[Incidence of short hamstrings and leg muscles at ages 3-17 years]

In 1991, 769 children and adolescents, 98% of the pupils in the various age groups in seven schools and ten kindergartens on Funen, were examined. Seventy-five percent of the boys and 35% of the girls over the age of ten proved to have such short hamstrings that one knee had a extension deficit without violence of > or = 40 degrees when the hip was flexed 90 degrees. More than 10% of the boys over the age of ten had an extension deficit of > or = 60 degrees. Forty-five children had a difference > or = 15 degrees between the two legs. The triceps surae muscles are too short if the corrected foot can only be pressed slowly to the right angle. This was found to be the case for 25-64% of the children from the age of three to 17. Therefore, we must conclude that it is necessary to allow time in kindergarten and school for the children to stretch their muscles a few minutes daily.

5q-: pathogenetic importance of the common deleted region and clinical consequences of the entire deleted segment

Partial deletion of chromosome 5q (5q-) is a frequent aberration in myelodysplasias and acute nonlymphocytic leukemias. It causes clinical and hematological symptoms termed the 5q-syndrome. Although more than 30 different 5q deletions are described, recent studies have demonstrated 5q31 as the common deleted region and have mapped a tumor suppressor (IRF-1) and a cluster of interleukin genes to 5q31. Furthermore, del(5)(q13q33) is associated with longer survival, which means that 5q segments other than 5q31 also are of importance. These data suggest that loss of the suppressor releases the malignancy, interleukin losses determine the hematology and deletion of other 5q segments affect survival.

[Changes of sexual behavior among Danish homo/bisexual men under the impact of HIV/AIDS epidemic]

In October 1991, 1.567 gay/bisexual men throughout Denmark returned an anonymous questionnaire enclosed in the magazine of the National Gay and Lesbian Association. Most were younger, well educated men living in the Copenhagen area. 76% had been tested for HIV, 15% were infected. As in 1988, the median number of partners in 1991 was 2-5. Eighty-two percent of the sexually active men engaged in anal sex, of these half used condoms consistently. Anal sex was practised more with steady partners and condom use was more common with casual partners. One out of eight had engaged in unprotected anal intercourse with a partner with discordant HIV-serostatus, down from one in three in 1988. It is concluded, that Danish gay men have not further limited their sexual life during the later years. The majority of the respondents have increased sexual safety, but risky sex still prevails among a substantial minority, and safe sex campaigns should continue.

The effect of salmeterol on the early- and late-phase reaction to bronchial allergen and postchallenge variation in bronchial reactivity, blood eosinophils, serum eosinophil cationic protein, and serum eosinophil protein X

The late asthmatic response to bronchial allergen challenge and the associated increase in nonspecific bronchial reactivity provides a model for studying the acute inflammatory mechanisms in asthmatic airways. In 12 asthmatic patients (aged 22-37 years) with known dual reaction to allergen challenge, salmeterol 50 micrograms, 100 micrograms, or placebo was administered as a single dose 10 min before allergen challenge in a double-blind, randomized order on three different study days 2 weeks apart. The bronchial reactivity (BH) to histamine was measured the day before and 24 and 48 h after allergen challenge. Salmeterol significantly inhibited the early (P < 0.02) and the late (P < 0.05) asthmatic reactions. After placebo, mean BH was significantly increased above base line at 24 and 48 h (P < 0.02). After 50 and 100 micrograms salmeterol, BH was less than base line at 24 h and returned to prechallenge values at 48 h. Blood eosinophils increased significantly (P < 0.05) 24 and 48 h after allergen challenge, and no difference was found between treatments. After pretreatment with placebo, serum eosinophil cationic protein (s-ECP) and serum eosinophil protein X (s-EPX) increased significantly (P < 0.05) 24 and 48 h after allergen challenge. After treatment with salmeterol 50 micrograms, s-EPX, but not s-ECP, increased significantly 24 h after challenge, but was normal at 48 h. After salmeterol 100 micrograms, no change in s-EPX or s-ECP was found. The results showed that salmeterol eliminated the allergen-induced dual asthmatic reaction and gave protection against increased BH.(ABSTRACT TRUNCATED AT 250 WORDS)

