STUDIES ON PHOTOTHERAPY IN NEWBORN INFANTS

ABSTRACT: Windorfer, A., Faxelius, G. and Boréus, L. O. (Departments of Clinical Pharmacology and Paediatrics, Karolinska Hospital, Stockholm, Sweden). Studies on phototherapy in newborn infants: Influence on protein binding of bilirubin and salicylate and on activity of acetylsalicylic acid esterase. Acta Paediatr Scand 64:293, 1975.– Phototherapy of newborn infants with hyperbilirubinemia was shown to result in an increase in hematocrit values and in the activity of the erythrocyte enzyme acetylsalicylic acid esterase. The elevation of the enzyme activity also could be produced in light-treated rabbits and in vitro after illumination of blood from adult volunteers. The binding of bilirubin to serum albumin and of salicylate to plasma proteins did not alter, nor did the concentrations of albumin or total proteins in plasma. It is concluded that light does not increase the unbound fraction of bilirubin in blood.     

Screening by nurses for aphasia in stroke- the Ullevaal Aphasia Screening (UAS) test

Purpose: In Norway, the speech therapist is responsible for the assessment of language impairment after stroke, but many hospitals have no speech therapist. This study therefore developed and evaluated a simple method to be used by nurses to detect aphasia in the acute stage of stroke; the Ullevaal Aphasia Screening (UAS) test. Method: The study was carried out among 37 stroke patients admitted to an acute stroke unit. They were assessed by nurses using the UAS, while the results of a comprehensive assessment by a speech therapist acted as the 'gold standard'. Results: The predictive value of a positive test was 0.67 and that of a negative test 0.93; only two out of 28 who screened negative on the UAS were diagnosed with mild aphasia by the speech therapist. The weighted kappa coefficient of agreement was 0.83, indicating a strong agreement between the nurses' and speech therapists' scoring. The screening took 5-15 minutes to complete. Conclusion: The Ullevaal Aphasia screening test seems to be a short and valid screening instrument for aphasia in the acute stage of stroke, but further studies would be needed to substantiate the efficacy of the UAS test.     

Acid Nonspecific Esterase in Human Langerhans Cells

Epidermal dendritic cells showing a diffuse activity of acid nonspecific esterase were observed in three cases of mycosis fungoides stage I. As these cells by their appearance and localization resemble Langerhans cells, and dermal histiocytes and macrophages react in the same manner, this is another enzyme cytochemical suggestion of a relationship between Langerhans cells and the monocyte-macrophage-system.     

Atrial Sensing Performance of AV Universal Pacemakers During Exercise

To investigate the atrial sensing function of dual chamber pacemakers during exercise, we studied 57 patients aged 12 to 81 years (m = 65). They were paced for sinoatrial disorders (n = 15), second or third degree AV block (n = 37), or binodal disease (n = 11). The examination was performed 3-24 months (m = 11) after pacemaker implantation. Individual sensing thresholds were determined at rest in the supine position, and proper detection of atrial signals at the programmed sensitivity level was verified during a period of 5-9 minutes (m = 5.8). Without a change in the program of the unit, symptom-limited bicycle ergometry was performed at a maximum load of 25-200 Watts (m = 95) and 6-channel chest wall electrocardiograms were continuously recorded throughout the test, including recovery. During exercise, 25/57 patients (44%) exhibited poor atrial sensing of the pulse generator; after termination of exercise in 16 of the 25 patients, proper atrial sensing resumed within 1 to 7 minutes of recovery. In the remaining nine cases, ergometry was continued after lowering the sensitivity threshold to half the initial setting or, depending on the pacemaker model, by a value of 0.4 mV. This resulted in normal function of the pulse generator in all patients but one, who needed a sensitivity adjustment of another 0.4 mV. In a subgroup of 25 patients, telemetric atrial electrogram recordings were monitored during ergometry, 19 of which could be evaluated quantitatively. Besides random atrial signal variations, presumably due to ectopic beats or runs, a systematic decrease of the peak-to-peak amplitude by 0.1 to 1.6 mV (3-30%) was observed in 16/19 patients during exercise. Mean signal reduction amounted to 11.8% and was statistically significant at the 0.1% level. It is concluded from these findings that, besides testing of atrial sensing at rest, the follow-up of dual chamber pacemakers should include an exercise test.     

