[Medullary thyroid carcinoma--familial or sporadic disease?]

Medullary thyroid cancer may be autosomal dominantly inherited. Calcitonin is a very sensitive tumour marker in medullary thyroid cancer. It is essential to measure calcitonin in first grade relatives of these patients, in order to expose familial incidents of subclinical disease. In 55 patients with medullary thyroid cancer and no history of familial disease, nine close relatives with elevated calcitonin were identified in four different families. Eight of these nine have been thyroidectomized. Five were found to have medullary thyroid cancer, one had definite C-cell-hyperplasia, and two had equivocal C-cell hyperplasia. The last two, had elevated basal serum calcitonin-levels were increased, but with no further increase after intravenous pentagastrin bolus injection. Thyroidectomy did not modify these results and DNA-analysis may be necessary to draw a conclusion about the hereditary situation of these patients.

High-performance capillary electrophoresis for characterization of hapten-protein conjugates used for production of antibodies against soyasaponin I

Micellar electrokinetic capillary chromatography using sodium cholate as the micellar phase has been investigated for characterization of hapten-protein conjugates. Special focus has been placed on the hapten soyasaponin I which is a quantitatively dominating glycoside in seeds of several legumes including pea (Pisum sativum L.) and soybean [Glycine max (L.) Merr.]. Soyasaponin I has been isolated from pea and used as hapten for production of anti-saponin specific polyclonal antibodies. Soyasaponin I was coupled to Kunitz soybean trypsin inhibitor (KSTI) and bovine serum albumin. The degree of coupling was determined by high-performance capillary electrophoresis (HPCE). Capillaries dynamically coated with zwitterions were found to be efficient for reduction of interaction between the silica capillary surface and the proteins. The applicability of HPCE for determination of coupling density was confirmed by investigation of a model hapten (p-nitrophenyl-alpha-D-galactoside; PNPG) coupled to KSTI. The PNPG-KSTI conjugates were examined by both HPCE and by spectrophotometric determination of the PNPG density on KSTI. The HPCE method was shown to be efficient in studies of the formation of hapten-protein conjugates and to be more specific than alternative techniques applied for determination of coupling densities.

Analysis of dansyl amino acids in feedstuffs and skin by micellar electrokinetic capillary chromatography

Micellar electrokinetic capillary chromatography (MECC) using sodium dodecyl sulphate (SDS) and sodium cholate have been used for analyses of 30 dansylated (Dns) amino acids. The influences of sample preparation, Dns/amino acid ratio, sample solvent composition, and separation conditions including voltage, temperature, pH and buffer composition were investigated. Complete separations of acidic and neutral amino acids were obtained within 45 min in the SDS system. The efficiency expressed as number of theoretical plates for the applied capillary 0.52 m long were between 210,000 and 343,000, and the repeatability was very good with relative standard deviations on relative migration times between 0.09 and 0.70% and on relative normalised peak areas (RNPAs) between 0.85 and 3.41%. The linearity studies gave correlation coefficients between 0.9957 and 0.9993 for RNPAs against concentration. Detection limits were between 3 and 6 fmol or approximately 2 pg of each amino acid. Basic amino acids were separated in a MECC system using sodium cholate. Procedures and problems using Dns derivatisation for amino acids analysed by the MECC methods are described. Finally, examples of analyses of hydrolysates of real complex samples show, that this method can be applied to determine the amino acid composition of proteins in feedstuffs and skin.

Micellar electrokinetic capillary chromatography for determination of indolyl glucosinolates and transformation products thereof

Micellar electrokinetic capillary chromatography based on dodecyltrimethylammonium bromide as a surfactant has been developed for the qualitative and quantitative determination of indolylic compounds. Indolyl glucosinolates (indol-3-ylmethylglucosinolates), its degradation products, and further transformation products thereof have been included in the studies. The influence of various parameters on the separation has been investigated, resulting in efficient separation, even for structurally closely related compounds, with theoretical plate number per meter of capillary of up to 370,000 for some compounds. Repeatability and linearity of the method have been determined giving relative standard deviations for the migration times of the compounds between 0.5 and 0.9% and linear correlation coefficients between 0.9924 and 0.9996, respectively. The method can be successfully applied to follow the degradation of indolyl glucosinolates in detail.

