[Serology in patients with scleroderma]

In order to evaluate the practical clinical value of centromere, Scl-70, and nucleolar antibodies as demonstrated routinely by the Autoimmune Department of the Serum Institute of Copenhagen, 1293 sera from 497 patients with scleroderma (SSc) and other connective tissue diseases were tested for the three antibodies and for other nuclear antibodies. The three antibodies were found in 32, 15 and 15%, respectively, of sera from patients with SSc. Since more than one of the three antibodies was rarely demonstrated in any one serum, one of them was found in two thirds of sera from patients with SSc. The specificity of the three antibodies for SSc was 95% or more. Centromere antibody was found most frequently in patients with limited SSc. Scl-70 antibody was found almost exclusively in sera from patients with extensive SSc (involving the skin of the trunk). In such sera, centromere antibody was found in only 21%. Scl-70 antibody was overrepresented and centromere antibody was underrepresented in sera from patients with pulmonary involvement, the converse being true for sera from patients with calcinosis, esophageal involvement and telangiectasia.

Lipoid proteinosis

Lipoid proteinosis (Urbach-Wiethe disease) is a rare, recessively inherited disorder that is characterized by the deposition of hyaline-like material in the skin, oral cavity, and other tissues. It usually appears in infancy with hoarseness. We report a case of lipoid proteinosis in a 10-year-old boy that demonstrates the characteristic clinical, histologic, and ultramicroscopic features of this disease.

[Leprosy--still a possibility in Denmark]

A case of borderline tuberculoid leprosy in a 27 year old woman from the Philippines is presented. The diagnosis was made after repeated biopsies. Only a single mycobacterium was present and the histology of the initial biopsies was inconclusive. This case emphasizes that leprosy is still imported to Denmark, and that the diagnosis is often difficult and delayed for years.

Clinical manifestations in patients with autoantibodies specific for nuclear lamin proteins

IgG antibodies to nuclear lamin proteins have been found in serum samples from 31 patients using immunofluorescence on HEp-2 cells, Western blotting, and enzyme-linked immunosorbent assay, performed against a nuclear lamina preparation from Ehrlich ascites tumor cells. Antilamin antibodies were most prevalent among patients with nonerosive, seronegative polyarthritis, or patients showing serum antiphospholipid reactivity as well. It is possible that anti-lamin antibodies may thus be a marker for a subgroup of polyarthritis patients who have a different prognosis from that of those with seropositive rheumatoid arthritis. The mechanism for the combined occurrence of anti-lamin and antiphospholipid autoantibodies is obscure. Future studies will answer whether these two antibodies represent a distinct antibody profile in patients with antiphospholipid antibody syndrome.

[Systemic lupus erythematosus. 2. Factors of predictive significance for survival]

Sixty-one of 173 patients with systemic lupus erythematosus followed for a mean of 13.9 years had severe infections which influenced their survival more than could be accounted for by the mortality (20 per cent) caused by the infections. Patients with infections had more SLE manifestations than patients without infections, and they died of lupus manifestations more often than patients without infections. Patients who went into a permanent remission and patients who died of lupus differed most markedly by the rates of infection. The rate of infection was increased more than tenfold in patients treated with high dosages of glucocorticoid compared with patients who received low dosages. Treatment with cytostatics influenced the rate of infections to a moderate degree. Nephropathy also influenced survival but half of the patients with nephropathy maintained a normal plasma creatinine in spite of the long observation period. 16 per cent of the patients with nephropathy died of kidney failure or are receiving chronic hemodialysis.

[Systemic lupus erythematosus. 1. Disease manifestations, infections, thrombotic episodes, causes of death and survival in a case load of 173 patients followed for 13.9 years]

One hundred and seventy-three patients had systemic lupus erythematosus according to the 1982-ARA-criteria. The mean disease duration at the time of the study was 16.4 years, and the patients were followed by three Copenhagen clinics for a mean of 13.9 years until 1987/88 or death. Half of the patients had nephropathy, 61 patients developed severe infections, and 39 patients had thrombotic episodes. Fifty-six patients died during the observation period, 24 due to active lupus (12 of kidney failure), 12 because of infections, and 11 because of atherosclerotic cardio-vascular disease. The patients had 10-, 15- and 20-year survival rates of 80, 65 and 48 per cent. The deaths were evenly distributed throughout the observation period.

Short- and long-range processes in structure-from-motion

Human ability to detect 3-D structure in an array of 2-D moving dots was tested. Under limited exposure time, we found high detection rates only when the 2-D motion was restricted to the spatio-temporal region of short-range motion. Long-range moving dots failed to produce a strong impression of 3-D structure and yielded only weak detection rates. This result is consistent with the view that the processing of long-range motion is more serial than that of short-range motion.

