A case report of alprazolam-induced stuttering

A case is presented in which, by a double-blind, placebo-controlled trial, alprazolam was shown to produce reversible stuttering. Because this effect has been associated with tricyclic antidepressants but not benzodiazepines, the case provides further evidence for pharmacologic effects similar to tricyclic antidepressants.

Investigation into the value of Papanicolaou stained cervical smears for the diagnosis of chlamydial cervical infection

Forty five (37%) of 121 female contacts of men with non-gonococcal urethritis or gonorrhoea were chlamydia positive, as judged by isolation or by detecting elementary bodies in smears with a fluorescein labelled chlamydial monoclonal antibody. Only six (13%) of these, however, had Papanicolaou stained smears in which there were inclusion like changes suggestive of chlamydial infection. Furthermore, of 15 patients who had such cytological changes, chlamydiae were detected in only six and the abnormalities were found also in Papanicolaou stained smears from 10 (13%) of the 76 chlamydia negative patients. Modifying the Papanicolaou stained smears by including endocervical material did not increase sensitivity. In addition, destaining and restaining them with the monoclonal antibody was time consuming and the results were unreliable. The staining of cervical smears with Papanicolaou reagent is a technique of low sensitivity and specificity for diagnosing or screening for chlamydial cervical infection and cannot be recommended.

Results of the administration of diphosphonate for the prevention of heterotopic ossification after total hip arthroplasty

We evaluated the results in 177 patients with 200 total hip arthroplasties that had been performed for primary osteoarthritis. Severe postoperative heterotopic-bone formation (grades III and IV according to the classification of Brooker et al.) was found in thirty-six hips (18 per cent). The incidence of heterotopic bone formation was found to be slightly higher in the patients who had received diphosphonate than in the control group of patients who had received either a placebo or no drug therapy. The postoperative range of motion of the hips as well as ratings for pain, walking, and function did not differ significantly between the treated and untreated groups. The results of this study were consistent with those of previously published reports that demonstrated that while diphosphonates did not prevent heterotopic bone formation in laboratory animals they did result in a delay of mineralization of osteoid. This delay did not, as was hoped, significantly improve the range of motion of the involved hips in our series.

Regulation of pyruvate oxidation in blowfly flight muscle mitochondria: requirement for ADP

Blowfly (Phormia regina) flight muscle mitochondria oxidized pyruvate ( + proline) in the presence of either ADP (coupled respiration) or carbonylcyanide-p-trifluoromethoxyphenylhydrazone (FCCP-uncoupled respiration). There was an absolute requirement for ADP (Km = 8.0 microM) when pyruvate oxidation was stimulated by FCCP in the presence of oligomycin. This requirement for ADP was limited to the oxidation of pyruvate; uncoupled alpha-glycerolphosphate oxidation proceeded maximally even in the absence of added ADP. Atractylate inhibited uncoupled pyruvate oxidation whether added before (greater than 99%) or after (95%) initiation of respiration with FCCP. In the presence of FCCP, oligomycin, and limiting concentrations of ADP (less than 110 microM), there was a shutoff in the uptake of oxygen. This inhibition of respiration was completely reversed by the addition of more ADP. Plots of net oxygen uptake as a function of the limiting ADP concentration were linear; the observed ADP/O ratio was 0.22 +/- 0.025. An ADP/O ratio of 0.2 was predicted if phosphorylation occurred only at the succinyl-CoA synthetase step of the tricarboxylate cycle. Experiments performed in the presence of limiting concentrations of ADP, and designed to monitor changes in the mitochondrial content of ADP and ATP, demonstrated that the shutoff in oxygen uptake was not due to the presence of a high intramitochondrial concentration of ATP. Indeed, ATP, added to the medium prior to the addition of FCCP, inhibited uncoupled pyruvate oxidation; the apparent KI was 0.8 mM. These results are consistent with the hypothesis that it is the intramitochondrial ATP/ADP ratio that is one of the controlling factors in determining the rate of flux through the tricarboxylate cycle. Changes in the mitochondrial content of citrate, isocitrate, alpha-ketoglutarate, and malate during uncoupled pyruvate oxidation in the presence of a limiting concentration of ADP were consistent with the hypothesis that the mitochondrial NAD + -linked isocitric dehydrogenase is a major site for such control through the tricarboxylate cycle.

