The lack of HSD17B3 in male mice results in disturbed Leydig cell maturation and endocrine imbalance akin to humans with HSD17B3 deficiency

Hydroxysteroid (17β) dehydrogenase type 3 (HSD17B3) deficiency causes a disorder of sex development in humans, where affected males are born with female-appearing external genitalia, but are virilized during puberty. The hormonal disturbances observed in the Hsd17b3 knockout mice (HSD17B3KO), generated in the present study, mimic those found in patients with HSD17B3 mutations. Identical to affected humans, serum T in the adult HSD17B3KO mice was within the normal range, while a striking increase was detected in serum A-dione concentration. This resulted in a marked reduction of the serum T/A-dione ratio, a diagnostic hallmark for the patients with HSD17B3 deficiency. However, unlike humans, male HSD17B3KO mice were born with normally virilized phenotype, but presenting with delayed puberty. In contrast to the current belief, data from HSD17B3KO mice show that the circulating T largely originates from the testes, indicating a strong compensatory mechanism in the absence of HSD17B3. The lack of testicular malignancies in HSD17B3KO mice supports the view that testis tumors in human patients are due to associated cryptorchidism. The HSD17B3KO mice presented also with impaired Leydig cell maturation and signs of undermasculinization in adulthood. The identical hormonal disturbances between HSD17B3 deficient knockout mice and human patients make the current mouse model valuable for understanding the mechanism of the patient phenotypes, as well as endocrinopathies and compensatory steroidogenic mechanisms in HSD17B3 deficiency.

Isoflurane produces antidepressant effects and induces TrkB signaling in rodents

A brief burst-suppressing isoflurane anesthesia has been shown to rapidly alleviate symptoms of depression in a subset of patients, but the neurobiological basis of these observations remains obscure. We show that a single isoflurane anesthesia produces antidepressant-like behavioural effects in the learned helplessness paradigm and regulates molecular events implicated in the mechanism of action of rapid-acting antidepressant ketamine: activation of brain-derived neurotrophic factor (BDNF) receptor TrkB, facilitation of mammalian target of rapamycin (mTOR) signaling pathway and inhibition of glycogen synthase kinase 3β (GSK3β). Moreover, isoflurane affected neuronal plasticity by facilitating long-term potentiation in the hippocampus. We also found that isoflurane increased activity of the parvalbumin interneurons, and facilitated GABAergic transmission in wild type mice but not in transgenic mice with reduced TrkB expression in parvalbumin interneurons. Our findings strengthen the role of TrkB signaling in the antidepressant responses and encourage further evaluation of isoflurane as a rapid-acting antidepressant devoid of the psychotomimetic effects and abuse potential of ketamine.

Effects of PSA Removal from NCAM on the Critical Period Plasticity Triggered by the Antidepressant Fluoxetine in the Visual Cortex

Neuronal plasticity peaks during critical periods of postnatal development and is reduced towards adulthood. Recent data suggests that windows of juvenile-like plasticity can be triggered in the adult brain by antidepressant drugs such as Fluoxetine. Although the exact mechanisms of how Fluoxetine promotes such plasticity remains unknown, several studies indicate that inhibitory circuits play an important role. The polysialylated form of the neural cell adhesion molecules (PSA-NCAM) has been suggested to mediate the effects of Fluoxetine and it is expressed in the adult brain by mature interneurons. Moreover, the enzymatic removal of PSA by neuroaminidase-N not only affects the structure of interneurons but also has been shown to play a role in the onset of critical periods during development. We have here used ocular dominance plasticity in the mouse visual cortex as a model to investigate whether removal of PSA might influence the Fluoxetine-induced plasticity. We demonstrate that PSA removal in the adult visual cortex alters neither the baseline ocular dominance, nor the fluoxetine-induced shift in the ocular dominance. We also show that both chronic Fluoxetine treatment and PSA removal independently increase the basal FosB expression in parvalbumin (PV) interneurons in the primary visual cortex. Therefore, our data suggest that although PSA-NCAM regulates inhibitory circuitry, it is not required for the reactivation of juvenile-like plasticity triggered by Fluoxetine.

Evidence for Competition for Target Innervation in the Medial Prefrontal Cortex

Inputs to sensory cortices are known to compete for target innervation through an activity-dependent mechanism during critical periods. To investigate whether this principle also applies to association cortices such as the medial prefrontal cortex (mPFC), we produced a bilateral lesion during early development to the ventral hippocampus (vHC), an input to the mPFC, and analyzed the intensity of the projection from another input, the basolateral amgydala (BLA). We found that axons from the BLA had a higher density of "en passant" boutons in the mPFC of lesioned animals. Furthermore, the density of neurons labeled with retrograde tracers was increased, and neurons projecting from the BLA to the mPFC showed increased expression of FosB. Since neonatal ventral hippocampal lesion has been used as an animal model of schizophrenia, we investigated its effects on behavior and found a negative correlation between the density of retrogradely labeled neurons in the BLA and the reduction of the startle response in the prepulse inhibition test. Our results not only indicate that the inputs from the BLA and the vHC compete for target innervation in the mPFC during postnatal development but also that subsequent abnormal rewiring might underlie the pathophysiology of neuropsychiatric disorders such as schizophrenia.

