Effects of growth hormone on the ontogenetic allometry of craniofacial bones

Organism size is controlled by interactions between genetic and environmental factors mediated by hormones with systemic and local effects. As changes in size are usually not isometric, a considerable diversity in shape can be generated through modifications in the patterns of ontogenetic allometry. In this study we evaluated the role of timing and dose of growth hormone (GH) release on growth and correlated shape changes in craniofacial bones. Using a longitudinal study design, we analyzed GH deficient mice treated with GH supplementation commencing pre- and post-puberty. We obtained 3D in vivo micro-CT images of the skull between 21 and 60 days of age and used geometric morphometrics to analyze size and shape changes among control and GH deficient treated and non-treated mice. The variable levels of circulating GH altered the size and shape of the adult skull, and influenced the cranial base, vault, and face differently. While cranial base synchondroses and facial sutures were susceptible to either the direct or indirect effect of GH supplementation, its effect was negligible on the vault. Such different responses support the role of intrinsic growth trajectories of skeletal components in controlling the modifications induced by systemic factors. Contrary to the expected, the timing of GH treatment did not have an effect on catch-up growth. GH levels also altered the ontogenetic trajectories by inducing changes in their location and extension in the shape space, indicating that differences arose before 21 days and were further accentuated by a truncation of the ontogenetic trajectories in GHD groups.

Assessment of the efficacy of MRI for detection of changes in bone morphology in a mouse model of bone injury

PURPOSE

To determine whether magnetic resonance imaging (MRI) could be used to track changes in skeletal morphology during bone healing using high-resolution micro-computed tomography (μCT) as a standard. We used a mouse model of bone injury to compare μCT with MRI.

MATERIALS AND METHODS

Surgery was performed to induce a burr hole fracture in the mouse tibia. A selection of biomaterials was immediately implanted into the fractures. First we optimized the imaging sequences by testing different MRI pulse sequences. Then changes in bone morphology over the course of fracture repair were assessed using in vivo MRI and μCT. Histology was performed to validate the imaging outcomes.

RESULTS

The rapid acquisition with relaxation enhancement (RARE) sequence provided sufficient contrast between bone and the surrounding tissues to clearly reveal the fracture. It allowed detection of the fracture clearly 1 and 14 days postsurgery and revealed soft tissue changes that were not clear on μCT. In MRI and μCT the fracture was seen at day 1 and partial healing was detected at day 14.

CONCLUSION

The RARE sequence was the most suitable for MRI bone imaging. It enabled the detection of hard and even soft tissue changes. These findings suggest that MRI could be an effective imaging modality for assessing changes in bone morphology and pathobiology.

Microarchitecture, but not bone mechanical properties, is rescued with growth hormone treatment in a mouse model of growth hormone deficiency

Growth hormone (GH) deficiency is related to an increased fracture risk although it is not clear if this is due to compromised bone quality or a small bone size. We investigated the relationship between bone macrostructure, microarchitecture and mechanical properties in a GH-deficient (GHD) mouse model undergoing GH treatment commencing at an early (prepubertal) or late (postpubertal) time point. Microcomputed tomography images of the femur and L4 vertebra were obtained to quantify macrostructure and vertebral trabecular microarchitecture, and mechanical properties were determined using finite element analyses. In the GHD animals, bone macrostructure was 25 to 43% smaller as compared to the GH-sufficient (GHS) controls (P < 0.001). GHD animals had 20% and 19% reductions in bone volume ratio (BV/TV) and trabecular thickness (Tb.Th), respectively. Whole bone mechanical properties of the GHD mice were lower at the femur and vertebra (67% and 45% resp.) than the GHS controls (P < 0.001). Both early and late GH treatment partially recovered the bone macrostructure (15 to 32 % smaller than GHS controls) and the whole bone mechanical properties (24 to 43% larger than GHD animals) although there remained a sustained 27-52% net deficit compared to normal mice (P < 0.05). Importantly, early treatment with GH led to a recovery of BV/TV and Tb.Th with a concomitant improvement of trabecular mechanical properties. Therefore, the results suggest that GH treatment should start early, and that measurements of microarchitecture should be considered in the management of GHD.

