Intraoperative angiography in minimally invasive direct coronary artery bypass grafting

Intraoperative angiography in minimally invasive direct coronary artery bypass grafting without cardiopulmonary bypass and in hybrid procedures is reported. Twelve procedures were performed in a specially designed surgical-radiologic suite with a cross-disciplinary organization. In 2 patients the anastomosis was successfully revised on the basis of angiographic findings. In 4 of the 12 patients anastomosis of the left internal mammary artery to the left anterior descending coronary artery performed as a minimally invasive direct coronary artery bypass grafting procedure was combined with percutaneous transluminal coronary angioplasty of lesions in other coronary vessels in the same session. Intraoperative angiography allows a reliable diagnosis of an anastomosis or graft failure and prompt and reliable correction, and it allows the combination of minimally invasive direct coronary artery bypass grafting and angioplasty in one session.

Key factors in the identification of the high-risk patient with unstable coronary artery disease: clinical findings, resting 12-lead electrocardiogram, and continuous electrocardiographic monitoring

This article reviews a range of methods for identifying high-risk patients with unstable coronary artery disease, including clinical evaluation, the resting 12-lead electrocardiogram, continuous vectorcardiography, and a combined risk evaluation using continuous vectorcardiography and measurement of troponin-T. Clinical evaluation is not very accurate for identifying high-risk patients and modern techniques have not been fully validated in clinical trials. The combination of continuous vectorcardiography and biochemical monitoring is a very powerful method of identifying both very high- and very low-risk patients and may be increasingly used in the future.

Prevalence of very mild to severe dementia in Denmark

OBJECTIVES

The prevalence of dementia has been estimated in several countries and a meta-analysis has shown moderate and severe dementia in people aged 65 years and older to be between 4% and 6%. The Odense study is aiming to estimate the prevalence and incidence of dementia and to identify risk factors.

MATERIAL AND METHODS

A total of 3346 persons, equivalent to 64.5% of a random sample of 5237 persons aged 65-84 years living in the municipality of Odense, Denmark, underwent a two phase diagnostic procedure including a screening with CAMCOG, the cognitive section of The Cambridge Examination for Mental Disorders of the Elderly, seven neuropsychological tests, medical examination, and CT scan. The severity of dementia was assessed by the CDR (Clinical Dementia Rating).

RESULTS

The prevalence rate was 7.1%, including the very mildly demented, defined as persons rated questionably demented according to the CDR scale. The prevalence rate of very mild dementia was 2.8%. The proportion of cases with very mild dementia decreased with increasing age while the prevalence rate increased.

CONCLUSION

Inclusion of very mild cases of dementia resulted in a higher prevalence rate than generally reported, and the prevalence rate increased exponentially with age which was mainly due to Alzheimer's disease.

Vectorcardiographic monitoring of patients with acute myocardial infarction and chronic bundle branch block

AIMS

This study was set up to describe vectorcardiographic patterns in patients with bundle-branch block and acute myocardial infarction.

METHODS AND RESULTS

Sixty-five patients admitted to the coronary care unit with bundle-branch block and suspected acute myocardial infarction were monitored by dynamic vectorcardiography with trend analysis. In 28 patients, a clinical diagnosis of acute myocardial infarction was made. In patients with left bundle-branch block and acute myocardial infarction, the pattern of QRS vector-difference evolution was similar to that in patients with the narrow QRS complex, while ST vector-magnitude changes increased over time. Using a cut-off value for QRS vector-difference at 12 h of more than 20 microVs and a specific trend curve pattern, acute myocardial infarction in the presence of left bundle-branch block could be diagnosed with an accuracy of 71%. For patients with right bundle branch block, using a maximum ST vector-magnitude of > 200 microV during the first 4 h, acute myocardial infarction could be diagnosed with a 78% accuracy.

CONCLUSION

Our results indicate that dynamic vectorcardiography is a valuable tool in diagnosing and monitoring acute myocardial infarction in patients with bundle branch block.

Acetylation of or beta-cyclodextrin addition to potato beneficial effect on glucose metabolism and appetite sensations

Functional foods are gaining more and more interest from health scientists. One way to improve the nutritional properties of foods may be to modify the starch component, often included to stabilize the food product. In this study two chemically modified starches-a 1-2% acetylated potato starch and a starch enriched with 2% beta-cyclodextrin-and a native, unmodified potato starch (control) were investigated with regard to 6-h energy expenditure, substrate metabolism, hormone concentrations, and subjective appetite sensations. Subjects were 11 healthy, normal-weight, young men. The starch (50 g) was prepared as a pudding with fruit sauce and whipped cream (3180 kJ, 49% of energy from carbohydrate, and 40% of energy from fat). The meal was given in the morning after a 2-d carbohydrate-rich, weight-maintenance diet. After the modified-starch meals, response patterns for plasma glucose (P < 0.01), insulin (P < 0.05); gastric inhibitory polypeptide (P < 0.05), subjective satiety (P < 0.05), and fullness (P = 0.06) were significantly different from response patterns after the meal with the control starch. Thus, a flattening of the glucose curve, a lower insulin and gastric inhibitory polypeptide response, and higher fullness ratings were observed after the meal with the beta-cyclodextrin starch. Satiety ratings were higher after both meals with modified starch than after the meal with the control starch. In conclusion, a minor modification insulinemic (1-2%) of native potato starch improved the glycemia, insulinemic, and satiating properties of a meal. This was especially true for the beta-cyclodextrin-enriched starch. Slower gastric-emptying rate or delayed intestinal absorption of the modified starch may explain the observed differences.

Electromyography in myopathy

Electromyography (EMG) is the most common procedure for screening patients with myopathies and remains the most important technique for assessing the course of the disease over time. Fibrillation potentials, positive sharp waves, myotonic or complex repetitive discharge, as well as polyphasic potentials are non specific and can occur in both myopathic and neurogenic lesions. The most sensitive and specific parameter for myopathy in conventional EMG is the decreased duration of motor unit potentials (MUP), but this can also be seen in disorders of the terminal motor fibers or the neuromuscular junction. More advanced techniques such as single fiber EMG, macro EMG, scanning EMG and turns/amplitude analysis have opened additional possibilities for analysis of the motor unit and the interference pattern, by which both the sensitivity to early changes and specificity for myopathic alterations is increased. The importance of combining different techniques to improve diagnostic yield and specificity is stressed.