Visual curve tracing properties

Subjects decided whether 2 dots were on the same curve or 2 different curves, and the curvature of the curves or the proximity of other (distractor) curves to the target curve was varied. Response time increased as the arc length of the curve connecting the 2 dots increased, suggesting that the curve was traced to perform the task. Tracing rate was faster for low- than high-curvature contours and was increasingly slower as distractor contours were increasingly proximal to the traced curve. Proximity results were predicted by a model in which response time depends on the ratio of the distance between the dots and the distance between adjacent lines. Curve tracing operations used to integrate information along contours are sensitive to several properties of the contours. The implications of the sensitivity of tracing operations to these curve properties are discussed.

Autoantibodies to lamins A and C in sera of patients showing peripheral fluorescent antinuclear antibody pattern on HEP-2 cells

Lamins A, B, and C are the major proteins of a polymeric structure called nuclear lamina, which is intercalated between chromatin and the inner membrane of the nuclear envelope. Using immunofluorescence on HEp-2 cells, specific enzyme-linked immunosorbent assay, and Western blotting performed against nuclear lamina preparation from Ehrlich ascites tumor cells, we characterized three patients, whose sera contained antibodies to nuclear lamins. The reaction pattern observed in two of the patients may result from single or combined occurrence of anti-lamin A and C antibodies. The third patient had antibodies that probably recognized an epitope in the carboxy-terminal region of lamin C. The sera were donated by a heterogeneous group of patients, and no common clinical or laboratory signs seemed to link them together.

Aligning pictorial descriptions: an approach to object recognition

This paper examines the problem of shape-based object recognition, and proposes a new approach, the alignment of pictorial descriptions. The first part of the paper reviews general approaches to visual object recognition, and divides these approaches into three broad classes: invariant properties methods, object decomposition methods, and alignment methods. The second part presents the alignment method. In this approach the recognition process is divided into two stages. The first determines the transformation in space that is necessary to bring the viewed object into alignment with possible object models. This stage can proceed on the basis of minimal information, such as the object's dominant orientation, or a small number of corresponding feature points in the object and model. The second stage determines the model that best matches the viewed object. At this stage, the search is over all the possible object models, but not over their possible views, since the transformation has already been determined uniquely in the alignment stage. The proposed alignment method also uses abstract description, but unlike structural description methods it uses them pictorially, rather than in symbolic structural descriptions.

The development of AIDS or AIDS-related conditions in a cohort of HIV antibody-positive homosexual men during a 3-year follow-up period

One hundred and thirty-three homosexual men seropositive for the antibody against human immunodeficiency virus (HIV) were enrolled in a prospective study in 1984-85. The 3-year cumulative incidences of the acquired immunodeficiency syndrome (AIDS) and AIDS-related conditions, by life-table analyses, were 18% and 34%. The cumulative incidence of immune deficiency defined as CD4 lymphocytes less than 0.5 x 10(9) l-1 was 70% at 3 years. Absence of antibodies to p24 antigen, HIV antigenaemia, CD4 lymphocytes less than 0.3 x 10 l-1 and elevated serum level of IgA were significantly associated with the development of AIDS. There was no association between disease progression and persistent generalized lymphadenopathy. When adjusted to the probable year of infection, these results are in accordance with previous cohort studies. It is concluded that most, or all, subjects seropositive for HIV will develop progressive loss of CD4 lymphocytes followed by clinical signs of immune deficiency, and that differences among previous cohorts with respect to disease progression are probably due to differences in the duration of infection.

Necrotizing keratitis caused by Capnocytophaga ochracea

We studied three cases of Capnocytophaga keratitis that demonstrated stromal necrosis and a ring infiltrate. In all cases, the keratitis occurred in a previously diseased or traumatized cornea. One patient was treated with chronic antiamoebic therapy for presumed Acanthamoeba keratitis. Two cases resulted in corneal perforation. Laboratory isolation was difficult because of slow, fastidious growth. Capnocytophaga is not uniformly sensitive to commonly used topical antibiotics such as the cephalosporins and aminoglycosides, but may respond to treatment with topical clindamycin.

Living with Asthma. I. Genesis and development of a self-management program for childhood asthma

This paper traces the roots of Living with Asthma, a self-management program for childhood asthma, from the Children's Asthma Research Institute and Hospital (CARIH), a residential treatment center in Denver, Colorado. The basic components of the program were developed and tested over the 40-year history of CARIH; the findings of an educational unit were added to this accumulated knowledge and expertise to complete the system. The program rests heavily on social learning theory, particularly two major tenets: 1) the concept of reciprocal determinism and 2) the learning/performance dichotomy. The crucial role of these concepts is described here, especially with respect to the design of the program and the selection of dependent variables. The remainder of this article describes the essentials of Living with Asthma, particularly the skills taught and performed by patients in a formal evaluation of the system. The design of the study, characteristics of patients enrolled in the program, and results obtained with the system are discussed. The program proved highly effective in significantly improving the knowledge of asthma in parents and their children, and in developing positive attitudes in both groups. It also produced significant reductions in the number of attacks experienced by the youngsters and improved their peak flow values. Participation in the program resulted in changes in morbidity indices of asthma, including significant reductions in school absenteeism and health-care costs incurred because of the disorder. These changes, it was concluded, reflected the result of the performance by patients of the self-management skills taught in Living with Asthma, coupled with the exceptional medical treatment they received.

