Egg-grown and tissue-culture-grown variants of influenza A (H3N2) virus with special attention to their use as antigens in seroepidemiology

A field strain of influenza A (H3N2) virus isolated in embryonated eggs during the 1984-5 influenza outbreak (A/Finland/13/85E) was compared in an antigenic analysis with virus from the same clinical specimen isolated in MDCK cell cultures (A/Finland/13/85M). The M-virus appeared to be more sensitive to haemagglutination-inhibiting antibodies against heterologous viruses than did the E-virus. The results of propagation and plaque purification experiments support the hypothesis that a single clinical specimen may consist of distinct antigenic variant subpopulations promoted selectively by the host during isolation procedures. Receptor-binding properties are discussed as a possible explanation for this selectivity. A set of 471 paired sera consisting of pre-epidemic and post-epidemic specimens taken from the same subjects in 1984-5 was studied for haemagglutination-inhibiting antibodies to six influenza A (H3N2) virus strains, including the E-virus and the M-virus from A/Finland/13/85. Of the antigens used, the M-virus detected significant antibody increases more frequently than did the E-virus (10.0 v. 5.9%). The superiority of the M-virus may rest primarily in its ability to pick out anamnestic antibody responses. Irrespective of this cross-reactivity, pre-epidemic antibody to the M-virus was fairly well associated with protection. In the set of sera (230 specimens) collected in summer 1985 to represent different age groups, the antibody status against the M-virus was significantly better than the status against the E-virus. The results suggest that, at least in some instances, antibody to MDCK-grown virus is a more accurate indicator of the immune status of a community than antibodies to egg-grown virus variants.

Growth of fat grafts after operation for partial bone growth arrest: demonstration by computed tomography scanning

Three patients who had fat grafts implanted at operation for partial bone growth arrest had computed tomography scanning of the operated bone 3-10 years after operation so that the fate of the grafts could be clarified. Two patients had a bridge in the tibia and one in the femur. The density in Hounsfield Units in the enlarged cavities showed that the fat grafts had grown in parallel with regained bone growth. In two adult patients, the grafts, enlarged during the period of growth, remained as adipose tissue for years. A thick layer of compact bone formed around the cavities. Partial regeneration of the growth plates occurred.

Studies on ergometer exercise testing. II. Effect of previous myocardial infarction, digoxin, and beta-blockade on exercise electrocardiography

The results of exercise electrocardiography were studied in a random sample of 317 subjects with clinical suspicion of coronary artery disease. In 278 patients with coronary artery disease the rate of false negative tests was 18% with and 12% without previous myocardial infarction. If ST elevation was considered a negative response, the corresponding values were 25% and 13%, respectively, p less than 0.01. The greatest prevalence of negative tests was seen after anterior myocardial infarction: 27% or 42% when ST elevation was not included into positive responses. The sensitivity of exercise-induced ST depression for the presence of multivessel disease was lower after anterior infarction (67%) than in other patients with previous infarction (86%), p less than 0.01. The corresponding specificities were 71% and 22%, respectively, p less than 0.005. If ST elevation was included into positive responses these differences were abolished. In subjects without myocardial infarction the sensitivity was 89% and specificity 43%. Digitalized patients had somewhat higher sensitivity in the exercise electrocardiogram than those without digoxin, 90% vs. 81% (p less than 0.05), but the difference was not seen with exclusion of ST elevation. The specificity was not influenced by digitalis. beta-blockade had no effect on the sensitivity or specificity, but the prevalence of postexercise ST evolution was lower with (11%) than without (30%) beta-blockade. The prevalence of slowly ascending ST depression was reduced by three factors: the presence of digitalis in patients without previous myocardial infarction, infarction itself, and the extent of coronary artery disease. We conclude that exercise electrocardiography has only a limited value in prediction of multivessel disease.(ABSTRACT TRUNCATED AT 250 WORDS)

Studies on ergometer exercise testing. I. Significance of the type of ST-segment response, sex, and chest pain

Ergometer exercise electrocardiographic (EECG) data were surveyed in a series of 328 patients (277 men and 51 women) subjected to coronary arteriography. The sensitivity and specificity of EECG for coronary artery disease (CAD) were 84% and 54%, respectively. The predictive accuracy of a positive test for CAD was 95% in men and 81% in women. The predictive accuracy of a negative test was 25% in men and 62% in women. When slowly ascending ST depression was considered insignificant, the sensitivity of EECG declined to 71%, with an increase in specificity to 64%. CAD was present in 89% of the patients with slowly ascending ST depression and 65% of them had a multivessel disease. Seventy-two subjects had postexercise ST-segment elevation. The predictive value of this sign for CAD was 94%. Exercise-induced chest pain had quite a similar diagnostic significance as EECG. The prevalence of CAD in patients with a history of typical angina was 94% in both sexes. Atypical chest pain was associated with normal coronary arteriography in 59% of males and 100% of females.