Non-invasive risk stratification within 48 h of hospital admission in patients with unstable coronary disease

AIMS

In this study we evaluated the prognostic value of three methods of early risk estimation in patients with unstable coronary disease.

METHODS AND RESULTS

The methods evaluated were: clinical risk estimation at hospital admission, continuous ST analysis with computerized vectorcardiography for 24 h and serial measurements of creatinine kinase-MB for 48 h. Twenty-seven (14%) of the 195 patients died or had a non-fatal infarction within one year. Clinical risk evaluation correctly identified a subgroup of patients with low risk but did not otherwise predict outcome. Fifty-six (29%) patients had ST vector magnitude episodes on vectorcardiography, 70 (38%) had three or more episodes of ST change vector magnitude and 74 (38%) had a peak creatinine kinase-MB value of 6 microgram.l-1 or more. The even rate for patients with ST vector magnitude episodes (23%) was significantly higher than for those without (10%; P < 0.05). For patients with and without three or more episodes of ST change vector magnitude the event rate was 23% and 9% respectively (P < 0.05) and for patients with and without creatinine kinase-MB > or = 6 microgram.l-1 the event rate was 23% and 8% respectively (P < 0.01). The positive predictive value of having none, either one or both of the ST or creatinine kinase-MB markers positive was incremental.

CONCLUSION

Continuous vectorcardiographic monitoring of ischaemia in combination with serial creatinine kinase-MB measurement considerably improves risk stratification in unstable coronary disease.

[Budesonide and beclamethasone dipropionate inhalation powders. The effect on bone and collagen turnover in children]

The objective of the study was to assess bone and collagen turnover in asthmatic children treated with dry powder budesonide from the Turbohaler and dry powder beclomethasone dipropionate from the Diskhaler in a dose of 800 micrograms/day. Thirteen prepubertal children with asthma were studied. The study was conducted as an open crossover study with two treatment periods and treatment free run-in and wash-out periods. All periods were of two weeks' duration. At day 14 in each period blood samples were taken for assessment of serum osteocalcin, the carboxyterminal propeptide of type I collagen (PICP), and the aminoterminal propeptide of type III collagen (PIIINP). At the same time urine was collected for assessment of creatinine corrected pyridinoline (uPYR/cr) and deoxypyridinoline (udPYR/cr) crosslinks.

RESULTS

Osteocalcin concentrations were not influenced by any of the treatments. During budesonide treatment PICP was reduced by 18% (p = 0.03), PIIINP by 24% (p = 0.0002), uPYR/cr by 16% (p = 0.03) and udPYR/cr by 21% (p = 0.12). During treatment with beclomethasone dipropionate PICP was reduced by 20% (p = 0.01), PIIINP by 36% (p = 0.0002), uPYR/cr by 18% (p = 0.004) and udPYR/cr by 13% (p = 0.02). The suppressive effect of beclomethasone dipropionate on PIIINP was more marked than that of budesonide (p = 0.001). It is concluded that treatment with dry powder budesonide and beclomethasone dipropionate 800 micrograms/day is associated with suppression of bone and collagen turnover. The suppression seems to be more marked during treatment with beclomethasone dipropionate. Long term effects and effects of lower doses of budesonide and beclomethasone dipropionate on bone and collagen markers needs further study.

[Doppler ultrasound of blood flow in the hepatic veins]

The blood flow in the hepatic veins can normally be studied easily by Doppler ultrasound. The pattern of blood flow in normal individuals is described, and its relation to the cardiac cycle and changing pressure in the right atrium. The blood flow shows variations in healthy persons, and may change in cases of heart disease and hepatic disease. Conditions such as atrial fibrillation, tricuspid regurgitation, abnormal relaxation, restrictive cardiomyopathy, constrictive pericarditis and cardiac tamponade are reflected in the hepatic veins, and the pattern of blood flow may help in diagnosis, and in grading the pathology. In cirrhosis and portal hypertension the heart-synchronous variation in velocity is reduced. This is due to increased resistance to blood flow across the liver and the pressure gradient becoming larger than the variations in pressure in the right atrium.

Ischaemia detected by continuous on-line vectorcardiographic monitoring predicts unfavourable outcome in patients admitted with probable unstable coronary disease

BACKGROUND

Several methods have been suggested for risk stratification of patients with unstable coronary syndromes. However, most of these are applied several days after hospital admission.

METHODS

In this study we investigated the prognostic value of continuous ST-segment and QRS vector monitoring with computerized vectorcardiography (VCG), serial measurements of creatine kinase isoenzyme MB (CK-MB), predischarge stress testing and baseline data in patients with unstable angina pectoris or non-Q-wave infarction.

RESULTS

During the 24 h VCG monitoring, 56 (29%) of the 195 patients had ST-vector magnitude (ST-VM) episodes of ischaemia. Seventy-four (38%) patients had a peak CK-MB value of 6 micrograms/l or higher during the 48 h sampling period. Several discrete variables were associated with death or non-fatal infarction at 1 year of follow-up in an univariate analysis. Among these were age > or = 65 years, female sex, St depression on the admission ECG or VCG monitoring, and elevated CK-MB levels, but neither the occurrence, duration nor intensity of chest pain. With Cox's proportional hazards regression analysis, ST-VM episodes on VCG monitoring were identified as independent markers of the risk of death (P = 0.013), death or non-fatal infarction (P = 0.035) and death, non-fatal infarction, unstable angina during the first year, or revascularization before hospital discharge (P = 0.005).

CONCLUSIONS

VCG monitoring of ischaemia provides independent prognostic information in unstable angina. High-risk patients can easily be identified within 24 h of hospital admission. Whether early intervention based on these criteria will result in improved prognosis remains to be shown in future studies.

