Immunomodulation by LongoVital in patients with recurrent aphthous ulceration

LongoVital (LV) (DK. Reg. No. 5178/75) is a herbal based tablet enriched with recommended doses of vitamins. Peripheral lymphocyte subsets: T-helper/CD4 (OKT4+) and T-suppressor/cytotoxic/CD8 (OKT8+) were studied quantitatively in 31 otherwise healthy patients with minor recurrent aphthous ulceration (RAU) during 6 months' daily LV intake in a double-blind, randomized, crossover 1-year study. Fourteen had had LV during the first 6 months (GrA) and 17 LV during the latter 6 months (GrB). OKT4+ percentages increased significantly during the LV period in both groups (P less than 0.05). OKT8+ percentages increased in both groups, however, only significantly in GrA (P less than 0.05). It is concluded that LV acts as an immunostimulator in patients with RAU and that the increase in T-lymphocyte subsets may account for the previously reported benefit of LV in RAU prevention.

LongoVital in the prevention of recurrent aphthous ulceration

LongoVital (LV) (DK. Reg. No. 5178/75) is a herbal based tablet enriched with recommended doses of vitamins. The present study was undertaken to investigate prevention of recurrent aphthous ulceration (RAU) during 6 months' daily intake of LV as compared with placebo in a double-blind, randomized clinical, cross-over 1-yr study. The population comprised 29 otherwise healthy minor RAU patients (18 F, 11 M), mean age 36 (18-67), with an estimated average number of recurrences the previous year of 12.8 (3-30). The number of recurrences was significantly reduced on LV the latter 4 of the 6 months (P less than 0.01) where 31% were totally free of recurrences. Subjective all-over evaluation of treatment period was significantly in favor of LV. LV induced no adverse reactions and is the first harmless systemic treatment which has proved better than placebo in the prevention of RAU.

Prognosis of late versus early ventricular fibrillation in acute myocardial infarction

To determine the prognosis of late ventricular fibrillation (VF) after acute myocardial infarction (AMI), the length of the monitoring period after AMI was extended. All patients in this series were continuously monitored in a coronary care unit to ensure observation of all VF within 18 days of AMI. From 1977 to 1985, 4,269 patients were admitted with AMI and 413 (9.6%) had in-hospital VF. Of these 281 (6.8%) had early VF (less than 48 hours after AMI) and 132 (3.2%) had late VF (greater than or equal to 48 hours after AMI). In-hospital mortality was 50 and 54% for early and late VF, respectively (p = 0.31). Kaplan-Meier survival analysis showed better survival after discharge for patients with early versus late VF (p = 0.009) but this difference was fully explained by the presence of heart failure. Survival analysis showed the same prognosis after 1, 3 and 5 years for early and late VF, when VF was not associated with heart failure. When VF was associated with heart failure (secondary VF) early VF had a greater mortality than late VF after 2 and 5 years. Logistic regression analysis showed that heart failure (relative risk 1.9 [1.1 to 3.1]) and cardiogenic shock (relative risk 3.9 [1.8 to 8.5]) were significant risk factors for in-hospital death. Late VF compared to early VF had no prognostic implication (relative risk 1.0 [0.6 to 1.6]). For patients discharged from the hospital, risk factors were heart failure (1.8 [1.1 to 2.8]) and previous AMI (1.6 [1.3 to 2.1]).(ABSTRACT TRUNCATED AT 250 WORDS)

Effect of doxapram on postoperative pulmonary complications after upper abdominal surgery in high-risk patients

In a double-blind randomised trial an infusion of doxapram, 2 mg per min for 6 h immediately after surgery and repeated on the first postoperative day, or the same volume of saline, was given to 39 patients who underwent upper abdominal surgery and who were at high risk of postoperative day, or the same volume of saline, was given to 39 patients who underwent upper abdominal surgery and who were at high risk of postoperative pulmonary complications. The patients were assessed pre-operatively and during the first 5 postoperative days by physical examination, spirometry, blood-gas analysis, and chest radiography. Postoperative pulmonary complications were defined as temperature over 38 degrees C for 2 days, abnormal auscultation, pathological radiography, and/or productive cough. Data from 16 patients per group were analysed. Significantly more patients in the placebo group had three criteria of postoperative pulmonary complication compared with the doxapram group (63% vs 19%). The doxapram group also had higher PaO2 postoperatively.