Arctic herbivore diet can be inferred from stable carbon and nitrogen isotopes in C3 plants, faeces, and wool

The use of stable isotopes in diet analysis usually relies on the different photosynthetic pathways of C3 and C4 plants, and the resulting difference in carbon isotope signature. In the Arctic, however, plant species are exclusively C3, and carbon isotopes alone are therefore not suitable for studying arctic herbivore diets. In this study, we examined the potential of both stable carbon and nitrogen isotopes to reconstruct the diet of an arctic herbivore, here the muskox ( Ovibos moschatus (Zimmermann, 1780)), in northeast Greenland. The isotope composition of plant communities and functional plant groups was compared with those of muskox faeces and shed wool, as this is a noninvasive approach to obtain dietary information on different temporal scales. Plants with different root mycorrhizal status were found to have different δ15N values, whereas differences in δ13C, as expected, were less distinct. As a result, our examination mainly relied on stable nitrogen isotopes. The interpretation of stable isotopes from faeces was difficult because of the large uncertainty in diet–faeces fractionation, whereas isotope signatures from wool suggested that the muskox summer diet consists of around 80% graminoids and up to 20% willows. In conclusion, the diet composition of an arctic herbivore can indeed be inferred from stable isotopes in arctic areas, despite the lack of C4 plants.

Challenging the myth of the irrational dairy farmer; understanding decision-making related to herd health

Veterinarians working with dairy cows are suggested to refocus their efforts from being task-oriented providers of single-cow therapy and develop themselves into advice-oriented herd health management advisors. The practising cattle veterinarian's ability to translate knowledge into on-farm application requires a profound understanding of the dairy farm as an integrated system. Consequently, educating and motivating farmers are key issues. To achieve such insight the veterinarian needs to work with several scientific disciplines, especially epidemiology and (behavioural) economics. This trans-disciplinary approach offers new methodological possibilities and challenges to students of dairy herd health management. Advisors working with dairy herd health management may sometimes experience that farmers do not follow their advice. Potentially, this could lead to the interpretation that such farmers are behaving irrationally. However, farmers who are confronted with advice suggesting a change of behaviour are placed in a state of cognitive dissonance. To solve such dissonance they may either comply with the advice or reduce the dissonance by convincing themselves that the suggested change in management is impossible to implement. Consequently, herd health management advisors must understand the fundamental and instrumental relationships between individual farmers' values, behaviour and perception of risk, to stimulate and qualify the farmer's decision-making in a way that will increase the farmer's satisfaction and subjective well-being. Traditionally, studies on herd health economics have focussed on financial methods to measure the value of technical outcomes from suggested changes in management, following the basic assumption that farmers strive to maximise profit. Farmers, however, may be motivated by very different activities, e.g. animal health and welfare or other farmers' recognition, making it impossible to provide 'one-size-fts-all' consultancy because the best decision depends heavily on the internal logic and context-bound reality on each dairy farm. Relevant information may be available, but to be implemented at farm level it has to be communicated effectively. This requires a trustworthy communicator. Consequently, veterinarians are recommended to receive training in communication; keywords in this process are dialogue and reflection. An educational framework based on science and the authors' experience is presented. The aim is to guide practising cattle veterinarians into a personal learning process considered necessary for them to be recognised by farmers as trustworthy dairy herd health advisors.

Timing of growth hormone treatment affects trabecular bone microarchitecture and mineralization in growth hormone deficient mice

Growth hormone (GH) is essential in the development of bone mass, and a growth hormone deficiency (GHD) in childhood is frequently treated with daily injections of GH. It is not clear what effect GHD and its treatment has on bone. It was hypothesized that GHD would result in impaired microarchitecture, and an early onset of treatment would result in a better recovery than late onset. Growth hormone deficient homozygous (lit/lit) mice of both sexes were divided into two treatment groups receiving daily injections of GH, starting at an early (21 days of age) or a late time point (35 days of age, corresponding to the end of puberty). A group of heterozygous mice with normal levels of growth hormone served as controls. In vivo micro-computed tomography scans of the fourth lumbar vertebra were obtained at five time points between 21 and 60 days of age, and trabecular morphology and volumetric BMD were analyzed to determine the effects of GH on bone microarchitecture. Early GH treatment led to significant improvements in bone volume ratio (p=0.006), tissue mineral density (p=0.005), and structure model index (p=0.004) by the study endpoint (day 60), with no detected change in trabecular thickness. Trabecular number increased and trabecular separation decreased in GHD mice regardless of treatment compared to heterozygous mice. This suggests fundamental differences in the structure of trabecular bone in GHD and GH treated mice, reflected by an increased number of thinner trabeculae in these mice compared to heterozygous controls. There were no significant differences between the late treatment group and GHD mice except for connectivity density. Taken together, these results indicate that bone responds to GH treatment initiated before puberty but not to treatment commencing post-puberty, and that GH treatment does not rescue the structure of trabecular bone to that of heterozygous controls.