Chronic renal failure with gout: a marker of chronic lead poisoning

EDTA (calcium disodium edetate) lead mobilization and x-ray fluorescence (XRF) finger bone lead tests were done in 42 patients with chronic renal failure and without persisting lead intoxication. Nineteen of 23 patients with gout and 8 of 19 without gout had positive EDTA lead mobilization tests. Those patients with gout excreted significantly more excess lead chelate than those without gout. In the gout group 17 patients denied any childhood or industrial exposure to lead. They had a greater number of positive tests and excreted significantly more excess lead chelate than 14 patients with neither gout nor lead exposure. These results confirm that gout in the presence of chronic renal failure is a useful marker of chronic lead poisoning. Of 27 patients with positive lead mobilization tests, only 13 had elevated XRF finger bone lead concentrations (sensitivity 48%). Three of 15 patients with negative lead mobilization tests had elevated XRF finger bone lead concentrations (specificity 80%). Although the XRF finger bone lead test is a convenient noninvasive addition to the diagnostic evaluation of patients with chronic renal failure and gout, its application is limited due to the lack of sensitivity of the method.

Calcium inhibition of the NAD+-linked isocitrate dehydrogenase from blowfly flight muscle mitochondria

Free Ca2+ was shown to inhibit the NAD+-isocitrate dehydrogenase from blowfly flight muscle mitochondria. Inhibition by free Ca2+ concentrations of 40 microM or greater was found in the absence or presence of ADP and citrate, two known activators of the enzyme. Calcium decreased the affinity of the enzyme for its substrate, the magnesium DL-isocitrate chelate; no change in the apparent V of the reaction was observed. Calcium was inhibitory when activity was measured in the presence of fixed concentrations of magnesium DL-isocitrate chelate in the presence of several fixed concentrations of either free isocitrate3-, an activator, or free Mg2+, an inhibitor of the enzyme. That NAD+-isocitrate dehydrogenase from blowfly flight muscle mitochondria was not activated by micromolar free Ca2+ is consistent with the view that calcium does not play a role in regulating the flux through the tricarboxylate cycle in this species.

Whole body cellular and collagen nitrogen in healthy and wasted man

The classical literature shows that wasting of body protein takes place mainly from the cellular compartment leaving high proportions of extracellular collagen. Whole body nitrogen ( WBN ) is proportional to whole body protein (cellular + extracellular) while whole body potassium ( WBK ) is almost entirely intracellular. WBK might be an adequate index of cellular wasting. WBN was measured by neutron activation and WBK by counting 40K in 29 healthy males and 131 male and female patients with wide ranges of body composition. Our wasted patients with Crohn's disease or ulcerative colitis, had higher WBN / WBK ratios than matched healthy controls and the difference between the two groups was in the cellular ratio (23.6 mol of N/mol of K, 0.33 g of N/mmol of K, 3 mmol of K/g of N). A multiple regression model for all the subjects represented cellular nitrogen by a term in WBK and extracellular nitrogen by simple anthropometric measurements. The partial regression coefficient of WBN on WBK was 22.6 +/- 1.1 (SE) mol of N/mol of K; this was also similar to the cellular ratio. Our results were compatible with extracellular protein (mainly collagen, which is 35% of normal whole body protein) remaining resistant to wasting even when severe loss of cellular protein occurs. The high ratios of WBN / WBK in wasted patients can be explained by this disproportionate wasting of cellular substances and they do not imply alterations in the cellular N/K ratio. We suggested that the stable ratio of WBK to cellular protein makes it an effective index of cellular wasting. The resistance of collagen to wasting and the preponderance of extracellular mass in the fat-free mass of wasted subjects, make WBN and fat-free mass unreliable guides to the extent of wasting.

Sensitivity of detecting Chlamydia trachomatis elementary bodies in smears by use of a fluorescein labelled monoclonal antibody: comparison with conventional chlamydial isolation

Commercially produced fluorescein labelled monoclonal antibodies for the detection of Chlamydia trachomatis have recently become available. One is for detecting inclusions in cell culture (culture confirmation) and the other for detecting elementary bodies in smears from potentially infected sites. We have compared the two monoclonal antibodies with our routine isolation method, which utilises Giemsa staining of cycloheximide treated McCoy cell cultures. The culture confirmation system offered no advantages over Giemsa staining for the detection of inclusions in cell monolayers. By contrast, using monoclonal antibody to detect elementary bodies in smears was much quicker and simpler and slightly more sensitive than isolation of chlamydiae in cell culture. For specimens from seven babies with conjunctivitis and from 35 female contacts of men with non-gonococcal urethritis, there was complete agreement between the results of detecting inclusions in culture and those of seeking elementary bodies in smears. For samples from 100 men with non-gonococcal urethritis and from 100 men with gonorrhoea there was 99% and 94% agreement, respectively, between the results of the two tests. Other aspects and possible uses of the new detection system are discussed.