Sequelae one year after meningococcal disease

Of 99 consecutive patients with meningococcal disease, 6 died during the acute stage. The 93 survivors were examined one year after hospitalization. 21 (40%) of the adults and 6 (15%) of the children had definite sequelae, and an additional 27% and 11% possible sequelae. 6 adults (12%) and 1 child (2%) had definite neurological sequelae. Electroencephalography (EEG) abnormalities were observed in 7 adults (14%) and 2 children (5%). Epileptogenic activity was present in 3 of these, but none had experienced seizures. 8 adults (19%) and 5 children (14%) had sensorineural hearing loss or impaired vestibular function. Cerebral computerized tomography (CT) scan showed definite and possible abnormalities in 1 (3%) and 6 (18%), respectively, of the 34 patients tested. Neuropsychological tests were performed in 9 patients, 2 of these showed definite impairment. The frequency of neurological abnormalities was higher than in many previous studies, probably reflecting the more comprehensive examinations performed in the present study. However, only 3 patients had serious sequelae. The results suggest that the occurrence of sequelae after meningococcal disease is related to the severity of the acute disease. This may explain the higher rate of sequelae in adults, who have a higher proportion of seriously ill patients. The presence of meningitis is not required for the occurrence of neurological sequelae.

Genomic instability in colorectal cancer: relationship to clinicopathological variables and family history

Recent reports have suggested that one or more genes may cause replication errors (RER) during colorectal tumorigenesis. Additional alleles are seen in the tumors when analyzing random microsatellite loci. We have studied seven dinucleotide repeat loci, located on seven different chromosomes, by use of polymerase chain reaction amplification and denaturing polyacrylamide gel electrophoresis. We found that 16.5% (40 of 243) colorectal cancers showed RER at one or several loci (RER+). This includes 31% (4 of 13) among cases with a strong positive family history according to previously published criteria and 17% (35 of 207) among cases with no history of familial cancer. Interestingly, no significant association was found between RER+ tumors and a general familial clustering of cancer. Microsatellite instability was significantly associated with DNA diploid status of the tumor (P < 0.001), with the location of the tumor in the proximal colon (P < 0.001), and with poorly differentiated tumor phenotype (P < 0.001). Patients with RER+ at > or = 2 loci tumors had an increased survival (P = 0.05). We further analyzed 84 breast cancers and 86 male germ cell cancers using the same seven markers. None of the tumors were RER+, indicating that this phenomenon may be specific to certain types of tumors.

Laser surgery in otorhinolaryngology: a 10-year experience

Carbon dioxide laser was introduced in ENT in the early 1970s, and is now a routine treatment modality in many departments. The CO2 laser is a non-coagulating laser and works by evaporation of the tissue. Strict safety routines are important in laser treatment. However, our experiences with laser surgery are good. In the present study of 216 patients with a total of 479 treatments, we experienced no major complications. Laser surgery should be considered a valuable surgical complement, it is, however, important to gain knowledge about its pros and cons.

[Cytogenetic diagnosis in leukemia]

Cytogenetic diagnosis of leukemia was taken into use at the Norwegian Radium Hospital in late 1988. The article presents results from the period 1989-90. The samples arrived the laboratory on the same day they were obtained from the patients, and the results indicate that the transport had no effect on outcome. The success rate (obtained by cytogenetic diagnosis) was 82%. Among the persons who were diagnosed successfully, 66% showed clonal abnormalities. Diagnostic and prognostic implications are discussed.

No evidence for constitutional chromosome instability in testicular cancer

Chromosome aberrations in 20 lymphocytes of 20 patients with testicular germ cell tumors (TGCT) treated with surgery alone were compared with those of 20 cells from 20 healthy controls using standard G-banding technique. No increase in structural aberrations was found in the cancer group. An unexpected finding was that of more cells with losses of chromosomes being present in the control group. These losses predominantly affected small chromosomes in the control group, whereas the pattern of chromosome loss was different in the cancer group. The literature claiming increased chromosome instability in TGCT patients is reviewed. Point estimates and 95% confidence intervals to exclude such a hypothesis based on our results were calculated.

