Serodiagnosis of scrub typhus with antigens immobilized on nitrocellulose sheet

This study was designed to develop a simple method for serodiagnosis of scrub typhus. The basis of the method is detection of anti-Rickettsia tsutsugamushi antibody in patient serum by reaction with antigens dot blotted on a nitrocellulose sheet (NCS). The final evaluation of the reaction is performed by observing the color intensity which develops as a result of sequential treatments of the NCS with peroxidase-conjugated anti-human immunoglobulin G or immunoglobulin M antibody and with the substrate of the enzyme. After various trials, we found that the best results were obtained by using a purified antigen which adhered to an NCS at 0.2 to 2 micrograms of protein per dot and a test serum diluted 1,000- to 4,000-fold. Under these conditions, almost all antibody-positive sera showed a distinct color at the dot on the NCS, so that a positive reaction could be distinguished by the naked eye from a negative reaction with antibody-negative sera, which developed only a faint color. A comparison of the results of screening of antibody-positive and -negative sera by this method and the immunofluorescence test showed that both methods produced similar results. From these results, it is concluded that this dot immunoassay can be useful for the serodiagnosis of scrub typhus.

Purification and partial characterization of a type-specific antigen of Rickettsia tsutsugamushi

A type-specific antigen (54- to 56-kilodalton polypeptide) in the envelope of Rickettsia tsutsugamushi was purified from each of three prototype strains (Gilliam, Karp, and Kato) by a combination of mild anionic detergent treatment, gel filtration, and reverse-phase high-performance liquid chromatography. The purified antigens from the three strains were shown to have similar amino acid compositions: primarily aspartic acid, glutamic acid, and glycine, with lesser amounts of cysteine, methionine, and tyrosine. The N-terminal amino acid sequences of the antigens were 74.3% homologous among the three strains.

Immunoblotting analysis of anti-rickettsial antibodies produced in patients of Tsutsugamushi disease

The reactivity of sera from patients of Tsutsugamushi disease (scrub typhus) with the antigenic polypeptides of Rickettsia tsutsugamushi was analyzed by the immunoblotting method. The reactivity varied greatly among the sera of individual patients tested. IgG and IgM antibodies of most patients reacted with the 54-56 kilodalton (54-56K) polypeptide located on the rickettsial surface, suggesting that this polypeptide is a predominant antigen in the infection. Other polypeptides of 60K, 50-52K, 46-47K, 35K, and 21-25K were reactive with some but not all sera. From the reactivity of these polypeptides, it was suggested that the 54-56K polypeptide is both strain-specific and group-specific, the 60K polypeptide is group-specific, and the 35K and 21-25K polypeptides are subgroup-specific. IgG antibodies seem to be more cross-reactive with polypeptides of multiple strains than IgM antibodies and have a tendency of increased cross-reactivity that was observed in the sera obtained at the later stage of illness.

Tracheobronchial rupture caused by blunt chest trauma: acute respiratory management

The clinical management of 12 patients with major intrathoracic tracheobronchial rupture (complete, 3; incomplete, 9) due to blunt trauma has been reviewed and compared with that of two groups of patients with chest injuries not involving the tracheobronchial tree, 17 patients with multiple rib fractures and 17 with chest injuries requiring thoracotomy for control of pneumothorax and hemothorax. The effect of injury on ventilatory function was significantly greater in the patients with tracheobronchial injury in whom an elevated PCO2 at the time of admission was associated with a poor prognosis. Conventional ventilatory management with endotracheal intubation and positive pressure ventilation causing increased air leakage produced further deterioration of pulmonary function in four of the patients with tracheobronchial disruption. The use of a double-lumen endobronchial tube in two patients with tracheobronchial rupture facilitated ventilatory support and subsequent operative management.