Nervous system effects of long-term occupational exposure to toluene

Forty-three male rotogravure printers with long-term toluene exposure and 31 age- and sex-matched offset printers without toluene exposure were examined in detail. Clinical, neurophysiological, neuropsychological and neuroradiological examinations and assessment of autonomic functions did not reveal any statistically significant differences between the groups. The results suggest that occupational long-term exposure to toluene under these circumstances does not have clinically significant adverse effects on the nervous system. Exposure to toluene seemed to be associated with heavy drinking.

[Experience in the use of the tumor markers CEA, GICA and TPA in the postoperative monitoring of colorectal neoplasms]

Current use of tumour markers in the followup to malignant digestive tract neoplasias is restricted mainly by the non optimal sensitivity levels and specificity of these markers. These aspects of CEA, GICA and TPA markers used in follow-ups for 23 patients surgically treated for Duke's stage B2 neoplasias of the colon and rectum were examined over the period 1980-1983. Each marker examined displays its own individual characteristics of sensitivity and specificity. An X-ray endoscopic confirmation is required in all cases as no single marker is sufficiently reliable to be used as a diagnostic tool on its own. It is concluded that biological markers should be used as part of a follow-up programme embracing more than one diagnostic procedure.

Epidurally placed free fat grafts visualized by CT scanning 15-18 years after discectomy

Four patients operated on in 1965-1968 for disc protrusion had CT scanning of the area operated on. In all patients viable fat tissue was demonstrated in the area in which fat tissue had been transplanted on the dura 15-18 years earlier.

Sequential internal mammary artery (IMA) grafts in coronary artery bypass surgery

Since 1972, double or triple left IMA bypasses have been made on 61 consecutive patients with a total of 123 distal anastomoses to the LAD or to the LD branches of the LAD. There were 54 additional vein grafts with 102 distal anastomoses. The number of single IMA grafts in the same period of time was 400. Hospital mortality was 2 patients (3.3%), with a late mortality of 7 patients (11.3%), 2 of them being heart-related, one of hypernephroma, one suicide, and of unknown cause in the remaining 3 patients. Five patients refused postoperative angiography. There were 50 patients with one or more postoperative angiograms available for the analysis after a mean follow-up time of 35.1 (0.5 to 128) months. The late patency of the left IMA anastomoses was 97% (98/101) and 82.4% (84/102) of the vein anastomoses. There were 2 anastomotic left IMA occlusions to the LD at 2 weeks and 10 months, respectively, and to LAD at 13 months. No left IMA graft had become completely occluded. According to the trend analysis, there was a 97.5% patency at 5 years, and 95.7% at 10 years with left IMA grafts compared to 78.4 and 67.9, respectively, with vein grafts. Ten left IMA grafts were dilated, 2 narrowed and 36 unchanged at the late angiography. Sequential left IMA graft, in appropriate cases seems to result in the most superior patency rate of all types of grafts.

Blood acetaldehyde concentration gradient between hepatic and antecubital venous blood in ethanol-intoxicated alcoholics and controls

After ethanol (0.8 g kg-1 body weight orally) significant concentrations of acetaldehyde (2-20 mumol 1(-1] were found in hepatic venous blood of moderately intoxicated non-alcoholic male Caucasians in spite of the absence of detectable levels (less than 2 mumol 1(-1] in simultaneously taken antecubital blood. In thirteen chronic alcoholics the elevation of blood acetaldehyde was more constant in the hepatic than in the peripheral vein. Fructose infusion caused a marked elevation of acetaldehyde both in the hepatic and peripheral vein of four controls, but not of four alcoholics, who eliminated ethanol about 50% faster than controls. The rate of disappearance of acetaldehyde from sampled and in vitro incubated hepatic venous blood was similar to that observed after addition of acetaldehyde in vitro to ethanol-free control blood (2 nmol ml-1 min-1 at 20 mumol 1(-1) acetaldehyde; Km about 30 mumol 1(-1]. Uptake of acetaldehyde in blood was calculated to explain maximally 30-40% of the concentration gradient between central and peripheral blood.

