Eikenella corrodens endocarditis and liver abscess in a previously healthy male, a case report

Background

Eikenella corrodens is one of the HACEK bacteria constituting part of the normal flora of the oropharynx, however, still an uncommon pathogen. We report a case of a large Eikenella corrodens liver abscess with simultaneously endocarditis in a previously healthy male.

Case presentation

A 49-year-old Danish man was admitted because of one-month malaise, fever, cough and unintentional weight loss. On admission there was elevated white blood cell count and C-reactive protein, as well as affected liver function tests. Initially pneumonia was suspected, but due to lack of improvement on pneumonia treatment, a PET-CT scan was performed, which showed a large multiloculated abscess in the liver. The abscess was drained using ultrasound guidance. Culture demonstrated Eikenella corrodens. Transesophageal echocardiography revealed aortic endocarditis. The patient was treated with antibiotics and abscess drainage, on which he slowly improved. He was discharged after 1.5 months of hospitalisation. On follow-up 2 months later, the patient was asymptomatic with normalized biochemistry and ultrasound showed complete regression of the abscess.

Conclusions

This is the first case of documented Eikenella corrodens concurrent liver abscess and endocarditis. The case report highlights that Eikenella corrodens should be considered as a cause of liver abscess. Empirical treatment of pyogenic liver abscess will most often cover Eikenella corrodens, but the recommended treatment is a third generation cephalosporin or a fluoroquinolon. A multiloculated liver abscess may require drainage several times during treatment. The finding of Eikenella corrodens should elicit an echocardiography to diagnose endocarditis even in patients without clinical signs of endocarditis.

The stethoscope - A 200th anniversary

René T.H. Laënnec was the man who designed the first monaural instrument for mediate auscultation. The invention became a medical breakthrough. An instrument capable of enhancing the subtle sounds created by the human heart and lungs. This evolutionary instrument also had the benefit of decreasing the oftentim s too direct bodily contact between the doctor and the patient. Laënnec carefully described the different sounds created by the human organs and attempted to link them to the post mortem findings. Even though many doctors were enthusiastic regarding this new medical breakthrough, the stethoscope also had its opponents, but John Forbes' English translation of Laënnec's De l'auscultation midiate as well as William Stokes' treatise on the use of the stethoscope spread the news to the medical world. In Denmark the stethoscope was introduced by Oluf Lundt Bang, S.M. Trier and E. Hornemann. The next step forward was the develop- ment of the binaural stethoscope by G.P. Camman in New York. The Littmann Electronic Stethoscope (3M Health Care) created by David Littmann is considered the leading product globally in this medical field. Digitization, ultrasound and Doppler effect, as well as 2D and 3D printing, are evidence of an on-going evolution within this field of medical equipment as we get ready to celebrate the stethoscopes 200th anniversary.

On the history of Cinchona bark in the treatment of Malaria

How and when the medical value of Cinchona bark was discovered is obscure, but it is said that the powder was given to a European for malaria for the first time in the 1630s. The bark was brought to Europe by Spanish missionaries and it was recommended by the cardinal Juan de Lugo. In the 1660s, the use of Cinchona bark became known in England - and in Denmark by Thomas Bartholin. It was used for the treatment of malaria, but several debates on its value continued up to the 1730s. However, successful treatment of malaria was obtained by Thomas Sydenham, Robert Tabor and Francesco Torti. Sydenham emphasized a modern view that Cinchona bark was a unique specific drug for the treatment of malaria, and the treatment was fully accepted when Torti's Therapeutice specialis appeared. In the early 18th century, botanical expeditions were arranged in search of the most valuable Cinchona species for cultivation. The content of quinine was impor- tant, and determination of quinine was realized when Pierre Pelletier and Joseph Caventou isolated the alkaloid from the bark in 1820. Dutch plantations and quinine industry dominated the market, but the supply of quinine came to an end when the Japanese occupied Indonesia in 1942, cutting off the rest of the world from the main supplies of Cinchona. Synthetic antimalarials were developed and chloroquine became the drug of choice, but the intensive use of these drugs caused drug resistance. Chloroquine-resistant strains of P. falciparum are now treated with other drugs as artemisinin and artemether.

[A historical perspective of Ebola virus]

The 2014 Ebola fever outbreak was the first of its kind in West Africa. This epidemic, affecting multiple countries, by far exceeded any previous outbreak in case counts and geographical spread. But Ebola viruses are not new to Africa, as they have occurred in epidemic proportion in the central part of the continent since 1976. The objective of this article is to compare previous outbreaks with the ongoing epidemic in an effort to identify some of the factors which have con-tributed to the size and scope of the existing outbreak.

[On the history of barbiturates]

Throughout the history of humanity, numerous therapeutic agents have been employed for their sedative and hypnotic properties such as opium, henbane (Hyoscyamus niger) and deadly nightshade (Atropa belladonna), but also alcohol and wine. In the 19th century potassium bromide was introduced as a sedative - and antiepileptic drug and chloral hydrate as sedative-hypnotics. A new era was reached by the introduction of barbiturates. The story started with the chemist Adolf von Baeyer. His breakthrough in the synthesis of new agents as barbituric acid and indigo and his education of young chemists was of great importance for the science of organic chemistry and the development of the dye and medicine industry in the late 19th century. The next important step was the development of barbiturates. The pioneers were Josef von Mering and Emil Fischer. Using the Grimaux-method they synthesized various barbiturates. It was von Mering who got the idea of introducing ethyl groups in the inactive barbituric acid to obtain sedatives, but the synthesis was succeeded by the chemist Emil Fischer. Experiments with dogs clearly showed sedative and hypnotic effect of the barbiturates and the oral administration of barbital (Veronal) confirmed the effect in humans. Barbital was commercialized in 1903 and in 1911 phenobarbital (Luminal) was introduced in the clinic, and this drug showed hypnotic and antiepileptic effects. Thereafter a lot of new barbiturates appeared. Dangerous properties of the drugs were recognized as abuse, addiction, and poisoning. An optimum treatment of acute barbiturate intoxication was obtained by the "Scandinavian method", which was developed in the Poison Centre of the Bispebjerg Hospital in Copenhagen. The centre was established by Carl Clemmesen in 1949 and the intensive care treatment reduced the mortality of the admitted persons from 20% to less than 2%. To-day only a few barbiturates are used in connection with anaesthesia and for the treatment of epilepsy, and chemists are focusing on drugs with more selective effects.