Novel epididymal proteins as targets for the development of post-testicular male contraception

Apart from condoms and vasectomy, modern contraceptive methods for men are still not available. Besides hormonal approaches to stop testicular sperm production, the post-meiotic blockage of epididymal sperm maturation carries lots of promise. Microarray and proteomics techniques and libraries of expressed sequence tags, in combination with digital differential display tools and publicly available gene expression databases, are being currently used to identify and characterize novel epididymal proteins as putative targets for male contraception. The data reported indicate that these technologies provide complementary information for the identification of novel highly expressed genes in the epididymis. Deleting the gene of interest by targeted ablation technology in mice or using immunization against the cognate protein are the two preferred methods to functionally validate the function of novel genesin vivo. In this review, we summarize the current knowledge of several epididymal proteins shown eitherin vivoorin vitroto be involved in the epididymal sperm maturation. These proteins include CRISP1, SPAG11e, DEFB126, carbonyl reductase P34H, CD52, and GPR64. In addition, we introduce novel proteinases and protease inhibitor gene families with potentially important roles in regulating the sperm maturation process. Furthermore, potential contraceptive strategies as well as delivery methods will be discussed. Despite the progress made in recent years, further studies are needed to reveal further details in the epididymal sperm maturation process and the factors involved, in order to facilitate the development of new epididymal contraceptives.

Characterisation of projectiles composed of depleted uranium

Projectiles suspected to be composed of depleted uranium (DU) were found in Kosovo. Their properties were analysed using alpha and gamma ray spectrometry, mass spectrometry and electron microscopy. They were found to be composed of DU with small amounts of other elements such as Ti. 236U was detected in the penetrators, reflecting the use of reprocessed fuel. No transuranium elements were detected. The typical external dose rate meter is not the best option for mapping the location of penetrators from the ground. Monte Carlo calculations were performed in estimating possible skin doses. Penetrators in long-lasting contact with skin may cause a notable equivalent dose to skin.

Dosimetry of beta-ray ophthalmic applicators: comparison of different measurement methods

An international intercomparison of the dosimetry of three beta particle emitting ophthalmic applicators was performed, which involved measurements with radiochromic film, thermoluminescence dosimeters (TLDs), alanine pellets, plastic scintillators, extrapolation ionization chambers, a small fixed-volume ionization chambers, a diode detector and a diamond detector. The sources studied were planar applicators of 90Sr-90Y and 106Ru-106Rh, and a concave applicator of 106Ru-106Rh. Comparisons were made of absolute dosimetry determined at 1 mm from the source surface in water or water-equivalent plastic, and relative dosimetry along and perpendicular to the source axes. The results of the intercomparison indicate that the various methods yield consistent absolute dosimetry results at the level of 10%-14% (one standard deviation) depending on the source. For relative dosimetry along the source axis at depths of 5 mm or less, the agreement was 3%-9% (one standard deviation) depending on the source and the depth. Crucial to the proper interpretation of the measurement results is an accurate knowledge of the detector geometry, i.e., sensitive volume and amount of insensitive covering material. From the results of these measurements, functions which describe the relative dose rate along and perpendicular to the source axes are suggested.

Calculation of beta-ray dose distributions from ophthalmic applicators and comparison with measurements in a model eye

Dose distributions throughout the eye, from three types of beta-ray ophthalmic applicators, were calculated using the EGS4, ACCEPT 3.0, and other Monte Carlo codes. The applicators were those for which doses were measured in a recent international intercomparison [Med. Phys. 28, 1373 (2001)], planar applicators of 106Ru-106Rh and 90Sr-90Y and a concave 106Ru-106Rh applicator. The main purpose was to compare the results of the various codes with average experimental values. For the planar applicators, calculated and measured doses on the source axis agreed within the experimental errors (<10%) to a depth of 7 mm for 106Ru-106Rh and 5 mm for 90Sr-90Y. At greater distances the measured values are larger than those calculated. For the concave 106Ru-106Rh applicator, there was poor agreement among available calculations and only those calculated by ACCEPT 3.0 agreed with measured values. In the past, attempts have been made to derive such dose distributions simply, by integrating the appropriate point-source dose function over the source. Here, we investigated the accuracy of this procedure for encapsulated sources, by comparing such results with values calculated by Monte Carlo. An attempt was made to allow for the effects of the silver source window but no corrections were made for scattering from the source backing. In these circumstances, at 6 mm depth, the difference in the results of the two calculations was 14%-18% for a planar 106Ru-l06Rh applicator and up to 30% for the concave applicator. It becomes worse at greater depths. These errors are probably caused mainly by differences between the spectrum of beta particles transmitted by the silver window and those transmitted by a thickness of water having the same attenuation properties.

Mometasone furoate nasal spray in the treatment of perennial non-allergic rhinitis: a nordic, multicenter, randomized, double-blind, placebo-controlled study

In order to evaluate the efficacy and safety of mometasone furoate nasal spray (MFNS) in patients with perennial non-allergic rhinitis (PNAR) a phase III, double-blind, randomized, placebo-controlled, Nordic multicenter study was performed at 16 sites (7 in Sweden, 3 in Denmark, 3 in Finland and 3 in Norway). A total of 329 patients (age 18-82 years) with a mean duration of PNAR of 9 years were included in the study. The total duration of the study was 11 weeks: 2 weeks of screening, 6 weeks of treatment and 3 weeks of follow-up. Inclusion criteria were unspecific rhinitis symptoms and exclusion criteria were a positive skin prick test as well as intolerance to aspirin or non-steroidal anti-inflammatory drugs. Endoscopy was performed to exclude patients with structural anomalies and nasal polyps. The primary efficacy variable was the subject's total overall evaluation. In the intention-to-treat (ITT) group of patients (n = 329) the improvement rates were 56% (MFNS) and 49% (placebo). In the per-protocol (PP) group (n = 251) the corresponding figures were 58% and 47%. Stratifying for groups of patients having moderate symptoms, the results were 54% vs 43% in the ITT group and 56% vs 41% in the PP group. The therapeutic response showed greater improvement in total nasal score as recorded by the investigator in the groups treated with MFNS as compared to the placebo group (p = 0.09 [PP], p = 0.14 [ITT]). Adverse events occurred during the study, upper respiratory tract infections and headache being the most frequently reported, but there was no statistically significant difference between MFNS and placebo. The results of this study indicate that MFNS is a safe and effective treatment for patients with PNAR.