Prevention of progression of coronary atherosclerosis by treatment of hyperlipidaemia: a seven year prospective angiographic study

The progression of coronary atherosclerosis was assessed by repeat angiography in 28 patients and 20 controls with hyperlipidaemia (serum cholesterol concentration greater than 7.2 mmol/l (278 mg/100 ml) or serum triglyceride concentration greater than 2.0 mmol/l (177 mg/100 ml), or both) and symptomatic coronary artery disease of two or three vessels. Twenty eight patients (26 men and two women) were treated with diet and drugs (clofibrate or nicotinic acid, or both) to lower lipid concentrations. Twenty men taking part in a simultaneous study served as non-randomised controls. They received medical treatment for coronary artery disease but no treatment to reduce lipid concentrations. The initial levels of coronary risk factors and the angiographic state were comparable in the two groups. In the 28 patients total cholesterol, total triglyceride, and low density lipoprotein cholesterol concentrations were reduced by an average 18%, 38%, and 19% respectively by treatment for hyperlipidaemia and high density lipoprotein cholesterol concentration was increased on average by 10%. The treatment maintained these concentrations during a follow up of seven years. By all criteria coronary lesions progressed significantly less in the patients than the controls: the angiographic state remained completely unchanged in nine (32%) of the patients compared with only one (8%) of the surviving controls; of the arterial segments at risk, 46 (16.5%) progressed in the patients compared with 50 (38.2%) in the controls (p less than 0.001); and the coronary obstruction increased less in patients than in controls (p less than 0.05). Cardiac survival was 89% in seven years in the patients compared with 65% in five years in the controls (p less than 0.01). The anginal symptoms diminished or remained stable in 16 of the 24 patients who survived until the end of the study. The progression of coronary atheromatosis was significantly greater in those patients who during the seven years of treatment had an average total cholesterol concentration, VLDL plus LDL cholesterol concentration, or ratio of LDL to HDL cholesterol concentration above the respective median value than in those with the corresponding values below median. On the other hand, the patients with HDL cholesterol concentrations above the median during treatment showed less progression than those with lower HDL cholesterol concentrations. The increase in coronary obstruction was inversely related to the average HDL cholesterol concentration during treatment. The progression was not, however, related to LDL cholesterol concentration during treatment.(ABSTRACT TRUNCATED AT 400 WORDS)

Experience with arm veins as aorto-coronary bypass grafts

In a series of 1,000 coronary bypass operations 15 patients received arm vein grafts. In these cases the saphenous veins were either absent or inadequate and the mammary arteries alone were not sufficient for multivessel coronary revascularization. Altogether, 34 coronary anastomoses were performed with 16 arm vein grafts; additional coronary endarterectomy was needed in four instances. Together with mammary artery or saphenous vein grafts these patients each had, on the average, 3.6 coronary anastomoses. There was no operative mortality and no complication related to the arm vein grafts. Postoperatively all the patients were free of angina pectoris. A follow-up angiogram (mean 1.4 years postoperatively) showed a patency rate of 87% for arm vein grafts. A frequent finding was an uneven diameter of the grafts. In three patients aneurysmal dilatation (of 8.3 to 9.8 mm in diameter) was revealed. Although the patency rate to date is satisfactory, our experience is too limited in time numbers to judge long term durability.

Phase I trial of intermittent high-dose dacarbazine

A phase I study was conducted with dacarbazine (DTIC) protected from light and administered iv as a single dose every 3 weeks. Eighteen patients received 47 courses of DTIC, with doses ranging from 850 to 1980 mg/m2. Hypotension was the dose-limiting toxic effect and it may be secondary to the citric acid present in the pharmaceutic preparation of DTIC. Sporadic myelosuppression was seen at doses greater than 1380 mg/m2. Other side effects noted were nausea and vomiting, acute diarrhea, headache, a "flu-like" syndrome, and a hypersensitivity reaction to sunlight. No antitumor activity was found. The results of this study indicate that this may be a qualitatively different way of giving DTIC, and that the side effects of this drug may be intermingled with those of citric acid in this particular schedule. If the conventional pharmaceutic preparation of this drug is not modified, further studies with high-dose DTIC protected from light should be discouraged.