Skin lesions in human yersiniosis

Various types of skin manifestations of human yersiniosis were examined with routine histological and immunohistological methods. The biopsy material consisted of sixteen cases of erythema nodosum, eight cases of erythema multiforme, and one case of erythema figuratum. The principal histopathological changes in erythema nodosum were septal or diffuse, mild panniculitis and in seven cases also necrotizing vasculitis in small, medium-sized or large arteries. Perivascular lymphocytic infiltration without vasculitis was the most prominent feature in erythema figuratum. By using a polyvalent conjugate, immunoglobulins in vessel walls in the dermis were found in two cases of EM. The rapid course of the skin eruptions and the frequency of necrotizing vasculitis in arteries fit the changes seen in an experimental Arthus reaction, in which necrotizing vasculitis is followed by lymphocytic inflammation consistent with a delayed type of reaction.     

Modern Methods for Reliable Preoperative Localization of Insulinoma

A case of insulinoma is reported in which the correct localization of tumor was made with PTP and immunoreactive insulin values from the portal venous system and in which pancreas angiography indicated a false positive tumor localization. PTP should be done to every patient to confirm the preoperative location of the insulinoma(s).     

HORMONAL CHANGES IN NONCIRRHOTIC MALE ALCOHOLICS DURING ETHANOL WITHDRAWAL

Serum concentrations of iodothyronines, cortisol, prolactin,testosterone and the respective tropic hormones were measuredin 32 noncirrhotic male alcoholics, aged 28–51 years,at the end of a long drinking period and subsequently duringethanol withdrawal over 1–2 weeks. Seven men had testicularatrophy. On admission one patient had high values for serumthyroxine (T4) and free thyroxine index (FT4I). A blunted responseof serum thyrotropin (TSH) to thyrotropin-releasing hormone(TRH) was found in 9 men. Apart from a blunted TSH-responsein one man the abnormalities disappeared during the first weekof alcohol abstinence. Simultaneously the mean levels of serumT4, FT4I, triiodothyronine, free triiodothyronine index andreverse triiodothyronine were reduced by 12, 14, 5, 8 and 21%,respectively, and the mean of the maximum TSH-response to TRHwas increased by 55%. At the time of stopping drinking two menhad high morning values and six an abnormal diurnal rhythm ofserum cortisol. High serum ACTH-levels associated with normalserum cortisol concentrations were found in 12 men. During thefirst week of alcohol abstinence the mean morning values forserum cortisol and ACTH were reduced by 18 and 42%, respectively.The serum ACTH-levels remained high in 6 men but the abnormalitiesin cortisol secretion disappeared. On admission four men hadlow serum concentrations of testosterone which were normalizedduring ethanol withdrawal over one week. At the same time themean level of serum testosterone was increased by 19%. Mildhyperprolactinaemia found in 7 patients on admission disappearedin 4 men during the first week of ethanol withdrawal. Duringthe second week of alcohol abstinence no further changes wereoccurring in the hormonal parameters studied. The present study indicates that clinically significant hormonalchanges are only occasionally seen in chronic alcoholic menwithout liver damage. Whether high serum ACTH-levels in chronicalcoholics without hypercortisolism indicate an ethanol-inducedACTH-resistance remains to be determined by further studies.     

Stopping Insulin Treatment in Middle-aged Diabetic Patients with High Postglucagon Plasma C-Peptide

ABSTRACT We studied the successfulness of stopping insulin treatment in middle-aged diabetic patients aged 45–64 with a high postglucagon C-peptide level and the effects of this change on glycaemic control, serum lipids and lipoproteins. Insulin treatment was successfully stopped in 15 of our 22 patients who satisfied the inclusion criteria for the study and were selected on the basis of a computer file including practically all diabetic patients treated with insulin in the Kuopio University Central Hospital region (population base 250000 inhabitants). Insulin therapy was restarted in seven patients during the first 3 months after discharge. During the following 9 months insulin therapy was restarted in another three patients so that after a 1-year follow-up period half of the diabetic patients whose insulin therapy was stopped had been switched back to insulin. Insulin therapy was seldom successfully stopped if the postglucagon C-peptide value was under the limit of 1.0 nmol/l. Glycaemic control did not change during the follow-up, although there was a significant weight loss in diabetic patients. No changes were observed in serum lipids or lipoproteins with the exception of LDL cholesterol, which showed a significant reduction during the 3-month follow-up. In conclusion, insulin therapy can often be successfully stopped in patients with postglucagon C-peptide over the limit of 1.0 nmol/l without worsening of glycaemic control and without unfavourable changes in serum lipid and lipoprotein levels.     

Persistence of borrelial DNA in the joints of Borrelia burgdorferi‐infected mice after ceftriaxone treatment

Yrjänäinen H, Hytönen J, Hartiala P, Oksi J, Viljanen MK. Persistence of borrelial DNA in the joints of Borrelia burgdorferi‐infected mice after ceftriaxone treatment. APMIS 2010; 118: 665–73. We have earlier shown that Borrelia burgdorferi‐infected and ceftriaxone‐treated mice have viable spirochetes in their body, since immunosuppressive treatment allows B. burgdorferi to be detected by culture. However, the niche of the persisting spirochetes remained unknown. In the present study, we analyzed the tissues of B. burgdorferi‐infected and ceftriaxone‐treated mice by culture and PCR to reveal the foci of persisting spirochetes. C3H/HeN mice were infected via intradermal needle injection with B. burgdorferi s.s. N40. The mice were treated as follows: (i) short (5 days) and (ii) long (18 days) course of ceftriaxone at 2 weeks of infection and killed after either 10 or 30 weeks, or (iii) the mice received ceftriaxone for 5 days at 18 weeks of infection and were killed 21 weeks after the treatment. All samples of ceftriaxone‐treated mice were culture negative, whereas all untreated controls were culture positive. Importantly, B. burgdorferi DNA was detected in the joints of 30–100% of the treated mice. In conclusion, these results combined with earlier results suggest that the joint or a tissue adjacent to the joint is the niche of persisting B. burgdorferi in ceftriaxone‐treated mice.     