Distractible children show abnormal orienting to non-attended auditory stimuli

Event-related potentials were recorded in response to intermittently presented, non-attended trains of identical auditory stimuli in healthy 9-year-old children. In abnormally distractible children (n =24), the first tone in each train elicited a significantly larger N1 vertex response than in the non-distractible children (n 24), suggesting that increased distractibility may be associated with an abnormally strong cerebral orienting towards non-attended stimuli. A later negativity at around 300 ms, which increases in amplitude with stimulus repetition and may thus reflect the building up of a functional neuronal representation of the stimulus properties, was significantly smaller in the distractible than in the non-distractible children. These findings demonstrate that event-related potential measures may be useful in helping to understand the information processing found in distractible children.

The use of TL detectors in dosimetry of systemic radiation therapy

A method for determining absorbed doses to organs in systemic radiation therapy (SRT) is evaluated. The method, based on thermoluminescent (TL) dosimeters placed on the patient's skin, was validated and justified through a phantom study showing that the difference between measured (TL dosimeters in the phantom) and derived (TL method) values is within 10%. Six radioimmunotherapy (RIT) patients with widespread intraperitoneal pseudomyxoma were also studied. In dose evaluations, special emphasis was on kidneys. In addition to the TL method, the absorbed doses to kidneys were calculated using MIRD formalism and a point dose kernel technique. We conclude that in SRT the described TL method can be used to estimate the absorbed doses to those critical organs near the body surface within 50% (1 SD).

Brain aging: impaired coding of novel environmental cues

Studies of the spatial memory capacities of aged animals usually focus on performance during the learning of new environments. By contrast, efforts to characterize age-related alterations in spatial firing information processing by hippocampal neurons typically use an environment that is highly familiar to the animals. In the present study we compared the firing properties of hippocampal neurons in young adult and aged rats as they acquired spatial information about new environmental cues. Hippocampal complex spike cells were recorded while rats performed a radial arm maze task in a familiar environment and then recorded again after many of the spatial cues were changed. After the change in the environment, in aged rats 35-42% of place fields retained their original shape and location with respect to the maze center, although they usually rotated to another arm. By contrast, all place fields in young animals either disappeared or appeared in a new location. Some of the new place fields appeared in the new environment during the first 5 min of exploration, whereas others needed more than 30 min to develop fully. In the familiar environment spatial selectivity of place cells was similar in young and aged rats. By contrast, when rats were placed into a new environment, spatial selectivity decreased considerably in aged memory-impaired rats compared with that of young rats and aged rats with intact memory performance.

Oral contraceptive containing natural estradiol for premenopausal women

An open multicenter trial was performed in six centers in Finland to study the efficacy, safety and acceptability of a new biphasic oral contraceptive pill containing natural estradiol and cyproterone acetate. The participants were 288 women with a mean age of 39.3 +/- 3.4 years (range 30-49) who were willing to use the new pill as their only contraceptive method. In total, 23% of the women were smokers. The cumulative experience was 2800 treatment cycles during the first year. The net 12-month continuation rate was 63%. One pregnancy occurred in a woman who lost 5 tablets in the second treatment cycle, which gives a 12-month cumulative pregnancy rate of 0.4%. Serum progesterone values, determined twice during the third treatment cycle, showed ovulation inhibition in 95% of women. There were no serious side effects. Intermenstrual bleeding was recorded by 35.5% and 24.5% of women at 3 and 12 months, respectively. The bleedings became scantier in most women and dysmenorrhoea disappeared. No changes were observed in total and high density lipoprotein cholesterol concentrations after 1 year. With the exception of intermenstrual spotting, the efficacy, safety and acceptability of the new pill was almost as good as that of the modern low dose oral contraceptives. This is the first pill containing natural estradiol that has gained clinical acceptance and which can also be prescribed for smokers over 35 years old until the climacteric.

Changes in risk factors for unfavorable pregnancy outcome among singletons over twenty years

OBJECTIVES

To examine the change in the prevalence and relative effect of pre-pregnancy risk factors for low birthweight and/or stillbirth and/or neonatal mortality over a period of twenty years.

DESIGN

Two prospectively collected one year birth cohorts.

SETTING

The two northernmost administrative districts of Finland.

PATIENTS

A birth cohort for 1966 comprising 11905 singleton births and a cohort for 1985-86 containing a further 9247.

MAIN OUTCOME MEASURES

Risk factors for poor pregnancy outcome.

RESULTS

In twenty years the prevalence of low birthweight infants among singletons decreased from 4.2% to 3.1% and that of stillbirths and neonatal deaths from 2.4% to 0.9%. The impact of single marital status decreased and while maternal age < 19 years was not an independent risk factor, the age > or = 35 years related more to poor pregnancy outcome. The proportion of multiparous women was halved but multiparity had a protective influence on pregnancy outcome meanwhile the impact of primiparity decreased markedly. In spite of more effective health education, the prevalence of heavy smokers was 4 times higher in the 1980s as compared with the 1960s, and its impact on adverse outcomes increased, with odds ratio (OR) 1.72 (confidence interval (CI) 1.14-2.61) in 1966 and OR 2.15 (CI 1.61-2.88) in 1985-86. The number of mothers with a previous low birthweight baby was halved but the impact of low birth weight was still great in the latter cohort (OR 2.47; CI 1.64-3.71). The impact of an earlier stillbirth and/or neonatal death increased significantly, with an OR 1.53 (CI 1.10-2.14) in 1966 and OR 2.95 (CI 1.81-4.81) in 1985-86, but the number of mothers concerned was halved from that in 1966.