Serotonin 5-HT2 receptor, dopamine D2 receptor, and alpha 1 adrenoceptor antagonists. Conformationally flexible analogues of the atypical antipsychotic sertindole

Conformationally flexible analogues of the atypical antipsychotic sertindole (1-[2-[4-[5-chloro -1-(4-fluorophenyl)-1H-indol-3-yl]-4-piperidinyl]ethyl]-2-imidazolidi non e) were synthesized. Replacement of the 4-piperidinyl ring in sertindole by a 2-(methylamino)ethoxy group or a 2-(methylamino)ethyl group (e.g. 1-[2-[2-[5-chloro-1-(4-fluorophenyl)-1H -indol-3-yloxy]ethyl-methylamino]ethyl]-2-imidazolidinone and 1-[3-[[2-[5-chloro-1-(4-fluorophenyl)-1H-indol-3-yl] -ethyl]methylamino]propyl]-2-imidazolidinone results in binding affinities for serotonin 5-HT2A and dopamine D2 receptors, as well as alpha 1 adrenoceptors, which are very similar to those of sertindole. (Methylamino)alkyl groups of other chain lengths, 3-(methylamino)propyloxy groups, and 2-(methylamino)ethylsulfanyl groups do not have such properties. The capability of the 2-(methylamino)ethoxy group and the 2-(methylamino)ethyl group to replace the 4-piperidinyl ring in sertindole is reflected in molecular modeling studies using recently published receptor-interaction models for 5-HT2 and D2 receptors. Structure-affinity investigations concerning the substituents in the indole nucleus and the 2-imidazolidinone ring system in the 2-(methylamino)ethoxy and the 2-(methylamino)ethyl analogues of sertindole have led to high affinity serotonin 5-HT2A receptor antagonists with selectivity versus dopamine D2 receptors and alpha 1 adrenoceptors (e.g. 1-[2-[[2-[6-chloro-1-(4-fluorophenyl) -1H-indol-3-yloxy]ethyl]methylamino]-ethyl]-2-imidazolidinone and 1-[3-[[2-[6-chloro-1-(4-fluorophenyl) -1H-indol-3-yl]ethyl]methylamino]propyl]-2-imidazolidinone). The latter derivative has also high selectivity for 5-HT2A receptors versus serotonin 5-HT2C receptors. Replacement of the basic amino group by nitrogen-containing six-membered rings has led to 5-chloro-1-(4-fluorophenyl)-3-[(4-methylpiperazinyl)-ethoxy]-1H-in dole, which has high affinity for dopamine D2, versus low affinity for serotonin 5-HT2A receptors and alpha 1 adrenoceptors.

[Attitudes to treatment with cytostatic agents. Do cancer patients, physicians, nurses and healthy individuals vary in their views?]

Cancer patients' attitudes to chemotherapy were compared with those of doctors, nurses, and healthy controls. 98 cancer patients, 42 healthy subjects, 44 oncologists, 35 surgeons, 32 oncology nurses, and 70 surgical nurses received a questionnaire presenting a hypothetical situation involving a toxic chemotherapy regimen. Each of them was asked to indicate the minimal benefit with respect to chance of cure, prolongation of life and relief of symptoms they would demand in order to accept the treatment. The patients and surgical nurses were the most reluctant towards the treatment. The subgroup of patients under 50 years which matched the oncologists, surgeons, and controls with respect to age, cohabitant status, and children were significantly more willing to accept the regimen than the control persons and professional groups were. Patients under 40 years would accept the toxic treatment even with hardly any benefit in terms of chance of cure (7%, median), prolongation of life (three months), and relief of symptoms (8%). Among the professionals, oncologists were most willing to accept the therapy, whereas surgical nurses and surgeons were the least willing.

Nucleoside transport inhibition by draflazine in unstable coronary disease

OBJECTIVES

In a randomised, double-blind, placebo controlled study, we evaluated the tolerability and safety of draflazine, a nucleoside transport inhibitor, in the treatment of patients with unstable angina and non-Q-wave infarction.

METHODS

Twenty-one patients were randomised to treatment with draflazine 3.5 mg or matching placebo given as an i.v. infusion and haemodynamic and symptomatic tolerability were investigated. Myocardial ischaemia was evaluated by means of vectorcardiography and blood analysis of the MB fraction of creatine kinase.

RESULTS

The study drug was well tolerated by all patients and it did not cause any adverse haemodynamic effects, nor other serious adverse events. Three patients in the placebo group reported five adverse events, as compared to a single adverse event in the draflazine group. Cardiovascular events were detected in 7 patients in the placebo group and in 5 patients receiving draflazine. The mean duration of chest pain during the 24 hour observation period was 91.4 min in the placebo group compared to 75.5 min in draflazine treated patients. Neither the vectorcardiographic nor biochemical measures of ischaemia differed between treatment groups.

CONCLUSION

Nucleoside transport inhibition by draflazine was well tolerated by patients with unstable coronary disease. It seems to be a promising method of adenosine enhancement in acute myocardial ischaemia. The potential cardioprotective effect of the drug needs further evaluation in larger trials.

[Suicidal thoughts and suicidal attempts among 15-24 years old individuals in the Danish educational system]

The purpose of the study is by the instrumentality of an anonymous and voluntary interview study to expose the extent of suicidal ideation and suicide attempts among 15-24-year-olds in the Danish educational system. 3042 persons participated in the study. About 40% of those interviewed had at least once had suicidal ideation and almost one in every twenty confirmed that they had attempted to commit suicide. Furthermore, the study showed that almost one in every ten had experienced suicide in the family. The study showed that frequent or chronical suicidal ideation and self-destructive behaviour can be considered risk factors of suicide attempts and possible predictors of future suicidal behaviour. It also appeared that the students who had experienced suicide in the family had a risk of committing suicide that was three times as high as that of the students who had not experienced suicide in the family. The results of the study also suggest that it is probably only the tip of the iceberg which is detected or registered by the treatment system. To all appearance, close on 75-90% of young suicide attempts are not registered officially. This bears witness of the fact that many of these 15-24-year-olds apparently received no help after their suicide attempt.

Thrombin inhibition with inogatran for unstable angina pectoris: evidence for reactivated ischaemia after cessation of short-term treatment

BACKGROUND

The acute coronary syndromes of unstable angina and non-Q-wave infarction are initiated by coronary plaque rupture and subsequent thrombus formation. Thrombin is central to this response as it activates platelets and the coagulation system. In an open design study we assessed the tolerability and safety of the low molecular weight thrombin inhibitor, inogatran, for unstable angina or non-Q-wave infarction.

METHODS

Thirty-seven patients, treated within 72 h of symptoms, were allocated consecutively to groups to receive a 4 h infusion with one of three doses of inogatran. Thrombin generation and activity were measured with plasma markers at baseline, after the 4 h treatment period and 4 h later. Ischaemia was monitored using continuous vectorcardiography during the 4 h of treatment and during the subsequent 4 h after inogatran infusion had been stopped, to detect any increase in ischaemic events after the period of treatment. In addition, 12 patients received inogatran as an infusion for 72 h.