[On the history of vitamin K, dicoumarol and warfarin]

The history of the discovery and development of vitamin K and its antagonists, the oral anticoagulants dicoumarol and warfarin, are fascinating, triumphant landmarks in the annals of medicine. Vitamin K was found by Carl Peter Henrik Dam and Fritz Schønheyder from the University of Copenhagen. The discovery was initiated by Dam, by a lucky choice of chicks in the dissertation of sterol metabolism, since the vitamin is not formed by intestinal bacteria in these animals. In these experiments the lack of an unknown factor in the synthetic diet caused internal bleeding similar to that found in scurvy, but the bleeding was not reversed by vitamin C and it could not be explained by the lack of classical vitamins. In 1935 the unknown antihaemorrhagic factor was named vitamin K and a few months later the phenomenon was also observed by H.J. Almquist and E.L.R. Stokstad in Berkeley. The activity of the factor was determined by bioassay in different extracts of green vegetables and alfalfa by Dam and Schønheyder. Vitamin K was isolated in 1939 by Dam and Paul Karrer in Zurich and the structure was determined by Edward Adelbert Doisy. Dam and Doisy were awarded the Nobel Prize in 1943. A dramatic story starts the discovery of dicoumarol. In the 1920s cattle in Canada began dying of internal bleeding with no obvious precipitating cause. Frank W. Schofield, a veterinary pathologist in Alberta, found that the mysterious disease was connected to the consumption of spoiled sweet clover hay and noted a prolonged clotting time. Ten years after a farmer traveled in a blizzard with his dead cow and a milk can of the unclotted blood to the University of Wisconsin. Only the door to the biochemical department of Karl Paul Link was open. This event started the isolation of the anticoagulant agent dicou- marol which was formed by microbial induced oxidation of coumarin in the mouldy sweet clover hay. More than hundred dicoumarol-like anticoagulants were synthesized by Link and his co-workers. A potent hemorrhagic agent named warfarin was first used as an effective rat poison. However, warfarin became the drug of choice and the break- through in the treatment of thromboembolic diseases. Today new oral anticoagulants are competing with warfarin.

Long-term follow-up on affinity maturation and memory B-cell generation in patients with common variable immunodeficiency

PURPOSE

Common variable immunodeficiency (CVID) comprises a heterogeneous group of primary immunodeficiency disorders. Immunophenotyping of memory B cells at the time of diagnosis is increasingly used for the classification of patients into subgroups with different clinical prognoses. The EUROclass classification is a widely used method. Levels of somatic hypermutation (SHM) have proven useful as a prognostic marker for recurrent respiratory tract infections. As time of presentation and diagnosis is highly variable in CVID patients, and diagnostic delay is a common problem, it is important to know whether classification parameters are stable over time. The purpose of the study was to address this question in a cohort of 33 CVID patients followed from 3 to 19 years after diagnosis (average follow-up 8.8 years).

METHODS

Levels of class-switched memory B cells were analyzed using flow cytometric immunophenotyping, and patients were classified according to the EUROclass criteria. Affinity maturation of B cells was measured using Igκ-REHMA, which assesses somatic hypermutation in kappa light chain transcripts. Clinical manifestations in terms of splenomegaly, autoimmune disease and granulomatous disease were also determined.

RESULTS

Switched memory B cells and levels of SHM were not consistently stable markers in a long-term follow-up setting. At a given time during follow-up, 60% of the patients were assigned to the EUROclass group SmB- (less than 2% switched memory B cells), but only 23% were consistently assigned to this group. Associations between clinical manifestations and levels of switched memory B cells or SHM were not observed in our study.

CONCLUSION

Based on our findings, we suggest that immunologic characteristics in CVID patients should be evaluated several times after diagnosis using internationally standardized methods.

[History of gold--with danish contribution to tuberculosis and rheumatoid arthritis]

Gold has a long history as a therapeutic agent, first as gold particles and colloidal gold, then as a soluble salt made by the alchemists, and potable gold was recommended almost as a panacea against different diseases. Gold compounds were introduced in the treatment of tuberculosis, based initially on the reputation of Robert Koch, who found gold cyanide effective against Mycobacterium tuberculosis in cultures. Although several investigations of gold salts showed no convincing effect in experimental tuberculosis in guinea pigs, the idea of using gold compounds as chemotherapy was furthermore encouraged from the work of Paul Ehrlich with arsenicals. The enthusiasm and the craving desperately for a remedy for tuberculosis forced Danish physicians, in the mid-1920s to treat tuberculosis with Sanocrysin (gold sodium thiosulfate). Professor Holger Møllgaard, in collaboration with the clinicians the professors Knud Secher and Knud Faber, was the theoretical promoter of the project. He recommended sanocrysin-antiserum therapy, since sanocrysin caused serious reactions in tuberculosis animals, possible by releasing toxins from tubercle bacilli "killed" by sanocrysin. However the enthusiastic response to sanocrysin in Europe declined along by controlled trials and reports on toxicity in the 1930s. The belief that rheumatoid arthritis was a form of tuberculosis caused a renaissance in chrysotherapy. In France Jacques Forestier obtained encouraging results in the treatment of rheumatoid arthritis with myochrysine and other gold salts, and he pointed out the disease modifying effect of chrysotherapy. In Denmark Knud Secher, who was the clinical initiator of Sanocrysin therapy in tuberculosis, now became the founder of chrysotherapy in rheumatoid arthritis. Although new potential agents are now taking over in the treatment of arthritis, it is still believed, that there is a place for the chrysotherapy. However a new future for gold, in the form of nanoparticles, appears on the horizon, especially in the imaging, diagnostics and therapies of cancer.

[Ambroise Paré (1510-90)--and features of the history of surgery]

For six centuries the barbers of Europe practiced surgery. In 1215 a papal edict forbade members of the clergy (physicians) from performing surgical procedures as contact with blood was felt to be contaminating to men of the church. Bloodletting and minor surgery was now turned over to the barber-surgeons and this was in agreement with the medical doctors who felt that these procedures were beneath their dignity. The barber-surgeons were sometimes called "doctors of the short robe" to distinguish them from the medical doctors and surgeons who were called "doctors of the long robe", although university status was hardly given to the surgeons. Ambroise Paré started as a barber-surgeon and his eminence was honoured by the long robe. It was his experience at the Hôtel Dieu that permitted him to serve as a surgeon to the French army and through his open mind Paré made many innovations during his career. Paré abolished the painful practise of cautery to stop bleeding and used ligatures and dressings instead. A multitude of subjects were included in his writings such as military surgery, aneurysm, hernia, obstetrics and plague, and through his techniques he guided the development of the gentle art of surgery. Paré became the founder of modern surgery, a restorative process that heals the body with minimal suffering.

Immunodeficiency associated with FCN3 mutation and ficolin-3 deficiency

Ficolin-3, encoded by the FCN3 gene and expressed in the lung and liver, is a recognition molecule in the lectin pathway of the complement system. Heterozygosity for an FCN3 frameshift mutation (rs28357092), leading to a distortion of the C-terminal end of the molecule, occurs in people without disease (allele frequency among whites, 0.01). We describe a patient with recurrent infections who was homozygous for this mutation, who had undetectable serum levels of ficolin-3, and who had a deficiency in ficolin-3-dependent complement activation.

Antibodies against double-stranded DNA in patients with connective tissue diseases. Comparison between Crithidia luciliae kinetoplast immunofluorescence test and Farr technique

Antibodies against double-stranded (ds) DNA were demonstrated by an immunofluorescence technique using Crithidia luciliae kinetoplast as antigen, and by means of the Farr technique. Both techniques were used simultaneously in 172 sera from patients with systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), juvenile rheumatoid arthritis (JRA), temporal arteritis (TA) and from healthy controls. Comparable results were obtained with the two techniques. SLE patients with active disease had higher titres of IgA antibodies than patients with inactive disease. Of the patients with RA and JRA, 10% had significant titres of dsDNA antibodies. Patients with TA and normal controls had either no dsDNA antibodies in their sera or very low titres without complement-fixing properties.