CONCLUSIONS

The prevalence of pregnancies with an adverse outcome decreased markedly, as did the prevalence of many of the risk factors. The proportion of > or = 35 years old parturients and of heavy smokers increased. The impact of primiparity decreased, while that of a previous outcome as assessed from pre-pregnancy factors has not improved in these twenty years, especially where primiparous parturients are concerned.

Perinatal outcome of pregnancies complicated by vaginal bleeding

OBJECTIVE

To examine the effect of first and/or second trimester vaginal bleeding on pregnancy outcome.

DESIGN

A prospective one-year birth cohort.

SETTING

Two northernmost administrative districts of Finland.

PATIENTS

8718 singleton pregnancies, of whom 807 (9.3%) reported bleeding during the first (601) and/or second trimester (206); light bleeding in 595 cases and heavy bleeding in 212. The remaining 7911 women served as a reference group.

MAIN OUTCOME MEASURES

Low birth weight rate (LBW), preterm birth rate, congenital malformations and perinatal mortality rate.

RESULTS

Bleeding was most frequent in women of more advanced age (> or = 35 years old), with previous miscarriages, with infertility problems or using an IUCD prior to the pregnancy. Parity, smoking and social status were not associated with bleeding. Caesarean section rate and placental complications during the third trimester and at delivery were more common among the bleeders than in the reference group. The LBW rate was three-fold among the bleeders and the preterm birth rate two-fold. The risk (OR) of a LBW infant among second trimester bleeders was 4.1 (95% CI 2.6-6.4), that of preterm birth 2.9 (95% CI 1.9-4.6), and that of congenital malformations 2.9 (95% CI 1.7-4.7). No association existed between bleeding and perinatal mortality.

CONCLUSIONS

Bleeding during the second trimester indicates a poor pregnancy outcome and an increased risk of LBW, and preterm birth and/or congenital malformation.

Chemosensitizing effect of an antiestrogen, toremifene, on ovarian cancer

The chemosensitizing effect of an antiestrogen, toremifene, was studied on 2 human ovarian cancer cell lines in vitro and on 3 fresh surgical ovarian tumor explants with the aid of the subrenal capsule assay (SRCA). Also, 11 patients with secondarily drug resistant, recurrent gynecologic cancer (8 ovarian and 3 uterine cancers) were treated with 240 mg toremifene daily for 1 week before each course of cytostatics. Toremifene potentiated the effect of doxorubicin on both cell lines. This was also the case on 1 cell line that was not completely resistant to doxorubicin. The SRCA showed a clear potentiating effect of toremifene only on the tumor overtly resistant to the combination of cisplatin, doxorubicin, and cyclophosphamide. Of the 11 patients treated with toremifene and cytostatics, the response of 8 patients was evaluable: 3 had partial response, 3 no change, and 2 progressive disease. Toremifene seems to have a chemopotentiating effect on gynecologic drug-resistant tumors.

Transdermal oestrogen replacement therapy in a Finnish population

In an open, multicentre study, transdermal administration of oestradiol (E2) by means of skin patches was investigated in a Finnish patient population suffering from typical post-menopausal symptoms. A total of 249 women applied a patch twice weekly for 6 months. Whereas 85% of the subjects were experiencing hot flushes and 83.5% sweating before therapy, only 5.7% and 11.8%, respectively, reported these symptoms at the end of the trial. Furthermore, 97.6%, 95.7% and 94.8% of the subjects reported that depression, headache and sleep disturbances, respectively, had disappeared during therapy. Skin irritation occurred in 18.2% of these predominantly fair-skinned women. Frequent sauna bathing did not interfere with the patch therapy. General acceptance of the treatment was excellent, 84.8% of the patients completing the treatment, of whom 78% were willing to continue the treatment after the trial. These results show that transdermal administration of E2 is effective in relieving post-menopausal symptoms. Local tolerability was good and the majority of the patients considered the transdermal treatment to be superior to their previous oral replacement therapy.

Occurrences of antibodies against Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis in middle ear effusion and serum during the course of acute otitis media

The occurrence of IgG, IgM and IgA class antibodies against a type-specific capsular polysaccharide of Streptococcus pneumoniae (Pn) and against a whole cell antigen of Haemophilus influenzae (Hi) and Branhamella catarrhalis (Br) was studied using the ELISA method on middle ear effusion (MEE) samples of 85 patients and paired serum samples of 40 patients during the course of acute otitis media (AOM). Although specific antibodies to all of these three bacteria appeared in MEE during the course of an AOM episode, antibodies against the infecting bacteria of that particular AOM episode were more often prominent. The antibodies were also detectable in the MEE without simultaneous presence in the serum. The middle ear infection was prolonged more often if specific antibodies to the infecting bacterium could not be detected in the MEE obtained at the beginning of the AOM attack. The present study indicates that AOM caused by Pn, Hi or Br may induce both a systemic and a local production of specific antibodies against the causative organisms during the course of otitis media. The occurrence of such antibodies in MEE seems to play a major role in the resolution of AOM.