RESULTS

Inogatran was tolerated well. There were no adverse haemodynamic effects or allergic reactions. Minor bleeding events were detected in 37% of the patients. The biochemical and vectorcardiographic findings indicated suppression of thrombin generation after the 4 h treatment period compared with baseline. During the first 4 h after inogatran treatment, thrombin activity and episodes of ischaemia were increased compared with during the treatment period.

CONCLUSION

Inogatran was tolerated well and was safe, but its discontinuation was followed by a reactivation of thrombin activity and ischaemia. Whether this reactivation represented a rebound phenomenon, or merely resulted from the discontinuation of an effective therapy, cannot be established from the present study.

Lack of prognostic significance of epidermal growth factor receptor and the oncoprotein p185HER-2 in patients with systemically untreated non-small-cell lung cancer: an immunohistochemical study on cryosections

The prognostic role of the epidermal growth factor receptor (EGFR) and the related receptor p185HER-2 in lung cancer is as yet undefined. We investigated the immunohistochemical expression of EGFR (monoclonal antibody R1; Amersham) and p185HER-2 (polyclonal antibody A485; Dako) in cryosections. A total of 186 unselected and systemically untreated patients with non-small-cell lung cancer (NSCLC) diagnosed and treated at Odense University Hospital, Denmark, were included. Median follow-up period was 66 months. EGFR and p185HER-2 was highly expressed in 55% and 26% of cases respectively. Expression of EGFR was independent of p185HER-2 expression. The expression of EGFR was higher in squamous cell carcinomas whereas the level of p185HER-2 staining was higher in adenocarcinomas. Expression of either or both receptors was not correlated with age, histological grading, stage and prognosis. We conclude that immunohistochemical detection of these growth factor receptors failed to demonstrate a prognostic significance in patients operated on for NSCLC.

The WHO-EURO Multicentre Study: risk of parasuicide and the comparability of the areas under study

The 15 areas under study in the WHO/Euro Multicentre Study on Parasuicide vary considerably with regard to socio-economic factors, culture, life-styles, etc. In this paper, the authors discuss whether the traditional high risk factors for suicidal behavior (such as unemployment, abuse, divorce, etc.) take on different weights depending on local societal and cultural settings. Results from analyzing covariations between various background factors characteristic of the different areas under study and the frequency of attempted suicide showed weak or insignificant correlations, indicating that high-risk factors can only be identified from international pooled data with great care.

Bone and collagen turnover during treatment with inhaled dry powder budesonide and beclomethasone dipropionate

OBJECTIVES

To assess bone and collagen turnover in asthmatic children treated with dry powder budesonide from the Turbuhaler and dry powder beclomethasone dipropionate from the Diskhaler in a dose of 800 micrograms/day.

SUBJECTS

Thirteen prepubertal children with asthma.

DESIGN

Open crossover study with two treatment periods and treatment free run-in and wash-out periods. All periods were of two weeks' duration. At day 14 in each period blood samples were taken for assessment of serum osteocalcin, the carboxyterminal propeptide of type I collagen (PICP), and the aminoterminal propeptide of type III collagen (PIIINP). At the same time urine was collected for assessment of creatinine corrected pyridinoline (uPYR/cr) and deoxypyridinoline (udPYR/cr) crosslinks.

RESULTS

Osteocalcin concentrations were not influenced by any of the treatments. During budesonide treatment mean (SEM) PICP was reduced by 18% (8%) (p = 0.03), PIIINP by 24% (3%) (p = 0.0002), uPYR/cr by 16% (6%) (p = 0.03), and udPYR/cr by 21% (13%) (p = 0.12). During treatment with beclomethasone dipropionate mean (SEM) PICP was reduced by 20% (6%) (p = 0.01), PIIINP by 36% (3%) (p = 0.0002), uPYR/cr by 18% (4%) (p = 0.004), and udPYR by 13% (5%) (p = 0.02). The suppressive effect of beclomethasone dipropionate on PIIINP was more marked than that of budesonide (p = 0.001).

CONCLUSION

Treatment with dry powder budesonide and beclomethasone dipropionate 800 micrograms/day is associated with suppression of bone and collagen turnover. The suppression seems to be more marked during treatment with beclomethasone dipropionate. Long term effects and effects of lower doses of budesonide and beclomethasone dipropionate on bone and collagen markers needs further study.

Cancer patients, doctors and nurses vary in their willingness to undertake cancer chemotherapy

Cancer patients' attitude to chemotherapy were compared with those of doctors, nurses and healthy controls. 98 cancer patients, 42 healthy subjects, 44 oncologists, 35 surgeons, 32 oncology nurses and 70 surgical nurses received a questionnaire presenting a hypothetical situation involving a toxic chemotherapy regimen. Each were asked to indicate the minimal benefit with respect to chance of cure, life prolongation and symptom relief they would demand to accept the treatment. The patients and the surgical nurses were most reluctant with regard to the treatment. The subgroup of patients under 50 years which matched the oncologists, surgeons and controls with respect to age, cohabitant status and children were significantly more willing to accept the regimen than the controls and professional groups. Patients under 40 years would accept the toxic treatment with hardly any benefit as chance of cure (7%, median), life prolongation (3 months) and symptom relief (8%). Among the professionals, oncologists were most willing to accept therapy, whereas surgical nurses and surgeons were least willing.

Do nonsteroidal anti-inflammatory drugs decrease the risk for Alzheimer's disease? The Rotterdam Study

Based on reports that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may reduce the risk for Alzheimer's disease (AD), we studied the cross-sectional relation between NSAID use and the risk for AD in a population-based study of disease and disability in older people. After controlling for age, education, gender, and use of benzodiazepines, we found a relative risk (RR) for AD of 0.38 (0.15 to 0.95) when comparing NSAID users (n = 365) to NSAID non-users (n = 5,893). To address confounding by indication or contraindication, we compared NSAID users with a subset of NSAID non-users who were using topical medication for ear, eye, or dermatologic conditions (n = 365). In this comparison, the adjusted RR for AD was 0.54 (0.16 to 1.78). These findings are compatible with a possible protective effect of NSAIDs on the risk for AD.