[Treatment of defecation blockade caused by deep recto-vaginal fossa with total pelvic floor reconstruction using a prolene-net]

The causes of severe defaecation blockage resulting from compression of the rectum and deep recto-genital fossa are reviewed and are illustrated by three patients who had previously undergone hysterectomy and who had incapacitating defaecation blockage and abdominal pain requiring morphine in two of the patients. The condition had not been diagnosed despite previous hospital contact for many years in two of the patients. Complete reconstruction of the pelvic floor with prolene net was performed. Subsequent defaecography showed normalization of defaecation without rectal compression and with relief of the abdominal pain and dependence on morphine in two of the patients. Rectal compression resulting from an abnormally deep recto-genital fossa should be included in the differential diagnostic deliberations in patients with severe constipation and defaecation blockage. Complete reconstruction of the pelvic floor with prolene net is considered, in the preliminary findings, to be a reasonable alternative in the treatment of this condition.

High resolution chromosome banding in search of germ line mutations applied on testicular cancer patients

Patients with bilateral and/or familial testicular cancer are assumed to demonstrate germ line mutations if such mutations are instrumental in testicular cancer patients. Constitutional rearrangements have to our knowledge not been reported, while an increased level of constitutional chromosome instability has been claimed. Lymphocytes from 12 Norwegian patients with bilateral or familial testicular cancer have been studied by high resolution Giemsa banding. A possible germ line mutation would be expected to be seen in every cell. It is therefore sufficient to examine one pair of the individual chromosomes obtained, if necessary, from several cells. Based on our previous findings of loss of heterozygosity in the chromosome regions 3p and 11p in testicular tumors, these chromosome arms were paid special attention. However, no mutations were observed in these regions nor in any other chromosome. Applying a 95% confidence interval, we conclude that less than 23% of familial and/or bilateral testicular cancer patients are caused by germ line mutations large enough to be detected with high resolution banding of at least 450 G-bands per haploid genome. The presented analyses were used to standardize the resolution determination in our laboratory.

Stapedectomy versus stapedotomy: a comparison

Two hundred and fifty consecutively operated stapes procedures operated by the author for otosclerosis are presented. A fat-wire stapedectomy prostheses (Schuknecht) was used in 152 cases and a Fisch teflon-wire piston was used in 98 ears. Of the 250 procedures 33 patients had bilateral surgery. The operations were done in local anaesthesia in most cases and with endomeatal incision. The fat-wire prostheses gave in 95% a closure within 10 dB and the rest 5% closed within 11-20 dB. The Fisch teflon-wire piston gave a closure within 10 dB in 87%, within 11-20 dB in 12% and within 21-30 dB in 1%. The speech reception was better after operation in 97% of patients operated with the fat-wire prostheses and in 99% of patients having the teflon-wire piston. It was a significant difference at 20 dB level of speech improvement (p < 02) in favour of the teflon-wire piston. The surgery for otosclerosis is a special procedure seeking refinements in surgical techniques to increase safety and maintain acceptable results. Our results show that the small fenestra technique with 4 mm piston will give better speech reception and better hearing in the high frequencies. To achieve a high standard the operations for otosclerosis should probably be centralised to let the surgeon do a minimum of 8 to 10 procedures every year.

Transtympanic ventilator tubes in the treatment of seromucous otitis. Indications and results

400 patients with bilateral secretory otitis media (SOM) were treated with ventilating tubes (VT) in a prospectiv study. The ear drums were normal on both sides before VTs treatment thus allowing ear drum changes and complications during VT treatment to be recorded. 618 VT were placed in the ear drum after suction of the fluid. In 182 patients unilateral myringotomy with suction of fluid were done and VT placed in the contralateral ear. Adenoidectomy with myringotomy, with an obstructing adenoid, gave 30% better chance. 10 different VTs were used. The most frequent pathology found in the ear drum after one period of VT treatment was tympanosclerosis. In the ears only treated with myringotomy tympanosclerosis occurred in 1%. 3 factors seemed to give more tympanosclerosis: metal (stainless steel or titanium), polyethylene and prolonged stay-time in the ear drum. Chronic perforations of the ear drum occurred with great variations between the different tubes. The Goode modified T-tube caused perforations in 17%. In the other VTs the perforations occurred in 2.1%. Chronic perforation together with tympanosclerosis will happen more often when the VT is made of polyethylene compared to silicone or fluoroplastic (p < 05). 90% of the perforations were located at the site of the VT. The ideal VT will stay in for 8-18 months at an average and it can be shown to improve middle ear function better than only waiting or myringotomy. Long-term VTs should not be used at the first VT procedures.