Deposits of plasma proteins in the skin during treatment with carbamazepine and diphenylhydantoin

Biopsies from skin of normal appearance from 18 patients treated with carbamazepine and diphenylhydantoin were investigated by a direct immunofluorescence technique. Seventeen had deposits of plasma proteins at the dermoepidermal junction, 16 had deposits in the vessel walls, and one had autofluorescence of the nuclei in the epidermis and vessel walls. These findings did not correlate with changes in serum IgG, IgA, IgM, IgD, IgE or alpha 2-macroglobulin. Eight patients had elevated alkaline phosphatase, 4 elevated IgG and one elevated IgA. Three had low values of IgA, and all had normal values of IgM, IgD and IgE, and blood cells. In three patients, carbamazepine was withdrawn, whereupon the deposits disappeared in two and decreased in the third, who changed to another drug. The changes were quantitatively and qualitatively similar to those seen in systemic lupud erythematosus induced by these drugs.

[From willow bark to acetylsalicylic acid]

Acetylsalicylic acid is one of the most widely used drugs in the world. Its ancestry the salicylates, including salicin and salicylic acid, are found in the bark and leaves of the willow and poplar trees. The ancient Sumerians and Egyptians, as well as Hippocrates, Celsus, Pliny the Elder, Dioscorides and Galen used these natural products as remedies for pain, fever and inflammation. In the Middle Ages these remedies were used for fever and rheumatism by Hildegard of Bingen and Henrik Harpestreng. The first "clinical trial" was reported by Edward Stone in 1763 with a successful treatment of malarial fever with the willow bark. In 1876 the antirheumatic effect of salicin was described by T. MacLagan, and that of salicylic acid by S. Stricker and L. Riess. Acetylsalicylic acid was synthesized by Charles Gerhardt in 1853 and in 1897 by Felix Hoffmann in the Bayer Company. The beneficial effect of acetylsalicylic acid (Aspirin) on pain and rheumatic fever was recognized by K. Witthauer and J. Wohlgemuth, and the mechanism of action was explained in 1971 by John Vane. Today the antithrombotic effect of acetylsalicylic acid and new aspects of ongoing research demonstrates a still living drug.

[Reasons for the construction of Bispebjerg Hospital--a hospital with light, air and freedom of nature]

Since the 1850ies the city of Copenhagen changed, ramparts were removed or remodelled as parks, industries were established. The new factories and wharfs expanded, labourers were needed; many country people moved into the city to find work and thus the population increased immensely. In Copenhagen a few hospitals only were present around 1850; The Royal Frederik Hospital (now the Museum of applied Arts) was the only hospital in the modern sense of the word. Other institutions with "hospital" as part of their name as e.g. General Hospital (Almindelig Hospital) or Ladegaarden were a mixture of hospital and workhouse and The Royal Maternity Hospital founded in 1750. The wealthy and the upper middle class citizens were nursed or cured at home. At the end of the nineteenth century medical doctors could successfully cure some diseases, and surgeons could after the introduction of the anesthetic and aseptic treatment carry out operations with diminished risks of complications. Copenhagen's first modern hospital, Municipal Hospital (Kommunehospitalet) opened 1863, but in a very short time it was permanently overcrowded. Although two small hospitals Blegdam Hospital (isolation hospital) and the Oresund Hospital (quarantine station) were established a large new hospital was needed. Although the financial situation of the city of Copenhagen was strained due to the expenditures caused by the rapidly growing population within the city itself and the villages incorporated into it, the first social democratic mayor Jens Jensen wanted to secure his voters the same care and treatment as citizens of better means. As this view was accepted by the majority of the city council a hospital in the then modern and functional pavilion system (ascribed to Florence Nightingale) with buildings surrounded by gardens was planned. The architect Martin Nyrop (1849-1921) who had just completed the monumental and beautiful Copenhagen City Hall along with the engineer AC Karsten (1857-1931) and landscape architect Edvard Glaesel (1858-1915) were entrusted with the task to develop the design of the hospital. Bispebjerg Hospital was built in the years 1907-13 on a piece of land of 21 hectares on a slope facing southeast at Bispebjerg Bakke at the lower end bordering on Lersøen, a lake which eventually was filled and drained. The 6 red 2-story brick pavilions are located around an axis along Bispebjerg hill with southeast facing bedrooms over viewing the lush patient gardens. These sick rooms all had large double windows at the southeast providing excellent daylight. On the walls are washable frescoes with motifs from nature. Pavilion buildings are flanked by two avenues with linden trees on both sides and connected by crossroads between the buildings. Underground tunnels link the buildings. On both sides, the two lower pavilions on the same side of the central avenue staircase are linked together by a long covered bridge leading from the first floor of the first building to the ground flour in the next building because of the terrain slope. This bridge connects the two pavilions with a building with operating theatres so that patients can be transferred indoors between operation theatre and sick room. Surrounding the sick pavilions administrative building, rheumatic outpatient department, laundry, kitchen and engine house are placed. Between the buildings, avenues and crossroads gardens designed with benches, beautiful flowerbeds and bouquets were established to the leisure of the patients. The hospital offers a wealth ot fine architectural designs and presents itself as a kind of garden village within the city.

First attempt to produce experimental Campylobacter concisus infection in mice

AIM: To infect mice with atypical Campylobacter concisus (C. concisus) for the first time.

METHODS: Three separate experiments were conducted in order to screen the ability of five clinical C. concisus isolates of intestinal origin and the ATCC 33237 type strain of oral origin to colonize and produce infection in immunocompetent BALB/cA mice. The majority of the BALB/cA mice were treated with cyclophosphamide prior to C. concisus inoculation to suppress immune functions. Inoculation of C. concisus was performed by the gastric route.

RESULTS: C. concisus was isolated from the liver, ileum and jejunum of cyclophosphamide-treated mice in the first experiment. No C. concisus strains were isolated in the two subsequent experiments. Mice infected with C. concisus showed a significant loss of body weight from day two through to day five of infection but this decreased at the end of the first week. Histopathological examination did not consistently find signs of inflammation in the gut, but occasionally microabscesses were found in the liver of infected animals.

CONCLUSION: Transient colonization with C. concisus was observed in mice with loss of body weight. Future studies should concentrate on the first few days after inoculation and in other strains of mice.

Quantitative and qualitative estimations of IgE bound to basophil leukocytes from hay fever patients

IgE was removed from human basophils of 4 nonatopic persons and 10 hay fever patients allergic to timothy grass pollen by treating the cells with buffer adjusted to pH 4. IgE could be removed and refixed to the same cells. Refixation was demonstrated by immunofluorescence and by the ability of basophils to release histamine on exposure to timothy pollen. Removed total IgE and specific IgE directed against timothy pollen were estimated, and a linear correlation to the level of total IgE and specific IgE in serum was found. The total number of IgE molecules per basophil was calculated to be in the range of 30,000 to 300,000, and timothy-specific IgE constituted 4%-15% of the total IgE molecules on the cells. It was furthermore established that specific cell-bound IgE was linearly correlated to the pollen concentration releasing 20% of the histamine contents of the basophils. Separated 2gE from sensitized and nonsensitized basophils could be bound to basophils from other patients, resulting in a change in cell sensitivity. This could be ascribed to additional binding to free cell receptors as well as to a partial replacement of bound IgE. Basophils from non-atopic persons could not be sensitized by incubation with surface IgE from atopic persons. The results indicate that acid treatment is a simple method suitable for removing IgE from basophils. This IgE is intact and can be quantitated.