Secretory antibodies specific to Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis in middle ear effusion during acute otitis media

The occurrence of specific secretory antibodies against the type-specific capsular polysaccharide of Streptococcus pneumoniae (Pn) and against the whole cell antigen of Haemophilus influenzae (Hi) and Branhamella catarrhalis (Br) were measured by the ELISA method in 211 middle ear effusion (MEE) samples of 85 children with acute otitis media (AOM) during the course of the disease. Antibodies against at least one of those bacteria were detected at the initial visit in 33.6% of the ears and later in 20%. All in all, such antibodies could be found in 50% of the ears during the follow-up. Pneumococcal secretory antibodies were found in 5 out of 116 ears only, anti-Hi antibodies in 52 and anti-Br antibodies in 42 ears. The specific secretory antibodies were detected against all these bacteria regardless of the bacterial etiology of the AOM attack in question. The AOM attack was prolonged more often if such antibodies were not found in the MEE sample taken at the initial visit. The appearance of such antibodies during the disease seemed to imply termination of the AOM episode in question. The conclusions of this study are that during an AOM attack a local production of antibodies in middle ear against the three most common bacteria. Pn, Hi and/or Br, causing AOM may be induced. The appearance of such antibodies in MEE seems to be beneficial for the resolution of AOM.

Hearing asymmetry among occupationally noise-exposed men and women under 60 years of age

Interaural asymmetry of hearing thresholds at 4 kHz was analysed in four populations exposed to occupational noise. The left ear was found to be on average significantly worse than the right ear, among both the male and female subjects. In the male population the left ear was twice as often the worse ear as the right one. In the female population the corresponding ratio was 1.5. The average inferiority of the left ear increased as a function of the hearing threshold level. Among subjects with abundant shooting (reindeer herders) the average inferiority of the left ear was close to the average of all male subjects. Interaural difference increased as a function of the hearing threshold level, both among subjects with the left ear and subjects with the right ear being the worse one. In the male population the interaural difference was significantly greater in the former than in the latter group of subjects.

The grand multipara--still an obstetrical challenge?

To study whether grand multiparity (parity of 6 or more) still carries risk, we studied two birth cohorts in northern Finland: the first comprised 12,231 births to 12,068 mothers in 1966 and the second comprised 9478 births to 9362 mothers in 1985/86. The percentage of grand multipara decreased from 7.7 to 4.0. The grand multipara made fewer antenatal visits than the others. The proportion of grand multipara referred to maternity outpatient clinics of hospitals was smaller, but the mean number of visits was higher than of lower parity women. The mean number of admissions to hospital was similar in both groups but grand multipara stayed longer in hospital, smoked less (4.3% vs. 22.7%) and had a higher incidence of essential hypertension than women of lower parity. The grand multipara had fewer caesarean sections (7.5% vs. 14.1%) and vacuum extractions (0.5% vs. 5.1%) but more inductions of labour (33.1% vs. 23.5%) than mothers of lower parity. The number of low birth weight (LBW) infants (less than 2500 grams), stillbirths and neonatal deaths (before 28 days) was significantly lower in 1985/86 than in 1966 in women of lower parity but there was no such change in grand multipara. However, the percentage of LBW infants was smaller among grand multipara than among women of lower parity in both cohorts (2.7% vs. 4.1%, NS). The stillbirth plus neonatal death rate in grand multipara was higher than in women of lower parity (1.9% vs. 0.9%, P less than 0.05) partly because of a higher incidence of major congenital anomalies.

Changes in prognosis of twin births over 20 years

The study is based on two birth cohorts from the years 1966 and 1985-1986. Perinatal mortality of twins has fallen over 20 years from 9.2% to 3.1%. Improvement is particularly remarkable in neonatal mortality (less than 28 days) of preterm (less than 34 gestational weeks) twins, from 47.4% to 8.6%, whereas the incidence of stillbirths has not fallen greatly. The proportion of preterm births has not fallen significantly, 48.4% vs. 38.1%. Many factors, considered favourable to the course and outcome of pregnancy have improved simultaneously: women are taller, less overweight, and more educated; pregnancies are wanted and sick and maternity leave provisions have improved. The follow-up of twin pregnancies and deliveries has been centralized and is more effective. In particular, neonatal care is also better than 20 years ago. The prognosis of twins has improved in parallel with the singletons, but the perinatal mortality is still approximately four time and the incidence of prematurity ten times more than in singletons.

Antibodies against Streptococcus pneumoniae, Haemophilus influenzae and Branhamella catarrhalis in middle ear effusion during early phase of acute otitis media

Serum type (IgG, IgM and IgA-class) and secretory type antibodies specific to Streptococcus pneumoniae (Pn), Haemophilus influenzae (Hi) and Branhamella catarrhalis (Br) were measured by enzyme-linked immunosorbent assay (ELISA) in 46 serum and 114 middle ear effusion (MEE) samples from 85 children with acute otitis media (AOM). The samples were obtained within 12 h from the onset of the ear symptoms. Serum (but not secretory) type antibodies to the infecting Pn serotype were found in 24% of the MEE samples of the patients with Pn AOM and, correspondingly, serum and/or secretory type antibodies to Hi and Br were seen in 54% and 63% of the MEE samples of the patients with Hi or Br AOM, respectively. Moreover, antibodies against bacteria other than the causative one could also be found in the MEE. The occurrence of the serum type antibodies against these bacteria in the MEE was closely correlated with their serum levels. The findings of this study indicate that during the very early phase of AOM, the MEE contains both serum type antibodies originating from the serum, and secretory antibodies of middle ear origin. Among them there are antibodies specific to the three most common bacteria causing AOM (Pn, Hi, and Br) regardless of the bacterial etiology of the AOM attack in question.