Karyotyping of a hematologic neoplasia developing shortly after treatment for cerebral extragonadal germ cell tumor

Hematologic malignancies may be associated with mediastinal extragonadal germ cell tumors. It may be that the hematologic malignancy is a part of the natural history of the teratoma, one germ cell tumor line being able to differentiate into hematological cells, or the hematologic malignancy is related to the treatment, or the two malignancies develop independently. Cytogenetic analysis of bone marrow from a patient with a germ cell tumor in the brain and the almost simultaneous appearance of a hematologic neoplasia showed a rearranged karyotype in that all 15 analyzed cells had the same karyotype: 50,XY, +X, +del(1)(p21), +10, +11, -12, +der(12)t(12;?)(q?;?). Our findings were consistent with the interpretation that the hematologic malignancy was derived from the germ cell tumor.

[Coloanal reservoir in low rectal cancer]

On the basis of a case history a method of treating low rectal cancer is presented. The method includes resection of the rectum and mucosal protectomy with establishment of a colo-anal reservoir.

Malignant mesenchymoma of the scrotum

Paratesticular sarcomas are rare, especially the malignant mesenchymoma. To our knowledge only four cases of paratesticular malignant mesenchymoma have been described previously. All were localized to the spermatic cord. We present a case of malignant mesenchymoma in the scrotum free of the spermatic cord.

Breast cancer and other cancers in Norwegian families with ataxia-telangiectasia

Patients who are homozygous for ataxia-telangiectasia (AT) have an exceptionally high incidence of cancer. Heterozygous individuals for the disease have been reported to be at an increased risk of cancer, particularly breast cancer in female carriers. We have analyzed eight Norwegian families with AT for cancer incidence in the parents, in the parents' sibs, grandparents, and grandparents' sibs. Two of the obligate heterozygote females have had premenopausal breast cancer. This incidence is significantly higher than expected for that group. No increase in the cancer incidence was observed in the parents' sibs, the grandparents, or the grandparents' sibs. Since the incidence of AT is low, data from many sources have to be combined to allow any conclusion.

Spinal muscular atrophy type I combined with atrial septal defect in three sibs

All three children of an unrelated Norwegian couple were born with spinal muscular atrophy (SMA I) as confirmed by autopsy in two of them. Two of the children died at birth, whereas one lived for 7 weeks on support systems that included artificial ventilation. All three children had large atrial septal defects (ASD). One had valvular aortic stenosis. Another had arrhinencephaly and transient pleural effusion which was evacuated during pregnancy. The findings may reflect concurrence of unrelated disorders caused by genetic or environmental factors, segregation of linked genes, pleiotropism or the existence of a previously unknown disease.

Otitis media with effusion: can erythromycin reduce the need for ventilating tubes?

Otitis media with effusion (OME) is a common condition among children and is characterized by nonpurulent fluid in the middle ear and fluctuating conductive hearing loss. Most children will spontaneously regain normal air-filled middle ears, but a certain number will have persistent problems. In our department we will treat annually about 500 children on an outpatient basis, with the insertion of ventilating tubes in the eardrum. The reason for this study was to evaluate the effect of erythromycin, instead of inserting a ventilation tube, in children with bilateral OME of longer duration than three months (double blind/placebo). The study comprises 147 children, 1-15 years of age, 83 boys and 64 girls, all with OME for more than three months. All the patients were candidates for tube insertion. In the group treated with erythromycin, 12 patients out of 69 had bilaterally air-filled middle ears after one month, as compared to 19 out of 72 in the group treated with the placebo. No difference was noted due to sex or age. The results support our indication and timing for ventilation tube insertion.

