Significance and specificity of antibodies to neutrophils detected by western blotting for the serological diagnosis of primary sclerosing cholangitis.

Antibodies against neutrophils have been detected in sera from patients with primary sclerosing cholangitis and inflammatory bowel diseases either by immunofluorescence or by enzyme-linked immunosorbent assay. To assess primary sclerosing cholangitis-specific antibodies, we examined sera from 30 patients with clinically and morphologically well-established primary sclerosing cholangitis by Western blotting against neutrophils and compared these results with those obtained by testing sera from patients with inflammatory bowel diseases. By Western blot using sonified neutrophils, 24 (80%) of 30 primary sclerosing cholangitis sera were positive. Five antigenic determinants at 95, 60, 55, 40 and 30 kD were visualized. Twenty-eight of the primary sclerosing cholangitis sera also showed the characteristic perinuclear fluorescence pattern by immunofluorescence on neutrophils. Thus a serological diagnosis of primary sclerosing cholangitis could be made in 80% of patients based on these two methods. In contrast, only 9% of 23 patients with ulcerative colitis and 10% of 60 patients with Crohn's disease were positive by Western blot, and these patients also showed positive perinuclear fluorescence pattern by immunofluorescence, suggesting an overlap between inflammatory bowel diseases and primary sclerosing cholangitis. Although some patients with classical primary biliary cirrhosis and autoimmune chronic active hepatitis had antibodies against primary sclerosing cholangitis epitopes, none of the patients with obstructive bile duct disorders, collagen diseases, Wegener's granulomatosis or other hepatic and nonhepatic disorders were positive by Western blot, indicating the specificity of these five primary sclerosing cholangitis-related neutrophilic epitopes.     

Effects of tennis training on lipid metabolism and lipoproteins in recreational players.

OBJECTIVE: To investigate the short term effects of tennis training on lipid metabolism and to find out if a typical tennis training programme has positive longitudinal effects on cardiovascular risk factors in recreational players. METHODS: The experimental design consisted of an exercise study and a subsequent longitudinal study. In the exercise study the short term metabolic effects of a two hour technically orientated tennis training (TT) session and a running intensive tennis training (RIT) session were investigated in 16 recreational tennis players (eight men: 46 (SD 7) years, 177 (6) cm, 81 (10) kg; and eight women: 44 (5) years, 165 (5) cm, 64 (6) kg). In the longitudinal study the long term effects of a six week RIT programme in 22 players (11 men and 11 women) of similar characteristics were compared with those in 16 control subjects (eight men and eight women). The results of the exercise study (higher lipolytic activity and cardiopulmonary demand, as well as acceptance by the players) led to the RIT method being chosen for all training sessions in the longitudinal study. RESULTS: In RIT, significantly higher values for heart rate (148 (SD 10) v 124 (11) beats/minute) and lactate (2.8 (1.1) v 1.5 (0.6) mmol/l), significantly higher post exercise concentrations of serum glycerol (0.37 (0.15) v 0.29 (0.14) mmol/l) and high density lipoprotein cholesterol (1.31 (0.55) v 1.20 (0.50) mmol/l) and a higher acceptance than in TT (15 of the 16 players preferred RIT) were found. During the six week tennis training programme the changes in body weight (-1.41 (1.56) v 0.00 (1.50) kg) and anaerobic threshold (1.04 (0.84) v -0.08 (0.92) km/h) were significantly different between the training and control group. In the training group several parameters of the lipoprotein profile tended to change in an antiatherosclerotic direction. CONCLUSIONS: The results indicate that typical regular tennis training influences cardiovascular risk factors in a positive manner and can be suggested as an attractive alternative to other current health orientated sports programmes. A more frequent use of running intensive exercises during tennis training is recommended.     

Toxic drug-induced hyposmia with lovastatin]

We present the first case of hyposmia after application of lovastatin. Unclear disorders of smell should prompt a detailed drug anamnesis.     

Cerebrospinal Fluid Density Influences Extent of Plain Bupivacaine Spinal Anesthesia

Background: The attempts to explain the unpredictability of extent of spinal block provided by plain local anesthetic solutions have resulted in many clinical reports; however, causes of this uncertainty are as yet unknown. Recently, normal values of the human cerebrospinal fluid densities have been studied showing important interindividual variations, especially between females and males. The current study was designed to evaluate as primary endpoint the influence of cerebrospinal fluid density values on the extent of spinal block with plain bupivacaine. The ancillary endpoints were search of factors explaining the interindividual differences in cerebrospinal fluid density values reported and determination of the relation between upper extent and regression of spinal anesthesia.

Methods: Sixty-four consecutive patients undergoing peripheral orthopedic surgery with spinal block were enrolled. Spinal anesthesia was performed in the lateral decubitus position with the operated side upward. Two milliliters of cerebrospinal fluid was sampled before injection of 3 ml plain bupivacaine 0.5%. The patient was immediately turned supine and remained in the horizontal position until the end of the study. Maximal sensory block level and time to sensory regression to L4 were determined for each patient enrolled. Cerebrospinal fluid and bupivacaine densities as well as cerebrospinal proteins, glucose, sodium, and chloride concentrations were measured.

Results: A highly significant correlation between cerebrospinal fluid density and maximal sensory block level was found (P = 0.0004). However, this correlation was poorly predictive (R2 = 0.37). Cerebrospinal fluid density, proteins, and glucose concentrations were significantly higher in men than in women: 1.000567 +/- 0.000091 versus 1.000501 +/- 0.000109 g/ml (P = 0.014), 0.46 +/- 0.18 versus 0.32 +/- 0.13 g/l (P = 0.001), and 3.27 +/- 0.7 versus 2.93 +/- 0.5 mm (P = 0.023), respectively. A highly significant (P = 0.0004) and predictive (R2 = 0.73) inverse correlation was found between maximal upper sensory extent and sensory regression to L4.