[Spinal stenosis. A review]

Spinal stenosis is characterized by a broad spectrum of symptoms which are often vague. Therefore, patients suffering from this condition are typically seen by various specialists over a long period of time. Among the symptoms are various degrees of low back pain, neurogenic claudication, parasthesias, muscle weakness and reflex abnormalities. When spinal stenosis is suspected, CT-scanning seems to visualise stenosis well. Because the localisation of the stenosis is often unknown, myelography is still the first choice. CT-scanning can then provide supplementary information regarding the specific location. MR-scanning is not as yet used as a routine procedure, but will in time replace both procedures. Conservative treatment consisting in analgesics and physiotherapy is sufficient in some cases. When conservative treatment is not enough, surgical intervention consisting in decompression by broad laminectomy is performed. Fusion is performed when there are signs of vertebral instability or in young patients. Operational results are often good. Failure is seen following insufficient decompression.

Therapeutic experiences with 947 epileptic out-patients in oxcarbazepine treatment

Efficacy and tolerability of the new antiepileptic drug oxcarbazepine, was evaluated in a retrospective multicentre study. The records of all 947 epilepsy patients treated with oxcarbazepine in the eight participating centres from 1981 through 1990 were examined. The median daily dose of oxcarbazepine was 30 mg/kg in children, 18 mg/kg in adults, and 15 mg/kg in elderly patients, given b.i.d. or t.i.d. The mean plasma levels of the main active metabolite of oxcarbazepine was 88, 79, and 68 mumol/l in children, adults, and elderly, respectively. In patients shifted to oxcarbazepine treatment, seizure frequency was unchanged in 51-66%, 32-48% had a decrease, and 1-10% an increase in seizure frequency, considering the individual seizure types separately. Adverse events were reported in one third of patients, most frequently affecting the CNS (dizziness: 6%; sedation: 6%; fatigue: 6%). Rash was reported in 6% of patients, half of these patients had previously had an allergic reaction to carbamazepine. Hyponatremia was found in about a quarter of the patients from whom data were available. No congenital malformations were seen in nine live-born, first trimester oxcarbazepine-exposed children.

The effect of single doses of inhaled beclomethasone dipropionate on the circadian rhythm in serum osteocalcin in normals

A single dose of 2.5 mg prednisone leads to a significant transient decrease in serum osteocalcin, which is only demonstrated by frequent serum sampling. The aim of the present study was to evaluate whether a single dose of inhaled beclomethasone dipropionate causes transient changes in serum osteocalcin, indicating a systemic effect on bone cells. In a double-blind, placebo controlled, cross-over design we evaluated the effects of single doses of 250 micrograms and 1000 micrograms beclomethasone on the circadian rhythm in serum osteocalcin. Fifteen normal subjects aged 23-38 years were studied twice with an interval of one week with hourly blood sampling from 16.30 until 17.00 the following day; 1000 micrograms beclomethasone, but not 250 micrograms, suppressed serum cortisol by 14.4 +/- 6.7% (p = 0.03). Neither of the beclomethasone doses significantly altered the time pattern of serum osteocalcin. We conclude that a single inhaled dose of beclomethasone in the therapeutical range does not acutely influence osteoblastic activity as judged from serial measurements of serum osteocalcin.

Allergy caused by light-cured ear-moulds

This investigation was conducted after the occurrence of allergic contact dermatitis in three laboratory technicians all engaged in the production of UV-light-cured acrylate ear-moulds. Ninety patients fitted with such moulds claimed discomfort to the same extent as patients with traditionally made acryl moulds. Of thirteen patients seen for clinical examination, seven were tested for allergy in the same way as the technicians and four were found to be sensitized to monomere metacrylates in the wax. The handling of the base materials in the laboratory as well as the UV-light-curing procedure needs further investigation.

