Reduced lung function in leukaemia patients undergoing bone marrow transplantation

20 patients with leukaemia in remission or early relapse received an allogeneic bone marrow graft. Patients were conditioned according to Seattle protocol with high dose cyclophosphamide and total body irradiation to a total dose of 8 Gray to the lungs delivered by a 6 MV linear accelerator at a dose rate of approximately 0.06 Gray/min. As prophylaxis against the graft versus host reaction, methotrexate and/or cyclosporin A were given. Lung function was studied prior to treatment and every 3 months thereafter. Before treatment a marked decrease was seen in the CO diffusion capacity when compared to the predicted value, while the flow volume relationships were within normal limits. The cause of this is unknown, but may be due to previous infections and the cytostatic treatment given. After bone marrow transplantation, a further irreversible decrease was seen in the CO diffusion capacity and vital capacity indicating an additive effect of the lung irradiation.

Cytomegalovirus infection after bone marrow transplantation: relation of pneumonia to postgrafting immunosuppressive treatment

Five fatal cases of CMV associated interstitial pneumonia occurred among 20 patients who had received allogenic bone marrow transplantation for acute leukemia or aplastic anaemia. This outcome was analysed in relation to prospectively obtained data on complement fixing (CF) and IgM anti-CMV titres and excretion of CMV in urine or pharynx. Altogether 16 patients had primary or reactivated CMV infection. Five of these patients receiving corticosteroids at the time of infection, at a dose of more than 1 mg/kg/day, failed to mount a significant CF antibody response, excreted large amounts of virus, and died from pneumonia, while the remaining 11 infected patients obtained high CF antibody titres and showed no severe symptoms related to CMV infection. IgM antibodies occurred simultaneously with CF antibodies in most cases of primary and reactivated infection. The results of the study suggest a protective role of the humoral immune response to CMV infection in BMT recipients, and passive immunisation with CMV hyperimmune globulin should be attempted especially in patients given additional immunosuppression with high dose corticosteroids.

Calcium, parathyroid hormone and calcitonin in normal pregnancy and preeclampsia

Calcium, parathyroid hormone (PTH) and calcitonin (CT) in serum, and the fractional renal excretion of calcium (FECa) were determined in (1) normal pregnant women, (2) patients with preeclampsia, and (3) normal nonpregnant control subjects. Serum calcium, corrected for individual variation in serum protein, was reduced and FECa increased in the normal pregnant group when compared to the nonpregnant control group. In preeclampsia serum calcium did not differ significantly from the normal pregnant group, but FECa was considerably lower and also reduced below the level in the nonpregnant control group. PTH was slightly lower during normal pregnancy than after delivery, but did not deviate significantly from the nonpregnant control group; in preeclampsia PTH did not deviate significantly from the levels in normal pregnancy. CT was the same in the third trimester of pregnancy in both groups. Changes in serum calcium and FECa were not correlated to PTH or CT. It is concluded that both normal pregnancy and preeclampsia are accompanied by considerable alterations in calcium metabolism, that PTH and CT in both groups are mainly unchanged and at nonpregnant level, and that the increase and decrease in renal calcium excretion in normal pregnancy and preeclampsia, respectively, may be attributed to changes in kidney function.

Microbial colonization and infectious complications in bone marrow transplant recipients treated in strict protective isolation

Bone marrow transplantation was carried out in 10 patients (5 with acute leukemia and 5 with aplastic anaemia). Protection against endogenous and exogenous infection was attempted by a rigorous sterile protective isolation regimen, comprising laminar-air-flow cabinets, daily decontamination of skin, mucous membranes and intestines. All supplies of food, fluids, medicine and equipment were sterilized. In all patients a heavy suppression of the normal bacterial flora was obtained after approximately 1 week and 85% of a total of 1026 days of decontamination revealed only scanty growth in one or a few regions of the patients. The surviving microorganisms were Candida albicans and non-pathogenic commensals (mainly Staphylococcus albus). In 1 patient only an exogenic microorganism was introduced possibly by transfusion or staff. 16 febrile episodes were recorded in the patients during decontamination covering 21% of the period. Four episodes were caused by bacteria (Klebsiella pneumoniae, Pseudomonas aeruginosa and mixed). In most of the remaining episodes the etiology was not established. The results thus show that endogenous pathogenic bacteria can be eradicated by the regimen, and that systemic antimicrobial chemotherapy can be restricted and guided by the results of the previous and contemporary cultures. However, viral infections remain a major problem in these patients. Efforts should be maintained to avoid entrance of exogenic bacteria by staff and supplies.

An improved technique for Ia-determination in guinea pigs

The serological typing of determinants within the guinea pig histocompatibility complex (GPLA-complex) has, until now, largely been carried out by the 51Cr-release technique. As target cells, a mixture of B and T cells from peripheral blood and lymph nodes were used. However, for the detection of Ia-determinants, which predominantly are expressed on the surface of B cells, the use of lymphocyte suspensions with a relatively low content of B cells can cause some evaluation problems. We have developed a simple method for obtaining a relatively pure suspension of B cells, making use of the ability of guinea pig T cells to form rosettes with rabbit red blood cells and the possibility of removing these by sedimentation on lymphoflot. By employing these purified B cells, an improved serological detection of Ia-determinants of the guinea pig histocompatibility complex is made possible.