Congenital paraxial hemicorpectomy. A case report

Although physicians may be familiar with terms such as "fibular paraxial hemiamelia," they often do not realize that the defects may involve more proximal levels than are first apparent. The following case report demonstrates a paraxial defect that begins at the level of T2 and extends the remainder of the body. No previous case has been reported, and because of the peculiar distribution of the anomaly, the situation has been termed "congenital paraxial hemicorpectomy."

Purification and properties of thiol beta-lactamase. A mutant of pBR322 beta-lactamase in which the active site serine has been replaced with cysteine

The specifically mutated enzyme thiol beta-lactamase has been expressed in Escherichia coli by means of the trp promoter and purified to homogeneity. The gene for this enzyme results from a single base change N410 A----T in the gene of pBR322 RTEM beta-lactamase (EC 3.5.2.6, penicillinase, penicillin amido-beta-lactamhydrolase) which alters the codon for the active site Ser 70 to that for Cys. Precursor thiol beta-lactamase is processed to give the same NH2-terminal sequence as that for wild type enzyme. In contrast to the wild type enzyme, thiol beta-lactamase contains one free titratable thiol group/molecule. Thiol beta-lactamase catalyzes the hydrolysis of beta-lactams with a substrate specificity that is distinct from that of wild type enzyme. For benzyl-penicillin and ampicillin, the Km values are similar to wild type values although the kcat values are 1-2% that of wild type enzyme. For the cephalosporin nitrocefin, the Km is greater than 10-fold that of the wild type and the kcat is at least as large as the kcat for the wild type enzyme. Thiol beta-lactamase is different from wild type beta-lactamase in that it is not competitively inhibited by boric acid although a small degree of noncompetitive inhibition does occur. Whereas the circular dichroism spectra of both enzymes are nearly identical, thiol beta-lactamase at 40 degrees C is 3-fold more resistant to trypsin than is the wild type enzyme.

Treatment of primary osteoarthritis of the hip. A comparison of total joint and surface replacement arthroplasty

Of 285 total hip arthroplasties (260 patients) performed for primary osteoarthritis during a six-year period, 135 were resurfaced using a Tharies prosthesis (total hip articular replacement with internal eccentric shells) and 150 were treated with the Trapezoidal-28 total hip replacement. From each of these two groups 100 hips (ninety-one patients in the Tharies group and eighty-six in the Trapezoidal-28 group) that had been followed for two to seven years were evaluated at the time of follow-up in accordance with a predetermined protocol. The patients were younger in the Tharies than in the Trapezoidal-28 group (average ages, fifty-eight and sixty-six years), included more men (sixty compared with thirty-five), and were more active postoperatively. The average follow-up was forty-seven months for the total joint-replacement group and thirty-eight months for the surface replacement group. At follow-up the ratings for pain, walking, and function according to the University of California at Los Angeles 10-point scale and the clinical results were identical in the two groups. Heterotopic ossification (Brooker grade III or IV) developed after thirteen Trapezoidal-28 and twenty-two Tharies arthroplasties. Radiographs made at six and twelve months and at final follow-up showed that the incidence of radiolucencies about the acetabular component was higher in the resurfacing group: fifty-seven with complete radiolucent lines after an average follow-up of thirty-eight months compared with thirty-six with complete lines after an average follow-up of forty-seven months. There were three failures in the joint-replacement group: a hematogenous staphylococcal deep infection that required a Girdlestone procedure, a femoral stem fracture that required revision, and loosening of an acetabular component for which revision was performed. There was also one dislocation, successfully treated by closed reduction. Similarly, in the resurfacing group there were three failures: two loose acetabular components, revised successfully, and one loose femoral component that necessitated total joint arthroplasty. Multivariate stepwise regression analysis showed that the factors that affected the final extent and width of the acetabular radiolucencies adversely after resurfacing were: any radiolucent lines that were visible at six months, a high level of physical activity after arthroplasty, and a thin superior cement mantle.(ABSTRACT TRUNCATED AT 400 WORDS)

In vivo X-ray fluorescence estimation of bone lead concentrations in Queensland adults

A group of 200 Queensland adults without known health problems had in-vivo estimation of finger bone lead concentrations using X-ray fluorescence analysis (XRF). Forty of these subjects had elevated levels of bone lead of 25 ppm or more, consistent with exposure to the metal. Although the correlation between Queensland residence during childhood and raised bone lead levels was not significant, there were significant correlations between childhood residence in a painted wooden house and raised levels, and between occupational exposure and raised levels. Of the 40 subjects with elevated lead levels only two had neither a history of occupational exposure or childhood residence in a wooden house, whereas 11 of the 25 who had a history of both occupational and residential exposure were positive. The data are consistent with lead in housepaint, or absorbed during occupational exposure, being the two major sources of raised bone lead concentrations.