Serum IgE in nonatopic smokers, nonsmokers, and recent exsmokers: relation to lung function, airway symptoms, and atopic predisposition

The influence of smoking on serum IgE (s-IgE) was studied in a selected nonatopic population. The variation in s-IgE was followed during 1 year of smoking abstinence. The study included 287 smokers and 137 never smokers. IgE was higher in smokers compared with IgE in never smokers (p less than 0.005). Male smokers had higher s-IgE than female smokers (p less than 0.01). S-IgE was independent of age and claims of atopy among first-degree relatives. Weighted pack-years consumption was defined for cigarette smokers by modifying pack-years consumption by nicotine content of the brand smoked. Weighted pack-years consumption was associated with level of s-IgE (p less than 0.05). S-IgE was higher in smokers with airway symptoms compared with that in smokers without symptoms (p less than 0.01). In smokers older than 50 years of age, there tended to be decreased FEV1 residuals (0.05 less than p less than 0.06), and presence of airway symptoms was (p less than 0.03) associated with high levels of s-IgE independent of each other. In 92 quitters, s-IgE increased during the first 26 weeks of abstinence (p less than 0.05), and after 1 year, s-IgE had returned to baseline. The increase was only observed in smokers younger than 40 years and had no relation to variations in FEV1 during the 1-year follow-up. The increase in s-IgE after smoking cessation was transient, of minor clinical importance, and probably caused by a relief from an immunosuppressive influence.

Biomonitoring of genotoxic exposure among stainless steel welders

A biosurvey in the Danish metal industry measured the genotoxic exposure from stainless steel welding. The study comprised measurements of chromosomal aberrations (CA), sister-chromatid exchanges (SCE), unscheduled DNA synthesis (UDS) in peripheral lymphocytes and serum immunoglobulin G. Environmental monitoring of welding fumes and selected metal oxides, biomonitoring of chromium and nickel in serum and urine and mutagenic activity in urine, and evaluation of semen quality were also done. Manual metal arc (MMA) welding and tungsten inert gas (TIG) welding were the dominant welding processes. A higher frequency of chromosomal aberrations, classified as translocations, double minutes, exchanges and rings, was observed in stainless steel welders than in non-welders. SCE was lower in welders working with both MMA and TIG welding than in reference persons. N-Acetoxy-N-acetylaminofluorene (NA-AAF)-induced UDS was lower in 23 never-smoking welders than in 19 unexposed never-smokers. Smoking was a confounding factor resulting in significantly higher CA, SCE, NA-AAF binding to DNA and mutagenic activity in urine. Age was also a confounder: CA, SCE, NA-AAF binding to DNA and UDS increased significantly with age. No significant correlation between SCE and CA or between CA and UDS was found. UDS decreased significantly with increasing lymphocyte count and a higher lymphocyte count was seen in MMA welders than in reference persons and in smokers than in non-smokers. Differences in the composition among lymphocytes in exposed persons compared with non-exposed are suggested. MMA welding gave the highest exposure to chromium, an increased number of chromosomal aberrations and a decrease in SCE when compared with TIG welding. Consequently improvements in the occupational practice of stainless steel welding with MMA is recommended.

Survival of patients with t(1;7)(p11;p11). Report of two cases and review of the literature

t(1;7)(p11;p11) is a relatively rare chromosome aberration, in most cases associated with acute myeloid leukemia or myelodysplasia. Earlier, many patients received chemotherapy for a malignant disease. The prognosis is usually poor. I describe two patients and review the literature. Thirty-six of the 73 had a history of previous exposure to chemotherapy or radiotherapy. Alkylating agents had been used in 29. The median survival after observation of the translocation was only 11 months, a much shorter survival time than is common for patients with secondary hematologic disorders. Sex, diagnosis, hemoglobin concentration, and percentage of metaphases containing t(1;7) were independent prognostic factors. Despite its relation to earlier chemotherapy, the chromosome aberrations associated with t(1;7) lack the cytogenetic features characteristic of therapy-induced disorders.