Deficiency of peptidoglycan and lipopolysaccharide components in Rickettsia tsutsugamushi

Analyses of chemical composition in whole cells of Rickettsia tsutsugamushi were performed and compared with those of the other rickettsiae and gram-negative bacteria. The results indicated that R. tsutsugamushi does not contain detectable amounts of 3-deoxy-D-mannooctulosonic acid, heptose, muramic acid, or glucosamine (less than 2, less than 2, less than 3, and less than 3 nmol/mg, respectively). The microorganism was found to contain four kinds of fatty acids (16:0, 18:0, 18:1, and 18:2), but not hydroxy fatty acids. Furthermore, in analysis by sodium dodecyl sulfate-polyacrylamide gel electrophoresis followed by silver or Coomassie blue staining, lipopolysaccharide bands were not detected in preparations treated with proteinase K. It is concluded that R. tsutsugamushi has little or no peptidoglycan or lipopolysaccharide.

Prediction in smooth pursuit

A quantitative analysis of prediction in smooth pursuit was made in 23 normal subjects. The target wave (random sinusoidal wave), which contains a predictive portion and a nonpredictive portion, was developed by the authors, using a microcomputer. Five parameters were established quantitatively after microcomputer A/D conversion of the eye movements every 10 ms. There was no significant difference in amplitude gain, retinal error velocity, velocity gain or acceleration gain between the predictive and the non-predictive portions. However, a significant difference between the predictive portion and the nonpredictive portion was found in phase lag. We therefore concluded that the predictive function in smooth pursuit, in normal subjects, is the most important factor in the phase relationship between target wave and eye movements.

Clinical features of cisplatin vestibulotoxicity and hearing loss

Patients treated with cisplatin were observed in an otoneurological study with special reference to cochlear and vestibular toxicity. Toxicity-related symptoms appeared to be almost all transient. As with leukopenia, hearing loss and dizziness often occurred after several weeks of administration. In the equilibrium examinations, some abnormal findings such as spontaneous nystagmus and positional nystagmus were seen. Caloric tests and body sway tests detected abnormal findings in the early stages of cisplatin-related vestibulotoxicity.

[Non-invasive estimation of aortic flow by local electrical impedance changes]

Aortic flow velocity was measured by catheter-tip flow transducer in 25 patients who underwent left cardiac catheterization for non-invasive estimates by the impedance method. Disk electrodes were attached to the skin at the levels of the second thoracic vertebra in the posterior median line and the V8 lead position for electrocardiography. Alternating current, 350 micro-amperes, 50 KHz constant, was applied to the outer electrode, and impedance changes were detected via the inner electrode. The e wave, or height of the first derivative dz/dt wave of the electrical impedance was lower in cases of old myocardial infarction and higher in cases of aortic valve regurgitation, as compared with the values of the healthy control group. The time lag between the start of the upward deflection and the peak value of the dz/dt wave coincided with that of the aortic flow curve as measured at the aortic arch and descending aorta. These time lags were about 20 to 30 msec as compared with the ascending aortic flow curve, and were -20 to -30 msec as compared with the abdominal aortic flow curve. There was a close correlation between the maximum flow velocity measured at the aortic arch and the height of the e waves. The regression equation was: Y = 0.21X - 1.53, r = 0.88, p less than 0.01. These data suggest that the first derivative of electrical impedance change as obtained by the disk electrode method reflects aortic flow at the arch and descending aorta.

Immunological properties of Rickettsia tsutsugamushi, Kawasaki strain, isolated from a patient in Kyushu