A study of inactivation of Chlamydia trachomatis by normal human serum

To assess the effect of human serum on the viability of Chlamydia trachomatis, organisms were mixed with unheated and heat inactivated homologous serum, and the numbers surviving after incubation at 37 degrees C for 1 hour were compared. With a pool of sera obtained from 12 donors, the number of chlamydiae surviving incubation in unheated serum was less than 1% of that surviving incubation in heat inactivated serum. The antichlamydial activity of the unheated pooled serum samples could be noticeably reduced by treatment with Mg-EGTA (ethyleneglycolbis (beta-amino ethyl ether)-N,N'-tetra-acetic acid). This indicated a requirement for calcium ions and showed that the alternative pathway of complement activation played only a minor role, if any, in the inactivation process. When 12 serum samples were tested individually it was found that four inactivated chlamydiae to an extent comparable with that seen with the pooled serum. The other eight samples showed only moderate (or slight) antichlamydial activity, with survival rates in unheated serum of 20-60% (or more than 60%) of those in heat inactivated serum. There was no correlation between the titres of antichlamydial antibodies and antichlamydial activity, all serum samples having undetectable or low concentrations of antibody on measurement by micro-immunofluorescence. The antichlamydial activity destroyed by heating was restored, however, when heat inactivated serum was mixed with an equal volume of an unheated serum that was not inhibitory to chlamydiae. When the latter serum was heated before addition antichlamydial activity was not restored, indicating the requirement of both a heat stable and a heat labile factor. This observation and the need for calcium ions for inactivation of chlamydiae are compatable with killing mediated by antibody and complement. Thus serum samples from individuals with no clinical or serological evidence of infection with chlamydiae vary in their ability to inactivate the organism, some having antichlamydial activity which is possibly mediated by antibody and complement.

Infection after total joint arthroplasty from distal extremity sepsis

At the UCLA Medical Center in three patients treated for hematogenous infection after total joint arthroplasty, the source was apparently an infection in the extremities at a site distal to the joint arthroplasty. In a 72-year-old woman with rheumatoid arthritis infection developed in the right hip after total hip arthroplasty following a Staphylococcus aureus infection at the site of a left metatarsophalangeal arthroplasty. In a 64-year-old man with osteoarthritis the staphylococcal infection that developed after right total hip arthroplasty was seeded from a pyarthrosis of the right knee. In a 61-year-old woman with rheumatoid arthritis the sites of bilateral knee arthroplasties were seeded from a soft tissue infection of the left foot. These cases illustrate the potential for infection from local wound sepsis distal to joint arthroplasty. Such infections, particularly in patients with rheumatoid arthritis, should be treated aggressively to avoid seeding of the more proximal total joint arthroplasty site.

The association of Mycoplasma hominis with arthritis

The facts that mycoplasmal arthritis occurs naturally in various animal species and can be induced experimentally have been the main reasons for searching for evidence of mycoplasmal infection in the joints of patients with rheumatoid arthritis. There is, however, no evidence that Mycoplasma hominis is involved in this disease. On the other hand, M. hominis and other mycoplasmas, including Ureaplasma urealyticum, have been isolated from the arthritic joints of several hypogammaglobulinemic patients, and there is some evidence to indicate that the organisms are responsible for the disease. Furthermore, on rare occasions M. hominis has caused arthritis in mothers after childbirth. The relationship between this agent and sexually acquired reactive arthritis (SARA) has been the subject of recent investigation. Sera from 27 patients with nongonococcal urethritis and 25 patients with SARA, all tested previously for antibody to Chlamydia trachomatis, were examined by a metabolism-inhibition technique for antibody to M. hominis. Interpretation of the first tests was difficult because tetracyclines given to some of the patients caused their sera to inhibit metabolism. This problem was overcome by use of a tetracycline-resistant strain of M. hominis. Antibody was found in the sera of only a few patients and not in those of SARA patients whose disease was considered to be nonchlamydial. The initiating factor in nonchlamydial SARA therefore remains an enigma.