A prospective, blind investigation of immunological reactions in chronic inflammatory bowel disease. Suppressor activity and immune capacity

In a paired, blind and prospective study including 36 patients with chronic inflammatory bowel disease, i.e. ulcerative colitis (UC) and Crohn's disease (CD), and 36 healthy volunteers, the immune capacity has been examined by three different test systems using peripheral blood mononuclear cells: spontaneous mitotic activity (SMA), concanavalin A (con A) activated lymphoblast transformation test (LTT) and autologous mixed lymphocyte reaction (AMLR). The same patients and controls were examined simultaneously for their suppressor activity by a con A induced suppressor activity (CAISA) test. SMA was similar in UC patients and controls. The lymphoblast transformation (LT) in UC patients was significantly reduced with submaximal concentrations of con A (1 and 2 micrograms), whereas AMLR was only non-significantly decreased. However, the results registered by these two test systems revealed a significantly positive correlation. CAISA in UC patients was significantly enhanced, but this finding showed no correlation to the reduced LTT and AMLR, indicating a primary defect in the mitotic capacity independent of the observed increment in CAISA. SMA, con A activated LT, AMLR and CAISA were similar in CD patients and controls.

A novel 3-D image-based morphological method for phenotypic analysis

A new approach for the study of geometric morphometrics is presented based on well-established image processing techniques in a novel combination to support high-throughput analysis necessary for large-scale determination of genotype-phenotype relationships. The method retains full 3-D data, and avoids manual landmark selection. Micro-computed tomography images are superimposed into a common orientation by rigid image registration with an isotropic scale factor. An average sample shape is determined by averaging the intensities of corresponding voxels of the registered images, and shape variation is determined by calculating the image gradient of the average shape. Localized shape differences between mean images or between an individual and a group mean are identified and quantified by surface-to-surface distance measures of superimposed images. Validation was performed using geometric shapes of known dimensions as well as biological samples of C57 BL/6 J and A/WySnJ mouse skulls, and shape variation of the mouse skulls was consistent with previously published results. Although the image gradient is sensitive to both image registration and filtration of the average image, the effect can be minimized by consistent use of image analysis parameters. While the proposed approach deviates from well-established landmark-based geometric morphometric tools, it is not intended to replace these current methods. Rather, it will be an important contribution to provide high-throughput screening in large-scale studies focused on understanding genotype-phenotype relationships so that subsequent morphometric approaches using established techniques can be better focused.

Phenotypic variability and craniofacial dysmorphology: increased shape variance in a mouse model for cleft lip

Cleft lip and palate (CL/P), as is true of many craniofacial malformations in humans, is etiologically complex and highly variable in expression. A/WySn mice are an intriguing model for human CL/P because they develop this dysmorphology with a variable expression pattern, incomplete penetrance and frequent unilateral expression on a homogeneous genetic background. The developmental basis for this variation in expression is unknown, but of great significance for understanding such expression patterns in humans. As a step towards this goal, this study used three-dimensional geometric morphometric and novel high throughput morphometric techniques based on three-dimensional computed microtomography of mouse embryos to analyze craniofacial shape variation during primary palate formation. Our analysis confirmed previous findings based on two-dimensional analyses that the midface in A/WySn embryos, and the maxillary prominence in particular, is relatively reduced in size and appears to be developmentally delayed. In addition, we find that shape variance is increased in A/WySn embryos during primary palate formation compared to both C57BL/6J mice and the F1 crosses between these strains. If the reduction in midfacial growth caused by the Wnt9b hypomorphic mutation pushes A/WySn mice closer on average to the threshold for cleft lip formation, the elevated shape variance may explain why some, but not all, embryos develop the dysmorphology in a genetically homogeneous inbred line of mice.

Outcome of systemic and analytic group psychotherapy for adult women with history of intrafamilial childhood sexual abuse: a randomized controlled study

OBJECTIVE

Research suggests that group psychotherapy for adults with a history of child sexual abuse (CSA) is generally beneficial. Only few studies have included random assignment. This study compared the effects of analytic (A) and systemic group psychotherapy (S) on CSA.

METHOD

One hundred and fifty-one women with intrafamilial CSA were randomly allocated to A or S. Quality of life, psychosocial function, psychological distress, and flashbacks were assessed before and after treatment. Both completer analyses and intent-to-treat analyses were carried out.

RESULTS

Eighty-two patients completed group therapy. Both therapies led to the improved quality of life, fewer psychopathological symptoms, and better overall functioning, but overall the outcome of S was significantly better than the outcome of A.