Gonococcal keratoconjunctivitis

Gonococcal keratoconjunctivitis is a potentially devastating infection, because Neisseria gonorrhoeae can cause a rapid, severe, ulcerative keratitis resulting in visual loss. The therapeutic decision making process is complicated by the necessity for prompt, effective parenteral therapy, frequent coinfection with other sexually transmitted diseases, and emergence of antibiotic resistance. Because of the evolving problem of antibiotic resistance and the need for cost containment, the current recommendations of hospitalization for intravenous penicillin may need to be modified. The third generation cephalosporin, ceftriaxone, has properties that suggest it may be the best available antimicrobial agent as a single-dose treatment of gonococcal conjunctivitis. Spectinomycin may be a useful alternative in the penicillin-allergic adult patient.

Lymphocyte transformation response to pokeweed mitogen as a predictive marker for development of AIDS and AIDS related symptoms in homosexual men with HIV antibodies

To identify factors that may predict the development of the acquired immune deficiency syndrome (AIDS) or AIDS related symptoms various immunological measurements were studied in a group of homosexual men attending screening clinics for AIDS in Copenhagen. Fifty seven men whose ratio of T helper lymphocytes to T suppressor lymphocytes (CD4:CD8 ratio) was less than 1.0 before the study began were included. Forty two were positive for antibody to the human immunodeficiency virus (HIV), of whom 38 were reinvestigated after a median observation period of 10 months. Among the seropositive men the transformation responses to pokeweed mitogen and cytomegalovirus and the absolute count of CD4 positive lymphocytes were the most common abnormal values. In particular, a low relative response to pokeweed mitogen on initial investigation correlated with a worsened clinical condition on reinvestigation. The risk of a worsened clinical condition was 55 times higher in seropositive men whose responses to pokeweed mitogen were low than in other seropositive men. The corresponding relative risks for low transformation responses to cytomegalovirus and for a decreased absolute count of CD4 positive lymphocytes were 18 and six. The relative response to pokeweed mitogen is therefore a very sensitive short term predictive marker of the clinical condition of seropositive patients who have a CD4:CD8 ratio of less than 1.0.

Parallel and serial processes in motion detection

Apparent motion was used to explore humans' ability to perceive the direction of motion in the visual field. A marked qualitative difference in this ability was found between short- and long-range motion. For short-range motion, the detection of the direction of motion is characterized by parallel operation over a wide visual field (that is, detection performance is independent of the number of objects in an array). When the positional displacement is large relative to an object's size, the direction of motion is detected in a serial manner. The process of detection is limited in this case by the ability to detect other events, such as appearance and disappearance of an object, and the ability to compute their spatio-temporal relations. The results are consistent with a previously suggested division of the motion detection system into short- and long-range processes. The direction of short-range motion can be perceived in parallel (preattentively), whereas long-range motion is attentive and requires more complicated computations. It seems that the detection of long-range motion is a conjunction task, combining the detection of disappearance and appearance.

Clinical implications of ribonucleoprotein antibody

Out of 97 patients with circulating ribonucleoprotein antibodies, 44 (45%) satisfied the criteria for systemic sclerosis, systemic lupus erythematosus, polymyositis/dermatomyositis, or rheumatoid arthritis. Forty-two (43%) of the 97 patients whose cases did not fulfill these criteria had at least two of the following three clinical manifestations: arthritis, Raynaud's phenomenon, and swollen or sclerotic fingers. A fifth of the latter group of patients had chronic, restrictive pulmonary disease or myopathy and two thirds had hypergammaglobulinemia, IgM rheumatoid factor, and sensitized epidermal nuclei. Few patients had hypocomplementemia. One patient had nephropathy. Most patients had an unchanged, benign disease course for, on the average, nine years. It is suggested that the term mixed connective tissue disease (MCTD) be reserved for such patients, and that the acronym MCTD be changed to SRA (swollen fingers, Raynaud's phenomenon, and arthritis). Treatment with glucocorticoids is necessary for only a minority of patients.

Neisseria gonorrhoeae keratoconjunctivitis

Clinical and laboratory findings of 47 patients with ocular infections secondary to Neisseria gonorrhoeae during a 5 1/2-year period were reviewed. In 16 patients (34%), corneal involvement was noted. Six of these patients had a severe ulcerative keratitis resulting in permanent visual loss and five required surgery for a corneal perforation. Patients with corneal involvement were older and presented later in the course of their disease than patients with isolated conjunctival involvement (P less than 0.005). An out-patient regimen of intramuscular antibiotics (either penicillin, cephalosporin, or spectinomycin [Trobicin]) appeared to be effective for infections limited to the conjunctiva in adults. If a topical antibiotic ointment is used in addition to parenteral antimicrobial agents, the authors' laboratory sensitivities suggest that erythromycin may be the drug of choice.