Changes in body composition and muscle protein degradation during nutritional supplementation in nutritionally growth-retarded children with cystic fibrosis

Changes in body composition and muscle protein degradation were studied in seven nutritionally growth-retarded children with cystic fibrosis (CF) before and after nutritional supplementation and in eight healthy children who served as controls. Supplemental feedings consisted of a peptide formula that increased dietary protein and energy intakes approximately 20-40% over a 6-month period, delivered either as oral supplement or overnight intragastric feeding. Body composition was assessed by anthropometric data and measurements of whole body potassium (40K) and creatinine excretion. Muscle protein degradation was measured by urinary 3-methylhistidine excretion, an index of myofibrillar protein catabolism. Compared with controls, CF children had significantly reduced body mass, body fat, and muscle mass, and a significantly increased rate of myofibrillar protein degradation. With nutritional supplementation, significant catch-up weight gain and improved linear growth were observed with evidence of accretion of lean body mass and muscle mass, and in all but one severely malnourished patient with progressive disease, there was normalization of the high rate of muscle protein degradation. Thus, this form of nutritional therapy has significant benefits in terms of body protein accretion and myofibrillar protein degradation.

Liver cadmium concentrations in metal industry workers

In vivo neutron activation analysis of liver cadmium concentration was performed in 285 metal workers, 130 of whom had been exposed to cadmium in the workplace. Only two workers showed pathological levels in excess of 50 ppm. However, mean liver, urine and blood cadmium levels were significantly different as between the exposed and the unexposed workers. In vivo neutron activation analysis of liver cadmium concentration is easy to perform and can readily be used for industrial screening whenever a hazard is suspected.

The retention and release of 37Ar from samples of human bone examined in vitro and a review of the implications for argon transfer from bone in vivo

The release rates and long term retention of 37Ar produced by the reaction 40Ca(n, alpha) 37Ar, following fast neutron irradiation, have been measured in vitro, in three samples of dried human femur. For each sample, the release rates were fitted to three exponential curves, of half-times approximately 2, 20 and 300 min. Some 60-80% of the 37Ar released was contained in the first component. The release rates for samples of trabecular and cortical bone were qualitatively similar, but after some 20 h the retained fraction of 37Ar was 28 +/- 0.6% in a sample of predominantly trabecular bone, and 33 +/- 0.7% in samples of predominantly cortical bone. The processes affecting the trapping and release of 37Ar from bone crystals are discussed. It is suggested that 37Ar escapes from bone mineral by back-diffusion along recoil damage tracks. The factors affecting the release of 37Ar from bone into the venous blood supply are discussed in the context of in vivo measurements of body calcium by the 37Ar method. The physiological processes and compartments likely to give rise to the long 37Ar exhalation half-times following irradiation in vivo: transfer from the mineralised bone matrix to blood capillaries, and uptake and washout from bone marrow, are considered. Uptake in bone marrow may be responsible for both of the observed half-times.

Revision surgery for failed surface arthroplasty of the hip

In 17 cases of revision surgery performed for failed surface arthroplasty of the hip at UCLA medical center, the minimum follow-up period was six months (average, 22 months). Causes of failure included aseptic loosening (15), sepsis (1), and unexplained pain (1). High-risk groups include those with deficiencies of bone stock, congenital dysplasia, coxa vara, and osteonecrosis. Nine hips were resurfaced and eight converted to conventional arthroplasties. The clinical results of revision and conversion were comparable with those of conventional revision surgery but less satisfactory than those of primary surgery. Fewer technical problems and complications were encountered when compared with conventional revision. The length of operation and blood loss were less, and there were no instances of sepsis, nerve palsy, instability, or femoral fracture. The major complication has been recurrent loosening, with a 17% incidence of failure requiring conversion to conventional replacement. The results, as in conventional revisions, have been suboptimal. The technical complexities have been many, especially with respect to femoral and acetabular revision.

Altered body composition and muscle protein degradation in nutritionally growth-retarded children with cystic fibrosis

To investigate nutritional growth retardation and the adaptive response to malnutrition in cystic fibrosis (CF), body composition and muscle protein catabolism were studied in nine malnourished CF children and eight healthy controls by anthropometry, measurement of whole body potassium, urinary creatinine excretion, creatinine height index, and urinary 3-methylhistidine excretion, an index of myofibrillar protein catabolism. CF children had a significant deficit of body mass (p less than 0.001), derived from both the body fat and the fat-free compartments, including a deficit in muscle mass (p less than 0.005). A deficit of muscle mass in CF was also reflected by a lower creatinine height index (mean +/- 1 SEM = 0.66 +/- 0.04 in CF, versus 0.85 +/- 0.5 in controls, p less than 0.02). Urinary 3-methylhistidine excretion was elevated in CF children and the mean (+/- 1 SEM) rate of muscle protein catabolism was 0.82 +/- 0.06 versus 0.53 +/- 0.04 kg-1 24 h-1 in CF and controls, respectively (p less than 0.01). 3-Methylhistidine excretion rates did not correlate with severity of disease as assessed by clinical score. We conclude that nutritional growth retardation in CF is characterized by a protein energy deficit resembling that of protein-energy malnutrition, but that in contrast to the normal adaptive response to protein-energy malnutrition, muscle protein catabolism is markedly increased. These data may have important implications regarding the clinical course and prognosis of CF and the design of optimal therapy.