Feasibility of intracardiac injection of drugs during cardiac arrest

In a cardiological department (Coronary Care Unit) routine treatment of asystole and electromechanical dissociation has comprised intracardiac injection (ICI) of drugs, usually given by trained nurses, using the parasternal approach into the right ventricle, followed by continued external cardiac massage. A 7-year experience is presented with 543 consecutive ICIs to 247 patients. Cardiac action was restored in half of the patients (125/247); 7.7% (19/247) were discharged alive. Autopsy was done in 80% of fatal cases (182/228). A left-sided pneumothorax was demonstrated in 9 of the 80 patients surviving ICI for greater than 1 h, a minor haemopericardium in three, but serious consequences in none. Lesions of the coronary artery or of the myocardium attributable to the ICI were never seen. Asystole in some patients was converted into ventricular fibrillation or ventricular tachycardia which in six patients proved intractable, but other serious cardiac arrhythmias having a possible connection with the ICI were not observed. It is concluded that during a cardiac standstill, drug treatment by ICI with good technique carries a low risk, quite acceptable in these circumstances, and from a theoretical point of view can be expected to have advantages over administration of the drug into a peripheral vein.

[Carcinoma in situ and carcinoma in patients with chronic oral candidiasis]

Chronic oral candidiasis is generally not considered a premalignant condition. We report on two patients with carcinoma in situ and carcinoma in the soft palate, probably preceded by long lasting chronic Candida infection. The first patient was a 56-year-old woman who suffered from disturbances in the calcium and potassium metabolism and high blood pressure due to a previous goiter operation during which the parathyroids had been removed. She also suffered from bronchitis and had been smoking 12 cigarettes a day for many decades. For several years she had had more or less constant symptoms from airway infections. Increasing symptoms from the throat had developed 2 years before referral and, in this period, she had been in constant antifungal therapy with no effect on the symptoms. Objectively, the entire soft palate, uvula and the palatoglossal arches were fiery red with whitish plaques which were not removable (Fig. 1). A biopsy revealed severe dysplasia and focal carcinoma in situ Subsequently, the lesion in the soft palate was partly removed by laser surgery followed by radiation therapy over a period of 2 month. One year later there was no signs of recurrence (Fig. 4). The second patient, a 53-year-old healthy woman, was referred because of difficulties in eating due to pain in the throat which had existed for 2 years. Without any effect on the symptoms, she had had antifungal therapy for 4 weeks. The patient had been smoking 15 cigarettes a day for many years. Objectively, an area with whitish plaques and nodules on an erythematous background was found (Fig. 5).(ABSTRACT TRUNCATED AT 250 WORDS)

[Treatment of acute myocardial infarction--an elucidative report]

The present-day optimal treatment of patients with acute myocardial infarction (AMI) is reviewed. The prehospital phase should be as brief as possible. Emergency observation and treatment in hospital should be initiated without delay. Schematic stages for mobilization have been discarded and free mobilization is recommended. Routine acute intervention with thrombolysis is recommended for patients in whom symptoms have been present for 6-12 hours and treatment with Aspirin is recommended. Beta-blocking agents are recommended for patients with increased risk after discharge. Treatment of ventricular and supraventricular arrhythmias, block and cardiac failure are reviewed in detail. Patients without complications should be monitored for three to five days and may be discharged after seven to ten days. Exercise ECG should be carried out at discharge to assess the working capacity, ischaemia and subjective reaction. The importance of good patient information is emphasized. Cessation of smoking, control of lipids and blood pressure are important as secondary interventions. As far as possible, outpatient control should be offered after discharge. The criteria for referral to specialized cardiological departments are established both for emergency and elective referral. Patients under the age of 70 years with high risk for repeated AMI or death after discharge (with residual ischaemia) should possibly be referred for coronary arteriography.