[Prenatal ultrasonic diagnosis and Down's syndrome]

A total of 8,923 children were born at the Regional Hospital, Trondheim, Norway between 1 January 1986 and 30 June 1989 to mothers from surrounding municipalities. Among these children, 14 were diagnosed after birth as having Down's syndrome. A proportion of 85% of the pregnant women in these municipalities had had a routine examination with ultrasound in the 16th to 22nd weeks of gestation at the Ultrasound Laboratory at the Regional Hospital. Ten of the children/fetuses with Down's syndrome in the study population had been subjected to a routine scan. Five of the ten were suspected to have Down's syndrome after the routine scan, and the diagnosis was confirmed by prenatal chromosomal analysis. (All these five fetuses were examined in 1987-88, which means that five of seven were detected in 1987-88). Another two fetuses (out of three) were suspected to have Down's syndrome after an ultrasound scan later in pregnancy. The diagnoses were confirmed by chromosome analyses after birth. One fetus was diagnosed in a 38 year old woman by amniocentesis in the 15th week of gestation. Our study suggests that routine ultrasonic scans can detect a significant proportion of fetuses with Down's syndrome in the second trimester.

HLA-B27 is necessary but not sufficient

It is discussed why some, but not all HLA-B27-positive persons get disease when triggered by certain infections. The conclusions are that a possible modifying gene may be found on the other HLA haplotype or outside the HLA complex. Given an epidemic infection afflicting a family, it is the possible differences of other environmental factors which may be of interest, not a further description of the infection initially recognized. The familial clustering of disease is based upon modifying genetic factor(s) and/or environmental factor(s) shared by the family members. Timing of the environmental factors may be instrumental. Penetrance of genetic predisposition may also depend on coincidence of randomly occurring environmental factors.

[Gene technology in the prevention of cancer]

Cancer may develop in connection with rare, genetic diseases or after exceptional, environmental exposures. Most commonly, however, cancer results from an unhappy coincidence of normal, genetic factors and ordinary, environmental conditions. Oncogenes are normal growth genes. Anti-oncogenes are normal regulatory genes which control growth genes. Cancer may result from changes (mutations) in an oncogene (such as in the Philadelphia chromosome), or from the lack of control of normal oncogenes. The latter may be due to loss of function of a suppressor gene (mutation in an anti-oncogene, such as in retinoblastoma) or through a change in the position of an oncogene (such as in Burkitt's lymphoma and in certain leukemias).

[Physiology and physiopathology of defecation]

The normal physiology of defaecation is reviewed with the object of understanding pathological defaecation. The significance of investigation of anorectal physiology in cases of disturbance of defaecation is emphasized in view of further understanding of the basic mechanisms and offers of rational therapy.

[Caustic injuries of the esophagus]

Several different agents can cause lesions of the esophagus if they are ingested. An esophagoscopy is necessary for proper evaluation of the damage. Our experience over the last 12 years substantiates that lye and strong alkalis are the most dangerous substances to swallow. The decision to do an esophagoscopy should be based on certain criteria listed in the paper.

Analgesic effect and tolerance of Voltaren and Ketogan in acute renal or ureteric colic

Fifty-six patients with renal or ureteric colic were entered into a randomised, prospective, double-blind investigation of the analgesic efficacy and tolerance of Voltaren versus Ketogan, both administered intramuscularly. There were no significant differences regarding pain-relief but side effects were fewer in patients treated with Voltaren.

Linkage disequilibrium analyses and restriction mapping of four RFLPs at the pro alpha 2(I) collagen locus: lack of correlation between linkage disequilibrium and physical distance

Restriction fragment length polymorphisms (RRLPs) located at short distances may demonstrate linkage disequilibrium. Under the assumption that the distances between the loci of the RFLPs are inversely related to the linkage disequilibria, gene order may be deduced. However, if the assumption is invalid, the results may be incorrect. We have studied four different DNA polymorphisms at the COLIA2 locus in 180 unrelated Norwegian individuals. Observed frequencies (presence/absence) for the different polymorphic sites were as follows: site A (EcoRI) 0.30/0.70, site B (MspI) 0.83/0.16, site C (StuI) 0.86/0.14, and site D (RsaI) 0.66/0.34. Of 16 possible haplotypes 12 were demonstrated, and 2 additional were deduced to be present. Restriction mapping of the four polymorphic sites gave the following order of the sites from the 5' to the 3' of the gene: A-D-B-C. Linkage disequilibrium was not found between the sites A and D; strong disequilibrium was found between sites A and C, and B and C; and less strong, between A and B, B and D, and C and D. Analysis of linkage disequilibrium coefficients between all pairs of loci demonstrated that there is no consistent relationship between linkage disequilibrium and physical distance (tau = -0.07). These results suggest that for a small region of the genome, factors such as deviating mutation rate and gene conversion may add significantly to rearrangements by recombination. Thus, a deduced gene order from linkage disequilibrium data has to be regarded with great caution.