Classification of fish-pathogenic vibrios based on comparative 16S rRNA analysis

No systematic classification of fish-pathogenic vibrios has been accomplished previously despite the use of serological, physiological, and genetical classification systems. In this study, a comparative 16S rRNA analysis of 34 strains (representing seven species) of fish-pathogenic vibrios was performed. The 16S rRNA sequences were obtained by using reverse transcriptase. Nearly complete sequences were obtained for nine strains. On the basis of the results of this analysis, the remaining strains were investigated by analyzing selected stretches containing a total of 560 nucleotides. With the exception of a few strains, including ATCC 43313 (serovar O9), our comparative 16S rRNA analysis confirmed that strains preliminarily identified as Vibrio anguillarum were phylogenetically closely related. Strains of V. anguillarum could be divided into groups, with the main group containing serotype O1 and O2 strains isolated from Atlantic salmon, rainbow trout, turbot, cod, and saithe. The other distinctive group was represented by type strain NCMB 6. This strain was nearly indistinguishable from the type strains of Vibrio ordalii and Vibrio damsela on the basis of the 16S rRNA stretches compared. The results of a comparative 16S rRNA analysis justified the status of Vibrio salmonicida as a distinct species. Originally, this species was characterized biochemically as a very homogeneous species. However, two strains, which were isolated from diseased halibut and from the intestines of healthy cod, could not be distinguished from V. salmonicida strains phylogenetically, although they differed from the original species description in several phenotypic traits. Our results indicate that V. salmonicida and Vibrio fischeri form a cluster that is clearly separated from the cluster that includes V. anguillarum.

[Necrotizing enterocolitis. Occurrence in Western Denmark]

We reviewed the clinical presentation, subsequent course and outcome of 45 newborn infants with neuotizing enterocolitis (NEC) seen on eight neonatal intensive care units during a 10 year period (01.01.82-31.12.91). The average incidence of NEC was found to be 1.2 (0.3-3.8) per 10,000 liveborn infants with a tendency to increase during the period. Eighteen percent had a birth weight of less than 1,000 g. Thirty-six percent had a birthweight between 1,000 and 1,500 g. Twenty-nine percent had a birthweight between 1,500 and 2,500 g. The last group made up of 16% had birth weights above 2,500 g. The mortality was determined by the severity of the disease, being 0% for infants within Bell's stage I, 25% in Bell's stage II and 71% in Bell's stage III. Sixty-nine percent of the infants were diagnosed in stage III, probably because of low attention to NEC in its early stages. The prognosis of surviving infants was good with no gastrointestinal symptoms when evaluated four to five years later.

Fungal arthritis. A review

Fungal arthritis (FA) due to a candida infection was reviewed in English literature and described in 45 cases. The increasing use of potent antibiotics, immunosuppressives, and especially the use of artificial joints, predisposed to the infection. Weightbearing joints, particularly the knees, were most frequently affected. Symptoms were described as a warm, tender and swollen joint, and the duration of symptoms prediagnosis was described as being up to 4 years. Amphotericin B was the treatment drug of choice, and in cases of no response, supplemented with either flucytosine or ketoconazole. Local FA healed in all cases. FA in an artificial joint resulted in all cases in removal of the prostheses. Mortality in systemic fungal infections including FA was 50%.

Epileptic seizures, arthrogryposis, and migrational brain disorders: a syndrome?

INTRODUCTION

Arthrogryposis multiplex congenita (AMC) may be associated with multiple developmental defects. In some severely affected newborns with AMC, autopsy studies have suggested a common mechanism of malmigration at the spinal and cerebral levels. To our knowledge, a constellation of arthrogryposis, epileptic seizures, and brain migrational anomalies in adult patients has not previously been described in a clinical material.

MATERIAL AND METHODS

Six consecutive adult patients with arthrogryposis multiplex congenita and epileptic seizures form the basis of the present study. Five patients had joint contractures and reduced muscle volume restricted to the lower extremities, whereas one patient had predominantly upper extremity affection. They were studied with magnetic resonance imaging (MRI), EEG, EMG, a neuropsychological test battery, and chromosome analysis.

RESULTS

Four of them had clear evidence of migrational brain disorders, demonstrated by MRI, in three of them roughly corresponding to the focal epileptiform EEG activity. Five of the patients had partial seizures, whereas one only had generalized tonic-clonic seizures. The MRI findings included polymicrogyria, pachygyria, and fused schizencephaly. Four had neurogenic EMG changes, one had myopathic EMG features, and one had an unremarkable EMG pattern in affected muscles. All patients with demonstrable migrational disorders showed abnormal neuropsychological features. Three patients were mentally retarded. A chromosome abnormality in the form of a ring chromosome 18 was present in one patient.

CONCLUSION

We suggest that AMC, epileptic seizures, and migrational brain disorders may form the integral parts of a hitherto undescribed syndrome in adults. A wide-spread defect in neuronal migration along the entire neural axis may be the underlying mechanism of the cerebral and the peripheral symptoms.

Increase of endo-peptidases and exo-peptidases in thyroid-tumors

Production of proteolytic enzymes is important for the invasive properties of malignant tumours. In this series of 43 cases of various non-neoplastic and neoplastic thyroid lesions, the activity of dipeptidyl peptidase I and dipeptidyl peptidase IV was increased in papillary carcinomas. In addition, cathepsin B and cathepsin L were markedly elevated in 2 of 3 follicular carcinomas, and tryptase, which is a marker of mast cells, was also significantly elevated in follicular carcinomas. Our results indicate that proteolytic proteins are important in thyroid carcinomas, and in addition there seem to be some differences between papillary and follicular tumours. Larger studies are needed to confirm these findings.

The effect of phenobarbital on cerebral blood flow in newborn infants with foetal distress

The effect of phenobarbital on cerebral blood flow (CBF) was investigated by the intravenous Xenon133 clearance technique in seven term newborn infants with signs of mild to moderate hypoxic ischaemic encephalopathy, all on sustained spontaneous ventilation. Phenobarbital treatment had no significant effect on CBF 60 min after loading dosage (20 mg/kg i.v.). Likewise, no significant change in mean arterial blood pressure, heart rate or transcutaneous gas tensions was observed. Though slight changes in CBF of short duration cannot be excluded, conventional dosage of phenobarbital to term newborn infants with foetal distress apparently imposes no risk of cerebrovascular damage.

[Septic 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]

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.