Nine isolates of Rickettsia tsutsugamushi were obtained from patients with Tsutsugamushi disease (scrub typhus) in Miyazaki Prefecture in Kyushu. Immunological analyses of these patients' sera and the isolates were performed by indirect immunofluorescence, indirect immunoperoxidase or immunoblotting techniques. In the analysis of reactions of the patients' sera with the prototype strains Gilliam, Karp, and Kato and with the isolates, sera from two patients, including Kawasaki, showed similar profiles and cross-reaction with the two isolates recovered from the corresponding patients, but reacted only weakly with the prototype strains. With guinea pig polyclonal antibodies against the isolate and prototype strains, Kawasaki strain showed some degree of cross-reaction with Gilliam strain but not with either Karp or Kato strain, nor with Shimokoshi strain which is known to be different antigenically from the prototype strains. Additionally, strain-specific murine monoclonal antibodies against Gilliam, Karp, and Kato strains did not react at all with Kawasaki strain. These results suggest that the Kawasaki strain may be different antigenically from the prototype strains and Shimokoshi strain. The finding two strains of the same antigenic type (Kawasaki) among only nine isolates suggests the presence of Kawasaki-type rickettsiae in Miyazaki Prefecture. Shimokoshi strain also did not react with these strain-specific monoclonal antibodies, suggesting that strains of R. tsutsugamushi antigenically distinct from the prototype strains, such as Kawasaki and Shimokoshi strains, may easily be recognized by their nonreactivity with these monoclonal antibodies.

Production and characterization of monoclonal strain-specific antibodies against prototype strains of Rickettsia tsutsugamushi

We have developed 18 hybridoma cell lines which secrete murine monoclonal strain-specific antibodies to prototype strains of Rickettsia tsutsugamushi: nine anti-Gilliam, four anti-Karp and five anti-Kato antibodies. All the monoclonal antibodies reacted only with their homologous strains in direct and indirect immunofluorescence (IF), or indirect immunoperoxidase (IP) test. By IF and IP tests with the monoclonal antibodies, 22 strains of R. tsutsugamushi, which were newly isolated from mites, field rodents and patients with Tsutsugamushi disease (scrub typhus) in Japan, were all clearly identified as either Gilliam or Karp type. Analysis by polyacrylamide gel electrophoresis and immunoblotting techniques revealed that the monoclonal antibodies recognized primarily the polypeptides of an apparent molecular weight of 54 to 56 kilodaltons of the homologous rickettsial surface. The monoclonal antibodies produced in the present study should enhance the serotyping and further analytical investigation of the rickettsial antigens since they recognize the strain- or type-specific polypeptides and do not show any cross-reaction among strains.

Quantitative comparison between saccadic and ataxic pursuits

Smooth pursuit has been determined by the examiners' visualization as 'smooth pursuit', 'saccadic pursuit', or 'ataxic pursuit' according to the shapes of the eye movements on the ENG (electronystagmography) recording paper. Even since the introduction of computers for the measurement of smooth pursuit, however, no trial to compare quantitatively between smooth pursuit, saccadic pursuit and ataxic pursuit had been made up to the present. In the present work we analysed 10 smooth (normal) pursuits, 23 saccadic pursuits and 7 ataxic pursuits quantitatively with a microcomputer and found that the phase relationship between target movements and eye movements was the most prominent factor for distinguishing smooth pursuit pattern differences.

Characterization of polypeptides in Rickettsia tsutsugamushi: effect of preparative conditions on migration of polypeptides in polyacrylamide gel electrophoresis

The polypeptide compositions and antigenic components of Rickettsia tsutsugamushi were analyzed by modifying the solubilization conditions prior to polyacrylamide gel electrophoresis and by using monoclonal antibodies in immunoblotting experiments. Several polypeptides were converted to larger or smaller molecules by using various conditions for rickettsial sample preparation. Solubilization of a sample in 2-mercaptoethanol-containing buffer resulted in conversion of high-molecular-weight polypeptides to smaller polypeptides and conversion of some of the 43-kilodalton (43K) polypeptide to a 46K polypeptide. The heat modifiability of selected polypeptides was shown by heating samples at 100 degrees C. A major polypeptide on the rickettsial surface which showed strain-specific antigenicity appeared at the 43K position in samples solubilized at 37 degrees C but moved to the 56K position after samples were heated at 100 degrees C. Immunoblotting with an anti-56K polypeptide monoclonal antibody demonstrated that the reactive antigens existed predominantly as the higher-molecular-weight polypeptides. These polypeptides were converted to 43K polypeptides at 37 degrees C or the 56K polypeptides at 100 degrees C by cleavage of disulfide linkages with 2-mercaptoethanol treatment.