Identification of hip surface arthroplasty failures with TcSC/TcmDP radionuclide imaging

The roentgenographic identification of femoral component loosening after hip surface arthroplasty is often impossible because the metallic femoral component obscures the bone-cement interface. The use of combined technetium sulfur colloid and technetium methylene diphosphonate radionuclide imaging has been especially useful in the diagnosis of loosening. In 40 patients, follow-up combined TcSC and TcmDP scans at an average of three, nine, and 27 months postoperation revealed significant differences in the isotope uptakes in patients who had loose prostheses compared with those without complications. Scans were evaluated by first dividing them into eight anatomical regions and then rating the uptake in each region or 'zone' on a five-point scale. Results were compared using the Student's t-test and differences were noted between normal controls and patients who had femoral component loosening. Combining both TcSC and TcmDP studies increased the statistical significance obtained when comparing patients who had complications to those in the control group.

Obesity and cardiovascular risk

In this paper the general concepts of the relationship between body weight, food intake and susceptibility to vascular disease are re-examined in the light of recent evidence. Several studies suggest that the traditional view of the relationship between mortality and adiposity as direct and linear are mistaken and that the relationship is 'U' shaped with minimal mortality at 'average' rather than 'ideal' weight. Furthermore, the notion that higher levels of food energy intake may be responsible for the enhanced susceptibility to arterial disease are also challenged by those in the lower than the upper ranges of total caloric intake. This may account for some of the anomalous inverse relationships found within countries between food (including fat) intake and arterial disease deaths, findings which have stood for years in irreconcilable contrast with the direct relationship between fat intake and cardiovascular mortality between countries. These apparently paradoxical relationships may be explained by the further unexpected finding of low order but highly significant inverse correlations between food energy intake and adiposity. This has supported the notion of a spectrum of energy conservation/dissipation with the energy conserver storing fat even on low intakes and the dissipator expending a high intake yet remaining lean. Adaptive responses to excess intake and to food deprivation may also be involved in this constitutional variation in energy handling.

Immunity to reinfection of the genital tract of marmosets with Chlamydia trachomatis

Eleven marmosets inoculated intra-vaginally with either of 2 serotypes (D/E and H) of Chlamydia trachomatis developed a self-limited infection which persisted usually for 10-42 days. Animals re-inoculated on one or more occasions were, however, infected generally for a shorter duration, usually 3-7 days. Curtailed infections were observed after re-inoculation with either the same or a different serotype, indicating that immunity was not serotype specific but cross-protective. IgM and/or IgG chlamydial antibody, measured by micro-immunofluorescence, developed in most of the marmosets on primary infection and was not serotype specific. The antibody titres were boosted on re-infection and there was a correlation between pre-existing high antibody titres and infections of short duration. Chlamydial infection of the genital tract was accompanied by acute inflammation which persisted in about half of the immune animals for up to several weeks despite rapid clearance of the organisms. These features of the experimental infection should help to provide a greater understanding of the immunobiology and pathogenesis of chlamydial genital-tract infections of humans.

A microbiological study of non-gonococcal proctitis in passive male homosexuals

In a study of 180 male homosexual patients attending a venereal disease clinic, a correlation was sought between symptoms and signs of proctitis and the isolation of Neisseria gonorrhoeae, group B streptococci, Chlamydia trachomatis, Ureaplasma urealyticum, Mycoplasma hominis and herpes simplex virus. Faecal specimens were examined for enteric pathogens and serological tests for hepatitis B virus, syphilitic and chlamydial infections were performed.

There was no association between proctitis, as diagnosed by examination of a Gram-stained rectal smear, and the isolation of any micro-organism or detection of a positive serological test. There was, in addition, no association between any symptom or abnormal physical sign and any positive microbiological findings. Since 23% of patients from whom N. gonorrhoeae was isolated had no abnormal physical signs, it is difficult to assign a pathogenic role to other micro-organisms isolated from patients with and without clinical signs of proctitis. Approaches to further investigation of the problem are discussed.

