Contact allergy to gold in dental patients

Summary Gold sodium thiosulphate (GSTS) In patch test series commonly yields positive reactions. In this study of dental patients, the clinical relevance of these positive reactions, the suitability of gold compounds as patch test materials, and value of the lymphocyte proliferation test in gold contact allergy, were evaluated. The frequency of positive patch test reactions to GSTS was 12·4% in the dental series. Fifty-two patients, only two of whom were male, were studied. Thirteen (25%) had had symptoms from jewellery or dental restorations. However, in most cases gold allergy was subclinical. A 10% aqueous solution of gold sodium thiomalate (GSTM) was almost as good as 0·5% GSTS in petrolatum as a marker of gold contact allergy, but 0·001% potassium dicyanoaurate (PDCA) yielded a high percentage of false-negative results. Seventy-three per cent of the subjects with positive patch tests to GSTS responded to gold compounds in vitro in the lymphocyte proliferation test, whereas 13 controls without gold contact sensitivity were negative. Consistent results in skin and lymphocyte proliferation tests provide support for the concept that gold salt-induced'allergic-like' reactions are truly allergic in nature.     

Langerhans'' cell population in topical patch-test and systemic flare-up sites of nickel-sensitive guinea pigs

Guinea pigs were sensitized to nickel by using the maximization method of Magnusson and Kligman (1969), challenged by topical and systemic applications of the allergen, and the epidermal Langerhans' cell (LC) density studied with ATPase histochemistry. Similar LC counts were found in unchallenged skin of nickel-sensitized and control animals (657 ± 151 vs. 671 ± 16 cells/mm²). Topical patch-test challenge with nickel sulphate lowered the LC count in both sensitized and control animals to some extent, but the changes were not statistically significant. In contrast, systemic (intraperitoneal) nickel sulphate challenge induced a statistically significant (P <0–001) LC decrease in the previous topical test sites of sensitized guinea pigs, while no such decrease was evident in the corresponding skin sites of control animals. The method of nickel sensitization, topical challenge, and subsequent systemic challenge is a versatile experimental model for studying the pathology of the LC population in delayed-type hypersensitivity skin reactions.     

THE EARLY ULTRASTRUCTURAL ALTERATIONS IN THE RABBIT CEREBRAL AND CEREBELLAR CORTEX AFTER COMPRESSION ISCHAEMIA

The early ultrastructural alterations in the rabbit cerebral and cerebellar cortex after compression ischaemia
The ultrastructural alterations in the rabbit cerebral and cerebellar cortex resulting from 30 minutes complete, permanent cerebral ischaemia were studied. The ischaemia was induced by raising the intracranial pressure (ICP) above the systolic arterial pressure (compression ischaemia). Immediately after releasing the ICP the brain was fixed by intravascular glutaraldehyde perfusion. Samples from the cerebral and cerebellar cortex were processed for electron microscopy. The ultrastructural changes were relatively minor; there was a generalised, slight intracellular oedema, most prominent in the subpial area; the nuclear chromatin was clumped, the endo. plasmic reticulum and cisternae of the golgi apparatus became somewhat dilated, the inner matrix of the slightly swollen mitochondria showed increased electron lucency, and microtubules and ribosomes began to loose their compact structure. These changes, unaccompanied by any extensive volumetric change of any cellular compartment, agree well with the recently presented hypothesis of two different types of anoxic-ischaemic nerve cell injury. This cellular reaction to complete, permanent compression ischaemia represents the type of injury that is seen resulting from ischaemic insults during which no flow of fluid irrigates the ischsemically injured cells.     

Contributors to satisfaction with management in hospital wards

The Purpose of this study was to identify management-related factors contributing to personnel satisfaction in hospital wards. The sample population consisted of the employees of 15 hospital wards in four medical departments. The wards were classified into two categories on the basis of the satisfaction of the personnel with the management: 'satisfied wards' (seven wards with a highly satisfied personnel, n = 124) and 'other wards' (eight wards, n = 186). The employees of 'satisfied wards' reported more innovative activities and continuous quality improvements, more possibilities to participate in decision-making, more efficient communication within the ward and between other units, and more managerial activities for promoting the well-being of the staff compared with the personnel of 'other wards'. According to the ratings of the nursing directors, the quality of patient care in the 'satisfied wards' was higher, but there were no differences in cost-effectiveness between the study groups.     

Neonatal Septicaemia in Finland 1981–85

ABSTRACT. A survey of blood culture-confirmed neonatal septicaemia was carried out in seven delivery hospitals in 1981–85, for a second successive five-year period. The total number of cases was 377, to compare with 410 in the previous five-year period. Group B streptococcus (GBS) was throughout the major pathogen (29%), followed by Staphylococcus aureus (15%) and Escherichia coli (14%), while Staphylococcus epidermidis (10%) has emerged as a significant new causative agent. Septicaemia with very early onset was predominant: 49% of the cases had onset within the first 24 hours; in the majority the symptoms were present from birth. GBS was responsible for 49% of the cases detected in the first 24 hours of life. The overall mortality was 20% as compared to 23% in the previous five-year period, whereas in the very early onset septicaemia mortality was now 18%, down from the preceding 30%. Despite the modest progress, GBS septicaemia with very early onset remains a significant problem, and effective preventive measures are needed.     