The time factor in resuscitation initiated by ambulance drivers

This study is concerned with the value of basic CPR (manual ventilation and closed chest cardiac massage) initiated within 5 min in delaying brain damage after cardiac arrest in adult patients at ambient temperature. In 88 cases of cardiac arrest, basic CPR was initiated within 5 min of collapse by trained ambulance personnel. Basic CPR was continued during transport to the hospital in ambulances not equipped with defibrillators. Advanced CPR was instituted in all patients upon hospital arrival. All 11 patients eventually discharged from the hospital without apparent brain damage arrived at the hospital within 10 min of cardiac arrest. A significant number of patients arriving later could be resuscitated acutely but later died unconscious or were discharged with severe brain damage. We conclude that basic CPR, including bystander CPR initiated within 5 min of cardiac arrest is likely to be of long-term value only if definitive advanced life support can be provided within 10 min after the patient's collapse.

Intraoral infection with Mycobacterium chelonae. A case report

An 8-year-old girl had a visibly enlarged submandibular lymph node and a reddish, spongy swelling of the gingiva in the upper right canine region. Culturing of the gingival tissue resulted in the isolation of Mycobacterium chelonae, and the patient showed a specific skin hypersensitivity reaction to M. chelonae sensitin. The gingival swelling disappeared spontaneously without scarring within 5 weeks after the biopsy. There was no recurrence intraorally during the 2 1/2-year follow-up, the generalized lymphadenopathy subsided within 2 years, and at the last visit, the submandibular lymph node could barely be felt. The patient received no medication during the course of the disease. A tortoise held as a pet by the girl could possibly have been the source of infection since iatrogenic sources of infection could be excluded.

Psychologic stress and recurrent aphthous ulceration

The present study was undertaken in order to test the hypothesis that psychological stress is a provoking factor in attacks of recurrent aphthous ulceration (RAU). The population consisted of 22 patients (17 women, 5 men; mean age 39 yr, variation 17-69) with minor RAU. Psychologic stress was evaluated by means of the social readjustment rating scale (SRRS) and a visual analog scale (VAS). In each subject evaluation took place twice: once in the presence of new ulcer(s) and once in the absence of subjective and objective symptoms of RAU. At both stages, the SRRS scores were obtained on the basis of the preceding 2 wk and, VAS scores on the basis of the preceding week. The results showed no statistically significant differences in neither SRRS nor VAS scores between the two stages. Thus, no association between psychologic life stress and recurrences of RAU could be demonstrated, and it is concluded that more standardized circumstances are needed if any such association should be demonstrated.

T-lymphocyte subsets in recurrent aphthous ulceration

Peripheral T-lymphocyte subsets: T-helper (OKT4) and T-suppressor (OKT8) cells were studied quantitatively in 20 patients with recurrent aphthous ulceration (RAU) in ulcerative, as well as inactive, stages of the disease. The figures were compared with T-lymphocyte subsets from matched control donors with no history of RAU. The ratio of T-helper: T-suppressor cells was significantly lower in both stages in the patients compared with controls due to a significantly increased number of T-suppressor cells in RAU patients. The number of T-helper cells in the patients did not differ significantly in either stage compared with controls. The study support the hypothesis of recurrent aphthous ulceration being a disorder of immunodeficiency.

Rapid radiometric detection of mycobacterial growth from smear-positive tissue samples from pigs

Rapid demonstration of mycobacteria in slaughter pigs is important for medical, epidemiological and economic reasons. The Bactec radiometric system detected more mycobacteria in less time than conventional culture on solid medium.