Equilibrium disorders and R-R intervals in ECG

We have measured RR intervals on patients with equilibrium disorders to check the function of the autonomic nervous system. And we have obtained two parameters (coefficient of variation "CV%" (the static function of the autonomic nervous system] and "A-B" (the dynamic function of the autonomic nervous system). The dynamic function of the autonomic nervous system (A-B) further deteriorated in elderly patients with central nervous system disorders. We concluded that disorders in the dynamic function of the autonomic nervous system affected the autoregulation which caused the central nervous system disorders, especially in elderly patients.

Gain of slow-phase velocity of optokinetic nystagmus

Although slow-phase velocity of optokinetic nystagmus (OKN) increases according to the increase of stimulus velocity, it is not obvious whether both are quite equal or not. In this study, gain of slow-phase velocity in OKN response to stimulation velocity was analyzed by two methods of stimulation, constant acceleration, and constant velocity stimulation. In our observation, the gain of slow-phase velocity was not equal to 1.0 even at low-speed stimulation. On the other hand, the number of nystagmus almost corresponded to the number of stimulation stripes passing through the center of an OK-drum up to high-speed stimulation. The results of this study indicate that pursuit eye movement of slow-phase OKN should not be quite equal to that of the eye tracking test, i.e. being required to continuously look at a moving spot.

Analysis of polypeptide composition and antigenic components of Rickettsia tsutsugamushi by polyacrylamide gel electrophoresis and immunoblotting

Polyacrylamide gel electrophoresis of lysates of purified Rickettsia tsutsugamushi revealed as many as 30 polypeptide bands, including major bands corresponding to molecular sizes of 70, 60, 54 to 56, and 46 to 47 kilodaltons. Compared with the polypeptide composition of the rickettsiae of Gilliam, Karp, and Kato strains and a newly isolated Shimokoshi strain, the major polypeptide in the Kato strain (54-56K) and in the Karp strain (46-47K) migrated a little faster and slower, respectively, than the corresponding polypeptides in the other strains. The largest major polypeptide (54-56K) was digestible by the treatment of intact rickettsiae with trypsin and variable in content in separate preparations, suggesting that the polypeptide exists on the rickettsial surface and is easily degraded during the handling of these microorganisms. Several surface polypeptides of rickettsiae, including the 54-56K and 46-47K polypeptides, were detected by radioiodination of intact rickettsiae followed by polyacrylamide gel electrophoresis of the lysate; however, the 70K and 60K polypeptides were not labeled. Immunoblotting experiments with hyperimmune sera prepared in guinea pigs against each strain demonstrated that the 70K, 54-56K, and 46-47K polypeptides showed antigenic activities. The 54-56K polypeptide appeared to be strain specific, whereas the 70K and 46-47K polypeptides cross-reacted with the heterologous antisera.

Quantitative measurement of smooth pursuit using the continuously changing sinusoidal wave in neurological patients

In a previous paper [Ohashi, Watanabe, Kobayashi, Mizukoshi: ORL 47: 49-56] we developed a new sinusoidal wave with 20 continuously changing sinusoidal waves from 0.1 to 2.0 Hz and reported that in normal subjects the limit of smooth pursuit was 1.2 Hz, retinal error velocity (REV) was the most reliable parameter as input of smooth pursuit and amplitude gain was the most reliable parameter as output. In the present paper, we analyzed smooth pursuit system by the same method and discussed the relation between input and output of smooth pursuit in patients with neurological disorders. Our results indicated that the relationship between input and output of the smooth pursuit was particularly abnormal in patients with cerebellar disorders.

