-dimensional collagen gels. Treatment with bFGF and VEGF induced invasion of the gel and the formation of tube-like structures. TIMPs (1, 2, and 3) were added to the cultures to determine their effect on invasion. An in vivo chorioallantoic membrane (CAM) assay was performed using methylcellulose discs containing bFGF with or without TIMP-3. Induction of new blood vessels was observed with a stereomicroscope.

RESULTS

TIMP-3 inhibits chemotaxis of vascular endothelial cells toward VEGF and bFGF, inhibits collagen gel invasion and capillary morphogenesis in vitro, and inhibits bFGF-induced angiogenesis in the CAM assay in vivo.

CONCLUSIONS

TIMP-3 has the potential to inhibit angiogenesis. These results allow us to speculate on a possible mechanism by which mutant TIMP-3 protein might contribute to the Sorsby fundus dystrophy phenotype.

Leuconostoc spp. septicaemia in a child with short bowel syndrome

Septicaemia caused by the vancomycin-resistant Gram-positive bacteria Leuconostoc spp. is uncommon. We report a case of Leuconostoc spp. septicaemia in a child with short bowel syndrome fed through a central venous catheter and a gastrostomy. Leuconostoc spp. were isolated from several blood cultures. Despite several courses of antibiotics the fever continued and her condition deteriorated. After removal of the thrombotized central venous catheter her condition improved. Leuconostoc spp. was isolated from the thrombotic masses.

CD4 lymphopenia in a patient with cryptococcal osteomyelitis

Cryptococcus neoformans is a rarely reported cause of osteomyelitis. In most cases, no obvious underlying condition is found. Immunological laboratory data, however, are not generally available. In the present case of cryptococcal osteomyelitis, idiopathic CD4 lymphopenia was detected. This immunodeficiency is found in cases of disseminated cryptococcosis by chance. Possibly, it may be one so far unrecognized underlying condition in cryptococcal osteomyelitis.

Fourier transform infrared microspectroscopic analysis identifies alterations in mineral properties in bones from mice transgenic for type X collagen

Type X collagen has been implicated in the morphogenetic events of endochondral ossification (EO), including the calcification of hypertrophic cartilage and trabeculae prior to their replacement by bone and marrow. Recently, transgenic mice, which expressed a truncated collagen X protein, were reported to exhibit morphologic alterations in all tissues arising through EO. Specifically, the growth plates were compressed within the zone of cartilage hypertrophy, and the number and size of calcified trabeculae were reduced. The condition in the mouse is comparable to Schmid metaphyseal chondrodysplasia in humans for which, to date, 20 defined type X collagen mutations have been reported. The transgenic mouse showed no alterations in mineralization by conventional histology, however, it did show a decrease in newly formed bony trabeculae, and a thinning of periosteal bones. Fourier transform infrared (FTIR) spectroscopy has previously been shown to provide quantitative and qualitative information about the relative amount of mineral and carbonate present, mineral composition, and crystal perfection. To determine whether the expression of abnormal collagen X molecules had an effect on mineral properties, the "quality" of mineral crystals was analyzed in thin sections of tibia from day 17 and day 25 genotypically negative (normal) and positive (mutant) mice from several independent transgenic mouse lines showing varying degrees of the mutant phenotype, by means of Fourier transform infrared microscopic analysis (FTIRM). The results indicate definite differences between normal and transgenic mice calcified cartilage mineral, both in the amount present and the "quality" of the crystals. Calcified cartilage mineral from transgenic mice exhibited less crystallinity and higher acidic phosphate content than the corresponding mineral from normal specimens.

Congenital pseudarthrosis of the tibia

The present concepts of the aetiology, prevention and treatment of congenital pseudarthrosis of the tibia are discussed. The satisfactory results of Ilizarov's method and vascularised fibular grafting make these methods optimal choices for treatment. When they are not available, a bone graft with intramedullary fixation is a valuable alternative.