CONCLUSION

Women with CSA sequelae benefit from both A and S. In the short-term, S is both statistically and clinically superior to A. Longer-term follow-up data are required for conclusions on maintenance of therapeutic gains.

Within- and Across-Person Uniformity of Body Condition Scoring in Danish Holstein Cattle

Body condition scores (BCS) are very useful for dairy herd management and breeding programs, but the consistency and quality of recordings made by consultants in the field are unknown. The objectives of this study were 1) to estimate the agreement in BCS within and among practicing dairy veterinarians and 2) to provide an indication of the effects of training and the value of calibration, and of what efforts need to be made to obtain a validity and precision in BCS adequate for management purposes. A total of 2,230 scores were recorded by 51 practicing dairy veterinarians and 6 highly trained instructors. The 6 instructors were cross-trained to validate calibration consistency in assigning BCS. Each individual scored approximately 20 cows twice, with the second scoring occurring approximately 2.5 h after the first. Between the 2 recordings, the respective instructors conducted a training session for the practicing veterinarians using other cows. A weighted kappa coefficient was used to assess agreement among and within classifiers. Excellent agreement (kappa > or = 0.86) was documented between repeated BCS recorded for the same cows by the highly trained instructors. In addition, the BCS provided by multiple classifiers from the instructor team appeared to be comparable across herds and classifiers. This legitimizes the use of BCS for benchmarking at both the cow and the herd level. The within-classifier and between-classifier kappa values were in the ranges of 0.22 to 0.75 and 0.17 to 0.78, respectively, in the group of practicing dairy veterinarians. Many of the veterinarians provided estimates of average BCS that differed considerably from the BCS recorded by the instructors. Between-classifier comparisons of herd BCS are not warranted unless a validation has been performed. If scores are collected by multiple classifiers with varying experience, a valid but imprecise estimate of the true population mean of BCS may be obtained if classifiers are inexperienced. The limited training effort used in this study seemed to have brought about substantial improvement in the validity and precision of the BCS determined by practicing veterinarians, compared with the BCS recorded on the same cows by highly trained classifiers.

Human Serum Proteins Preseparated by Electrophoresis or Chromatography Followed by Tandem Mass Spectrometry

Electrophoretic and chromatographic sample preparations were compared and together detected the presence of some 600 types of protein products in human serum. Proteins from crude serum preseparated by ionic electrophoresis, chromatography, or a combination of both were analyzed. Proteins were digested with trypsin or chymotrypsin. Naturally occurring peptides were also collected by reversed-phase chromatography. The resulting peptides were identified by tandem mass spectrometry. The peptides were either desorbed by a laser from a metal chip into a quadrupole-time-of-flight mass spectrometer or ionized as an electro-spray from reversed-phase chromatography via a metal needle under voltage into an ion-trap mass spectrometer. All of the commonly known proteins associated with serum were detected, and the two mass spectrometers agreed on the identity of abundant serum proteins. Preseparation of serum proteins prior to digestion markedly enhanced the capacity to detect un-common proteins from blood. Electrophoretic- and chromatography-based experiments were found to be complementary. Many novel cellular proteins not previously associated with serum were recorded.

Impact of polychaetes (Nereis spp. and Arenicola marina) on carbon biogeochemistry in coastal marine sediments

Known effects of bioturbation by common polychaetes (Nereis spp. and Arenicola marina) in Northern European coastal waters on sediment carbon diagenesis is summarized and assessed. The physical impact of irrigation and reworking activity of the involved polychaete species is evaluated and related to their basic biology. Based on past and present experimental work, it is concluded that effects of bioturbation on carbon diagenesis from manipulated laboratory experiments cannot be directly extrapolated to in situ conditions. The 45-260% flux (e.g., CO2 release) enhancement found in the laboratory is much higher than usually observed in the field (10-25%). Thus, the faunal induced enhancement of microbial carbon oxidation in natural sediments instead causes a reduction of the organic matter inventory rather than an increased release of CO2 across the sediment/water interface. The relative decrease in organic inventory (Gb/Gu) is inversely related to the relative increase in microbial capacity for organic matter decay (kb/ku). The equilibrium is controlled by the balance between organic input (deposition of organic matter at the sediment surface) and the intensity of bioturbation. Introduction of oxygen to subsurface sediment and removal of metabolites are considered the two most important underlying mechanisms for the stimulation of carbon oxidation by burrowing fauna. Introduction of oxygen to deep sediment layers of low microbial activity, either by downward irrigation transport of overlying oxic water or by upward reworking transport of sediment to the oxic water column will increase carbon oxidation of anaerobically refractory organic matter. It appears that the irrigation effect is larger than and to a higher degree dependent on animal density than the reworking effect. Enhancement of anaerobic carbon oxidation by removal of metabolites (reduced diffusion scale) may cause a significant increase in total sediment metabolism. This is caused by three possible mechanisms: (i) combined mineralization and biological uptake; (ii) combined mineralization and abiogenic precipitation; and (iii) alleviation of metabolite inhibition. Finally, some suggestions for future work on bioturbation effects are presented, including: (i) experimental verification of metabolite inhibition in bioturbated sediments; (ii) mapping and quantification of the role of metals as electron acceptors in bioturbated sediments; and (iii) identification of microbial community composition by the use of new molecular biological techniques. These three topics are not intended to cover all unresolved aspects of bioturbation, but should rather be considered a list of obvious gaps in our knowledge and present new and appealing approaches.