[Mercury--a major agent in the history of medicine and alchemy]

From ancient time the history of mercury has been connected with that of the medicine and chemistry. Mercury therefore contributes to the history of science throughout times. Knowledge of cinnabar (HgS) is traced back to ancient Assyria and Egypt, but also to China. The Greek philosophers were the initiators of theoretical science. The idea of the four elements, earth, air, water and fire, was introduced mainly by Empedocles and Aristotle in the 5th and 4th century BC. The theory encouraged the hope of transmuting metal to gold. The early development of practical alchemy is obscure, but some hints are given in the encyclopedia compiled by Zosimos about 300 A.D. in Alexandria. It also includes the invention of equipment such as stills, furnaces and heating baths. Medical treatment is described by Pliny and Celsus, e.g. the use of cinnabar in trachoma and venereal diseases. When the Arabs learned Greek alchemy by the Nestorians, they introduced or improved chemical equipments and new chemicals were obtained such as sublimate (HgCl2), different salts, acids, alkaline carbonates and metal oxides. The first recorded account of animal experimentation on the toxicity of mercury comes from Rhazes (al-Razi) in the 9th century and in the 11th century Avicenna (Ibn Sina) had the foresight to recommend the use of mercury only as an external remedy, and quicksilver ointments were used by the Arabs in the treating of skin diseases. In the medieval west scientific experiments were forbidden since the interpretation of the world order should not be changed. Greek and Arabic medicine and alchemy were therefore authoritative and the breakthrough in scientific inventions first appeared after the introduction of the Renaissance. The Renaissance medicine included ancient medicine as well as "modern medicine", based on iatrochemistry, and this chemical approach was introduced by Paracelsus. The medicine included sulphur and salts or oxides of for instance mercury, copper, iron, antimony, bismuth and lead. Most important was mercury when the outbreak of syphilis appeared in Europe at the end of the 15th century. The Arabian quicksilver ointment was remembered and used for the treatment of syphilis, but the treatment also included pills and ointments of sublimate and calomel (Hg2Cl2). The breakthrough in science was the discovery of oxygen by Priestley in the late 18th century. Priestley heated the oxide of mercury and examined the gas and thereafter Lavoisier recognized that combustion involves oxidation. All this led to a new understanding of respiration and furthermore established the basis of modern chemistry. The apothecaries of the 19th and 20th century showed many colourful mercurials as calomel, sublimate, cinnober, oxides of mercury and mercury. Calomel pills were used in acute and chronic diseases and furthermore as a diuretic drug before the organomercurials appeared in the 1920s. Skin diseases were treated with ointments or plasters of the mercurials or quicksilver. Antiseptics were introduced by Semmelweis hand-washing with chlorinated water before deliveries in obstetrics and by Lister's antiseptic ritual with carbolic acid during surgical operations. Also organomercurial "antiseptics" were used but unfortunately these agents were bacteriostatic rather than bacteriocidal and allergic contact dermatitis has been observed. Today the problems are solved by sterilization and aseptic conditions. Penicillin appeared in the 1940s and chlorothiazide in 1957 and new effective agents have taken over in the treatment of diseases with mercurials.

Potentiation of histamine release by Microfungal (1-->3)- and (1-->6)-beta-D-glucans

(1-->3)-beta-D-Glucans, a cell wall component in most microfungi, are suggested to play a role in the development of respiratory and general symptoms in organic dust-related diseases. The mechanisms by which they induce these effects are, however, not clear. In the present study, mediator release and its potentiation by the (1-->3)-beta-D-glucan as well as by the (1-->6)-beta-D-glucan found in yeast and other fungi were therefore examined. Blood leucocytes from healthy volunteers and from patients allergic to house dust mite were incubated with (1-->3)-beta-D-glucans with increasing 1,6-branchings: curdlan [a linear (1-->3)-beta-D-glucan], laminarin and scleroglucan, and furthermore with pustulan, a linear (1-->6)-beta-D-glucan. Histamine release was not observed on exposure to the glucans only, but in the presence of anti-immunoglobulin E (IgE) antibody or specific antigens, all the glucans investigated led to an enhancement of the IgE-mediated histamine release. The glucans induced a significant potentiation of the mediator release when present at concentrations in the range of 2-5 x 10(-5) M. These results suggest that (1-->3)-beta-D-glucan as well as (1-->6)-beta-D-glucan aggravates IgE-mediated histamine release. Knowledge concerning the effects of glucans on immune responses may be of importance for understanding and treating inflammatory and allergic diseases.

Deficiency of somatic hypermutation of immunoglobulin G transcripts is a better predictor of severe respiratory tract infections than lack of memory B cells in common variable immunodeficiency

Defects of memory B cells and of somatic hypermutation (SHM) are involved in the pathogenesis of common variable immunodeficiency (CVID). Here we report for the first time a systematic study of the relationship between memory B cell deficiency and SHM abnormalities in CVID, and relate these variables to prediagnostic infections. Isotype switched Vh3-23 transcripts were undetectable or low in 30% (IgG) and 63% (IgA) of the patients, but never in controls (P < 0.001). When measurable, the SHM fraction of transcripts was significantly lower in patients (IgM: median 32% vs. 56% (P = 0.0002); IgG: 72% vs. 87% (P = 0.0002); IgA: 81% vs. 88% (P = 0.04)). The concentration of switched (CD19+/CD27+/IgG+) and unswitched (CD19+/CD27+/IgM+/IgD+) memory cells was reduced in 75% and 58% of the patients, respectively. Patients with reduced concentrations of switched memory B cells had normal or low SHM, and only the IgG SHM fraction correlated with prediagnostic incidence of severe respiratory tract infections (P = 0.004).

Gastric inflammatory markers and interleukins in patients with functional dyspepsia treated with astaxanthin

The chronic active inflammation caused by Helicobacter pylori is dominated by neutrophils, macrophages, lymphocytes and plasma cells. Several interleukins are involved in the inflammatory process. The aim of this study was to investigate the effect of astaxanthin on gastric inflammation in patients with functional dyspepsia. Forty-four consecutive patients were included, and biopsies were examined for IL-4, IL-6, IL-8, IL-10, interferon-gamma, CD4, CD8, CD14, CD19, CD25 and CD30. Patients were randomized: 21 patients were treated with 40 mg of astaxanthin daily, and 23 patients were treated with a placebo. There was a significant decrease in gastric inflammation in H. pylori-positive patients from both groups. There were no significant changes in the density of H. pylori or in any of the interleukins during or after treatment. There was a significant up-regulation of CD4 and down-regulation of CD8 in patients with H. pylori treated with astaxanthin. Astaxanthin had an effect on the inflammation and on the density of H. pylori in mice in a study where the diet could be standardized without antioxidants (Bennedsen et al., 1999). These dietary conditions are impossible in studies involving humans, and may be due to the minor effect when the host have access to antioxidants in their diet.

