External pressure-blood flow relations during limb compression in man

The effect of increased tissue pressure on blood flow in subcutaneous and skeletal muscle tissue was studied in 8 healthy humans resting in horizontal position. Blood flow was measured by the local ¹³³Xe washout technique in the mid-calf region. Tissue pressure in the depot area was increased by inflating a compression cuff, 50 cm wide (knee to ankle). Blood flow rates were obtained from compressed tissues with normal vasomotor tone, at papaverine-induced vasoparalysis and during distension of the compressed vessels. The latter was achieved by inflating a proximal (extra) compression cuff on the thigh 10 or 20 mmHg above the pressure level in the more distally placed compression cuff. Increased tissue pressure was a potent stimulus for arteriolar dilatation (autoregulation) in both tissues. The autoregulatory response was to some extent counteracted by an increase in local vascular resistance in the postcapillary section as evidenced by the results of simultaneous venous stasis. Blood flow ceased in vasoparalysed tissues as well as in tissues with normal vasomotor tone, when the compression cuff was inflated to the level of the local diastolic blood pressure. Maintaining external compression at the diastolic blood pressure level, blood flow reappeared in both tissues, when the compressed vessels were distended by adding the proximal (extra) compression. It is concluded, that blood flow cessation in compressed tissues is caused by a widespread arterial-arteriolar collapse in diastole, as the volume of blood injected during the systolic peak is too small to expand also the distal sections of the precapillary vessels.     

Immune hierarchy among HIV‐1 CD8+ T cell epitopes delivered by dendritic cells depends on MHC‐I binding irrespective of mode of loading and immunization in HLA‐A*0201 mice

Recent human immunodeficiency virus type 1 (HIV‐1) vaccination strategies aim at targeting a broad range of cytotoxic T lymphocyte (CTL) epitopes from different HIV‐1 proteins by immunization with multiple CTL epitopes simultaneously. However, this may establish an immune hierarchical response, where the immune system responds to only a small number of the epitopes administered. To evaluate the feasibility of such vaccine strategies, we used the human leukocyte antigen (HLA)‐A*0201 transgenic (tg) HHD murine in vivo model and immunized with dendritic cells pulsed with seven HIV‐1‐derived HLA‐A*0201 binding CTL epitopes. The seven peptides were simultaneously presented on the same dendritic cell (DC) or on separate DCs before immunization to one or different lymphoid compartments. Data from this study showed that the T‐cell response, as measured by cytolytic activity and γ‐interferon (IFN‐γ)‐producing CD8⁺ T cells, mainly focused on two of seven administered epitopes. The magnitude of individual T‐cell responses induced by immunization with multiple peptides correlated with their individual immunogenicity that depended on major histocompatibility class I binding and was not influenced by mode of loading or mode of immunization. These findings may have implications for the design of vaccines based on DCs when using multiple epitopes simultaneously.     

Expression of epidermal growth factor receptor in glottic carcinoma and its relation to recurrence after radiotherapy

expression of EGFR was determined immunohistochemically in two groups of patients with glottic carcinoma, one that recurred after a full course of radiotherapy and one that did not. Using a 4-graded scale (-, +,++,+++) 80% (12/15) of the recurrent carcinomas had a staining intensity and proportion of stained cells of ++ or more. The same figure for non-recurrent carcinomas was 39% (7/18). The difference is statistically significant (chi-squared with Yates' correction, P &<5). The results indicate that an increased expression of EGFR may influence the rate of recurrence of glottic squamous cell carcinoma after radiotherapy.     

Plasma Potassium and Phosphate Concentrations—Influence by Adrenaline Infusion, β-blockade and Physical Exercise

ABSTRACT. Ljunghall S, Joborn H, Rastad J, Åkerström G (Departments of Internal Medicine, and Surgery, University Hospital, Uppsala, Sweden). Plasma potassium and phosphate concentrations—influence by adrenaline infusion, β-blockade and physical exercise. Acta Med Scand 1987; 221:83–93. Infusion of adrenaline into healthy male subjects reduced the plasma concentrations of both potassium and phosphate to a similar extent, in a dose-dependent manner, an effect which was prevented by the administration of propranolol. Ergometer bicycling until exhaustion, which caused marked accumulation of lactic acid in the blood and reduction of pH, induced great elevations of both plasma potassium and phosphate with close relationships between the raised plasma concentrations and the reduction in pH, also during β-blockade. However, longer-term aerobic exercise, without acidosis, also caused some rise of the potassium and phosphate concentrations. During recovery from anaerobic, but not from aerobic, exercise there was a rapid decrease of the plasma potassium levels while the phosphate values normalized gradually together with pH. From measurements of the ion concentrations both in the femoral effluent of one leg, which carried out maximal isokinetic work, and in the opposite antecubital vein it could be calculated that there was for potassium, but not for phosphate, a post-exercise uptake both in the exercised muscle and in the entire organism, indicating the participation of systemic factors.     