Canary finches (Serinus canaria) as an avian infection model for Lyme borreliosis

To investigate if passerine birds can be used as an avian model for Lyme borreliosis, the Borrelia burgdorferi sensu stricto strain Sh2-82 was inoculated subcutaneously on Canary finches (Serinus canaria). Spirochaetes could be detected in the blood by direct microscopy and an immunofluorescence assay (IFA) up to 2 weeks after the inoculation. DNA amplification (PCR) revealed B. burgdorferi DNA in the serum for up to 3 weeks, in the faeces up to 4 weeks, and from several internal organs at autopsy 3 months after the inoculation. Of particular interest was the finding of B. burgdorferi DNA in the liver of all birds at the end of the experiment, indicating a persistent infection. Four weeks after the primary infection, all infected birds showed an increase in anti Borrelia IgG antibodies and after 6 weeks all birds had seroconverted. Except for a brief episode of diarrhoea, none of the birds showed any signs of disease. This study shows that passerine birds experience short-term spirochaetemia after infection with B. burgdorferi, but show few clinical symptoms. This suggests that, although these birds can act as reservoirs of B. burgdorferi s.s., they may be of less importance as long lasting amplifiers for this pathogen.

Adult survivors of childhood sexual abuse. Do I have them in my practice?

The long term sequelae of childhood sexual abuse include many symptoms commonly encountered in general practice settings. Guidelines to empathic history taking, comprehensive assessment, and an overview of management are presented, together with a contextual background.

The role of type X collagen in endochondral ossification as deduced by Fourier transform infrared microscopy analysis

Type X collagen has been implicated in the morphogenetic events of endochondral ossification (EO), including the calcification of hypertrophic cartilage and trabeculae prior to their replacement by bone and marrow. Recently, transgenic mice which expressed a truncated collagen X protein were reported to exhibit morphologic alterations in all tissues arising through EO. Fourier Transform InfraRed (FTIR) spectroscopy has previously been shown to provide quantitative and qualitative information about the relative amount of mineral and carbonate present, mineral composition, and crystal perfection. To determine the role of collagen X in mineralization, the "quality" of mineral crystals was analyzed in thin sections of calcified cartilage from tibia obtained from several independent transgenic mouse lines showing varying degrees of the mutant phenotype and mice without type X collagen expression, by means of Fourier Transform InfraRed microscopy (FTIRM). In the present paper, the term "mineral quality" is employed to describe crystallinity/crystal maturation, and acid phosphate content. The results indicate significant differences between normal and transgenic mice bone mineral, both in the amount present and the "quality" of the crystals. In contrast, the analysis of the mineral in mice without type X collagen expression was not different from their age/sex-matched controls.

[Mikhail Bulgakov--a colleague and cult figure]

Mikhail Bulgakov (1891-1940) was medically qualified, but practised as a doctor only a few years before he launched on a full time career as a writer. His writings are marked by exuberant satire and burlesque phantasy, a genre condemned anti-Sovietic. Throughout his writing life, Bulgakov found it extremely difficult to get his writings published. He did not become known to the reading public inside and outside USSR until 30 years after his death.

Transhemispheric exchange of Lyme disease spirochetes by seabirds

Lyme disease is a zoonosis transmitted by ticks and caused by the spirochete Borrelia burgdorferi sensu lato. Epidemiological and ecological investigations to date have focused on the terrestrial forms of Lyme disease. Here we show a significant role for seabirds in a global transmission cycle by demonstrating the presence of Lyme disease Borrelia spirochetes in Ixodes uriae ticks from several seabird colonies in both the Southern and Northern Hemispheres. Borrelia DNA was isolated from I. uriae ticks and from cultured spirochetes. Sequence analysis of a conserved region of the flagellin (fla) gene revealed that the DNA obtained was from B. garinii regardless of the geographical origin of the sample. Identical fla gene fragments in ticks obtained from different hemispheres indicate a transhemispheric exchange of Lyme disease spirochetes. A marine ecological niche and a marine epidemiological route for Lyme disease borreliae are proposed.

Bacterial colonization of the larynx and trachea in healthy children

Fifty healthy children were included in the study; tracheal and laryngeal aspirations were performed after oral endotracheal intubation during minor surgery. The aspirates were evaluated and examined in the same way as aspirates from children suspected of pneumonia; 31 samples were accepted for the final analysis. After culturing, specimens from 30 children exhibited growth of potential pathogenic bacteria either from the larynx, the trachea or both. Prior to culture, bacteria were seen by microscopy in 24 samples from 30 children. These results indicate that the majority of healthy children carry potential pathogenic bacteria, not only in the larynx but also to a certain extent in the trachea. We conclude that aspirates from the larynx and the trachea are of limited value in the diagnosis of bacterial pneumonia in children.