Radiofrequency Current Application on Immature Porcine Atrial Myocardium: No Evidence of Areas of Slow Conduction After 12-Month Follow-Up

Electrophysiologic Sequelae 12 Months After Radiofrequency Current Application. Introduction : Radiofrequency current (RFC) application is a widely used procedure for treatment of supraventricular arrhythmias. The purpose of this study was to investigate late electrophysiologic sequelae of RFC lesions at immature atrial myocardium in pigs, as they have not yet been systematically investigated in vitro.
Methods and Results : RFC application (temperature guided) was performed in seven piglets (mean age 6 weeks) by a steerahle 6-French electrode catheter positioned at the lateral aspect of the tricuspid valve annulus. After 12 months, hearts were removed, and lesions with surrounding tissue were isolated. The viable tissue at the border of the specimen was paced with a cycle length of 500 and 600 msec. One hundred fifty impalements were performed on each specimen using capillary microelectrodes to record action potential characteristics from the lesion's surface and the surrounding tissue. In all seven specimens, no transmembrane action potentials from the fibrotic surface of each of the lesions could be recorded. The surrounding viable tissue was sharply demarcated electrically. No areas of slow conduction were detected. Action potential characteristics as mean maximum diastolic transmembrane potential, mean action potential duration at 90% repolarization, and upstroke velocity of phase 0 of the action potential were all normal.
Conclusion : No evidence of areas of slow conduction 12 months after RFC application at immature atrial myocardium suggests that this technique is safe regarding occurrence of late atrial tachyarrhythmias after the procedure.     

Studies on the phagocytic activity of the granulocytes in psoriasis and palmoplantar pustulosis

A kinetic method was used to determine the rates of phagocytosis of IgG-coated and C3b-IgG-coated latex particles by neutrophil granulocytes from twenty patients with psoriasis and twenty with palmoplantar pustulosis (PPP). Patients with psoriasis showed a highly increased rate of uptake of IgG-coated particles. An increased rate was also observed in patients with PPP. These results indicate enhanced Fc-receptor function. In healthy controls the uptake rate of C3b-IgG-coated particles was at least 30% higher than that of particles coated with IgG alone. In nearly half of the patients in the psoriasis and PPP groups the uptake rate failed to increase in the normal way, indicating that C3b dysfunction is common in both psoriasis and PPP. In neither group was there any relationship between the rate of phagocytosis and the clinical severity of the disease.     

Retinol-binding protein in serum and epidermis of patients with ichthyosis vulgaris

Fifteen patients with ichthyosis vulgaris of the dominant type were studied by immunological techniques for the detection of retinol-binding protein (RBP) in serum and epidermis. The serum RBP levels were all within the normal range thus indicating a normal vitamin A status in the blood. The epidermal RBP pattern was abnormal as judged by an indirect immuno-fluorescence technique. It is suggested that the decreased binding of RBP to ichthyosis epidermis is secondary to a reduced number of granular cells and not due to a disturbed vitamin A uptake per se.     

Factors influencing the determination of the occlusal vertical dimension by means of a screw jack

The screw jack method has recently been introduced as a new approach to assessing the occlusal height in edentulous patients. Its use is psycho-physical in nature, and is supposed to rely on neurophysiological mechanisms. Its accuracy has been tested, and it was found to be sensitive to two factors; (i) interactions between dentist and patient, and (ii) to time. More clinical and neurophysiological research is required to refine the method, before it can be expected to replace generally accepted methods.     

Different Substrate Specificities of Plasma Lecithin: Cholesterol Acyl Transferase in Fish Eye Disease and Tangier Disease

ABSTRACT Esterification of plasma free cholesterol is mediated by lecithin: cholesterol acyl transferase (LCAT). The free cholesterol of plasma high density lipoproteins (HDL) is considered to be the preferred substrate for LCAT. It therefore appeared as a paradox that plasma cholesterol esterification, both in vivo and in vitro, is normal in fish eye disease and Tangier disease, two familial conditions with extremely low plasma HDL levels. Fish eye disease plasma, however, was shown to have LCAT activity primarily acting on combined very low (VLDL) and low (LDL) density lipoproteins, denominated β-LCAT, while it lacked LCAT activity esterifying HDL cholesterol (α-LCAT). Here we show that Tangier plasma, in contrast, has both α- and β-LCAT. Thus, in both fish eye and Tangier diseases it is β-LCAT that explains the apparent normal plasma cholesterol estenfication. We also show that Tangier plasma, having α-LCAT activity, normalizes the low cholesteryl ester content as well as the abnormally small size of fish eye disease HDL particles during incubation.