Using programme budgeting and marginal analysis to assist population based strategic planning for coronary heart disease

OBJECTIVES

the objective of this project was to use programme budgeting and marginal analysis (PBMA), to inform the planning process of the South Western Sydney Area Health Service (SWSAHS) in respect of coronary heart disease (CHD).

METHODS

a working party was established to carry out the project. The group set the parameters of the project and identified the programme, and associated the activity and resource use. Three sub-groups were established to undertake the marginal analysis.

RESULTS

each sub-group (representing prevention, treatment, and rehabilitation for CHD) developed a list of potential strategies and provided estimates of resource use and consequences. These were prioritised and presented as recommendations to the SWSAHS. Some recommendations required enhancement funding for the SWSAHS. CONCLUSIOSN: while the use of PBMA presented some challenges, there were also some important outcomes. A comprehensive and detailed picture of resource use enabled the participants to form a view on how additional or reduced resources for CHD should be dealt with at the area level. The ultimate recommendations represent involvement by key stakeholders in the SWSAHS planning process, not just in identifying the 'vision' of CHD services, but also, how service delivery would be organised to achieve the overall objectives of reducing CHD morbidity and mortality.

Evaluation of the first strategic plan for Aboriginal health in south western Sydney, 1993-98

The 1993-98 Aboriginal Health Strategic Plan for South Western Sydney represented the first partnership of its kind between an Area Health Service, local Aboriginal Health Workers and the local Aboriginal Community Controlled Health Service in Australia. During 1998, an evaluation of the plan was undertaken as part of the preparation for the second Aboriginal Health Plan. Of the 45 strategies in the first plan, 38% had been fully implemented, 42% had been partly implemented, and 20% were not implemented at all. This paper discusses the importance of data collection and monitoring systems, the integration of Aboriginal health into mainstream services, the further development of Aboriginal health infrastructure, and continued leadership by senior managers.

[Emergency admissions to a general hospital. Why emergency admission? Is there an alternative?]

A study was conducted where the GPs in a district answered a questionnaire on reasons for hospital admission, divided into the categories: needed hospital investigation, hospital treatment, or needed care and nursing. They judged whether the admission could have been prevented. Finally, a multidisciplinary panel discussed ways to obtain better courses of admission. Of 266 admissions, 40 (15%) were due to a need for care and nursing. Ninety-seven (37%) of the admissions could be replaced by a short one-day stay, and 52 (20%) could have been postponed until the next day if that was possible. The panel discussion showed that municipalities can do more to strengthen the local professional support. It is concluded that the interface between primary care and the hospital should offer better opportunities for one-day admissions or sub-acute admissions, and that municipalities must be more aware of their responsibility for the care of fragile and ill people.

Outcome of lithium prophylaxis: a prospective follow-up of affective disorder patients assigned to high and low serum lithium levels

The purpose of the study was to examine the outcome of long-term lithium treatment in consecutively admitted affective disorder patients assigned to high and low serum lithium levels. A total of 91 patients were diagnosed according to DSM-III criteria and randomly allocated to two open treatment groups in which prophylactic lithium was administered in high (serum lithium 0.8-1.0 mmol L-1) and low (serum lithium 0.5-0.8 mmol L-1) doses, respectively. The patients were followed for 2 years or until discontinuation of lithium treatment or readmission to hospital for recurrence of affective illness. The main outcome of the treatment groups was compared with Kaplan-Meier survival curves and by Cox regression analysis. A total of 31 patients (34%) completed 24 months of prophylactic lithium treatment without recurrence and readmission to hospital. In total, 18 patients (20%) suffered a recurrence on lithium, and 42 patients (46%) discontinued lithium or were lost to follow-up. No effect of treatment group was seen, either for the total patient group or for the large subgroup of bipolar patients when analysed separately. A number of patients did not maintain their original assignment to the high serum lithium levels group. The results were analysed both according to assignment and according to actual serum lithium levels. Abuse of alcohol or medication was associated with a poor outcome. Only one third of the patients completed 2 years of lithium prophylaxis successfully. No difference in the protection against recurrences was observed between patients maintained on high and low serum lithium levels.