Three-dimensional reconstruction of entire vertebral bodies

This paper describes a technique for 3-D reconstruction of large cancellous bone regions. The output is a 3-D array describing the original cancellous bone region, and the output can be used for any kind of measurement of the bone architecture. The technique was developed as a tool for researchers conducting experimental and clinical studies related to cancellous bone architecture and, ultimately, to cancellous bone quality. A set of new and unbiased methods for quantification of cancellous bone has been a stimulus for the development of the technique, as the quantification methods rely on 3-D information. The technique is based on automated serial sectioning, and all steps from specimen preparation to image segmentation are described in detail. Examples of 3-D reconstructed vertebral bodies are given. By use of the described technique, between 300 and 600 sections can be made and registered per hour, which means that an average vertebral body can be reconstructed in about 2 h. Compared to previous implementations of the general principle of serial sectioning, this is a significant improvement both in resolution and in time efficiency.

Development of a receptor-interaction model for serotonin 5-HT2 receptor antagonists. Predicting selectivity with respect to dopamine D2 receptors

A receptor-interaction model for serotonin 5-HT2 receptor antagonists has been developed by conformational analysis with molecular mechanics (MM2(91)) and superimposition studies of serotonin 5-HT2 receptor antagonists. Substituted 3-(4-piperidinyl)-,1-(4- piperidinyl)-,3-(1,2,3,6-tetrahydropyridin-4-yl)-, and 1-(1,2,3,6-tetrahydropyridin-4-yl)-1H-indoles, substituted 3-(4-fluorophenyl)-1-(4-piperazinyl)indans, cyprohepatadine derivatives, ritanserin, and danitracene have been used as bases for the model. Other serotonin 5-HT2 receptor antagonists, such as ketanserin and MDL 11,939, are well accommodated into the model. Comparison of the model with a recently described receptor-interaction model for dopamine D2 receptor antagonists suggests a common pharmacophore for dopamine D2 and serotonin 5-HT2 receptor antagonists. Important steric differences between 5-HT2 receptor antagonists with additional high affinity for dopamine D2 receptors and serotonin 5-HT2 receptor antagonists with high selectivity versus D2 receptors are described. The geometry of the receptor-interaction model described is significantly different from that of a recently reported receptor-interaction model for 5-HT2 receptor agonists and antagonists developed by use of (+)-LSD as a template, suggesting the existence of two binding modes at the 5-HT2 receptor.

Evaluation of standardized methods for registration of time-dependent orthodontic tooth movements

An in vitro study was conducted to compare reproducibility of repeated recordings obtained from devices constructed for standardized registrations. An existing radiographic method and a new photographic technique were employed. On five in vitro models, half of the maxilla from dry skulls, special designed splints with a Troll-biten film holder were constructed. A stiff metal bar attached to the splints and to either an X-ray apparatus or a standard photographic camera made it possible to obtain standardized registrations. For each model 10 radiographs and photographs were taken before and after the canine was moved. Subtracting the values from well defined points for these pictures, 10 pairs of coordinates were available for each of the models with both methods. The findings showed very similar reproducibility for the two methods with 95 per cent of the discrepancies within a magnitude of 0.12 mm for the radiographic method and 0.14 mm for the photographic method. When evaluating the canine movements, similar results were observed. No significant difference could be detected in the five in vitro models. In addition, the results showed that a splint can be used as a stable reference for registration of tooth movements. Because of ethical objections to unnecessary radiation, the photographic registration technique might substitute the radiographs in future investigations where standardized periodic records are necessary for the description of tooth movement.

[Cor triatriatum with atrial fibrillation as initial symptom in adults]

Cor triatriatum is a rare congenital heart disease. In its classic form its consists of a fibromuscular perforated membrane which divides the left atrium and obstructs blood flow from pulmonary veins to mitral orifice. Clinical symptoms and signs resemble those of mitral stenosis. Traditionally cor triatriatum was encountered most often in infancy and childhood. We describe the case of a young man with cor triatriatum and atrial fibrillation, with syncope. He was operated on with total resection of the obstructing membrane. Modern echocardiography has made diagnosis more easy. Thus, an increasing number of cases of cor triatriatum are diagnosed in adults with few or no symptoms. Symptoms, diagnosis and treatment are discussed, with emphasis on these patients.

Immunological and hormonal responses to lung surgery during one-lung ventilation

The effects of lung surgery performed during one-lung ventilation and the associated endocrine stress response on natural killer (NK) cell activity and the distribution of white blood cells in peripheral blood were studied in 10 patients with malignant lung tumours. Patients were anaesthetized with general anaesthesia combined with thoracic epidural anaesthesia. The endocrine response was measured as changes in serum cortisol, plasma adrenaline and noradrenaline. A significant decrease of NK cell activity was found post-operatively accompanied by leucocytosis, neutrophilia and lymphopenia. Significant increases in serum cortisol were demonstrated at the end of operation and throughout the study period. Plasma adrenaline increased significantly during one-lung ventilation with a gradual normalization post-operatively. Plasma noradrenaline increased significantly during the whole post-operative course. In conclusion, lung surgery was accompanied by similar changes in NK cell activity, leucocyte and differential counts, serum cortisol and plasma adrenaline levels as demonstrated after other types of major surgery. The elevated noradrenaline level post-operatively is a new observation that may be specific for lung surgery.

Hysterothylacium aduncum (Rudolphi, 1862) infection in cod from the Oslofjord: seasonal occurrence of third- and fourth-stage larvae as well as adult worms

Hysterothylacium aduncum infections in cod from the Oslofjord were followed for 1 year. The recovered worms were grouped according to developmental stage [third-stage larvae (L3), fourth-stage larvae (L4) and adult worms] and according to location (in the gut or encapsulated on the viscera). The cod were found to be infected with H. aduncum (all stages lumped) throughout the whole year, with the prevalence approaching 100%. The abundance of the parasites (mean number per fish studied), however, was clearly lowest during the summer months. L3 and L4 recovered from the intestine dominated most of the time but showed a very clear peak during late winter and early spring. L3 recovered from the body cavity was the only stage that showed a clear peak during the summer months. Adult worms, although adult worms were present in very small numbers throughout the year, they tended to peak in May and then again in December and January. Since there did not seem to be a correlation between the accumulation of L3 in the body cavity and the length or age of the fish, the possibility of self-infection whereby the larvae reenter the gut and continue to develop into L4 and then into adults, is discussed.