CT-Scanning of the cochlea in Pendred's syndrome*

The inner ears of 5 adult patients with Pendred's syndrome were investigated using a Siemens SOMATOM DRG. Five normal hearing adults participated in the investigation as a control group. The CT-scanning comprised 10-15 consecutive scans of the cochlea. The CT evaluation was performed using both a special bone setting and a soft tissue setting. The cochlear content was quantitatively evaluated by drawing an irregular region of interest on the bone pictures. The region of interest was then transferred to the soft tissue pictures by means of the standard program of the CT-scanner. The resulting mean values of attenuation expressed in Hounsfield Units were significantly lower in the Pendred cochleas was demonstrated in all patients with Pendred's syndrome. The lower values of attenuation of the cochlea in Pendred's syndrome reflect the rudimentarily developed infra-cochlear osseous structures in this disease. We conclude that CT-scanning of the cochlea using this procedure is reliable enough to replace the conventional axial-pyramidal tomography when a Mondini cochlea is suspected.     

The effect of vasodilatation and sympathetic nerve activation on net water absorption in the cat's small intestine

The rate of net water uptake from the feline small intestine has been investigated during control conditions, during graded infusions of the vasodilator drug isopropylnoradrenaline, and during electrical stimulation of the regional sympathetic nerve fibres to the gut. Net water absorption rate was largely unaffected by intestinal vasodilatation. The fraction of the absorbate transported via the lymphatics remained also constant at 20–40% of the total absorption regardless of blood flow rate. Stimulating the sympathetic nerve fibres to the small intestine increased, however, net water absorption rate. The increase was particularly pronounced when blood pressure was kept constant during the period of stimulation. The absorption rate was on an average almost doubled at a stimulation frequency of 8 Hz during constant pressure conditions. The mechanism(s) explaining this nervous control of water absorption are tentatively discussed.     

Prevalence of Hyperglycaemia and Undiagnosed Diabetes Mellitus in Patients with Acute Myocardial Infarction

ABSTRACT The prevalence of hyperglycaemia and undiagnosed diabetes mellitus was assessed in 214 consecutive patients admitted to the coronary care units with acute myocardial infarction (AMI). On admission, 16 patients (7.5%) had known diabetes, and 19 patients, not previously known to be diabetic, had blood glucose concentrations of ≥9 mmol/1. Fifteen patients survived for 2 months at which time a 75 g oral glucose tolerance test showed diabetes in 9 (60%) and impaired glucose tolerance in 4 (27%). Ten of these 13 patients (77%) with abnormal glucose tolerance had elevated glycosylated haemoglobin (HbA_1c) on admission, indicating pre-existing glucose intolerance or diabetes. The prevalence of undiagnosed diabetes was 4.5% (9/198). However, we may have overlooked undiagnosed diabetes in a small number of patients on admission, since only a random blood glucose <8 mmol/1 rules out diabetes, WHO criteria. Elevated blood glucose in patients with AMI is more likely to reflect a stationary pre-existing abnormal glucose tolerance than a temporary stress-induced phenomenon.     

Lifetime costs of cerebral palsy

This study quantified the lifetime costs of cerebral palsy (CP) in a register-based setting. It was the first study outside the US to assess the lifetime costs of CP. The lifetime costs attributable to CP were divided into three categories: health care costs, productivity costs, and social costs. The population analysed was retrieved from the Danish Cerebral Palsy Register, which covers the eastern part of the country and has registered about half of the Danish population of individuals with CP since 1950. For this study we analysed 2367 individuals with CP, who were born in 1930 to 2000 and were alive in 2000. The prevalence of CP in eastern Denmark was approximately 1.7 per 1000. Information on productivity and the use of health care was retrieved from registers. The lifetime cost of CP was about €860 000 for men and about €800 000 for women. The largest component was social care costs, particularly during childhood. A sensitivity analysis found that alterations in social care costs had a small effect, whereas lowering the discount rate from 5 to 3 per cent markedly increased total lifetime costs. Discounting decreases the value of costs in the future compared with the present. The high social care costs and productivity costs associated with CP point to a potential gain from labour market interventions that benefit individuals with CP.     

ALCOHOL ABUSE AND HEALING COMPLICATIONS AFTER CERVICAL HIP FRACTURES

Osteonecrosis of the femoral head following femoral neck fracturesis a common condition. Spontaneous osteonecrosis, is, however,a rare disorder, which is observed with increased frequencyin alcohol abusers. In this retrospective study, we followed512 consecutive male patients who had sustained femoral neckfractures between 1984 and 1992; 82 of these 512 patients (16%)had earlier been registered at the Department of Alcohol Diseasesas high consumers of alcohol. The aim of the study was to determinethe relationship between the rate of healing complications andalcohol consumption. No differences were observed in the degreeof fracture dislocation, frequency of femoral head necrosis,and pseudoarthrosis among the abusers. Furthermore, no differenceswere found in causative events, primary operative treatment,post-operative complications, and the number of secondary operations.The abusers were significantly younger, had a higher rate ofearly retirement, and had an increased death rate. Our studysuggests that alcohol complicates the healing process to a lesserextent than earlier thought, and that osteonecrosis of the femoralhead after femoral neck fractures is equally conimon in non-abusersas in abusers.