Quantitative measurement of smooth pursuit using a continuously changing sinusoidal wave in normal subjects

In order to examine the frequency of a target wave and induced eye movements we designed and developed a new target wave (continuously changing sinusoidal wave). This target wave consisted of 20 sinusoidal waves from 0.1 to 2.0 Hz with 10 degrees amplitude (peak-to-peak amplitude is 20 degrees). Several parameters were calculated quantitatively with a microcomputer in normal subjects, and the following conclusions were obtained: The amplitude gain (peak-to-peak amplitude of eye movements/peak-to-peak amplitude of the target wave) and the retinal error velocity were appropriate parameters for representing the input and output of smooth pursuit. The limit of smooth pursuit was 1.2 Hz.

Hazard to endotracheal tubes by CO2 laser beam. Experimental report

Ignition or combustion of the endotracheal tube during CO2 laser microlaryngo surgery may cause fatal lung disorders. We undertook an experiment on ignition and combustion of endotracheal tubes by CO2 laser beam and came to the following conclusions: (a) the silicon endotracheal tube was nonflammable; (b) the spiral endotracheal tube was also nonflammable; (c) a pulse wave was recommended and 3-second intervals were necessary; (d) four sheets of moist gauze were necessary to prevent cuff trouble, and (e) it was advisable to set the O2 concentration below 25% when using the silicon endotracheal tube.

Effects of positive end-expiratory pressure on tissue gas tensions and oxygen transport

To determine whether positive end-expiratory pressure (PEEP) impairs peripheral tissue oxygenation, hemodynamic variables including blood and subcutaneous tissue gas tensions were measured at 0, 5, 10, 15, and 20 cm H2O of PEEP, in 9 patients who were being mechanically ventilated for acute pulmonary failure. Increasing the level of PEEP produced parallel decreases in cardiac output and oxygen delivery (DO2 = cardiac output X arterial oxygen content); however, there were no significant changes in mean arterial blood pressure (MAP), oxygen consumption (VO2), mixed-venous oxygen tension (PvO2), pH, or base excess. Subcutaneous tissue oxygen (PtO2) and carbon dioxide (PtCO2) tensions, which were directly measured in the femoral region by a mass spectrometer, also remained at their baseline levels (zero end-expiratory pressure). We concluded that peripheral tissue oxygenation is not impaired up to the level of 20 cm H2O of PEEP, even though DO2 significantly decreases.

[The causes of abnormal coagulation system in the early phase of burns]

The relationship between abnormality in blood coagulation and Burn Index (B.I.) were examined in 174 patients treated in our department for trauma during past 7 years. Platelet counts decreased rapidly and became minimal at 3rd or 4th hospital day, but PT, APTT, fibrinogen and FDP were abnormal in many cases over 30% BSA only within 24 hours after thermal injury. The platelet counts at 3rd hospital day and PT within 24 hours were well correlated with Burn Index (platelet vs. B.I. r = 0.665, p less than 0.01; PT vs. B.I., r = 0.587, p less than 0.01). And PT was also well correlated with plasma total protein (r = 0.686, p less than 0.01). AT-III, plasminogen and alpha 2 PI had also a tendency of interrelation to plasma protein level. These data suggest that systemic intravascular coagulation does not commonly complicate immediately after thermal injury, although consumption of coagulation factors are mainly occurred at the site of burn and correlated with the loss of plasma protein.

[Prophylactic and chemotherapeutic efficacy of pivmecillinam (PMPC) against infections after TUR-P and prostatectomy]