Reported adverse reactions to and consumption of nonsteroidal anti-inflammatory drugs in Denmark over a 17-year period

Over the 17-year period 1969-1985, 2,721 reports of 3,521 suspected adverse drug reactions (ADRs) associated with non-steroidal anti-inflammatory drugs (NSAIDs) were submitted to the Danish Committee on ADRs. The results are presented together with the consumption of each drug during the same period. The total sale of NSAIDs showed a four-fold increase during the 17 years, the average corresponding to a permanent intake by 2.2% of the population. The number of reported ADRs per defined daily dose (DDD) sold was markedly lower for "older" drugs like the butazones, indomethacin, ibuprofen, naproxen, ketoprofen, and fenoprofen than for the drugs marketed during the last decade. These differences could not be accounted for by the well-known biases attached to spontaneous ADR reporting. Of 67 fatal reactions, 25 were due to bleeding or perforation of a gastric ulcer, mostly during treatment with indomethacin and naproxen, and in elderly people, and 27 were caused by bone marrow depression or leukaemia, begun mostly during treatment with butazones, but some with indomethacin and naproxen as well. It is pointed out that all reports on fatal bone marrow depression associated with butazones were submitted before 1976 and that the fact that none have been received since that time could be a result of better understanding of the proper dosage of the drug.(ABSTRACT TRUNCATED AT 250 WORDS)

Infection with Rhodococcus equi in a patient with sarcoidosis treated with corticosteroids

A 51-year-old female farmer was diagnosed as having sarcoidosis. During 4 years of observation, slow radiological progression was observed. Cough then developed, necessitating treatment with corticosteroids. After 28 months of continuous treatment with prednisolone in low doses (5-7.5 mg daily), she suffered fever episodes, recurrent haemoptyses, general malaise and loss of weight. A chest roentgenogram showed a left upper lobe infiltrate, which progressed and finally cavitated, and rib destruction. Despite efforts, including a thoracotomy, 22 months passed before a diagnosis could be made. Blood and sputum cultures and cultures from the destroyed rib showed growth of Rhodococcus equi, a common soil organism which can cause infections in foals and other animals. Treatment with rifampicin and erythromycin was successful. R. equi has been reported to cause infection in patients with neoplastic disease and/or immunosuppression, but the disease might be more common than is suggested by the sparse case reports in the literature, owing to lack of familiarity with the organism, which will tend to be overlooked as a contaminant.

Long-term evaluation of 211 patients with internal derangement of the temporomandibular joint

This report is a long-term evaluation of 211 patients (158 women, 53 men) with TMJ clicking and/or TMJ incoordination, treated at the University Hospital of Copenhagen, Denmark, in the years 1971-77. Information on present symptoms and the effect of the initial treatment was obtained from questionnaires. Standard treatment procedures had been used in 153 patients while 58 patients had had counseling only. In the actively treated group, 59% were still doing well, 30% had unchanged symptoms and 5% experienced aggravated symptoms. In the counseled group, 40% were free of symptoms, 50% had unchanged symptoms and 7% aggravated symptoms. A highly significant association was found between the absence or presence of symptoms at the end of treatment according to patient records and the evaluation of the initial effect of treatment 8-15 yr later, which indicates that reliable results can be expected from a long-term evaluation of TMJ dysfunction patients. In the sample as a whole, the frequency of TMJ sounds was unchanged compared to the time of treatment (64% vs 66%). A significantly higher frequency was, however, found in the untreated group, indicating that treatment might have a positive effect on TMJ sounds. The frequency of recurrent headache had increased considerably over the years (6% vs 34%), 32% still experienced pain/tenderness on mandibular movement, 24% suffered from impaired mandibular mobility and 82% were aware of bruxism/clenching of teeth. Furthermore, we found a significant association between headache before treatment and headache, awareness of bruxism and clenching of teeth at the time of evaluation.(ABSTRACT TRUNCATED AT 250 WORDS)

Internal derangement of the temporomandibular joint in 211 patients: symptoms and treatment