Phase II evaluation of peroral carmofur, cyclophosphamide, and hexamethylmelamine as a second-line therapy in advanced epithelial ovarian carcinoma

A prospective phase II study was performed to evaluate the effect and tolerability of a peroral combination chemotherapy consisting of hexamethylmelamine, cyclophosphamide, and carmofur in patients with epithelial ovarian cancer previously heavily treated by cisplatin-based chemotherapy but no longer responding to it. Of the 27 patients 1 showed a clinical complete remission lasting 15+ months and 4 a partial remission of 6+ to 21 months. A further 7 patients had an unchanged situation of 4 to 13+ months. The median survival of the nonresponders was 3 months. The side effects were tolerable, mostly nausea and vomiting. Only 4 of 27 patients suffered from severe vomiting causing discontinuation of the therapy. The peroral ambulatory chemotherapy prolonged markedly the overall survival of about one-half of the patients with ovarian cancer who previously failed to respond to cisplatin-based chemotherapy.

Intracavitary irradiation of endometrial carcinoma using a high-intensity 60Co afterloading method

Intracavitary irradiation of endometrial carcinoma with an afterloading technique, employing Cathetron equipment, was used preoperatively and in patients with inoperable disease as a single therapy or together with external pelvic irradiation. In clinical stages I and II, the survival rates of patients treated preoperatively with afterloading techniques and with the manual Heyman method were quite similar, and the radiation induced complications were less frequent with the afterloading technique. In cases with a large uterine cavity, the one-source tandem method was replaced with a specific two-phase intracavitary irradiation technique. In this method the treatment catheter was positioned against one lateral uterine wall in the first phase, and against the opposite lateral uterine wall in the second phase of irradiation. In experimental studies the shape of the dose distribution curves resembled the uterine shape, and the measured doses were quite similar to those calculated from the radiograms. The treatment results of 32 patients irradiated by this method confirmed its clinical usefulness. Our results show that the afterloading technique is a practical alternative to the manual packing method in the preoperative irradiation of endometrial cancer. With specific instrument modifications the new technique is also useful in cases with a large uterine cavity, whereas the details in the treatment strategies using remote intracavitary irradiation alone or in combination with external radiotherapy need further development.

Semiquantitative culture results and pathogenic significance of obligate anaerobes in peritonsillar abscesses

We studied the bacteria in consecutive peritonsillar abscesses using semiquantitation of the primary culture findings and correlated the results to clinical parameters. Puncture-aspirated pus from 42 abscesses yielded 133 isolates. Group A streptococci were isolated 10 times and, unlike other bacteria, were isolated 4 times in pure culture; other beta-hemolytic streptococci were found in 8 abscesses, and anaerobes were found in 28. The infections were polymicrobial, with two to seven bacteria in 83%. Anaerobes were more abundant than nonanaerobes; members of the genera Streptococcus, Bacteroides, Peptostreptococcus, and Fusobacterium were the most important quantitatively, considering both frequency and abundance. In patients with ongoing antibiotic treatment, nonanaerobes (but not anaerobes) were less abundant than in untreated patients. The abundance of obligate anaerobes (specifically cocci and gram-positive rods) correlated to the severity of illness as defined by fever and short duration before hospitalization. With other groups of bacteria, no such correlation was found. The correlation was not explained by a difference between the antibiotic-treated and the untreated patients. The results indicate the value of the semiquantitation of culture data and the frequency and pathogenic significance of obligate anaerobes in peritonsillar abscesses.

Intracavitary irradiation of endometrial cancer of large uteri using a two-phase afterloading technique

A specific intracavitary two-phase technique was developed for irradiation of endometrial cancer located in uteri with a large uterine cavity. In this technique an insertion catheter (external diameter 9 mm) was used for the introduction and precise location of the treatment catheter (external diameter 6.4 mm). During the first phase of the therapy, one lateral half of the uterine body was irradiated. Thereafter the positions of the catheters were changed by 180 degrees, followed by irradiation of the other lateral half of the uterine body. Using a wax phantom and extirpated uteri as models, we observed that the dose distributions followed the uterine shape and the calculated doses in the radiographs. Clinical observations from 34 patients treated so far, and followed-up for periods of 3 months to 6 years, prove that this method yields similar results to those observed in previous studies employing the Heyman packing method or afterloading techniques with a one-source tandem in the intracavitary irradiation of endometrial cancer.

Double-blind comparison of nedocromil sodium (1% nasal spray) and placebo in rhinitis caused by birch pollen

A double-blind parallel group study was undertaken during May and June 1985 to compare the effect of nedocromil sodium (1% nasal spray) and placebo, taken twice daily, in relieving the symptoms of rhinitis caused by birch pollen. Two centres were involved. The 54 patients studied had a history of rhinitis in 2 previous birch pollen seasons and positive skin tests to birch pollen. Patients were treated for 4 weeks, but to compare the effects of the 2 treatments the peak pollen periods were used. For dairy card symptoms, results in the 2 centres differed: in Tampere, there were trends in favour of nedocromil sodium with respect to itching (P = 0.04, sneezing (P = 0.06) and total symptoms (P = 0.09); in Oulu no significant differences were seen. Nasal peak expiratory flow rates were slightly better in the nedocromil sodium group. In respect of antihistamine usage, results in the 2 centres were similar and significantly more were used in the placebo group (P less than 0.01). At the end of the trial, both the patients' and the investigators' opinions of treatment effect favoured nedocromil sodium. There were no serious side effects. The results suggest that nedocromil sodium 1% nasal spray, when given twice daily, is effective in the treatment of seasonal allergic rhinitis.