Life-threatening, recurrent anaphylaxis caused by allergy to gliadin and exercise

Background Exercise-induced urticaria or anaphylaxis is regarded as a distinct form of physical allergy. In some patients the symptoms occur only after ingestion of various food products in connection with exercise. We have come across patients with cereal dependent exercise-induced anaphylaxis. Objectives The purpose of the present study was to analyse the allergens in cereals responsible for the severe anaphylactic symptoms and to verify the test methods suitable for screening the patients with cereal dependent exercise-induced anaphylaxis. Methods The patients underwent skin-prick tests (SPT) with common inhalant and food allergens as well as with various cereal extracts. IgE-immunoblotting was used to identify the allergenic fractions. Results Five patients found positive in SPT with NaC1 wheat suspension had IgE antibodies to wheat, rye, barley and oats, especially directed against the ethanolsoluble protein fractions in immunoblotting. No IgE antibodies were detected against other cereals. The patients had been unaware of any cereal allergy since anaphylaxis occurred only in association with exercise postprandially. The patients were directed to follow a gluten-free diet and have been free from symptoms, being able to continue their outdoor physical activities. Conclusion Wheat gliadin and the corresponding ethanol-soluble proteins of taxonomically closely related cereals were found to be the allergens in cereal-dependent exercise-induced anaphylaxis. Skin-prick testing with NaC1 wheat suspension was a simple and practical test to screen patients with this kind of occult, possibly life-threatening, allergy to cereals.     

Double-contrast Barium Enema versus Colonoscopy in the Diagnosis of Neoplastic Disorders: Aspects of Decision-making in General Practice

A total of 190 patients, referred by general practitioners fora double-contrast barium enema, were subsequently examined withcolonoscopy. With colonoscopy and histology as the referencestandard, sensitivity, specificity, positive and negative predictivevalues, and accuracy for the radiological detection of cancerand polyps were calculated. No cancer was overlooked by theradiological examination, but there were four false positives.The overall sensitivity for polyps was 70%, increasing to 81%for polyps 10 mm. The predictive value was 93–97% forthe exclusion of polyps. The caecum was reached in 187 patientsby double-contrast barium enema (98%) and in 164 patients (86%)by colonoscopy. Lesions in four of 12 patients who had radiologicalchanges were undetected at the first colonoscopy, but a repeatexamination showed polyps 10 mm in size. Although colonoscopyis a more sensitive technique for the detection of small mucosallesions, the general practitioners may, in the vast majorityof patients, rely on a negative result for polyps and cancerobtained by the double-contrast barium enema. The latter islinked with a number of false-positive cases, while colonoscopyis associated with technical difficulties; both techniques maylead to repeated examinations, regardless of which was the firstchoice.     

IgE-binding components of baker's yeast (Saccharomyces cerevisiae) recognized by immunoblotting analysis. Simultaneous IgE binding to mannan and 46–48 kD allergens of Saccharomyces cerevisiae and Candida albicans

The Saccharomyces cerevisiae allergens were characterized by IgE-immunoblotting with serum samples of 83 patients; 63 represented patients with atopic dermatitis with previous positive skin prick test or RAST for S. cerevisiae, seven patients with AD but negative test results and 13 were non-atopic controls. Disrupted whole body extract of S. cerevisiae was used in the assays. From the patients tested 41 patients with atopic dermatitis appeared positive in IgE immunoblotting revealing 22 IgE stained bands. From these bands 10 represented intermediate allergens, and 12 minor allergens. The most frequent staining was obtained with the 48 kD band (39%). When the staining pattern of 45 kD and 48 kD bands and mannan was compared with Candida albicans allergens or purified baker's yeast enolase a simultaneous binding was seen with the 48 kD band of S. cerevisiae and the 46 kD band of C. albicans and enolase whereas the 45 kD band was neither associated with the 46 kD band of C. albicans nor purified enolase. High molecular weight staining was found in five samples. The staining pattern was associated with the mannose containing structures in parallel with C. albicans.     

Outer membranous vesicles and leukotoxic activity of Actinobacillus actinomycetemcomitans from subjects with different periodontal status

Abstract – Strains of A. actinomycetemcomitans (A.a) from juvenile periodontitis patients (JP), adult periodontitis patients (AP), and 14-yr-old healthy children were tested for the correlation between leukotoxin activity and the number of outer membranous vesicles measured in electron micrographs. To determine the potential for connective tissue destruction following the interaction of polymorphonuclear leukocytes (PMN) with the bacteria, the lysosomal release of neutro-phil elastase was assessed. The highest potential to kill leukocytes and to release lysosomal elastase from them was observed in the strains isolated from JP patients. No correlation existed between leukotoxic activity and the number of outer membranous vesicles per bacterium when the data from A.a. strains from all sources were combined. Furthermore, no significant differences were found between the numbers of outer membranous vesicles in the three groups tested. The only significant correlation between the number of vesicles and leukotoxicity was found in the A.a. strains derived from the mouths of healthy children.