[Communication between primary and secondary sector and its significance for patient care. Evaluation based on admission records and discharge letters of patients admitted acutely to a department of internal medicine]

The aim of this study was to evaluate the informative content of referrals and discharge summary letters concerning patients admitted acutely to the Department of Internal Medicine in a Danish district hospital, and to estimate the delivery time for discharge summary letters. A total of 132 patients were consecutively enrolled from May 2nd to May 30th 1995. The receiving doctor in the hospital on the day of admission as well as the general practitioner who received the discharge summary letter were asked to complete a specific designed questionnaire. The referrals were often insufficient regarding patient history (in particular data on psychosocial aspects and prescribed medicine) and physical examination. Every fifth referral was never received by the hospital. The delivery time for discharge summary letters was 13 days (0-87 days). In every fifth case the information was needed earlier. The discharge summary letters often lacked information concerning what the patients had been told, prognosis and suggestions concerning social medicine. This study indicates that the collaboration between general practitioners and doctors in hospital can be improved by of enhancing the informative content of referrals and discharge summary letters and the expedition time of discharge summary letters.

Serum protein electrophoresis: potential test for use in geriatric companion animal health programmes

The electrophoretic patterns of 117 serum samples from 37 clinically healthy old dogs (age: 10.0 +/- 2.5 years, mean +/- SD) 47 old dogs (age: 9.7 +/- 2.0 years) with different diseases, 18 clinically healthy young dogs (age: 2.9 +/- 1.6 years) and 15 young dogs (age: 2.0 +/- 1.0 years) with different diseases were evaluated using agarose as a supporting matrix. Three major electrophoretic patterns were identified after densitometric scanning. The first pattern was a predominant pattern for the young healthy dogs (found in 67% of dogs in that group) and was considered normal for healthy dogs. The second pattern had relatively higher proportions of beta and gamma globulins (polyclonal immunoglobulinaemia) and was a predominant pattern among the old healthy dogs (found in 51% of dogs in that group). The findings regarding the second pattern appear to suggest that they had been exposed to antigens during their lives and that they had a well developed and responsive humoral immune response. The third pattern was characterized by high levels of alpha globulins, it was the most common pattern in the old diseased dogs (found in 70% of the dogs in that group). The third pattern was considered to indicate an inflammatory response among old dogs when compared to young dogs (P < 0.01). These patterns appear to suggest that because of aging and/or accumulated injury geriatric dogs will have high levels of polyclonal gamma-globulinaemia or acute phase reactants. The observed patterns, especially the one showing high levels of alpha-globulins, could be a valuable parameter in the search for individuals requiring special attention and thus for the establishment of health programmes for geriatric dogs. With further effort, serum protein electrophoresis might prove to be a useful test for the evaluation of geriatric companion animals for diagnostic, prognostic and therapeutic reasons.

Cholinergic dysfunction of heart, pupil, salivary glands, and urinary bladder in healthy volunteers during long-term treatment with clomipramine

Cholinergic functions were studied in ten non-depressed healthy volunteers who were treated with 50 mg clomipramine daily for 3 weeks and subsequently with 100 mg daily for a further 3 weeks. Impairments in heart rate variation (HRV) at rest and standing, of the pupillary light response and of salivation were related to serum levels of clomipramine. Since reduction of HRV is closely related to dose (r = -0.83, P less than 10(-2] and is a better predictor of serum levels than the other measures examined, it is suggested that the easy obtainable function test of HRV at standing can be used as an estimate of over-all cholinergic dysfunction during treatment with tricyclic antidepressants.

Familial giant hypertrophic gastritis (Ménétrier's disease)

Familial giant hypertrophic gastritis involving three generations is reported. A review of the literature, where approximately 200 cases are described, showed only few cases of familial occurrence of this disease, and only in siblings. Our findings suggest dominant heredity, but considering the sparsity of familial occurrence reported earlier, heredity seems to be of only minor pathogenetic significance.