This report is a retrospective evaluation of 211 patients (75% women, 25% men) treated for TMJ clicking and/or TMJ incoordination at the University Hospital, Copenhagen, in 1971-77. In both sexes, the age group 20-30 yr dominated and the main part of the population belonged to the social middle class. The reasons for seeking treatment were mainly TMJ sounds, pain and impaired mandibular mobility. Neither subjective complaints nor objective signs of dysfunction were associated with dental/occlusal status or with the presence of malocclusions. The patients had been treated with reversible modalities (65%), occlusal adjustment (8%) and counseling alone (27%). Of the actively treated patients, 43% had experienced relief within 1 month and at the end of treatment 72% had reduced or no symptoms. It was not possible to demonstrate any association between the duration of symptoms before treatment and the duration of treatment/number of consultations.

Right and left ventricular ejection fractions: relation to one-year prognosis in acute myocardial infarction

Right and left ventricular ejection fractions (RVEF and LVEF) were measured by radionuclide angiography in 423 patients with acute myocardial infarction (AMI). All investigations were performed at hospital discharge. Of 304 patients with first AMI, 26% had normal ejection fractions, 10% had a decrease in RVEF only, 46% a decrease in LVEF only, and 18% decrease in both RVEF and LVEF. Death from cardiac causes occurred in 52 patients in a one-year follow-up period. A reduced RVEF at hospital discharge had little, if any, relation to one-year mortality. In contrast, there was an inverse curvilinear relationship between LVEF and one-year cardiac mortality.

No increased incidence of postoperative sore throat after administration of suxamethonium in endotracheal anaesthesia

Sixty patients were divided into two groups (A and B) of 30 patients each to investigate the effect of using suxamethonium in endotracheal anaesthesia on the incidence of postoperative sore throat. The patients were anaesthetized with thiopentone, fentanyl, droperidol, N2O and pancuronium. Before endotracheal intubation with a Mallinckrodt lo-pro-tube, patients in Group A were given pancuronium, whereas patients in Group B were given suxamethonium. There was no difference in the incidence or severity of sore throat 20-30 h postoperatively between the two groups (P = 0.5). The type 2 error (beta) was low (the risk of overlooking a "true" difference in incidence of 0.20 was calculated to be 0.04). These results contradict those of a recent study, which demonstrated an increased incidence of postoperative sore throat following the use of suxamethonium in mask anaesthesia.

Colony formation by subpopulations of human T lymphocytes. VI. Further studies on colony phenotype, function, and cloning efficiency

Phytohemagglutinin (PHA)-induced colony formation in semisolid agar medium by human peripheral blood T lymphocytes showed an increasing cloning efficiency with decreasing numbers of cultured cells. Ninety percent of CD4+ cells (inducer/helper phenotype) and 20% of CD8+ cells (cytotoxic/suppressor phenotype) formed colonies when cultured at 10-200 cells/ml culture in the presence of sheep red blood cells (SRBC) and a source of interleukin-2 (IL-2). Probably all T-colony-forming cells, but none of the subsequent colony cells, expressed the Leu-8 antigen. The cloning efficiencies of FACS-sorted cells expressing the natural killer antigenic phenotypes Leu-7+ and CD16+ were found to be less than 1%. The costimulatory effect of red blood cells for colony formation was specific for SRBC and not observed in the presence of red cells obtained from seven other species including man. All T-lymphocyte colonies obtained from unseparated peripheral blood mononuclear cells expressed the CD25 antigen (IL-2 receptor) and colonies were always composed of either CD4+ or CD8+ cells. None of the colony cells expressed the Leu-8 or the CD16 antigens. By their specific morphology in agar culture the majority of colonies composed of CD4+ cells were easily recognized, but but approximately one-third of the CD4+ colonies could not be distinguished from colonies composed of CD8+ cells. On expansion of individual colonies in liquid subculture in the presence of interleukin-2, approximately 15% of the colonies developed natural killer (NK)-like cytotoxic activity, being capable of direct killing of K562 tumor cells. It is concluded that the present method for growing human T colonies exhibits the same cloning efficiency as the most efficient liquid culture systems. Individual T colonies are composed exclusively of T inducer/helper or T cytotoxic/suppressor cells, they are never of mixed phenotype, and they do not contain cells of natural killer phenotype. Regulatory mechanisms influencing colony formation are operating between and within the various subsets of T lymphocytes.