Epithelial cell kinetics of the gastric mucosa during Helicobacter pylori infection

Helicobacter pylori is an important pathogen in major gastroduodenal diseases, including inflammation with ulceration and gastric malignancies. Alterations in H. pylori associated cell turnover in gastric epithelial cells are examined in relation to inflammatory activity, bacteria load and cytokines which may improve knowledge concerning the outcome of gastric diseases caused by H. pylori. Antral biopsies from 42 dyspeptic patients including 27 H. pylori-positive and 15 H. pylori-negative patients were tested for apoptotic activity by the TUNEL assay, and immuno-histochemically for p53 and the proliferative marker Ki-67. H. pylori infection, bacteria load and inflammatory activity were associated with increased cell turnover as judged by enhanced activities of TUNEL, p53 and Ki-67. Only p53 was significantly correlated to IFN-gamma, IL-8 and IL-10. The H. pylori-positive state was furthermore accompanied by varying degrees of altered distribution pattern of the markers studied, with occasional presence of apoptosis in the deeper pit zones, upward extension of Ki-67 and to a lesser degree of p53. Given a similar pattern of change in proliferation and apoptosis in some neoplastic lesions in other parts of the gastrointestinal tract, such studies in cell turnover may provide insights valuable in the investigations of potential precursors of gastric malignancies.

[Pictures from the Dolphin Pharmacy in Copenhagen]

The development of the pharmacy in the 19th and 20th centuries is illustrated by education and activity in the Dolphin Pharmacy in Copenhagen. The career within chemistry and pharmacy started with an apprenticeship of 4 year in the pharmacies. The Dolphin Pharmacy was responsible for part of the examination, i.e. the examination of the preparation of medicine. Passing the examination the chemist's assistant was free to prepare and to dispense medicine. Graduation as a pharmaceutical candidate was necessary to obtain license. Lectures in chemistry, physics, pharmacy, botany and pharmacognosy were obtained at the University of Copenhagen and the Polytechnic, but no curriculum was available. A rational education was obtained later on by the establishment of the School of Pharmacy in 1892. The proprietor pharmacists of the Dolphin Pharmacy were excellent scientists who contributed to the development of pharmacy. Pictures of the pharmacy from about the 1930s show the manufacture of medicines on the basis of a prescription and a pharmacopoeia. Ointments containing zinc white, sulphur and tar were used for various skin diseases and for the tiresome cough; cough mixtures containing codeine or extract of ipecacuanha root were used. In the 1930s the medicine for injection was sterilized and the tablet machine was the breakthrough for a rational production in the pharmacy. However, at the end of the 1900s it was no more possible to compete with the pharmaceutical industry and all the production of medicine was taken over by the industry.

["Never at rest--always on the move"--Professor, Surgeon Peter Kisby Moller (1849-1940)'s diaries from study tours to London and Paris in 1876 and to Berlin in 1890]

In the years 1926-28, after his retirement in 1921 from the post of professor of surgery at Odense Hospital, Peter Kisby Møller (1847-1940) wrote his autobiography. He dedicated the biography to his four sons, three of whom were medical doctors. He based the autobiography on diaries written daily in a neat hand ever since childhood. As a newly qualified medical doctor at the age of 29 years, Peter Kisby Møller eagerly devoted himself to the field of surgery, and in 1876 he embarked on a tour of foreign study. His main goal was to study the treatments and results of the great gynaecological surgeons of the time and thus increase his store of knowledge of gynaecology. He visited clinics of urology and studied the new antiseptic treatment introduced by Lister that significantly decreased mortality. He visited many famous London hospitals and observed the surgery of sir Spencer Wells who was internationally known for his ovariotomies at the time. Later Kisby Møller visited Jules-Emile Péan, Alphonse Guérin, Louis-Félix Terrier, and Just Lucas-Championnière in Paris. P.K. Møller was hardworking, faithful to his patients, and a devout Christian.

[From the bath- and massage to the sports clinic--the Rheumatological Department of Bispebjerg Hospital 1913-2006]

At the turn of the previous century, the number of inhabitants in the City of Copenhagen increased greatly. A new large hospital, Bispebjerg Hospital, stood ready in 1913. At the time, access to light, fresh air, and open spaces was considered to be important factors in the battle against disease. Physical treatment such as different forms of bathing, massage, exercise, electricity and radioactivity were also much relied upon, and a large building for this treatment in the form of a Roman thermal bath was built at the clinic of physical medicine. The first head of the clinic, Hans Jansen (1875-1933), was a specialist in internal medicine who studied physical treatments for a wide range of diseases, including phototherapy, as a collaborator of the Nobel Prize laureate Niels Finsen. Later, Jansen focused on the treatment of rheumatoid arthritis. It was left to the internal medicine ward at Bispebjerg Hospital to introduce the first effective treatment with the gold compound Sanocrysin during the 1930's. In 1918, physical therapy, physiatry (in Danish, fysiurgi), was established as a medical speciality in Denmark. The next head of the clinic, from 1933 Knud Aage Rasmussen (1897-1976), a specialist in fysiurgi, focused on the treatment of regional and general rheumatic pain syndromes. The rehabilitation of patients with different diseases by gymnastic exercises had been in use from the start of the clinic, but in the late 1940's more emphasis was put on this treatment under the influence of impulses from the USA, and as a response to demographic change with an increased number of older individuals with physical challenges in the City of Copenhagen. A rehabilitation ward was established and together with the clinic of physiotherapy formed a new department in 1968 under the leadership of Lone Gjørup (1923-2005). At the same time, interest in the treatment of inflammatory rheumatic diseases rose after the discovery of glucocorticoids as potent anti-inflammatory compounds. The department at Bispebjerg Hospital followed this dual course of treatment of inflammatory diseases with new drugs and rehabilitation. Recent new technology and interest in sports medicine promoted research in physical training in the clinic and eventually gave rise to a separate research and development unit devoted to sports medicine.

Delineation of Campylobacter concisus genomospecies by amplified fragment length polymorphism analysis and correlation of results with clinical data

Campylobacter concisus has been as frequently isolated from human diarrhea as the important enteropathogen Campylobacter jejuni, but it also occurs in the feces of healthy individuals. The role of C. concisus in human disease has been difficult to determine, since the species comprises at least two phenotypically indistinguishable but genetically distinct taxa (i.e., genomospecies) that may vary in pathogenicity. We examined 62 C. concisus strains by amplified fragment length polymorphism (AFLP) profiling and correlated the results with clinical data. All C. concisus strains gave unique AFLP profiles, and numerical analysis of these data distributed the strains among four clusters. The clustering was of taxonomic significance: two clusters contained, respectively, the type strain (of oral origin) and a reference strain (from diarrhea) of each of the known genomospecies. Genomospecies 2 strains were more frequently isolated from immunocompetent patients and/or patients without concomitant infections that presented with fever, chronic diarrhea, and gut inflammation than was genomospecies 1, clustering with the type strain of oral origin. Bloody diarrhea was recorded only with C. concisus genomospecies 2 infections. We identified two additional C. concisus genomospecies: genomospecies 3 comprised a single strain from an immunocompetent patient, and genomospecies 4 contained five isolates from severely immunodeficient patients, i.e., organ transplantation recipients or those with hematological malignancies. All genomospecies 4 strains were of the same protein profile group and failed to react with a C. concisus species-specific PCR assay based on 23S rRNA gene sequences: the taxonomic position of this group requires closer investigation. Campylobacter concisus is genetically and taxonomically diverse and contains at least four distinct genomospecies that may exhibit differences in their spectra of virulence potential.