Lymphocyte subpopulations, lymphoblast transformation activity, and concanavalin A-induced suppressor activity in patients with ulcerative colitis and Crohn's disease

The following immunologic in vitro tests were applied on peripheral blood mononuclear cells (PBMC) from patients with chronic inflammatory bowel disease (IBD): concanavalin A (Con A)-induced suppressor test, Con A-activated lymphoblast transformation test, and spontaneous lymphoblast transformation test. Concomitant phenotypic characterization of subsets of PBMC was performed with monoclonal antibodies. Patients with ulcerative colitis and a control group with rheumatoid arthritis showed significantly reduced activity in the Con A-activated lymphoblast transformation test compared with healthy controls and patients with Crohn's disease. The distribution of PBMC subsets and the results of the other in vitro tests were similar for patients with IBD and healthy controls. Thus the decrease in Con A-activated lymphoblast activity was not due to an increased suppressor function as measured either by functional Con A-induced suppressor test or indirectly by T8 phenotype.

Sexual function in lithium-treated manic-depressive patients

Sexual function in 24 patients with major affective disorders who were given prophylactic lithium treatment was compared with that of a control group of surgical outpatients with no known psychiatric disease. Changes in sexual function during lithium treatment were also recorded retrospectively. Sexual dysfunctions were described by about one-fourth of both female patients and controls. About one-third of the male patients and controls reported sexual dysfunctions. We cannot exclude tha lithium in combination with other psychotropic drugs may increase the frequency of sexual dysfunction. Changes in sexual function during lithium treatment were reported by one-fourth of the patients. Of these, four reported a positive influence of the treatment and five a negative influence. Statistically, significantly more patients than controls were dissatisfied with their present sex life.

The indirect leucocyte migration inhibition assay--an endotoxin-sensitive chemokinetic assay. Part II

Depletion of agarose for endotoxins resulted in a low spontaneous migration of polymorphnuclear cells (PMNC). Re-addition of endotoxin, in casu lipopolysaccharide from E. coli 026:B6 (LPS), enhanced the spontaneous PMNC migration in a two-phased dose-response pattern, reaching maximum migration with LPS 1 x 10(-7) g/ml. Thus, the migration of PMNC under agarose seems to be a chemokinesis. Leucocyte migration inhibition factor (LIF), induced by PPD 50 micrograms/ml at endotoxin-free conditions, significantly reduced the PMNC migration compared to supernatants from control cultures, however not compared to the conventional limit of significance, MI = 0.80. With increasing PMNC migration there was an insignificant decrease in the MI. Addition of LPS, 1 x 10(-9) g/ml, during LIF induction caused a significant increase in LIF production, an effect which overshadowed the effect of PPD. Thus, the application of the conventional limit of significance, MI = 0.80, may result in false-negative or false-positive conclusions, depending upon the endotoxin contamination. A standardization of the endotoxin content in both steps of the indirect leucocyte migration inhibition assay seems mandatory in order to obtain a reliable and reproducible bioassay.

Concanavalin A induction of suppressor activity in the T-helper subset defined by monoclonal antibodies

Human monocyte-depleted peripheral blood mononuclear cells were separated in T4+ and T8+ populations by a panning technique. Petri dishes coated with goat anti-mouse antibodies were plated by peripheral blood mononuclear cells coated by monoclonal antibodies, either T4 or T8. The cell populations were separated into adherent and non-adherent populations based on binding to the goat anti-mouse-coated plastic dishes. The purity of the adherent populations was 96%. T4+ and T8+ populations were used as effector cells in the concanavalin A-induced suppressor test. The T4+ population revealed a pronounced suppressor activity similar to that exhibited by the T8+ population. This finding was independent of two different sources of monoclonal antibodies, T4/T8 and OKT4/OKT8. The registered suppressor activity in the monoclonal antibody-defined helper population could not be explained either by a switch of the membrane phenotype from T4+ to T8+ cells or by an increased interleukin 2 consumption of the concanavalin A-treated cells.

Monocyte/T-cell interactions in Con A induced suppressor activity

It is well documented that peripheral blood mononuclear cells (PBMC) can exert a Con A induced suppressor activity. The PBMC content of monocytes and its impact on registered suppressor activity of PBMC populations was examined. It was found that monocytes were unnecessary for the Con A induction of PBMC, and monocytes exhibited no Con A dependent suppressor potential. Furthermore, the presence of monocytes was found to be unnecessary for the Con A activated lymphocytes in order to exert their suppressor activity against the responder system, i.e. a Con A stimulated lymphoblast-transformation.