In vitro interactions of murine peritoneal macrophages and sarcoma cells. I. Promotion of tumor cells proliferation by macrophages

An ascites subline (AA) of the murine sarcoma MC1M grows in vivo in the peritoneal cavity but dies in vitro when cultured on glass or collagen. The viability of AA cells in vitro is not influenced in cocultures with fibroblast cell line L929, and is diminished in cocultures supplemented with macrophage culture supernatant or in cocultures with non-adherent peritoneal cells. However, AA cells proliferate in vitro on glass or collagen when cocultured with syngeneic, semisyngeneic, and allogeneic peritoneal macrophages. This was demonstrated by tritiated thymidine incorporation assay, by AA cell number counting, and by measuring AA cell protein content. Proliferation also occurs when AA cells are separated from the macrophage monolayer by millipore filters.

Diagnostic and prognostic implications of transient isolated negative T waves in suspected acute myocardial infarction

The diagnostic and prognostic implications of transient isolated negative T waves were studied in 127 patients in whom acute myocardial infarction (AMI) was suspected. Eight-four patients with no AMI and no electrocardiographic changes served as the control group. The 2 groups were well matched. Twenty-nine patients (23%) with isolated negative T wave had a significant increase in serum creatine kinase (CK)-MB levels and fulfilled the diagnostic criteria for AMI. The increase in serum CK-MB levels did not predict a higher risk of hospital mortality, but during follow-up (median 31 months), a serum CK-MB level above 30 U/liter identified patients with a significantly increased risk of dying (p less than 0.05). Both the number of affected electrocardiographic leads and the sum of negative T-wave amplitudes were significantly related to the follow-up mortality rate (p less than 0.01). The comparison between control subjects and patients with negative T waves during follow-up showed more events among the patients: AMI (17% vs 8%, p less than 0.02); death (24% vs 12%, p less than 0.01); and AMI or death (31% vs 19%, p less than 0.01). Thus, only 25% of patients with aggravated chest pain and isolated negative T waves have AMI. However, the long-term prognosis for the entire group of patients with isolated negative T waves is poor, and any therapeutic intervention should be initiated immediately.

Volumetric determination of extraoral swelling from stereophotographs. A method study in the buccal area

A stereophotographic method for volumetric determination of the extraoral swelling after mandibular third molar removal is developed. The method error was 1.0 cm3. Compared to the size of the maximal swelling after removal of impacted wisdom teeth, this error is considerable. The technique can, however, be improved and furthermore applied to measurements of volume changes in other cranio-facial areas, as well as in other parts of the body.

Decadronphosphate in the relief of complaints after third molar surgery. A double-blind, controlled trial with bilateral oral surgery

The purpose of the present double-blind study was to investigate the preventive effect of 4 mg dexamethasone (1 ml Decadronphosphate) on swelling, trismus and pain after removal of impacted mandibular third molars. The population comprised 30 healthy individuals (17 female, 13 male) who needed removal of 2 identical, impacted mandibular third molars. Each patient served as his own control as the teeth were removed in 2 sittings with either steroid or placebo injected into the masseter muscle just before starting the operation. Control visits took place 48 h and 7 days after the operations. The results showed that steroid administration led to about 50% reduction of postoperative swelling and trismus and to about 30% reduction of postoperative pain. No general or local complaints/complications occurred due to the steroid injection. It is concluded that prophylactic steroid treatment is effective in reducing postoperative complaints and that the administration is safe in the absence of contraindications for such administration. Prophylactic steroid treatment is therefore recommended in third molar surgery when pronounced postoperative reaction can be expected.