Steroid hormone regulation and tissue-specific expression of the human GnRH gene in cell culture and transgenic animals

In order to study the molecular mechanisms involved in the control of GnRH gene expression, the human GnRH gene was cloned and characterized. The gene was expressed in cells obtained from CNS tumors in transgenic mice generated utilizing 1131 bp of 5' flanking GnRH DNA fused to the simian virus 40 large T antigen. We have shown a stimulatory estrogen response element in the human GnRH gene by transient transfection studies. DNase I footprinting and an avidinbiotin DNA binding assay demonstrated that the human GnRH gene bound ER. The GN cell line was found to have nuclear ERs utilizing an 125I estradiol binding study and by in situ hybridization histochemistry. In order to study GnRH expression in vivo, either 5000 or 484 bp of GnRH flanking DNA was fused to the luciferase (Luc) reporter gene, and transgenic mice generated. Expression in the transgenic animals was found in the hypothalamus of animals bearing the -5000Luc transgene, but not in animals bearing the -484Luc transgene. The transgenic mice expressing the -5000Luc gene were gonadectomized resulting in a 20-30% increase in hypothalamic Luc expression in the males and a 65% increase in females, while mice who were gonadectomized and replaced with testosterone (males) or E2 (females) showed a 50% decrease in Luc expression over control levels. Thus, these studies present in vitro evidence of E2 modulation of GnRH gene expression and an in vivo model in which sensitive studies of GnRH regulation and expression can be performed.

[Urinary bladder diverticula]

We describe two patients with urinary tract infection and obstructive voiding problems which lasted for respectively 21 months and five years before a bladder diverticulum was diagnosed by cystography and cystoscopy. Both patients were operated on by open diverticulectomy. The post-operative courses were uneventful and both patients were relieved of urinary symptoms after surgery. The article includes a review of the literature on bladder diverticula.

Geographical distribution, host associations, and vector roles of ticks (Acari: Ixodidae, Argasidae) in Sweden

This review covers the geographic distribution and host relationships of the tick species in Sweden. Ixodes uriae White, I. caledonicus Nuttall, I. unicavatus Neumann, I. arboricola Schulze & Schlottke, and I. lividus Koch are ornithophagous species. I. trianguliceps Birula, I. canisuga Johnston, I. hexagonus Leach, and Argas vespertilionis (Latreille) are mammalophagous. I. ricinus (L.) and Haemaphysalis punctata Canestrini & Fanzago feed on both birds and mammals. All these tick species may be considered to be permanently present in Sweden. I. persulcatus Schulze, Hyalomma marginatum Koch, and the brown dog tick, Rhipicephalus sanguineus (Latreille), may be regarded as not indigenous to Sweden although they may be regularly introduced by spring-migrating birds or imported dogs, respectively. The first European record of the American dog tick, Dermacentor variabilis (Say), is reported. There are several records of Hyalomma aegyptium (L.) from imported tortoises in Sweden. Excluding other ticks imported on exotic pets and zoo animals, another 13 tick species are listed that may occur, at least occasionally, in Sweden. Because of its wide geographic distribution, great abundance, and wide host range, I. ricinus is medically the most important arthropod in northern Europe. I. ricinus is common in southern and south-central Sweden and along the coast of northern Sweden and has been recorded from 29 mammal species, 56 bird species, and two species of lizards in Sweden alone. The potential introduction to Sweden of exotic pathogens with infected ticks (e.g., I. persulcatus and H. marginatum on birds or Dermacentor spp. and R. sanguineus on mammals) is evident.

[Cystitis cystica--a premalignant condition?]

Although cystitis cystica is considered to be a premalignant disease of the urinary bladder, remarkably few reports document the progression from cystitis cystica and glandularis to carcinoma of the bladder. We describe three patients where cystitis cystica was demonstrated 12, three and one month before diagnosis of cancer. We believe cystitis cystica reflects mobilization of the humoral immune defence mechanism in response to various agents, among these a subclinical malignant tumour.

[The health survey in Finnmark--satisfaction with hospital services]

Global satisfaction with hospital services was examined in a comprehensive population study (age group 20-62) in the county of Finnmark, Norway. Indicators of availability of and access to the health care services in general appeared to have considerable impact on the evaluation of hospital services. People were least satisfied in municipalities with a high rate of turn-over of general practitioners, and among respondents who had difficulty in getting in touch with a general practitioner. Further, geographical proximity to hospitals and shutting down of local hospitals significantly influenced satisfaction. Various measures of health status, chronic disease and use of health care services were found to have marginal or no impact. On the other hand, low satisfaction with life in general, length of education and high preoccupation with health appeared to increase dissatisfaction.