Hybrid acute leukemia: therapeutical implications of immunological phenotyping

We phenotyped blood and bone marrow cells from a patient with acute Ph1+ acute leukemia longitudinally during the four months he received intensive chemotherapy. At presentation this case of biphenotypic acute leukemia had two immunologically different types of blast cells, one expressed CD10 (CALLA), CD13 (MY7) and CD33 (MY9) but lacked CD20 (B1), the other type expressed no CD10 or CD33. The phenotype, during AML induction therapy, changed to a more CD10+, CD20+ ALL one. ALL therapy based on these findings induced improvement in bone marrow function but the patient died of septicemia at day 134. The use of concomitant immunophenotyping (IP) and cell cycle analysis had shown proliferation advantage of the more lymphoid malignant cells. These results suggest that it is possible to induce lineage-associated changes in the phenotype of hybrid malignant cells and that these leukemias might be treated best according to longitudinal immunophenotyping of the blast cells.

Effect of spirapril on left ventricular hypertrophy due to volume overload in rats

The effect of the angiotensin-converting enzyme (ACE) inhibitor spirapril on structural and functional parameters of volume-overloaded rat hearts was evaluated in a time-course study. Left ventricular hypertrophy (LVH) was induced by graded disruption of the aortic valve in male Wistar rats. Four weeks later, structural (LV mass and LV wall thickness) as well as functional parameters [LV end-systolic and end-diastolic volumes, stroke volume (SV), ejection fraction (EF)] were determined in anesthetized animals by magnetic resonance imaging (MRI). The rats were then divided into two groups, one of them receiving spirapril (10 mg/kg/day) in food. LV parameters were evaluated by MRI at 4, 18, 25, and 32 days after treatment was started. MRI analysis before the start of treatment showed that both groups had developed a similar degree of eccentric LV hypertrophy. Similarly, LV wall thickness, end-systolic and end-diastolic volumes, SV, and EF did not differ between the groups. Treatment with spirapril resulted in stable LV weight during the follow-up period of 32 days, whereas the untreated group showed a significant steady increase in heart weight. LV end-diastolic volume, LV end-systolic volume, and SV were smaller in the spirapril group when measured after 25 and 32 days, but only the difference in end-diastolic volume reached statistical significance. LV wall thickness and EF were not affected by spirapril. After the last MRI determinations, blood pressure (BP) and the response to angiotensin I (ANGI) were measured in conscious animals. Systolic BP (SBP) and mean arterial pressure (MAP) were significantly lower in spirapril-treated rats, and the dose-response curve to ANGI was shifted to the right.(ABSTRACT TRUNCATED AT 250 WORDS)

Ph-positive chronic myeloid leukemia with loss of the segment distal to M-bcr

We describe a patient with chronic myeloid leukemia (CML) and a 22q- but no 9q+ chromosome. Southern blot analysis showed a BCR rearrangement. The patient soon developed profound and superficial thrombophlebitis in arms and legs and died from pulmonary embolisation 15 days after diagnosis. Five CML cases with a deletion of 22q but no known translocation of 22q11----qter have been described earlier. The present patient is the first such case, however, in whom a BCR rearrangement has been demonstrated.

Models for Human Implantation Derived from Implantation in vitro

This paper is a review of previously published laboratory results as well as data not published before. The developmental phases that separate the events of implantation are discussed and comparative studies are made of implantation in vitro in different species.

[The hyperimmunoglobulin E syndrome]

Hyperimmunoglobulin E syndrome is a rare disease. The clinical and immunological features of HIE are discussed on the basis of a case history. A 28 year old woman had a life-long history of infections of the skin and the sinopulmonary tract. Because of elevated serum-IgE and several positive skin- and RAST-tests she had erroneously been classified as having multiple allergies including food allergy. We found a very high serum-IgE and negative challenge test. Additionally we found decreased oxidative metabolism of blood neutrophils and monocytes. This finding could explain the increased susceptibility to infections in HIE-patients.