Interrelation of complaints after removal of impacted mandibular third molars

Swelling, pain and trismus were evaluated quantitatively after the removal of impacted mandibular third molars on 30 healthy individuals. Evaluation took place 48 h and 7 days after surgery. The mutual correlation between the complaints was determined as well as the correlation between the length of the operation and the degree of postoperative complaints. It is concluded from the study that the longer the operation takes, the more postoperative pain can be expected. However, neither swelling nor trismus is correlated with the length of time of the operation. The size of the swelling was not related to the degree of trismus or postoperative pain. A strong interrelation between postoperative pain and trismus indicates pain as the main reason for reduced mouth opening after removal of impacted mandibular third molars.

Myocardial infarct size: correlation with cardiac arrhythmias and sudden death

The study was made in order to determine the relationship between myocardial infarct size and the incidence of cardiac arrhythmias during acute myocardial infarction (AMI). In 317 consecutively admitted patients infarct size was estimated from serial serum CK-MB measurements. The ECG was continuously monitored during 18 days in hospital, and all electrocardiographic recordings were analysed daily. All patients were followed up one year after discharge. The median infarct size was larger among the 220 patients with arrhythmias than among the 97 patients without (814 Ul-1 vs 419 Ul-1, P less than 0.0001). There was a significant relationship between the estimated infarct size and the following arrhythmias: ventricular ectopic beats, sinus tachycardia, and atrioventricular block, whereas supraventricular ectopic beats showed no such relation. Patients with heart failure, however, had a high incidence of ventricular arrhythmias regardless of the size of their infarcts. The follow-up study demonstrated that the ventricular arrhythmias positively correlated with infarct size were also associated with significantly increased one-year mortality among hospital survivors. Thus, the present study indicates that not only pump failure, but also cardiac arrhythmias are connected with the negative influence of infarct size on prognosis.

Glucocorticosteroids and oral medicine

The article deals with the use of glucocorticosteroids in the treatment of the oral manifestations of Systemic Lupus Erythematosus (SLE), Discoid Lupus Erythematosus (DLE), Rheumatoid Arthritis (RA) in the temporomandibular joint, Pemphigus Vulgaris, Pemphigoid, Erythema Multiforme Exudativum (EME), Lichen Planus (LP), and Recurrent Aphthous Ulcerations (RAU). The benefit from steroids is discussed on the basis of current knowledge of etiology and pathogenesis of the various disorders. All of them are characterized by inflammation which appears secondary to a hypersensitivity reaction against autocomponents. Glucocorticoids do not interfere with the primary disease mechanisms. But it is concluded from the literature, that because of anti-inflammatory and immunosuppressive effects of the hormones, it seems reasonable to profit from steroids as palliatives in acute phases of the diseases and/or as long-term suppressors of the general host defense.

The length of hospitalization after acute myocardial infarction determined by risk calculation

The feasibility of the use of a Cox model for risk assessment of individualized hospital discharge after myocardial infarction was evaluated. First, a previously developed prognostic index computed at the fifth day after admission was tested on a new population of 1140 patients. It was confirmed that after 5 days half of the patients (52%) could be discharged with low risk. Second, a new competing risk variant of the Cox model that updates prognosis according to the occurrence of complications was developed that describes the risk of death, cardiac arrest, and cardiogenic shock within 44 days after hospital admission. With a risk of one of these events being below 2% during a 14 day period after proposed discharge, 453 patients of 966 survivors (47%) could be discharged after only 5 days. A longer stay (of up to 30 days) was proposed for 338 patients (35%) to achieve the same level of risk. The savings in hospitalization days would be 15%. These results were confirmed in a new sample of 197 patients from the same institution who were discharged according to the proposed system. Of the 169 day 5 survivors, 67% were discharged on days 6 through 15 and this resulted in only two unexpected deaths and a 20% savings in hospitalization days. We conclude that individually determined discharge time is feasible without increased risk of death of severe complications after early discharge.