Characterization and subgrouping of Campylobacter concisus strains using protein profiles, conventional biochemical testing and antibiotic susceptibility

OBJECTIVE

To characterize and subgroup clinical strains of Campylobacter concisus isolated from patients with gastrointestinal disease.

METHODS

A total of 109 C. concisus isolates from 98 patients obtained between June 1997 and December 1998 were analysed using protein profiles, conventional biochemical tube tests, ApiCampy, and susceptibility patterns by Neosensitabs and E-test.

RESULTS

Two groups were identified by using protein profiles. One resembled the ATCC 33237 type strain of oral origin, and a second group differing from it, particularly in the high molecular weight zone. Considerable diversity exists in the lower molecular range of the gels, also within assigned subgroups. Biochemical testing showed differences between the groups in the ability to reduce nitrate, ApiCampy testing also yielded differences between the two assigned groups, although reactions were highly heterogeneous. Resistance to erythromycin, ciprofloxacin, ampicillin, ceftriaxone and tetracycline occurred in 3%, 13%, 7%, 11% and 0% of the isolates when using Neosensitabs. The E-test yielded comparable results 7%, 5%, 0%, 2% and 3%, respectively.

CONCLUSION

Results indicate that C. concisus can be assigned to two broad groups based on differences in protein profiles. No distinct phenotypic marker was identified. Susceptibility patterns are not suitable for discrimination between the two assigned groups. Further studies using a polyphasic approach including the application of genetic methods are needed to assess the complex taxonomy of this potential pathogen.

Gastric inflammatory markers and interleukins in patients with functional dyspepsia, with and without Helicobacter pylori infection

Helicobacter pylori is the most important cause of gastritis, peptic ulcers and the development of gastric cancer. The chronic active inflammation is dominated by neutrophils, macrophages, lymphocytes and plasma cells. Several interleukins (IL-8, IL-10 and IFN-gamma) are involved in the inflammatory process in the gastric mucosa. The aim of this study was to investigate the gastric inflammation in patients with functional dyspepsia. Fifty-three consecutive patients were included and antral biopsies were obtained for histology, culture and immunohistochemistry. The sections were examined for the interleukins IL-4, IL-6, IL-8, IL-10 and IFN-gamma as well as for the cell markers CD4, CD8, CD14, Cd19, CD25 and CD30. Only CD4 and CD19 were significantly increased in patients with increased gastric inflammation and increased density of H. pylori. However, several of the examined markers (IFN-gamma, IL-8, IL-10 and CD14) showed a non-significant trend to be increased in patients with extensive gastric inflammation and high density of H. pylori. Therefore, an arbitrary index (IM11) for all the 11 immunological markers was made as an average value for each of the four morphological groups. For the four morphologically different groups of patients the values were 0.49, 0.77, 0.86 and 1.25, respectively. Significant increases in the index from none to moderate antral inflammation as well as the density of H. pylori were found (p<0.001). By using an index of inflammatory markers trends can be summarized and thereby significant which may be of importance when gastric inflammation is investigated in children and patients with functional dyspepsia.

Inflammation, immunity, and vaccines for Helicobacter infection

Pro-inflammatory cytokines such as IL-18, IFN-gamma, and IL-1beta play a significant role in the inflammation induced by Helicobacter. During the recent years of H. pylori research, the main focus has been on development of vaccines for therapeutic or prophylactic use against the infection. Both bacterial components of H. pylori as well as engineered vaccines have been tested as well as different forms of administration including systemic and oral/intranasal pathways.

Normal ICOS, ICOSL and AID Alleles in Danish Patients with Common Variable Immunodeficiency

Common variable immunodeficiency, CVID, is a primary antibody deficiency characterized by decreased levels of serum immunoglobulin G (IgG), decreased IgA and/or IgM and recurrent infections. It is assumed to be heterogeneous group of disorders caused by different genetic defects. Some patients have decreased levels of class switched memory B cells and/or decreased levels of somatic hypermutation which points to defects in the germinal centre (GC) reactions as cause of the disease in these patients. The inducible costimulator, ICOS, and its' ligand, ICOSL, are both involved in and necessary for the GC reaction and so is activation-induced cytidine deaminase, AID. Therefore, we sequenced the ICOS, ICOSL and AID genes in a cohort of 34 Danish CVID patients. We found 13 new single nucleotide polymorphisms (SNP) in the intron regions of the ICOSL gene as well as one SNP in exon 3. However, none of these polymorphisms were associated with CVID. We did not find a previously reported CVID-causing ICOS gene deletion or any other unique mutations in the ICOS or AID genes.

Double blind placebo controlled exposure to molds: exposure system and clinical results

The objective was to develop an experimental setup for human exposure to mold spores, and to study the clinical effect of this exposure in sensitive subjects who had previously experienced potentially building-related symptoms (BRS) at work. From three water-damaged schools eight employees with a positive histamine release test to Penicillium chrysogenum were exposed double- blinded to either placebo, approximately 600,000 spores/m3 air of P. chrysogenum or approximately 350,000 spores/m3 of Trichoderma harzianum for 6 min on three separate days. A statistically significant rise in symptoms from mucous membranes appeared from the 9-graded symptom scale after exposure to T. harzianum or placebo. Dichotomizing the data, whether the participants experienced at least a two-step rise on the symptom scale or not, gave borderline increase in mucous membrane symptoms after exposure to P. chrysogenum. In conclusion this is, to our knowledge, the first study to successfully conduct a human exposure to a highly controlled dose of fungal material aerosolized directly from wet building materials. This short-term exposure to high concentrations of two different molds induced no more reactions than exposure to placebo in eight sensitive school employees. However, a statistical type II error cannot be excluded because of the small sample size.

PRACTICAL IMPLICATIONS

In this double blind, placebo controlled study of mold exposure changes in symptoms, objective measurements and blood samples were small and mostly non-significant, and at the same level as after placebo exposure. The developed exposure system based on the Particle-Field and Laboratory Emission Cell (P-FLEC) makes it possible to deliver a precise and highly controlled dose of mold spores from water-damaged building materials, imitating realistic field exposure conditions. The present experiment is too small to rule out an effect of mold exposure; long-term experimental exposure studies on larger number of subjects are needed.