The NK function elucidated with respect to effector cells, target cells and other immunological in vitro tests

The microcytotoxicity assay and the leukocyte migration inhibition test were unable to reveal any specific reactivity in patients suffering from localized skin melanoma. The non-specific reactivity measured by the microcytotoxicity assay, the so-called NK activity was found to be associated to the cells bearing Fc receptors, irrespective of T and non-T identity. Further more the NK activity depends on the target cell used (established cell lines versus short-term cultures) and the lymphocyte/target cell ratio. The NK activity measured by microcytotoxicity assay and the leucocyte migration inhibition test were compared by simultaneous implementation of the two test systems. No correlation between significant leucocyte migration inhibition and NK activity was found. In a tumor neutralization test workout in a nude mouse model, it was found that patient lymphocytes decreased the number of tumor takes and increase the latency period. However, the specificity of these reactions were uncertain.

A continued evaluation of the experimental conditions of a Con A-induced suppressor test system

As shown previously, the suppressor activity measured by the Con A mixed lymphocyte culture assay exhibited a pronounced dependence on the technical parameters. In the present study it is shown that the length of the suppressor generation period, between 24 and 96 hours, had only a modest influence on the suppressor activity. However, when the activity in the responder system was high, there seemed to be a trend towards a slight increase of the suppressor level using a long generation period, i.e. 72 to 96 hours. An increase of the suppressor cell/responder cell ratio from 1/10 to 1/2 was followed by a rising suppressor level; a further increase of the ratio had no significant influence on the suppressor activity. A decrease of the ratio below 1/10 showed variable results: stimulation, no effect and suppressor activity. This variability might be due to technical reasons. DNA-synthesis was not necessary for the mechanisms involved in the Con A-elicited suppressor activity. No suppressor activity was obtained by Con A treatment of cells other than peripheral blood mononuclear cells, viz. autologous erythrocytes, allogeneic fibroblasts and allogeneic osteogenic sarcoma cells.

Con A induced suppressor test: an evaluation of the experimental conditions

The suppressor activity measured by the Con A mixed lymphocyte culture assay exhibited a pronounced dependence on the technical performance as well as a marked inter-individual variation. The activity exerted by the induced suppressor cells depended on the Con A concentration in the induction phase, and on the mitotic activity in the responder system. The patterns of suppressor activities obtained in an allogeneic and an autologous suppressor test system were identical. When calculating the suppressor activity it is suggested, that one uses the total activities of the test system, without any reduction corresponding to the activity of the mixed lymphocyte culture. It is suggested that the suppressor activity is expressed by a "suppressor profile" to make the results more applicable and the interpretation of different works meaningful.

Ethical aspects of clinical decision-making

The aim of the present investigation was to describe and to classify significant ethical problems encountered by the members of the staff during the daily clinical work at a hospital medical department. A set of definitions was prepared for the purpose, including the definition of a 'significant ethical problem'. During a three month period 426 inpatients and 173 outpatients were admitted. Significant ethical problems were encountered during the management of 106 in-patients (25 per cent) and 9 out-patients (5 per cent). No significant difference was found between the frequency of ethical problems in female and male patients, but a positive correlation was noted between the number of problems and the patients' age. The problem types were classified according to a problem list. The results of this investigation suggest that greater attention must be paid to discussions about ethical problems among doctors and other categories of health personnel and that, among others, medical students ought to be taught the analysis of ethical problems.

Disodium cromoglycate in the treatment of ulcerative colitis and Crohn's disease

A controlled clinical study on disodium cromoglycate (DSCG) at a dose of 800 mg per day versus placebo was carried out in 141 patients with ulcerative colitis and 25 patients with Crohn's disease. Those of the ulcerative colitis patients who had been on sulphasalazine treatment continued that treatment during the trial (101 patients). Forty patients were intolerant of sulphasalazine. No patient received steroids during the last month before the study. Patients with Crohn's disease had their possible sulphasalazine treatment stopped before the trial. No beneficial effect of DSCG as compared with placebo was found, as the DSCG and the placebo group showed the same number of relapses in patients with a clinically inactive ulcerative colitis at the start of the trial and the same number of patients improving, deteriorating, and maintaining steady state in patients with clinically active ulcerative colitis at the start of the trial. There was no difference between relapse rate in DSCG and placebo groups in patients with Crohn's disease. No correlation between the eosinophil count in rectal mucosa and the outcome of the attack of ulcerative colitis could be demonstrated.