Mexiletine for the Management of Ventricular Arrhythmias in Ischemic Heart Disease

Mexiletine, a type IB anti arrhythmic agent, has recently been released in the United States for use in the oral treatment of ventricular arrhythmias. It is as effective as other group IB and LA drugs, and less effective than group 1C agents such as propafawne, flecainide, and amiodarone; however, it has the advantage of being associated with fewer serious adverse effects. Mexiletine will control ventricular tachycardia in patients with drug-resistant arrhythmias in 20–30% of cases; in unselected populations it may abolish VT in 50–96%. It is recommended that mexiletine be combined with beta blockers and/or group IA drugs for treating resistant arrhythmias. Efficacy may be increased and adverse side effects reduced through use of smaller dosages and combination therapy.     

Bullying at school—an indicator of adolescents at risk for mental disorders

A number of 14–16 year old Finnish adolescents taking part in the School Health Promotion Study (n=8787 in 1995, n=17643 in 1997) were surveyed about bullying and victimization in relation to psychosomatic symptoms, depression, anxiety, eating disorders and substance use. A total of 9 per cent of girls and 17 per cent of boys were involved in bullying on a weekly basis. Anxiety, depression and psychosomatic symptoms were most frequent among bully-victims and equally common among bullies and victims. Frequent excessive drinking and use of any other substance were most common among bullies and thereafter among bully-victims. Among girls, eating disorders were associated with involvement in bullying in any role, among boys with being bully-victims. Bullying should be seen as an indicator of risk of various mental disorders in adolescence.     

The activation of the inflammatory cytokines in overweight patients with mild obstructive sleep apnoea

It is widely accepted that obstructive sleep apnoea (OSA) is linked with cardiovascular diseases. The relationship is complex and remains still poorly understood. The presence of chronic systemic inflammation has been connected with pathogenesis of both OSA and cardiovascular diseases. While atherogenesis is believed to be a process of many years, little is known about the potential impact of the largest OSA subgroup, mild OSA, on the development of cardiovascular diseases. The aim of the present study was to assess whether untreated mild OSA is associated with an activation of inflammatory cytokine system. The adult study population consisted of two groups: 84 patients with mild OSA [apnoea–hypopnoea index (AHI) 5–15 h^?1] and 40 controls (AHI <5 h^?1). Serum concentrations of pro‐ and anti‐inflammatory cytokines were measured before any interventions. After adjustments for age, sex, body mass index, fat percentage, most important cardiometabolic and inflammatory diseases, and non‐steroidal anti‐inflammatory medication, the mean level of tumour necrosis factor‐α was significantly elevated (1.54 versus 1.17 pg mL^?1, P = 0.004), whereas the level of interleukin‐1β (IL‐1β) was reduced (0.19 versus 0.23 pg mL^?1, P = 0.004) in patients with mild OSA compared with controls. The concentrations of the protective anti‐inflammatory cytokines, interleukin‐10 (1.28 versus 0.70 pg mL^?1, P < 0.001) and interleukin‐1 receptor antagonist (478 versus 330 pg mL^?1, P = 0.003) were elevated in the OSA group. The concentrations of C‐reactive protein increased, but IL‐1β decreased along with the increase of AHI. Mild OSA was found to be associated not only with the activation of the pro‐inflammatory, but also with the anti‐inflammatory systems.     

Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients

Tapiainen T, Kujala T, Kaijalainen T, Ikäheimo I, Saukkoriipi A, Renko M, Salo J, Leinonen M, Uhari M. Biofilm formation by Streptococcus pneumoniae isolates from paediatric patients. APMIS 2010; 118: 255–60. The clinical significance of pneumococcal biofilm formation is largely unknown. To clarify this, we tested whether the ability of pneumococcal clinical isolates to form biofilm in vitro accounts for the diverse clinical outcomes. Clinical pneumococcal isolates were cultured from the nasopharynx (n = 106), middle ear effusion (n = 43) and blood (n = 55) of 204 children altogether. Biofilm formation, assessed by measuring optical density (OD) values in microtitre plates after crystal violet staining, did not differ between the bacteria from different sources (p = 0.18), the mean OD values of the isolates being 0.119 [95% confidence interval (CI) 0.100–0.138] in the nasopharynx samples, 0.094 (95% CI 0.069–0.119) in the acute otitis media cases, 0.109 (95% CI 0.077–0.141) in the secretory otitis media cases, 0.122 (95% CI 0.084–0.160) in those with sepsis and 0.175 (95% CI 0.071–0.280) in those with other invasive infections. Serotypes 33 and 14 were the most efficient in forming biofilms, whereas serotypes 3 and 38 were poor biofilm producers. We conclude that the clinical presentation of pneumococcal disease did not differ in relation to biofilm formation in vitro, even though there was marked variation between the clinical isolates and serotypes.