Impaired prolactin response to arginine infusion and insulin hypoglycaemia in chronic renal failure

The elevated level of circulating prolactin present in the majority of uraemic patients on chronic haemodialysis is primarily due to hypothalamic pituitary dysfunction. So far this defect has been illustrated by demonstration of a blunted prolactin response to TRH and failure of L-dopa to suppress prolactin levels. In the present study two powerful prolactin and growth hormone stimuli, namely iv arginine infusion and insulin hypoglycaemia were applied in a group of uraemic patients on chronic haemodialysis and in age matched control subjects. The prolactin increments to arginine infusion (4.4 +/- 1.2 ng/ml vs 17.6 +/- 4.6 ng/ml, mean +/- SE) and to insulin hypoglycaemia (7.9 +/- 1.7 ng/ml vs 31.5 +/- 5.4 ng/ml) were significantly suppressed in the uraemic patients compared to the controls (P less than 0.05). In contradistinction the growth hormone rise provoked by the tests were similar in the two groups. Our results provide further insight into the hypothalamic pituitary derangement in uraemic patients and confirm the presumption of an insensitivity of the lactotrophs to stimulation in uraemic patients.

Short- and long-term fluctuations in plasma prolactin concentration in normal subjects

The physiological changes in plasma prolactin concentration were studied in 447 normal subjects, including 65 men, 75 pre-menopausal women and 307 post-menopausal women. The within-day and day-to-day variation as well as the circadian and circannual rhythm of plasma prolactin levels were determined. Furthermore, the relationship between changes in prolactin and oestradiol-17 beta levels during the normal menstrual cycle and in the climacteric was studied. Pre-menopausal women had significantly (P less than 0.01) higher basal plasma prolactin concentration than men and post-menopausal women. Furthermore, they had significantly (P less than 0.01) higher day-to-day variation than men. This suggests that prolactin in women is secreted in a pulsatile fashion. Only small seasonal variations in both sexes were seen. The levels of plasma prolactin during the ovulatory and the luteal phase in the cycle were significantly (P less than 0.02) higher than that of the follicular phase, and a positive correlation between changes in plasma concentration of oestradiol-17 beta and prolactin was found. Also in post-menopausal women a relationship between plasma concentration of prolactin and oestradiol-17 beta was seen. It is concluded that the assessment on the physiological variation recorded during sleep in both sexes. However, only in women day-to-day changes and the changes related to the menstrual cycle and the climacteric are of importance.

Numerical assessment of asymmetry at scintigraphy of normal joint pairs with (99)Tcm polyphosphate

Numerical analysis of (99)Tcm polyphosphate distribution in 1 348 selected, non-pathologic joint pairs revealed a significantly higher right-sided accumulation in 37 per cent, a left-sided dominance in 21 per cent and no significant side difference in the remaining 42 per cent. The most common level of asymmetry was the shoulder joint.

Can postoperative pulmonary conditions be improved by treatment with the Bartlett-Edwards incentive spirometer after upper abdominal surgery?

During the immediate postoperative course after upper abdominal surgery, pulmonary complications often occur, caused, inter alia, by reduced regional ventilation and by atelectases as a result of: (1) narrowing of the small peripheral bronchi, and (2) impaired respiratory function. Based on these pathophysiological mechanisms, an instrument (Bartlett-Edwards Incentive Spirometer) has been devised, which aims at giving the patient an opportunity of sustained maximal inspiration under standardized and controlled conditions. The use of this instrument has been followed by reports of a considerable reduction in postoperative pulmonary complications. In a controlled clinical investigation of the pre- and postoperative condition of the lungs, we were unable to show any beneficial effect of the instrument. In general, we have a low frequency of severe postoperative pulmonary complications, as compared with the results reported in the literature. We ascribe this to our very effective pre- and postoperative respiratory therapy.

Survival of microorganisms and helminth eggs in green pills and cobs processed from a green crop irrigated with sewage

A grass crop which was contaminated with domestic sewage was dried in a hot air drying plant in order to observe the effect of the drying on pathogenic bacteria, virus and parasite eggs. The investigation showed, that pathogenic bacteria and virus were reduced with a factor 10(5)--10(6), and that parasite eggs were reduced with at least a factor 200, which is sufficient to secure that grasis irrigated with sewage and pre-served with hot air drying is used without hygienic risks.

Long-term prognosis of infants with idiopathic respiratory distress syndrome. Follow-up studies in infants surviving after the introduction of continuous positive airway pressure

Fifty-one children surviving IRDS with CPAP alone or CPAP and IPPV were studied at the age of 2.5 to 4.0 years. One child had developed tetraplegia and mental retardation and 6 children were speech-retarded. Correlation with perinatal events showed that this group of children had a significantly lower gestational age and birth weight, a lower Apgar score and a higher PCO2 prior to ventilatory treatment than the remainder. Re-examination by age 4.0 to 5.0 years showed persistent handicaps in only four of the seven children.