The prophylactic and chemotherapeutic efficacy of PMPC against infections after TUR-P has been investigated. Bacteriological evaluation: PMPC , 200-300 mg/day for 2-12 weeks, was administered to 49 patients, who had over 10(3)CFU/ml of microorganisms after CET or CEC treatment for 3-7 days. The eradication rate of microorganisms was 40.8% after 2 weeks, 52.2% after 4 weeks, 64.1% after 6 weeks, 65.0% after 8 weeks and 70.6% after 12 weeks. Effectiveness on pyuria : The improvement rate of pyuria against 59 patients who had over 10(5)/hpf of pyuria , was 15.3% after 2 weeks, 16.4% after 4 weeks, 25.4% after 6 weeks, 58.5% after 8 weeks, 72.7% after 10 weeks and 75.0% after 12 weeks. Overall clinical efficacy on PMPC was examined in 26 patients. The results of efficacy were 27.3% after 2 weeks, 48.0% after 4 weeks, 50.0% after 6 weeks, 69.2% after 8 weeks, 75.0% after 10 weeks and 77.0% after 12 weeks. The clinical response was evaluated according to a criterion for clinical evaluation of antimicrobial agent on chronic complicated UTI proposed by UTI committee in Japan. No severe adverse effect including allergic reaction was found. Following administration of PMPC , three patients experienced adverse gastric reactions, and drug administration was discontinued at week 6 or 8. PMPC was effective as a prophylactic chemotherapeutic drug against infections after TUR-P and prostatectomy.

Hemodynamic and diuretic effects of GIK (glucose-insulin-potassium) treatment on extensive burn patients

The effect of GIK (glucose-insulin-potassium) therapy, as an adjunctive treatment, on cardiac function and urine excretion in the early phase of extensive burn injury was investigated. In early postburn patients, within 48 hours after injury, the GIK therapy resulted in a prominent and continued elevation of cardiac index (CI) (p less than 0.05) due to elevated stroke volume index (SVI) (p less than 0.05) and left ventricular stroke work index (LVSWI) (p less than 0.05), and decreased total peripheral resistance (TPR) (p less than 0.05), whereas it produced only a transient increase of CI in the control patients and no noticeable changes in the septic patients. A comparative analysis of these parameters and blood volume in GIK-administered patients and 50% glucose-infused patients revealed the elevated left ventricular performance to be due to enhanced contractility of the heart. The GIK therapy also produced a remarkable and continued increase of urine volume (p less than 0.01), at least in part attributable to the elevated CI, whereas in the control and septic patients it produced only a transient increase of urine volume, merely reflecting the hyperosmolar property of the GIK solution.

Quantitative analysis of the visual vestibulo-ocular reflex using sinusoidal rotation in patients with peripheral vestibular disorders

In order to investigate interaction of the vestibular and optokinetic systems in patients with peripheral vestibular disorders, the visual vestibulo-ocular reflex (V-VOR) gain in 49 patients with peripheral vestibular disorders was quantitatively measured by using pendular harmonic sinusoidal rotation with optokinetic stationary stimuli. The patients were rotated sinusoidally both with eyes closed and open at an amplitude of 240 degrees and at a frequency of 0.1 Hz (peak velocity 75.4%s). Comparing the vestibulo-ocular reflex (VOR) and V-VOR gains in the patients with definite Meniere's disease (23 cases), benign paroxysmal positional vertigo (BPPV, 13 cases) and sudden deafness with vertigo or dizziness (13 cases), the VOR-DP and normal V-VOR gain were more frequently observed in patients with Meniere's disease (13 cases) and sudden deafness (7 cases) than in those with the BPPV (3 cases). In the four patients with bilateral Meniere's disease and sudden deafness, abnormally decreased VOR-gain (under 0.55) in the bilateral directions with slightly decreased V-VOR gain was measured when tested independently. However, abnormal V-VOR gain was observed in only one case of sudden deafness due to retrocochlear lesions. From our VOR and V-VOR gain observations comparing the caloric responses, we have concluded that the comparison of VOR with V-VOR gains provides additional information for evaluation of peripheral vestibular disorders as well as central nervous system disorders.