IgA and rheumatoid factor in ankylosing spondylitis

The elevated serum IgA in seronegative arthritis and psoriasis is not well understood. We examined 112 patients with ankylosing spondylitis for IgA RF, IgG RF and IgM RF by an ELISA method. Two, two and ten patients were RF positive in each Ig class, respectively. Presence of RF was not correlated with Ig concentrations, with presence of HLA-B27, nor with clinical disease signs. It was concluded that RF may be seen in ankylosing spondylitis, but the increased IgA concentrations in such patients are not IgA RF.

Prenatal diagnosis in a female carrying a deletion close to the Duchenne locus

Family studies including the proband are usually needed before a prenatal diagnosis may be performed for Duchenne muscular dystrophy. We report here on prenatal diagnosis in a family where the solitary index case was dead, and where the consultand and her mother were assumed to be carriers by independent evidence. DNA analysis revealed that both the consultand and her mother had an X chromosome deleted for DNA material in the Xp21 region. The female fetus also carried the deleted X chromosome.

Prenatal diagnosis of glycerol-kinase deficiency associated with a DNA deletion on the short arm of the X-chromosome

Amniocentesis was performed in a woman who previously had given birth to a boy who died at 12 months of age with a diagnosis of glyceroluria and adrenal insufficiency. A high amount of glycerol (9.0 standard deviations above mean for controls) was found in the amniotic fluid. Enzyme activity of glycerol-kinase (ATP:glycerol-3-phosphotransferase, EC 2.7.1.30) in the cultured amniotic fluid cells was very low. The pregnancy was terminated and a male fetus was aborted. Examinations of DNA isolated from the fetus did demonstrate deletions of two out of 16 DNA probes mapping to the short arm of the X-chromosome. The probes failing to hybridize to DNA from the fetus were C7 (DXS28) and L1.4 (DXS68), both mapping to Xp21.3 and located terminal to the Duchenne locus.

Evidence for a sperm mutation resulting in Duchenne muscular dystrophy

DNA analysis of Xp21 markers in a family with two brothers affected with Duchenne muscular dystrophy (DMD) revealed that the mutation most likely had occurred in a grandpaternal sperm. There is therefore a low risk that the maternal aunts and their daughters are carriers of the DMD gene.

Technical and biological aspects of pseudomosaicism and mosaicism

In 471 amniotic fluid cell cultures, single abnormal cells were found to be randomly distributed. The expected number of pseudomosaicisms for aneuploidy due to randomly distributed cells was 3.9, and the observed number was 4. Expected number of mosaicism for aneuploidy was 0.6, and none was observed. The findings indicated that pseudomosaicisms as well as mosaicisms may be diagnosed from randomly distributed single abnormal cells. The probability of erroneously confirming mosaicism increased with the number of cells analysed in the second culture.

Cholestyramine ointment in the treatment of perianal skin irritation following ileoanal anastomosis

Severe perianal skin inflammation in six patients, following continent reservoir operation and ileoanal anastomosis, resistant to ordinary therapy, was treated with cholestyramine ointment twice a day. Cure was achieved within ten days.

Central mucoepidermoid tumour of the mandible. Report of 2 cases

Central mucoepidermoid tumour is an uncommon tumour within the jawbones. The onset is insidious and the first symptom is usually swelling. The radiographic appearance resembles a multiocular cyst or ameloblastoma. Two new cases are presented, and their diagnosis, histopathology and treatment are discussed. The prognosis is fairly good after adequate surgical treatment.

Unilateral sensorineural hearing loss in children less than 15 years of age

1-10 years after the first examination, 56 children below 15 years of age with unilateral sensorineural hearing loss were re-examined with a test-battery consisting of puretone and speech audiometry, stapedius reflex tests, caloric tests, brainstem response audiometry and otoneurological tests. In no case was an acoustic tumour suspected on the basis of the test results. A small progression of the hearing loss occurred in only one ear. In no case did the healthy ears develop hearing loss during the observation period. Diagnostic procedures can in most of such cases be limited to pure-tone audiometry. Follow-up is indicated because some patients require advice considering education and evaluation regarding fitting of a hearing aid.

