The effect on immunity of long-term intensive training in elite swimmers

The impact of long-term training on systemic and mucosal immunity was assessed prospectively in a cohort of elite swimmers over a 7-month training season in preparation for national championships. The results indicated significant suppression (P < 0.05) of serum IgA. IgG and IgM and salivary IgA concentration in athletes associated with long-term training at an intensive level. There was also a trend towards lower IgG2 subclass levels in serum in athletes compared with controls (P= 0.07). There were no significant changes in numbers or percentages of B or T cell subsets, but there was a significant fall in natural killer (NK) cell numbers and percentages in athletes over the training season (P < 0.05). After individual training sessions there was a significant decrease in salivary IgA levels for athletes compared with controls (P= 0.02). In athletes there was a downward trend in salivary IgA levels over the 7-month training period in both the pre-exercise (P= 0.06) and post-exercise samples (P= 0.04). There were no significant trends in salivary IgG levels over the study period in either athletes or controls. The only significant change in salivary IgM levels was an increase in detection rate in the pre-competition phase in athletes (P= 0.03). The study suggests that training of elite athletes at an intensive level over both short- and long-time frames suppresses both systemic and mucosal immunity. Protracted immune suppression linked with prolonged training may determine susceptibility to infection, particularly at times of major competitions.     

Aortic root abscess in Actinobacillus actinomycetemcomitans endocarditis: non invasive diagnosis and successful outcome following early surgery

The case described is the first in which Actinobacillus actinomycetemcomitansendocarditis affecting the aortic valve was complicated by aorticroot abscess formation. The diagnosis was supported by the developmentof complete left bundle branch block, the presence of pericarditisand the two-dimensional echocardiographic appearance. Earlysurgery was performed and the diagnosis confirmed. The patientmade full recovery.     

A clinical evaluation in children of the Pharmacia ImmunoCAP system for inhalant allergens

Background The Pharmacia ImmunoCAP system (CAP) for assaying serum IgE specific antibodies was evaluated in a clinical setting against skin-prick test (SPT) perfonncd using Dome/Hollister-Steir allergen extracts. The five cotnmon inhalant allergens D. pteronyssinus. D. farinae, mould mix, grass mix and cat epithelium were tested concurrently by both methods in 167 children aged 7.5–12 years. The specific SPT for D. pteronyssinus and D. farinae were also tested against the CAP house dust mite (HDM) mix. Objective The purpose of the study was to determine the sensitivity and specificity of the Pharmacia ImmunoCAP system Tor detecting serum IgE specific antibodies to inhalant allergens in a clinical setting, using the SPT result as the ‘gold standard’. Methods The SPTs were performed using Dome/Hollister-Steir allergen extracts. The serum IgE specific antibodies were quantitated using the radioimmunoassay version of the Pharmacia ImmunoCAP system. A history of allergic disease was assessed using a validated questionnaire. Results SPT gave more positive reactions than CAP with the exception of cat epithelium. The concordance between SPT and CAP results was 91% over all the tests. The concordance with SPT was slightly higher for the specific CAP for D. pteronyssinus and D. farinae (93% and 95% respectively) than for the CAP HDM mix (86% and 90% respectively). There was a higher proportion of positive results for both SPT and CAP in the 115 children defined as having a history of allergic disease. Using SPT defined allergy as the gold standard, the sensitivity of the CAP system was 87% for the two specific house dust mites but was lower for cat epithelium (67%), mould mix (59%) and grass mix (46%). The sensitivity of the CAP system improved for D. pteronyssinus (96%) and the HDM mix (91%) when tested in subjects defined as having a history of allergy associated disease. The specificity of the CAP system showed less variation between allergens and ranged from 90–99%. Conclusion The results of this study of children aged 7.5–12 years demonstrate that, for the inhalent allergens tested, the Pharmacia ImmunoCAP system perfoms well in the setting of known allergic disease.     

The Variability of Immunoglobulins and Albumin in Salivary Secretions of Children

The variation of concentrations of immunoglobulins and albumin in consecutive daily collections of saliva was studied in 33 infants, aged 6 months to 5 years, for periods ranging from 16 to 26 days. The concentration and the within-child variability of IgA and albumin and the detection of IgG and IgM in saliva increased with age. Between-child variances were greater than the within-child variances by a factor of 2.8 for log (IgA) and 1.3 for log (albumin). The geometric mean IgA levels were consistently higher and IgG was detected more frequently during upper respiratory tract infections compared with periods of non-infection. There were no changes in albumin levels between infection and non-infection periods, suggesting a local immune response rather than serum leakage. There were significant within-child correlations (autocorrelations) between levels of IgA in saliva collected on consecutive days and samples collected up to 3 days apart. The autocorrelations between levels of albumin were significant for samples collected up to 2 days apart. The autocorrelation for IgA was significantly greater during infection periods compared with non-infection periods for samples collected on consecutive days.     

ULTRAVIOLET ACTION SPECTRUM WITH A PRISM-GRATING MONOCHROMATOR

SUMMARY.— A prism-grating monochromator has been assembled for use with various xenon or xenon–mercury radiation sources. The main advantage of the double monochromator is the low level of stray radiation. The disadvantage of the double instrument is the lowered intensity of radiation at the final exit; comparisons of various arc sources showed that a 2·5 kW xenon–mercury lamp gave adequate output in the ultraviolet (UV) range for action spectra studies. The UV action spectra were determined in normal subjects at 8 and 24 hr. and the results have been compared with those of other investigators.     

Management of Major Coronary Artery Dissection Complicating Percutaneous Transluminal Coronary Angioplasty-Successful Application of Two New Techniques

Percutaneous transluminal coronary angioplasty may be complicated by the occurrence of major coronary artery dissection, which may precipitate critical myocardial ischemia, necessitating urgent surgical intervention. We report two cases of massive dissection following angioplasty, in which novel methods were used to stabilize arterial integrity. In the first, laser balloon angioplasty was used to repair the dissection; in the other, a coronary stent was inserted. In both cases, coronary artery patency was achieved with reperfusion of the distal coronary bed, thus avoiding the need for acute surgical intervention. Both patients are free of limiting symptoms at follow-up.     

Action spectra of topical psoralens: a re-evaluation

The action spectra for producing minimal phototoxic erythema with topical 0 1% trimethyl psoralen (TMP) and 8-mcthoxypsoralen (8-MOP) were determined with a double monochromator in the range of 295–380 nm. Both psoralens induced photosensitivity in the range of 313–365 nm; TMP was 54% more effective than 8-MOP. There was no difference in the dose needed to produce minimal UV erythema or phototoxic erythema with 8-MOP and TMP at 295 and 305 nm, but at 313 nm with 8-MOP, photosensitivity was enhanced 3.5 times, and with TMP, sensitivity was enhanced 55 times. The peak sensitivity with 8-MOP was at 330 nm and for TMP it was 335 nm. No photosensitivity occurred above 380 nm. Results suggest that TMP and 8-MOP are significantly photoreactive at 320–335 nm. Commonly used UV-A light sources show peak emission around 360 nm. If there is a relationship between development of erythema and therapeutic effectiveness then this raises the possibility of alternative UV light sources for phototherapy with psoralens.