[The last case of smallpox in Denmark--the organizing conditions in 1970]

Smallpox contributed to many deaths in Denmark up to the introduction of the vaccination in the beginning of the 19th. Century. The last minor smallpox epidemic in Denmark was in 1924, and subsequently no doctors had special experience in smallpox. In September 1970 a Norwegian medical student died from smallpox in Copenhagen after returning from a journey to Afghanistan, where he has been hospitalized for enteritis. During the 5 days in Copenhagen before hospitalization he had had extensive contacts with many people. He was hospitalized at Blegdamshospital and was isolated, and the diagnosis of smallpox was verified on day 5. He was then totally isolated in a pavilion with 2 nurses and one doctor. The initial diarrhoea (Salmonella typhimurium), and later septicaemia with salmonella, the copious expectoration up to 1 1/2 l pr day (Streptococcus pneumoniae, Klebsiella pneumoniae, E. coli, 9-streptococci), the enormous exudation from the desquamated skin caused large problems concerning water, electrolytes and protein balance, requiring an input up to 13 1 per day. It was necessary to perform tracheotomy and artificial ventilation. He was treated as a patient with extensive burns with metal sheets and when his body temperature fell to 30 degrees C with electrical heat. He died after 25 days of smallpox with complicating extensive skin ulavs corresponding to a pathological picture of toxic epidermal necrolysis (TEN). The containment was successful in cooperation with the Danish National Board on Health, the Medical Officer of Health from Copenhagen and the county (where the patient lived), police, State Serum Institute, and Ministries of the Interior and Foreign Affairs. Vaccination of the exposed persons and the hospital staff, isolation in small groups (maximum 20 persons) of 589 primary contacts in the hospital pavilion-wards and 12 military tents were performed. No secondary cases occurred. The outbreak of smallpox in Copenhagen ended, and the city was not declared "local infected area", and we avoided a panic mass vaccination of large group of people. The article describes these activities, which are effectuated within a few days and headed by a capable and unanimous leadership, in a serious and complicated situation and with an engaged cooperation from the whole staff.

Deficiency of somatic hypermutation of the antibody light chain is associated with increased frequency of severe respiratory tract infection in common variable immunodeficiency

Reduced levels of somatic hypermutation (SHM) have recently been described in IgG-switched immunoglobulin genes in a minority of patients with common variable immunodeficiency (CVID), demonstrating a disruption of the normal linkage between isotype switch and SHM. To see if, irrespective of isotype, there is a tendency to use unmutated immunoglobulin genes in CVID, we studied SHM in kappa light-chain transcripts using a VkappaA27-specific restriction enzyme-based hot-spot mutation assay (IgkappaREHMA). Hot-spot mutations were found in 48% (median; reference interval, 28%-62%) of transcripts from 53 healthy controls. Values were significantly lower in 31 patients (median, 7.5%; range, 0%-73%; P < .0000001) of whom 24 (77%) had levels below the reference interval. Low levels of SHM correlated with increased frequency of severe respiratory tract infection (SRTI; P < .005), but not with diarrhea (P = .8). Mannose-binding lectin (MBL) deficiency also correlated with SRTI score (P = .009). However, the correlation of SHM and SRTI was also seen when only patients with normal MBL genotypes were analyzed (n = 18, P = .006). A slight decline of mutated fractions over years was noted (P = .01). This suggests that most patients with CVID fail to recruit affinity-maturated B cells, adding a qualitative deficiency to the quantitative deficiency characterizing these patients.

Illness and disability in Danish Chronic Fatigue Syndrome patients at diagnosis and 5-year follow-up

OBJECTIVE

Evaluation of the life impact of Chronic Fatigue Syndrome (CFS) over 5 years.

METHODS

Thirty-three adult patients meeting 1988 and 1994 CDC case criteria answered identical questionnaires at diagnosis and 5 years later, when a retrospective questionnaire was also completed.

RESULTS

Work disability was very high and increased further, social isolation remained high, emotional adjustment improved. There were increased problems with reading and with allergies. Two measures of improvement were used: The relation between these measures was weak. Length of illness, extent of disability and emotional adjustment were poorly related to measures of improvement. Average illness scores were unchanged, but most individuals improved in some ways while worsening or remaining the same in others. Only one participant (3%) neared recovery, one other was substantially better but still severely disabled.

CONCLUSION

CFS patients exhibit severe, long-term functional impairment. Substantial improvement is uncommon, less than 6%. Allergies and aspects of cognition may worsen, emotional adjustment often improves.

[From administrator to laundrymaid - aspects of the conditions of the staff at the Municipal Hospital of Copenhagen (Kommunehospital) after the opening in 1863]

The opening of the biggest and most advanced Danish municipal hospital of its time took place on the 19th of September 1863 in the city of Copenhagen. The hospital had the capacity to host about 700 patients and was equipped with modern facilities such as water closets, electricity, running water and baths. The daily routines at this large institution had to be throughly organized. This article focuses on the working environment, the rights and duties of the staff and its hierarchical structure. From the historical source material we have been able to classify the staff members into five different groups: the administrative personnel, the medical personnel, the attendants, the caretakers and finally the housekeeping personnel. Many members of the staff lived at the hospital, and a chief physician who wished to leave the premises for more than 36 hours had to obtain the permission of the Mayor of Copenhagen. The instructions regarding the rights and duties of members of the staff, dating back to 1863, shows that a very strict staff policy was needed to keep the hospital running. As an example, the administrator had to stand surety for furniture and equipment used at the hospital along with the stock of goods, for which he was responsible. WOrking in the hospital was a dangerous job. As surety he paid 1000 Rigsdaler, which was more than his yearly salary. The risk of being infected by the patients (e.g. with smallpox) was always present, and the modern machinery, the boiling steam and the treatment of patients in the baths of white spirit, resulted in serious injuries and even deaths. The nature of the working conditions of the laundrymaids is well illustrated by the fact that they were likely to be so worn-out after only six months that they had to give up their job.

[The Danish psychiatrist and professor Daniel Jacobson (1861-1939) - as sketched by friends and patients]

One of the nerve specialists/psychiatrists of the first part of the 20th. century, Professor Daniel Jacobson (1861-1939), chief physician of the Psychiatric Department, Frederiksberg Hospital, was an outstanding person as regards both character and appearance. He was a tall man, and his artistic looks and charismatic authority made him a popular therapist in the Scandinavian Countries. His patients included not only many devoted females, but also several Nordic artists - among these the Norwegian painter, Edvard Munch. Munch was treated in Jacobsons private nerve clinic at Frederiksberg in 1908-09 and during his stay he painted the characteristic portrait of Jacobson. Here we present a new collection of drawing, caricatures, verse and humorous texts from patients, colleagues and friends.

[Letters from the Nobellaureter Paul Ehrlich to the Director for the State Serum Institute in Copenhagen, Thorvald Madsen]

In 2003 some letters, written from 1905-1915 by the father to the chemotherapy, the Nobellaurter Paul Ehrlich (1854-1915) and his family written to Dr. Thorvald Madsen (1870-1957), Director of the State Serum Institute from 1909 to 1940 was found. In these letters the personal and scientific relations between the two scientists is described on the background of the letters found. The article is written with the intention to celebrate the 150-birthday of Paul Ehrlich and to document the close relations between Paul Ehrlich and the founders of the State Serum Institute in Copenhagen: Carl Julius Salomonsen (1847-1924) and Thorvald Madsen.