Pneumococcal bacteriology after pneumococcal otitis media with special reference to pneumococcal antigens

Fifty-four ears with evidence of pneumococcus (Pn) in the first acute otitis media (AOM) in 38 infants and with prolongation or recurrence of the MEF during the follow-up were observed for 7-22 months for the presence of Pn by culture or of pneumococcal antigen (Pn-ag) by counterimmunoelectrophoresis or latex agglutination methods in their MEFs. During the first three 1-month observation periods, Pn and/or Pn-ags were detected in 24% to 9% of these ears, always of the initial type/group. Later on new Pn types/groups appeared also. In two of the 9 MEFs persisting for greater than or equal to 3 months, initial Pn-ag, with culturable Pn, was repeatedly found but not for longer than 5 months. Of the 12 ears resulting in secretory otitis media (SOM) only one showed initial Pn-ag (and Pn) in the MEF of SOM. Pneumococcal type/group pattern associated with prolongation or recurrence of infection did not differ from that of initial AOM. In another series of 151 SOM ears in 97 children, Pn-ags were detected in 7 MEFs. Four of them grew Pn, each of the corresponding group. Our studies suggest that the persistence of Pn-ags in the middle ear after AOM is limited and their occurrence in the MEFs of SOM is rare. Thus, the role of the persistence of Pn-ags in prolonged, recurrent or secretory otitis media seems questionable.

Subepithelial space in otitis media

The role of the subepithelial space (SES) has not received sufficient attention in assessing pathogenesis, pathology, and therefore, clinical diagnosis and treatment of the various forms of otitis media (OM). Temporal bones from patients with OM were classified as cases of acute purulent (POM), serous (SOM), mucoid or secretory (MOM), or chronic otitis media (COM). Controlled morphometric studies were made of cellular components of the SES, along with studies of the epithelium and middle ear space. Corollary studies of biochemistry, cellular components, and prostaglandins (PGs) were done on fluid from the human middle ear. Middle ear effusions (MEE) from animal models of SOM, MOM, and POM were analyzed biochemically. Findings are surprising in that the SES was more actively involved in all forms of OM than had been thought, especially in MOM and COM. Implications are discussed.

Peritonsillar abscess: bacteriological evaluation

The pus from a series of 41 peritonsillar abscesses was examined bacteriologically. In the majority of the abscesses a mixed bacterial flora was found. The specimens yielded 0-7 different bacterial species per abscess (mean 3.0). One species alone was isolated only in five cases (12.5%). Both anaerobic and aerobic bacteria were isolated from the specimens of 25 patients (61%), only anaerobes from two specimens (4.9%), and only facultative bacteria from 12 specimens (29%). Beta haemolytic streptococci were cultured in 43.9% of the cases, but Streptococcus pyogenes group A in only 10 cases (24.4%). Thus, the pus of the peritonsillar abscess seems to be caused by a mixed bacterial infection, where anaerobic bacteria play a significant role. Indications of tonsillectomy in cases with peritonsillar abscess are discussed.

Secretory IgA, secretory component and pathogen specific antibodies in the middle ear effusion during an attack of acute and secretory otitis media

The total concentration of secretory IgA (SIgA) and secretory component (SC) as well as the occurrence of pathogen specific serum type (IgG, IgA and IgM) and secretory type antibodies against Streptococcus pneumoniae and Haemophilus influenzae in the middle ear effusion during an attack of otitis media were studied by using the ELISA method. The middle ear effusion samples were taken at 2 to 4 weeks' intervals from patients with recurrent acute otitis media (RAOM) or secretory otitis media (SOM). In the samples of the RAOM patients the SC/SIgA ratio was 2.2, while in the SOM samples the ratio was 13.6. Both serum and secretory type antibodies to the infecting bacteria could be detected in the middle ear effusions in both of the patient groups. The results of this study show that the middle ear can develop antigenic specific antibodies against the infecting bacteria. The increased production of SC seems to be related to the pathogenesis of SOM.

Sensorineural hearing loss in otitis media

Additional evidence is presented to support the hypothesis that both acute purulent otitis media (POM) and chronic suppurative otitis media (COM) can cause high frequency sensorineural hearing loss. In selected patients and in animals (chinchillas) in a pilot study using electrophysiological methods, both temporary threshold shifts and permanent threshold shifts of basal cochlear turn involvement were demonstrated in POM. Data of cochlear involvement in 475 ears with bilateral COM, 607 ears with unilateral COM, and 607 ears serving as controls were obtained from six centers in five countries. In group 1 (15 dB or greater), 43% of ears with unilateral COM and 42% of ears with bilateral COM showed losses, for a combined odds ratio eight times that in controls. In group 2 (30 dB or greater), 16% of ears with unilateral COM and 17% of ears with bilateral COM demonstrated, respectively, seven and ten times that in controls. These statistically significant findings influence clinical considerations.

Immunologic aspects of ozena

In order to be able to describe the systemic cellular immunity in patients with ozena, the following immunologic parameters were studied in 19 ozena patients: the number of T- and B-cells, the spontaneously proliferating cells, and the transformation response of lymphocytes to phytohemagglutinin and pokeweed mitogen. No differences could be found between the ozena patients and the healthy control subjects, however. Subsequently, with the methods used, we were unable to find any systemic cellular immuno-disorders in patients with ozena.

Aspects of biological potentials of mononuclear cells in middle ear effusions

Mononuclear phagocytes are cells common in the subepithelial space of the mucosa of the middle ear and in middle ear effusion during an attack of otitis media. Here we review studies to date on biological potentials of aural macrophages in the pathogenesis of otitis media. The origin of aural macrophages may be in the circulating pool of monocytes in the blood, in the pre-existing population of macrophages in the mucosa of the middle ear, in proliferation of macrophages in the middle ear, or in nasopharyngeal and tonsillar tissues. Macrophages demonstrate great phagocytic activity in eliminating tissue-debris, bacteria, and viruses. It seems likely that the secretory products of macrophages--such as lysozyme, components of complement, prostaglandins, collagenase, and other biologically active agents--play an important part in the pathogenesis of otitis media. There is also evidence available that aural macrophages play an important role in the regulation of lymphocytic response to antigens in active otitis media.