Quantitative analysis of the human visual vestibulo-ocular reflex in sinusoidal rotation

In order to investigate interaction of the vestibular and optokinetic system, a visual vestibulo-ocular reflex (V-VOR) gain in forty-five normal subjects was measured by manual and computer analysis. The test subjects sat in a newly devised, pendular rotating chair in an optokinetic drum. With this device pendular harmonic sinusoidal rotation and optokinetic stimuli could be given simultaneously. The test subjects were rotated sinusoidally at amplitudes of 120 degrees and 240 degrees and at frequencies of 0.05 Hz and 0.1 Hz (maximum velocities 18.8 degrees/s, 37.7 degrees/s, 75.4 degrees/s), and with eyes closed and open. Within these pendular stimuli, there was no response decline phenomenon nor influence of amplitude on frequency. The pure VOR gain measured in dark room with eyes open was about 0.6 and did not vary with the eyes closed as long as mental alertness was maintained. The V-VOR gain in a stationary optokinetic drum with eyes open was about 1.1. From our observations, the 0.1 Hz sinusoidal rotation with an amplitude of 240 degrees (maximum velocity, 75.4 degrees/s) is an appropriate stimulation for the V-VOR and VOR test battery in clinical practice.

[A new indicator to determine the optimal PEEP (author's transl)]

To elucidate the optimal PEEP for respiratory treatment, respiratory and haemodynamic studies were performed on 12 normovolemic patients with ARDS for various levels of PEEP (PEEP = 0, 5, 10, 20 cm H2O). In this study, it became clear, that Suter's best PEEP (maximal O2 transport should be taken as a reference for optimal PEEP) cannot be used in practice because O2 transport is usually maximal in ZEEP (PEEP=0) and changes with the alteration of FIO2. We propose "intrapulmonary nonshunt flow ((Qt-Qs)" as a new indicator to determine the optimal PEEP. The level of PEEP to achieve the maximal intrapulmonary non-shunt flow must be such that the decrease in intrapulmonary shunt flow is attained with minimal decrease of cardiac output.

Hyperamylasemia in acute carbon monoxide poisoning

Of patients with acute carbon monoxide poisoning admitted to the Trauma Intensive Care Unit of the Osaka University Hospital 39.5% (17/43) manifested hyperamylasemia. Iszyme studies in 16 such patients revealed 87.5% to be of the salivary type. Two patients presented with hyperamylasemia of the pancreatic-salivary type. There was no pancreatic type hyperamylasemia among these patients, negating the possible involvement of the pancreas in hyperamylasemia from carbon monoxide poisoning. There was a statistically significant difference in amylase levels between the arterial and the external jugular venous blood, indicating the salivary gland as the organ mainly responsible for hyperamylasemia in carbon monoxide poisoning. Amylase levels coincided well with the level of consciousness and the base excess. The amylase levels correlated significantly with beta-glucuronidase levels, suggesting the hyperpermeability of cell membranes of the salivary gland as the chief factor in hyperamylasemia secondary to acute carbon monoxide poisoning.

Computerised tomography as an indication of long-term outcome after acute carbon monoxide poisoning

21 patients with acute carbon-monoxide poisoning had repeated brain scans by computerised tomography (CT) between May, 1977 and June, 1979. On the basis of the initial CT findings, the 21 patients could be divided into two distinct groups. In 11, areas of low density were seen bilaterally in the globus pallidus. These areas were still present 3 months after initial CT. In all but one of these patients the outcome was poor. The remaining 10 had no abnormal findings on their initial brain CT scans; outcome was good in this group.

Designed and real working situations in machine systems operation

New work situations designed at the stage when new machine systems are introduced are realized on the assumption that the new systems can maintain their designed functions consistently, generally eliminating previous work habits and without sufficient knowledge about real working processes and skills. This may produce differences between designed and real working situations. Some examples are presented from observations on influence of modern design of cargo ships on their crews. It was difficult for crews to maintain stable working conditions, especially when machine systems deviated from their designed functions. Often the crew had to work in off-duty hours giving up private freetime activities. Among various factors contributing to the discrepancies between designed and real work, lack of availability of the new systems is the most important factor. Also important is lack of back-up systems which would function either when the machine systems are out of order or when previous working skills and habits must be applied. A need for developing methods of evaluation of these two factors from ergonomic points of view is pointed out.