Clinical and microbiological study of non-gonococcal urethritis with particular reference to non-chlamydial disease

A double-blind placebo-controlled study of minocycline in 221 men with non-gonococcal urethritis (NGU) was undertaken. Techniques were used which enabled diagnoses of chlamydial and mycoplasmal infections to be made within 24 hours of a patient attending a clinic. All patients from whom Chlamydia trachomatis was isolated were treated with minocycline, while patients from whom Ureaplasma urealyticum or Mycoplasma hominis was isolated, or from whom no micro-organisms were isolated, were treated on a double-blind basis with either minocycline or placebo. Chlamydia were isolated from 77 (35%) patients and were eradicated by minocycline from 76 (99%). Ureaplasmas were isolated initially from 96 (43%) patients. Treatment with minocycline eradicated them from 43 of 52 (83%) patients, and they disappeared from six of 31 (19%) patients who were treated with placebo. After one week significantly more patients had responded clinically to minocycline than to placebo. The response to minocycline was not influenced by the microbiological status of the patients, which suggests that ureaplasmas are playing a similar role to chlamydia in the pathogenesis of the disease and that an antibiotic-sensitive micro-organism may be producing disease in the isolate-negative group. An immunological approach is required to resolve the problem of the persistent urethral inflammation which occurred despite eradication of the micro-organisms.

Surface replacement of the hip with the Tharies system. Two to five-year results

The two to five-year clinical results of 200 Tharies surface replacements were comparable to those of conventional total hip replacement. The incidence of systemic complications, dislocations, and sepsis was low. There were ten cases of aseptic and one case of septic loosening. Nine minor secondary procedures were required in the series. In two patients the femoral component shifted asymptomatically into varus angulation, but no revision was needed. Fifty-five per cent of patients for whom serial radiographs were available had some progression of radiolucency, but there was poor correlation between the width of the zone and loosening until the patient became symptomatic. Improved techniques of preparation of the interface and of delivery, compression, and containment of the cement have improved the postoperative radiographic appearance of the more recently treated patients.

Alcohol and mortality: a U-shaped curve

In a longitudinal study of civil servants, 1422 men were classified according to their average daily alcohol intake. Over 10 years of follow-up, the mortality rate was lower in men reporting moderate alcohol intake than in either non-drinkers or heavier drinkers (greater than 34 g alcohol per day). Cardiovascular mortality was greater in non-drinkers and non-cardiovascular mortality was greater in the heavier drinkers. The heavier drinkers had higher mean blood pressures and contained a greater proportion of smokers. A multivariate analysis showed this U-shaped relationship between reported alcohol consumption and subsequent mortality to be largely independent of differences in smoking, blood pressure, plasma cholesterol, and grade of employment.

Microbiological, serological, and histopathological features of experimental Chlamydia trachomatis urethritis in chimpanzees

A laboratory-passaged genital strain of Chlamydia trachomatis and two unpassaged genital strains from patients with nongonococcal urethritis were inoculated intraurethrally into three young male chimpanzees. Chlamydia were recovered from the urethra of two animals and specific antibody responses were detected in all of them. Furthermore, a urethral polymorphonuclear leucocyte response, but not an overt discharge, occurred in all the chimpanzees about 1-2 weeks after inoculation. None of these events occurred in a chimpanzee inoculated with medium only. At necropsy three months after inoculation the submucosa of the urethra of one chimpanzee was densely infiltrated with small round cells. This suggests that a similar chronic lymphocytic response may occur in human chlamydial infection of the urethra.

Evidence of Chlamydia trachomatis infection in sexually acquired reactive arthritis

Thirty male patients with sexually acquired reactive arthritis (SARA) have been studied at the time of their initial presentation and thereafter. Chlamydia trachomatis was isolated from the urethral exudate of 9 (36.0%) of the 25 patients from whom urethral specimens were taken, and elevated titres of IgM antibody of C. trachomatis were detected in 11 (36.6%) of the 30 initial sera. Thirteen (43.3%) of the patients has a positive urethral culture and/or elevated titre of IgM antibody, and it is therefore suggested that 43.3% of these patients suffered an acute chlamydial infection at or near the time of the onset of their joint disease. The demonstration of 4-fold or greater rises and/or falls in IgM antibody titre (8 patients) and IgG antibody titre (6 patients) in a group of 15 men studied throughout the course of their disease strongly supports this conclusion. A positive urethral culture and/or raised titre of IgM serum antibody was also detected in 25 (50%) of 50 men with uncomplicated nongonococcal urethritis (NGU), suggesting that the prevalence of chlamydial infections in the 2 conditions is similar. Titres of IgG serum antibody to C. trachomatis were, however, significantly higher in patients with SARA than in those with NGU or other rheumatic diseases, and in healthy controls. The geometric mean titres (GMT) of IgG serum antibody in patients with SARA, NGU, rheumatoid arthritis, ankylosing spondylitis, systemic lupus erythematosus, and in healthy controls were 1:47.5, 1:8.6, 1:2.2, 1;2.2, 1:3.5, and 1:1.4, respectively. These findings suggest that an exaggerated antibody response to acute infection by C. trachomatis may be an important factor in the development of SARA in some but not all patients.