Gastric mucosal cytokine responses in Helicobacter pylori-infected patients with gastritis and peptic ulcers. Association with inflammatory parameters and bacteria load

Helicobacter pylori is an important pathogen in gastroduodenal inflammation and ulceration. Several mechanisms have been proposed to explain its role. We studied the cytokine production patterns in situ in gastric mucosal biopsies from H. pylori-positive and H. pylori-negative patients with dyspepsia. Immunohistochemistry with monoclonal antibodies was used. The study showed enhanced expression of interleukin (IL) -8, IL-10 and interferon-gamma (IFN-gamma) in H. pylori infection and a significant association was found between these cytokines and the following parameters: bacteria load, chronic inflammation and activity. These parameters were significantly correlated with the cell markers CD19 and CD56. The study indicates a dual effect of H. pylori on the Th1 response, i.e. a stimulation of the response verified by increased IFN-gamma and a feed-back verified by an increase of the counterinflammatory IL-10, which may dampen the inflammatory and cytotoxic effect of the Th1 response. Furthermore, the study confirms the connection between increase of IL-8 and inflammatory activity in gastric mucosa in H. pylori infection.

Chlamydia pneumoniae infection and its role in asthma and chronic obstructive pulmonary disease

Chlamydia pneumoniae (CP) is a common cause of respiratory tract infections, and several studies have asked whether it may play a pathogenic role in connection with bronchial asthma and chronic obstructive pulmonary disease (COPD). Evidence that CP infection is associated with these diseases is a cardinal item. However, evaluation of CP infection is hampered by difficulties in obtaining agreement on the definition of a gold standard. In the literature, serology is based on different cutoff points of antibody titres, which complicates the definition of CP seropositive findings and the classification of acute infection, chronic and past infection. In connection with acute and chronic infection, it is important to demonstrate the presence of CP by culture or polymerase chain reaction (PCR) in the respiratory tract, especially in the lower airways. Often, the results of serology is not associated with the findings by culture or PCR testing, which may involve the risk of inconclusive evidence. Evaluation of a possible presence of CP by clinical improvement after treatment with antibiotics is difficult since uncontrolled studies have been used and other microorganisms are also affected by antibiotics. Furthermore, many patients improve without antibiotics, and improvement has also been observed in patients remaining culture positive after treatment with antibiotics. It should also be noted that the antiinflammatory effects of antibiotics may improve the clinical status of patients. Despite these obstacles, studies point to the possibility that in some patients acute CP infections may lead to acute exacerbations of bronchial asthma. Whether a persistent CP infection contributes to chronic asthma or severe COPD, or whether it incites the diseases in previously healthy individuals is a question for further studies. Whether a causal relationship exists between CP infection and obstructive pulmonary disease or whether these patients are more susceptible to CP infection is unknown. Nevertheless, a cooperative role of CP in the proinflammatory mechanisms involved in these diseases remains to be examined since cellular studies show that CP stimulates the production and expression of cytokines, chemokines and adhesion molecules, actions that may amplify and prolong the inflammation.

[The human in the art: Henrik Have's painting for a medical thesis]

A painting made by the Danish painter and author Henrik Have (born 1946) illustrates the front page of Jette E. Kristiansen's medical thesis The Antimicrobial Activity of Psychotherapeutic Drugs and Stereo-isomeric Analogues (1990). The painting illustrates beautifully that art and science can go hand in hand. Even very complicated chemical, pharmacological and microbiological questions can be expressed by means of colours and by means of symbols used in everyday life, such as a spiral (DNA), or a pair of hands expressing working together. Prayers, wishes and the most difficult questions in receptor stereo-chemistry in eucaryotic and procaryotic cell-systems are illustrated in this painting. Synthetic chemistry and pharmacology are linked in the development of the synthetic dyes. The chemical colours are often the same in dyes and drugs. The red colour in the pharmacology is associated with the antibiotic drugs as sulfonamides as well as with the staining of Gram-negative bacteria. The yellow colour is associated with the antibiotic drugs, quinolones and the Ziehl-Neelsen staining for tubercle bacillii. The blue colour is associated with the psychoactive drugs, phenotiazines, as well as with methylenblue staining and the staining of Gram-positive bacteria. These association and symbols have been used in this painting.

[100 years with certificates: Danish Society of Insurance Medicine 1902-2002]

Danish Society of Insurance Medicine was formed in 1902 as an association between the Danish Society of Accident Insurance and the Danish Society of Life Insurance Medicine, both founded a year before. The purpose of the society is to apply and to further the scientific basis of insurance medicine. The meetings also play a role as a forum for discussions. The members of the society are all working part-time in an insurance company in Denmark (in contrast to many other countries where it is a full-time job). The members are mainly specialists in medicine and surgery. During the first half life of the society nearly all members were high-qualified doctors, i.e. professors and consultants at a university hospital in Copenhagen usually with a doctoral degree. These prominent doctors had a significant influence on insurance medicine in Denmark. The managing directors of the Insurance Companies were invited to the meetings. Many scientific works and textbooks were written on the subject. The society arranges two meetings yearly - one concerning with life insurance and one with accident-insurance medicine. Previously, the question put to the medical adviser was always "Which impairments can still be insured?", but today the question is the opposite "Which impairments are not insurable?" The members have increased to currently 112, still only men, but today the members are younger, comprise fewer professors and fewer with a doctoral degree. During the last 6 years, all interested members in the insurance companies have been invited to the meetings, providing a broader input for the discussions. The topic of the meeting is of current interest: new laws or a new treatment of a disease (medication, surgery) which has been introduced. One to three speakers open the meeting, followed by a discussion. The meetings are always concluded with a light meal and a glass of wine, in earlier days also with cigars and Danish schnaps. 190 meetings have been held during the last 100 years. Often the speakers are members of the society. In the future the Danish Society of Insurance Medicine will face new challenges as regards to the communication of knowledge about new diseases and new treatments in the light of with biostatistics and new insurance products.

[Mrs. Popp - and all the others: the first patients admitted to the Kommunehospital in Copenhagen on the opening day September 19, 1863]

The gates of the Kommunehospital in Copenhagen opened for the first time on September 19th, 1863. It is recorded that on this day 89 patients were admitted to the hospital. These patients have been subdivided according to occupation, their own or that of the family, as it was recorded on admission. The occupational groups are: journeymen, workers, seamen, servants, self-supporting and paupers. Most of the patients are men, reflecting the fact that on the opening day only male patients were moved from Almindelig Hospital that the new Kommunehospital was to replace. Most of the patients came from the working class, a few belonged to the middle-class. That was the general trend at Danish hospitals in the 1860s. The case records provide information about hospital life and about social conditions in 1863, as regards work and family life. According to an article in the 125 year's Anniversary publication of the hospital, the first patient admitted was a widow Mrs. Popp, who suffered from eczema. This study has shown that probably the first patient was a mate by the name of Frits Nygaard. He suffered from smallpox and was admitted already on the 9th of August to the isolation-house, which was taken into use before the official opening of the hospital.