Effect of physical training on exercise hemodynamics in patients with stable coronary artery disease. The use of impedance cardiography

Seventeen consecutive patients with stable coronary artery disease with a previous history of myocardial infarction were studied for evaluation of the effect of physical training on exercise hemodynamics. The patients were divided into two groups: Group A (n = 10), the control group and Group B (n = 7), the rehabilitated group. Patients in Group B had physical training for five months. The mean exercise time in Group B (trained group) was significantly greater than in Group A (17.0 +/- 3.3 vs 11.6 +/- 3.2, p less than 0.01). Cardiac output was measured by impedance cardiography. The resting hemodynamic parameters were not statistically different between the two groups. At sub-maximal levels of exercise, the blood pressure X heart rate product was the same in both groups. At maximal workload, the heart rate X blood pressure product was the same in both groups, while the cardiac output was significantly greater in Group B compared to Group A (16.0 +/- 5.7 vs 12.1 +/- 3.2 1/min, p less than 0.001). These results suggest that physical training may improve cardiac function during exercise.

Influence of acute myocardial infarct size on acute and one-year mortality

In order to determine the prognostic effect of the size of an acute myocardial infarction (AMI), we prospectively studied a consecutive series of patients below 70 years of age, who had been admitted to the coronary care unit because of clinical suspicion of AMI. In 218 patients the diagnosis AMI was confirmed and the size of their infarcts was estimated from serum CK-MB measurements. In 102 patients the suspicion of fresh AMI was disproven, and they served as a control group. Both groups of patients were similar with regard to distribution of age, sex and coronary risk factors. During one year after discharge, all patients were observed with regard to death. The follow-up was 100% for the one-year observation period. The one-year survival was found to be much better in the patients without AMI on admission than among those with AMI (P less than 0.01). The infarct size was larger among those who died than in those who survived (P less than 0.01); mortality in hospital and within one year was closely associated with the estimated infarct size (P less than 0.01). However, the influence of infarct size on survival decreased with time. After six months there was no difference in the survival rate.

Skeletal scintigraphy and radiography at onset of acute lymphocytic leukemia in children

99mTechnetium skeletal scintigraphy performed at the time of diagnosis was compared with pain and radiographs in 24 children with acute lymphocytic leukemia. Localized intense uptake of the labeled compound in one or several metaphyses and increased uptake in diaphyses were typical findings by scintigraphy. The skeleton of each child was subdivided into 18 regions, and investigated for the presence of pain and for possible radiographic and scintigraphic abnormalities. In a total of 432 regions (18 regions in each of 24 children), pain was present in 23 regions, radiographic anomalies in 54 regions, and abnormal technetium uptake in 98 regions. Signs and symptoms were most often found in the lower extremities. Pain and radiographic or scintigraphic abnormalities were not regularly found in the same skeletal regions. The individual number of radiographic abnormalities was negatively correlated with age, whereas the number of regions with abnormal technetium uptake was positively correlated with age. No significant correlation was found between the number of abnormal scintigraphic or radiographic regions and the clinical outcome of the disease.

Myocardial infarct size and cardiac performance at exercise soon after myocardial infarction

Infarct size was estimated from serial serum CK MB measurements in a series of 101 patients admitted less than 15 hours after the first acute myocardial infarction. A maximal symptom limited exercise test comprising impedance measurements for the estimation of stroke volume at rest and at different levels of exercise was performed early after admission by 26 patients. There was a slight, though not significant, negative correlation between infarct size and physical capability as measured by the duration of work. The rise in systolic blood pressure during exercise showed a significantly negative and the increase in heart a significantly positive correlation to infarct size. This suggests that the rise in blood pressure, which is less in patients with the larger infarcts, is compensated by an increase in heart rate, so that the same maximum of cardiac performance and myocardial oxygen consumption is reached. The increase in cardiac stroke volume during exercise was negatively correlated with infarct size. Stroke volume only increased during lower levels of exercise; the increase in cardiac output at higher levels of exercise was achieved entirely by an increase in heart rate. The magnitude of ST segment elevation during exercise showed a significantly positive correlation with infarct size, whereas the occurrence of arrhythmias during exercise was independent of it.