Ilizarov technique. Results and difficulties

Of 100 cases treated by the Ilizarov method, 91 patients were reviewed from February 1985 to March 1990. There were 32 tibial fractures (29 open) and 21 nonunions (nine infected). There were 47 cases of limb lengthening (28 tibia and 19 femur). The results were as follows: good, 83%; fair, 13%; and poor, 4%. Slight and intermittent pain in some wire of the device was frequent (69%). Average bone healing time in tibial fractures was 4.95 months and 5.83 months in tibial nonunions. In bone-lengthening operations, the average lengthening index in the tibia was 1.02 months/cm (lengthenings ranged from 3 cm to 10 cm, with a mean of 5.71 cm), whereas in the femur, the average lengthening index was 1.14 months/cm (lengthenings ranged from 3 cm to 7 cm, with a mean of 5.34 cm). Manually-tensed wires produced frequent problems (24.5%), whereas wire tensed by the dynamometric tensioner produced problems in only 7.8% of the cases. Despite good results, the Ilizarov technique requires adequate training to reduce an overall complication rate (approximately 30%).

Comparative study of microsatellite and cytogenetic markers for detecting the origin of the nondisjoined chromosome 21 in Down syndrome

Nondisjunction in trisomy 21 has traditionally been studied by cytogenetic heteromorphisms. Those studies assumed no crossing-over on the short arm of chromosome 21. Recently, increased accuracy of detection of the origin of nondisjunction has been demonstrated by DNA polymorphism analysis. We describe a comparative study of cytogenetic heteromorphisms and seven PCR-based DNA polymorphisms for detecting the origin of the additional chromosome 21 in 68 cases of Down syndrome. The polymorphisms studied were the highly informative microsatellites at loci D21S215, D21S120, D21S192, IFNAR, D21S156, HMG14, and D21S171. The meiotic stage of nondisjunction was assigned on the basis of the pericentromeric markers D21S215, D21S120, and D21S192. Only unequivocal cytogenetic results were compared with the results of the DNA analysis. The parental and meiotic division origin could be determined in 51% of the cases by using the cytogenetic markers and in 88% of the cases by using the DNA markers. Although there were no discrepancies between the two scoring systems regarding parental origin, there were eight discrepancies regarding meiotic stage of nondisjunction. Our results raise the possibility of recombination between the two marker systems, particularly on the short arm.

An occipito-temporal syndrome in adolescents with optimally controlled hyperphenylalaninaemia

The study included 16 adolescents with optimally controlled hyperphenylalaninaemia (McKusick 26160), of whom six did not require treatment according to conventional criteria. All except the two patients with lowest median serum phenylalanine level throughout childhood (most values at 200-300 mumol/L) had white matter abnormalities detectable with magnetic resonance imaging. The lesions were particularly prominent in the watershed regions between the posterior and middle cerebral arteries. In most patients with moderate or severe hyperphenylalaninaemia frontal white matter lesions were present as well. Normal proton magnetic resonance spectra indicated that the lesions were stable. Occipital EEG abnormalities were frequent, and deficient performance on a pattern-recognition test was a characteristic neuropsychological finding. Serum phenylalanine levels at about 300 mumol/L or below throughout childhood and early adolescence may be required to avoid lesions. The present study demonstrates the limitations of even an optimally controlled dietary regimen in hyperphenylalaninaemia.

[The health survey in Finnmark--how is the population satisfied with community health services?]

Global satisfaction with primary health care services among men and women aged 20 to 62 was examined in a comprehensive population study in the county of Finnmark in 1987-88. Access to general practitioners was found to be the most important determinant of global satisfaction. People were least satisfied in larger municipalities, in municipalities with low stability of doctors, and, when they had experienced difficulties in getting in touch with a doctor when the need arose. There was positive association between satisfaction with life in general and satisfaction with primary health care services. Various measures of health status, chronic disease and use of health services were found to have marginal or no impact on the overall assessment.

[Institutionalized treatment of agoraphobia with panic anxiety]

We describe an integrated behavioral-psychodynamic treatment programme for inpatients suffering from agoraphobia and panic anxiety. This programme emphasizes intensive drug-free exposure training followed by work with anxiety-laden dynamic conflicts. We present promising results of evaluation studies, and discuss the important role of cognitive reconstruction of anxiety and of passive and active avoidant attitudes in exposure training. Lastly, we make certain recommendations concerning the approach to anxiety problems in general practice.