Immunoglobulins, complement components and lymphocyte subpopulations in Bell's palsy

A significant decrease in the mean percentage of active and total T lymphocytes was found in 20 patients with Bell's palsy during the 1st week of the disease. In 8 patients the mean percentage of T helper cells was normal, whereas the mean percentage of T suppressor cells was significantly reduced. In 4 patients a normalization of the percentage of T lymphocytes and T suppressor cells was found 3 months after disease onset. The mean percentages of cells with membrane-bound immunoglobulins, EA- and EAC-rosetting cells and phagocytes were normal. Antibodies to peripheral nerve tissue were detected in low titers in 2 out of 20 sera. In the 20 patients the mean serum concentrations of IgG, IgA, IgM, IgE, C3 and C4 were normal.

Isoamylases and their thermolability in serum and cyst fluid from patients with pancreatic pseudocysts

The isoamylase pattern in serum and the amylase thermolability have been suggested as screening tests for the development of pancreatic pseudocysts. To study whether serum reflects the contents of pseudocysts, we have investigated the isoamylases and their thermolability in cyst fluid and in serum from 13 patients with pancreatic pseudocysts. No significant correlation was found between the contents in serum and cyst fluid with regard to total amylase and isoamylase P2 and P3 or with regard to the thermolability of total amylase and isoamylase P2 and P3. Thus, serum does not reflect the cyst contents of isoamylases or their thermolability. Therefore these serum amylase determinations can hardly be expected to be useful in distinguishing patients developing pseudocysts among patients with pancreatitis.

Radiographic evaluation of patients with Bechterew's syndrome (ankylosing spondylitis) and their first-degree relatives. Findings in the spine and sacro-iliac joints and relations to non-radiographic findings

One hundred and twenty-two hospitalized patients, 35 years or more of age with confirmed bilateral sacro-iliitis and 239 first-degree relatives, 25 years or more of age, were examined. All but 3 of the patients had confirmed ankylosing spondylitis (AS) in accordance with established criteria. The sacro-iliac joints were scored by a recently developed grading system. The prevalence of grade V sacro-iliits--extensive ankylosis--was greater in HLA B27-positive than in HLA B27-negative patients, and ankylosis of apophyseal joints, ossification of the interspinous ligament, or block vertebrae were not seen in HLA B27-negative patients. Shining corners and/or squared vertebrae were the most frequent findings of the dorsolumbar spine in patients with a disease course of less than 10 years. Mixed osteophytes were rare in patients below 40 years of age. All radiographic inflammatory changes scored in the spine-except for shining corners--were most often seen in patients with a disease history exceeding 20 years. Syndesmophytes and/or ankylosed apophyseal joints were less extensive in female than in male patients. No differences in the severity of radiographic changes in sacro-iliac joints or in frequency, severity or localization of different radiographic changes of the dorsolumbar spine were observed between HLA B27-positive patients with and those without psoriasis or acute anterior uveitis. Definite sacro-iliitis was restricted to HLA B27-positive relatives of HLA B27-positive probands and demonstrated in one-fifth of them. Shining corners and/or squared vertebrae were frequent findings in relatives with sacro-iliitis (45%), whereas apophyseal joint ankylosis, ossification of the interspinous ligament, block vertebrae and bridging syndesmophytes were not seen. Our results support the view that AS is not a defined disease entity and should be regarded as a syndrome. AS is an improper name for all patients fulfilling the Rome and/or New York criteria for definite AS, since many of them will probably never develop ankylosis of the spine or sacro-iliac joints.

Juvenile ankylosing spondylitis and HLA B27 homozygosity

Ten consecutive patients with juvenile ankylosing spondylitis were investigated in a prospective study. At least one of the parents of each patient had a positive history of probable or definite ankylosing spondylitis, Reiter's syndrome, or acute anterior uveitis. The patients and their parents were examined clinically and were HLA-typed. Nine of the 10 patients exhibited the genetic marker HLA B27, but only one patient was homozygous for HLA B27. This prevalence of homozygosity among HLA B27 positive persons could be expected to occur by chance alone. Based on the limited material studied, we cautiously conclude that HLA B27 homozygosity is probably not responsible for disease onset in childhood.