Biochemical pathology of otitis media with effusion

The sequential cytologic and biochemical events of middle ear effusion (MEE) were studied in experimental models of serous otitis media (SOM) and purulent otitis media (POM) in chinchilla. In the SOM model, the initial appearance of neutrophils was followed by macrophages. In the POM model, neutrophils were the predominant cells in MEE and the number of neutrophils was about 100-fold higher than in the SOM model. The activity of lysozyme in MEE was higher in POM than in SOM and correlated with the number of neutrophils and mononuclear phagocytes. The results of the present study suggest that neutrophils and mononuclear phagocytes are one of the main sources for lysozyme levels in MEE during otitis media.

Intranasal ipratropium in the treatment of vasomotor rhinitis

Ipratropium administered in the form of a nasal spray was compared with placebo in 30 patients with vasomotor rhinitis in a double-blind cross-over trial. There was a significant reduction in nasal hypersecretion during ipratropium treatment, but no effect on nasal blockage, sneezing or tickling. On the whole, 20 patients (66.7%) considered ipratropium worth using. 11 patients had mild side- effects, mainly nasal irritation, during ipratropium treatment and 7 with placebo. A therapeutical trial with ipratropium is appropriate in the management of severe rhinorrhoea in patients with vasomotor rhinitis.

Comparative trial of flunisolide and beclomethasone dipropionate nasal sprays in patients with seasonal allergic rhinitis

In order to evaluate the effects of flunisolide and beclomethasone dipropionate nasal sprays on seasonal allergic rhinitis, 45 patients were included in an open parallel comparative trial. The study design was open because of the different dosage schedules for the two preparations. Strict criteria were set up for patient selection, and all patients were carefully examined and assessed before and after the 4-week trial period. Throughout the whole treatment each patient kept a detailed daily record. A substantial or complete control of symptoms was achieved in 18 of the 21 patients on flunisolide and in 20 of the 22 on beclomethasone dipropionate. No serious side effects were observed. Thus it can be concluded that both test drugs are effective and well tolerated in the treatment of seasonal allergic rhinitis.

Late results of tympanoplasty using ossicle or cortical bone

Hearing results are presented for 164 ears with chronic otitis media which were operated on radically and obliterated with a musculo-periosteal flap (Palva flap), and in which tympanoplasty was performed. The ears were followed-up annually for 5-13 years (mean 6.8 years). Results are compared with the method of ossiculoplasty and with the condition of the stapes superstructure at operation. Ossiculoplasty using autogenous cortical bone columellas resulted in a somewhat greater improvement in the post-operative air-bone gap than ossiculoplasty with auto- or homo-graft ossicles, when compared with the pre-operative gap. Similarly, the post-operative gap improved more in ears with an intact stapes superstructure than in ears in which the stapes superstructure was absent. The use of an autogenous cortical bone columella can be recommended in cases in which the patient's own ossicles are affected by disease and cannot be used.

Inflammatory cells in mucoid effusion of secretory otitis media

Inflammatory cells were studied in 269 mucoid middle ear effusions of 202 patients with secretory otitis media (SOM). Although the effusions contained inflammatory cells in all cases, the number of cells, the proportion of viable cells and the proportions of different cell types showed marked heterogeneity. However, the effusions formed a sliding scale with regard to the above cellular parameters. We suggest that these differences in the cellular picture might reflect differences in immune mechanisms and responses in the different effusions, possibly representing different phases of the course of an established SOM. In the subgroups of patients with cleft palate (22) or atopy (16) the cellular picture resembled that seen in the other patients (164), with the exception that the effusions of the cleft palate patients were somewhat more lymphocytic. Thus, from the immunological point of view, the effusions in established SOM seem to behave similarly, irrespective of the differences in the etiological background of SOM.

Post-operative ear canal volume measurements

Post-operative volume determinations have been made of the ear canals of 93 chronic ears operated on radically (removing the bony posterior meatal wall at operation, obliterating the surgical cavity by musculoperiosteal flap, and reconstucting the meatus, by soft-tissue only in 81 ears, or by cortical bone chips and soft tissue in 12 ears), and of 30 normal ears, using a liquied-filling method and by determining the compliance of the ear canal at a pressure of +200 mm. H2O.

The liquid-filling method gave more exact results than did the impedance measureemnts, and the results of the later showed more dispersion in all groups of ears. In 51 ears without post-operative cavities and reconstructed without bone chips, the mean value of the ear canal volume was 0.9 ml. by the liquid-filling method, and 1.5 ml, by the compliance method (p<0.001). The corresponding values for 30 ears with post-operative cavities, but without bony reconstruction of the meatus, were 1.5 ml. and 1.9 ml. (p<0.01). The values were 0.9 ml. and 1.2 ml. in 12 ears with posterior canal walls reconstructed with bone chips (p<0.01), and 0.8 ml. and 1.0 ml. in 39 normal ears (p<0.001). The liquid method seems to be a very exact method, but quite trouble-some in routine clinical use; the compliance method is suitable in most ears in which there has been bony reconstruction of the posterior meatal wall, but not in ears in which the posterior ear canal wasll has been reconstructed with solft tissues only, because the soft posterior meatal wall was mobile at +200 mm. H2O pressure.