Selective, centrally acting serotonin 5-HT2 antagonists. 1. 2- and 6-substituted 1-phenyl-3-(4-piperidinyl)-1H-indoles

A series of 1-[2-[4-(1H-indol-3-yl)-1-piperidinyl]ethyl]-2-imidazolidinones has been synthesized. The 1-position of the indole is substituted with phenyl groups and in the 2- or 6-positions are additional substituents. An analogous series with the imidazolidinone ring opened to corresponding urea derivatives was also prepared. High potency and selectivity for 5-HT2 receptors (as compared with D2 and alpha 1 receptor affinities) were obtained with medium-large substituents such as 6-chloro, 6-methyl, and 6-trifluoromethyl or a 2-methyl substituent. Larger 6-substituents such as isopropyl considerably reduced activity, while the smaller 6-fluoro substituent afforded unselective compounds. Selective 5-HT2 antagonists were found by combining 6-substitution with both unsubstituted 1-phenyl and substituted 1-phenyl groups (2-F, 4-F, 4-Cl). However, 3-substitution of the phenyl group markedly reduced 5-HT2 receptor affinity, especially with a 3-trifluoromethyl substituent. Introduction of a 3-(2-propyl) substituent in the imidazolidinone ring reduced binding to alpha 1 adrenoceptors with a factor of 3-8. Practically no influence on 5-HT2 and D2 receptor affinities were found by the presence of this substituent compared to the 3-unsubstituted derivatives. Compounds with potent receptor binding also potently inhibited the quipazine-induced head twitch syndrome in rats. The compounds were equally active after oral and subcutaneous administration and they had a long duration of action (> 24 h). Especially urea derivatives were found to be considerably more potent at 24 h than at 2 h after subcutaneous administration. Some of the compounds potently inhibited isolation-induced aggression in mice, an effect which, however, did not correlate to 5-HT2 receptor-mediated activities. On the basis of these structure-activity studies 1-[2-[4-[6-chloro-1-(4-fluorophenyl)-1H-indol-3-yl]-1- piperidinyl]ethyl]-3-(2-propyl)-2-imidazolidinone (Lu 26-042, compound 4c) was selected for further pharmacological and toxicological investigations.

Selective, centrally acting serotonin 5-HT2 antagonists. 2. Substituted 3-(4-fluorophenyl)-1H-indoles

A series of 3-(4-fluorophenyl)-1H-indoles substituted in the 1-position with 4-piperidinyl, 1,2,3,6-tetrahydro-4-pyridinyl, and 4-piperazinyl was synthesized. By variation of the substituents in the benzene part of the indole nucleus in 1-[2-[4-[3-4-fluorophenyl)-1H-indol-1-yl]-1-piperidinyl]-ethyl]-2- imidazolidinones, the highest 5-HT2 receptor affinity and selectivity with respect to dopamine D2 receptors and alpha 1 adrenoceptors were obtained by 5-methyl substitution. Different substituents were introduced in the 1-position of the piperidine ring in the 5-methyl-substituted derivative. Thus replacement of the 2-(2-imidazolidinon-1-yl)ethyl side chain with a 2-(1,3-dimethyl-1-ureido)ethyl or methyl substituent resulted in unchanged affinity and selectivity for 5-HT2 receptors. Replacement with a 2-[3-(2-propyl)-2-imidazolidinon-1-yl]ethyl side chain reduced binding to alpha 1 adrenoceptors with a factor of four, while affinities for 5-HT2 and D2 receptors were retained, compared to the 3-unsubstituted imidazolidinone. Indoles substituted in the 1-position with 4-piperazinyl had generally weaker affinity for both 5-HT2 and D2 receptors compared to corresponding 4-piperidinyl- and 1,2,3,6-tetrahydro-4-pyridinyl-substituted indoles. Introduction of a methyl group in the 2-position of the 5-methyl-substituted indole resulted in further increase of selectivity for the 5-HT2 receptor. Compounds with potent receptor binding also potently inhibited the quipazine-induced head twitch syndrome in rats. The compounds were equally active after oral and subcutaneous administration and showed a long duration of action (> 24 h). In general, the derivatives were found to be considerably more potent at 24 h than at 2 h after the administration. The compounds within this series were prepared as analogues of the previously described 1-(4-fluorophenyl)-3-(4-piperidyl)-1H-indoles by interchange of the C-3 carbon atom and the nitrogen atom in the indole nucleus. The pharmacological results indicate that this isosteric replacement results in higher selectivity for 5-HT2 receptors compared to the former series. The 1-[2-[4-[2,5-dimethyl-3-(4-fluorophenyl)-1H-indol-1-yl]-1- piperidinyl]ethyl]-2-imidazolidinone has high affinity for 5-HT2 receptors (IC50 = 3.4 nM) and extremely low affinity for both dopamine D2 receptors (IC50 = 6900 nM) and alpha 1 adrenoceptors (IC50 = 2300 nM).

Detection of rhinorrhoea by cisternography in combination with single photon emission tomography, following lumbar injection of iodine-123-labelled albumin

Eight patients were examined. Seven had verified rhinorrhoea and six had had one or more episodes of pneumococcal meningitis. In four of the patients a fistula could not be visualized by computed tomography. All eight patients had injections of iodine-123-labelled albumin by lumbar puncture. Tomoscintigraphy (SPET) was performed 3, 6 and 8-9 h after injection. After 6-8 h we were able to demonstrate a fistula in seven of the patients with verified rhinorrhoea and the findings were confirmed by a subsequent operation. In one of the patients we were not able to visualize any leak of cerebrospinal fluid into the nasal cavity. This patient was not operated upon and we were not able to verify the findings in this patient. The operated patients all did well after the operation with no relapse of meningitis. In conclusion, SPECT-cisternography after intralumbar injection of iodine-123-labelled albumin is a valuable diagnostic tool for the detection of small fistulae in patients with rhinorrhea.

Mediastinal germ cell tumour associated with Klinefelter syndrome. A report of case and review of the literature

A 14-year-old boy with Klinefelter syndrome (KS) and a large mediastinal tumour is presented. Human chorionic gonadotropin and oestradiol were markedly increased. An attempt at radical resection was performed. Histological examination revealed a malignant germ cell tumour of mixed histologic pattern composed of choriocarcinoma and components of mature teratoma. Four courses of cisplatin, bleomycin, and etoposide were given. The patient is without any evidence of tumour recurrence 20 months after diagnosis. A review of the literature revealed another 40 cases of primary mediastinal germ cell tumour (PMGCT) associated with KS. Compiled data from larger series demonstrate that at least 8% of male patients with PMGCT have KS, 50 times the expected frequency. In contrast to PMGCT in patients without KS, all tumours were of nonseminomatous histology, and the average age was considerably lower, Tumours in prepubertal boys were associated with precocious puberty.