Infectivity of human coronavirus strain 229E

The replication of human coronavirus strain 229E was observed by using indirect immunofluorescence in infected monolayers of MRC continuous cells. By 8 h after infection, bright cytoplasmic fluorescence was detected in cells infected with human coronavirus 229E. Discrete foci of infection were observed from 8 to 16 h after infection in cells infected with high dilutions of human coronavirus 229E; each fluorescent focus corresponded to a single virus infection. A fluorescent focus assay is described, using indirect immunofluorescence, which is more sensitive than the established techniques of tube titration and plaque assay. Particle/infectivity ratios for unpurified and purified virus preparations revealed a considerable drop in infectivity on purification.

Experimental infection of the marmoset genital tract with Chlamydia trachomatis

A strain of Chlamydia trachomatis isolated in McCoy cells from the urethra of a patient suffering from non-gonococcal urethritis was inoculated into the vagina of 8 female marmosets. Chlamydiae were isolated repeatedly for 10-42 days from the lower genital tract of 7 of the marmosets. Six of the infected animals developed an acute inflammatory reaction in the genital tract and chlamydial inclusions in epithelial cells were seen in smears from 2 of them. In addition, each of 6 infected marmosets examined developed humoral antibodies to C. trachomatis. In contrast, 3 control animals inoculated intravaginally with chlamydia-free McCoy cells showed no evidence of chlamydial infection. Since the marmoset is small and easily bred in captivity, it should provide a useful model for studying the mechanisms of chlamydial pathogenicity.

The rôle of Chlamydia trachomatis in genital-tract and associated diseases

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A comparison of the sensitivity of immunofluorescence and Giemsa for staining Chlamydia trachomatis inclusions in cycloheximide-treated McCoy cells

In a clinical study of 190 men with non-gonococcal urethritis, Chlamydia trachomatis inclusions were sought in cycloheximide-treated McCoy cells by an indirect immunofluorescent antibody technique. The method was consistently reliable over a period of two years, and the results were obtained within 24 hours of a patient's attendance. The results correlated with those obtained by Giemsa staining in 91.6% of patients, and the new method was at least as sensitive as the established Giemsa-staining method.

New perspectives on the dietary management of diabetes

Some of the confusions and misconceptions surrounding the diabetic diet are discussed together with the reasons why there is controversy over its formation. Current understanding of the contribution which diet may make to the prevention of complications is outlined. A new approach to the dietary management of the diabetic is suggested.

Low frequency of chlamydial antibodies in patients with Crohn's disease and ulcerative colitis

Serum samples from 55 patients with Crohn's disease and from 23 patients with ulcerative colitis were tested for antibodies to Chlamydia trachomatis immunotypes by a micro-immunofluorescence technique. Antibody titres of 1:8 or greater against several immunotypes were detected in 14.5% of patients with Crohn's disease and in 21.7% of those with ulcerative colitis. These figures resemble the incidence in a healthy, non-venereal-disease population. Furthermore, there was no correlation between the presence of antibody and such factors as duration of symptoms, localisation of disease, or disease activity. These findings indicate that there is no reason to believe that Crohn's disease involves chlamydiae or that examination for chlamydial antibody is helpful in diagnosis.

Nutrient intake, adiposity, and diabetes

To study the role of nutritional factors in the genesis of diabetes, estimations of blood sugar concentration, food intake, and adiposity (as body mass index; BMI) were carried out on three normal population samples--namely, 961 employees of Beecham Ltd, 1005 employees of the Greater London Council, and 1488 middle-aged male civil servants (Whitehall study). Blood sugar concentrations and indices of glucose tolerance correlated positively with the degree of adiposity but tended to be negatively correlated with total food energy intake and its component nutrients (total carbohydrate, sucrose, and fat). This inverse trend was largely accounted for by highly significant inverse correlations between food energy intake and adiposity, a relation found in both sexes and in all three population samples and which extended across the whole range of nutrient intake and BMI. These findings suggest that greater degrees of adiposity are associated with lower than average food energy intakes and hence lower total energy expenditures. The association of increased adiposity with low food energy consumption may indicate an underlying "low energy throughput" state, and it may be the mechanisms of this, as well as the obesity, that are responsible for disease.