Trisomy 13: a preferentially male chromosome aberration interfering specifically with myeloid proliferation and differentiation? Report of a case and review of the literature

A case of trisomy 13 is presented: a 73-year-old man with acute nonlymphocytic leukemia (ANLL), FAB borderline M1/M2, and peripheral leukocyte and platelet counts that were difficult to control with chemotherapy. A literature review shows that 35 cases of trisomy 13 are known at present. They are characterized by male predominance (76%), preferentially myeloid disorders (ANLL, myelodysplastic syndromes, chronic myeloid leukemia), leucocytosis, and relatively high platelet counts and hemoglobins. It is suggested that trisomy 13 is a specific nosologic entity with male predominance and characterized by interference with proliferation and differentiation in the myeloid differentiation series.

No influence of the antidepressant paroxetine on carbamazepine, valproate and phenytoin

A single-blind, placebo-controlled, cross-over trial investigating possible interactions between paroxetine, a serotonin re-uptake inhibitor, and carbamazepine (CBZ), valproate (VPA) and phenytoin (PHT) was carried out in 20 outpatients with epilepsy. Patients on long-term treatment with CBZ, VPA, or PHT were given a 7-day placebo treatment, followed by paroxetine co-treatment for 16 days. Side effects were infrequent and mild. Paroxetine caused no changes in the plasma concentrations and all values were within the recommended ranges. No changes in protein binding were found. Plasma concentrations of paroxetine at steady state (8-147 ng/ml) were in the normal range for a 30-mg daily dosing regimen. None of the patients experienced epileptic seizures during the study.

The effect of nicotine, silver acetate, and placebo chewing gum on the cessation of smoking. The influence of smoking type and nicotine dependence

The effects of nicotine (NI), silver acetate (SA), and ordinary (PL) chewing gum on the cessation of smoking were compared through ratings on six smoking types and physiological nicotine dependence (F-score) in a placebo-controlled and randomized study that included 496 smokers in a group-support setting. Results were evaluated after 26 weeks. Ratings on smoking types 1, 3, 4, 5, and 6 and F-score were related to success rates. The effect of NI was superior to SA in smokers with high type 1 ratings, the effects of NI and SA were almost equal and superior to PL in smokers with high type 4 and 6 ratings, and the effect was independent of the F-score. Treatment of smokers with NI and SA should be restricted to smoking types in which an effect superior to PL is documented, and research should be performed to find support for smoking types where SA and NI have a clear effect.

Powder administration of pure budesonide for the treatment of seasonal allergic rhinitis

The objective of this study was to compare the efficacy and safety of a pure powder formulation of budesonide, delivered from a new multi-dose dispenser for nasal drug application, with the commercially available budesonide pressurized aerosol, and with placebo. Of 116 patients with grass pollen-induced allergic rhinitis, 112 finished the study, which comprised a 4-week treatment period, preceded by a 1-week run-in period. The patients were randomized to four parallel treatment groups: budesonide powder 400 micrograms daily; budesonide powder 800 micrograms daily; budesonide aerosol 400 micrograms daily; and placebo powder. Treatment was given once daily in the morning. The study was double-blind regarding comparison between budesonide powder and placebo. Assessment of efficacy, made by comparing mean scores of nasal symptoms and use of rescue medication, showed equal efficacy of all three budesonide groups compared with placebo. There were no differences between budesonide-and placebo-treated groups with regard to side effects. Budesonide treatment had no demonstrable effect on the HPA-axis assessed by measurement of 24-h urine cortisol. We conclude that budesonide, delivered as pure powder from a multi-dose dispenser, is effective and safe for the treatment of seasonal allergic rhinitis. This new formulation is a good alternative to the commercially available preparations, as it does not contain carrier gas, preservatives or lubricants.