Congenital sideroblastic anaemia with intrauterine symptoms and early lethal outcome

Sideroblastic anaemia is a rare disease, which most often presents in early childhood. A case of ringed sideroblastic anaemia with onset in early foetal life in a female infant, resulting in severe intrauterine symptoms, is reported. Six weeks after birth a bone marrow examination revealed a large amount of typical ringed sideroblasts, thus establishing the diagnosis. In spite of repeated blood transfusions, the haemoglobin content gradually decreased. The condition was refractory to pyridoxal phosphate treatment and continued to deteriorate with lethal outcome four months after birth.

The importance of sculpin (Myoxocephalus scorpius) as intermediate host and transmitter of the sealworm Pseudoterranova decipiens

A total of 186 sculpins (Myoxocephalus scorpius) were caught at Vega, Nordland, Norway, and examined for sealworm larvae (Pseudoterranova decipiens). Over 80% of the fish were infected. Very high infections were found with a maximum of nearly 300 larvae in one sculpin. Infections of this magnitude have so far not been reported from sculpins or any other fish species of this size. The importance of the sculpin in the life cycle and in the transmission of P. decipiens to seals or other fish species is briefly discussed.

[Nerve compression symptoms after a long bicycle ride--the Great Test of Strength]

Every year a bicycle-race over 540 km is arranged from Trondheim to Oslo, attracting approximately 5,000 amateur participants. It is well known that nerve compression syndromes may occur in connection with cycling, affecting in particular the ulnar nerve in the Guyon's canal and the pudendal nerve. A questionnaire study was carried out to evaluate the frequency of such complaints (N = 260). 32 (20%) of the 169 cyclists who completed the questionnaire reported numbness in the innervation area for the superficial branch of the ulnar nerve and 11% in the area of the median nerve. Approximately 15% reported paresis in the hand. The problem seemed to be transient. There was a slight tendency towards more symptoms among the most experienced cyclists, indicating that chronic compression may be more serious than the compression related to a single long tour.

[Septic sacroiliitis]

Septic sacroiliitis (SSI) is a rare form of pyogenic arthritis, which unrecognized or inadequately treated may cause longterm morbidity and eventually lasting disability. SSI is most frequently diagnosed among young adults, especially in drug abusers. Based on a literature survey three cases of SSI are presented, each representing characteristic aspects of SSI. The condition should be considered in cases of acute or subacute onset of pain in the gluteal region, hip or low back accompanied by fever. Laboratory findings are variable and non-specific. Definite bacteriologic diagnosis is only achieved in about 75% of the cases. In almost all of the cases, Tc-99m-MDP bone scintigraphy will in almost all the cases show increased uptake in the affected joint within one week after onset of symptoms. Generally antibiotic treatment leads to complete recovery.

Location of centres of resistance for maxillary anterior teeth measured on human autopsy material

The location of the centre of resistance (CR) of various consolidated units of maxillary anterior teeth was determined in this study using human autopsy material. The units studied consisted of two central incisors, four incisors, and six anterior teeth. When horizontal forces were applied the CR for the two- and six-tooth units was located approximately 6.5 mm apical to the bracket position. For the four-tooth unit, CR was placed slightly more occlusally, the distance being 5.0 mm. Applying vertical forces CR was located about 13.0 mm posterior to the bracket position for the two- and four-tooth unit. The incorporation of the canines into the incisor segment resulted in a distal shift of CR of 6 mm. CR for the six anterior teeth was, thus, located on a line 3 mm behind the distal surface of the canines. Increasing force levels had little effect on the location of CR for a given unit.

Rolando's fracture

The relationship between methods of treatment, quality of reduction and the occurrence of late disability and osteo-arthritic changes was studied in 17 Rolando's fractures. Three were undisplaced, 14 were displaced: of these excellent reduction was achieved in five of 11 treated by open reduction and in none of the three treated by percutaneous K wire fixation. After a median interval of 5.8 years, six of 16 reviewed patients had minor symptoms, while nine had no symptoms. Radiographic examination of 11 patients showed signs of osteoarthritis in six. We did not establish a relationship between the quality of reduction and the occurrence of late symptoms and osteoarthritis.

Dietary supplementation with omega-3-polyunsaturated fatty acids decreases mononuclear cell proliferation and interleukin-1 beta content but not monokine secretion in healthy and insulin-dependent diabetic individuals

The effects of dietary supplementation with omega-3-polyunsaturated fatty acids (omega-3-PUFA) on the proliferative response of PBMC and on the secretion of monokines and arachidonic acid metabolites from PBMC and monocytes (Mo) from healthy subjects and patients with recent-onset insulin-dependent diabetes mellitus (IDDM) were examined. Three groups of eight to nine healthy individuals were randomized to either 2.0 g/day or 4.0 g/day of omega-3-PUFA devoid of vitamins A and D, or an isocaloric amount of placebo. Furthermore, eight patients with recent-onset IDDM received 4.0 g/day of omega-3-PUFA. IL-1 beta production and TNF-alpha secretion was determined before and after 7 weeks of treatment, and 10 weeks after withdrawal of treatment. Significant increases in platelet and PBMC membrane eicosapentaenoic acid was found in omega-3-PUFA-treated individuals. omega-3-PUFA treatment significantly reduced the content of IL-1 beta in lysates of PBMC, but did not affect PBMC or Mo secretion of IL-1 beta, TNF-alpha or prostaglandin E2 (PGE2) or PBMC leukotriene B4 (LTB4) secretion in healthy subjects or in IDDM patients. A significant inhibition of the PHA-stimulated, but not the spontaneous or PPD-stimulated, proliferative response of PBMC was observed in healthy and diabetic subjects treated with omega-3-PUFA. No correlation was found between PHA-stimulated PBMC proliferation and PBMC secretion of TNF-alpha and IL-1 beta. There were no significant differences in the spontaneous or the PPD- or PHA-stimulated proliferative responses of PBMC between diabetic and healthy individuals at entry. We conclude that although dietary supplementation with 4.0 g/day of omega-3-PUFA inhibits the proliferation of PBMC and reduces IL-1 beta immunoreactivity in PBMC and Mo, it does not alter monokine, PGE2 or LTB4, secretion in healthy or IDDM subjects.