NIPH annals最新文献

A monoclonal CEA-EIA assay is evaluated with respect to clinically pertinent data. Comparison is done with the conventional CEA-RIA assay (Roche). Good interlaboratory reproducibility was found, and the stability was very good over the one year evaluation period. The EIA assay could be performed in samples of serum and plasma with compatible results. The correlation between the EIA and RIA values was different in different diagnostic groups, with high correlation in colo-rectal cancer, and low in non-malignant diseases, in which the EIA assay had a lower frequency of CEA positive values. In colo-rectal cancer the RIA assay shows a 20% specificity improvement compared with the EIA assay. This was also reflected in better predictability for true positive and true negative cancer diagnosis in this group of patients as well as increased ability to discriminate between malignant and non-malignant diseases. In other groups of patients, like lung cancer and uterine cervical cancer, such improvement was not seen. The discrimination between malignant and non-malignant diseases was comparable to that of the RIA assay. In follow-up series the EIA and RIA assays detected recurrences and responses to treatment in a quite similar way. In most cases of recurrences from colo-rectal cancer, however, the EIA values increased faster and were a better indicator for recurrent disease than the RIA values.

The results of the external quality assessment for clinical microbiology in Norway in 1984 are evaluated. Four distributions, each consisting of four simulated clinical specimens, were carried out. The assessment has, as in previous years, revealed some problem areas concerning laboratory procedures which are discussed.

Plasma concentration studies were performed in mice given high intravenous (i.v.) bolus injections or subcutaneous (s.c.) depot doses of benzylpenicillin. There was a marked difference in plasma concentration within and between individuals both after benzylpenicillin (BP) given i.v. and after benzylpenicillin procaine (BPP) given s.c. BP given i.v. resulted in a plasma half-life of 15.2 minutes, while BPP given s.c. resulted in a plasma half-life of 2.7 hours. Infection with an endotoxin-liberating meningococcal strain in BP-treated animals increased the plasma levels of BP compared with uninfected controls.

In 71 males who survived acute meningococcal disease 3 to 15 years ago at an age of about 20, associations between acute clinical conditions (including a few pre- and post-admission variables) and late sequelae have been studied. There was a higher rate of sequelae symptoms (mainly light neurological and mental disturbances) among survivors from meningitis (76%) than among those who had had both meningitis and septicemia (58%) or pure septicemia (50%). Twenty percent of control persons experienced such symptoms. "Changed Life" because of serious educational and working problems followed in 29% of the meningitis cases and 70% of the septicemia cases. Most of the clinical and laboratory factors separately examined were not significantly correlated to the sequelae rates. However, less than 2.5 mmol/l glucose in the cerebrospinal fluid (CSF) on admission (p less than 0.01), more than 1000 X 10(6) white blood cells per 1 in the cerebrospinal fluid (p less than 0.05), fever for more than 8 days (p less than 0.05), and probable cerebral symptoms the first week (p less than 0.05), were all positively correlated to a high rate of late sequelae. Well documented early sequelae correlated with serious late sequelae (p = 0.05). No conspicuous associations between acute antibiotic treatment and late sequelae were found. A combination of CSF glucose, blood thrombocytes, and cells in CSF on admission yielded a multiple regression score which seems to be a moderately reliable predictor of sequelae (R = 0.46). Hospital treatment should both aim at avoiding death and escaping residual effects. Because many prognostic factors for sequelae on admission are different from those for lethality, scoring for sequelae may be helpful in such secondary prevention of sequelae. Early standardized registration of sequelae may also be of value in tertiary prevention.

The virulence of two serogroup B meningococcal strains (270E+ and 840E+) having a high endotoxin release during in vitro growth, was compared with the virulence of corresponding variants (270E- and 840E-) liberating less endotoxin. The E-variants were isolated during subcultivations from the E+ strains. 270E+ and 840E+ were both serotype 15:P1.16, while 270E- was serotype 15:P1.2 and 840E- was non-typable. The SDS-PAGE patterns of the E+ and E- variants were also dissimilar. The E+ and E- variants differed in several other properties. Groups of mice were inoculated intravenously (i.v.) or intraperitoneally (i.p.) with E+ and E- meningococci. The endotoxin activities of inoculates and mouse blood were assayed by a Limulus lysate test. The mice received a similar infective dose of E+ and E- variants. A higher level of CFU and endotoxin was found in heart blood of E+ than of E-infected mice during the first hours after infection. Both 30h and 72h after inoculation, E+ variants were significantly more lethal to mice than E- variants (p less than 0.01).

Pregnant Belted Dutch rabbits were administered lynestrenol (17-alpha-ethynyl-oestr-4-en-17-beta-ol) orally on days 6-18 of gestation at a dose of 0.5 mg/kg/day. The dose littered on term and the surviving offspring were observed until four weeks old. Neurological disturbances characterized by behavioural abnormalities and locomotor disabilities were observed. About 40% of the offspring died within four weeks, and more than 70% of these had congenital malformations.

The need has arisen for a rapid test for detection of antibody production in the central nervous system (CNS) in patients with varicella-zoster (VZV) encephalitis. We have developed an immunofluorescence test based on semiquantitative determination of antibody concentration. In this work we have systematically examined some of the most important errors that may influence the quantification of the system. In the reported experiments six samples with known antibody dilutions and one control sample were tested for fluorescence "in the blind" on 716 slides. On each slide two samples were tested in six two-fold dilutions. The reproducibility of the differences between two titres was best when the fluorescence of each test sample in each pair had been directly compared under the microscope. Pairs of samples which had been tested in random order with very small chance of being directly compared, showed a higher number of errors. Of 224 pairs having four-fold or greater concentration difference, only one was not detected by the improved test. However, with only two-fold difference, the failure increased to 35%. Only three out of 62 pairs with the same concentration of antibodies falsely showed two-fold or greater difference of titres. No paired titres showed a difference opposite to what was expected. Based on the results reported in this paper we have started to use the test in routine diagnosis of encephalitis.

Eight hundred and fifty-six strains of more than ten species: Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus faecalis, Escherichia coli, Klebsiella spp, Proteus mirabilis, Proteus vulgaris, Enterobacter spp, Pseudomonas spp and Acinetobacter spp, were tested by the disc diffusion method against azlocillin and carbenicillin. Azlocillin was found to be superior to carbenicillin against Pseudomonas spp, and more than 90% of the tested strains had minimal inhibitory concentration (MIC) values well below the serum levels attainable after recommended doses of azlocillin. Against Enterobacteriaceae and Gram-positive cocci, however, azlocillin seemed to have little to offer.

The external quality assessment scheme for clinical microbiology (EQA-M) used in Norway in 1983 is described and the results are evaluated. Altogether three distributions, each consisting of 3--4 simulated clinical specimens, were carried out. All specimens were distributed as "open" tests (identifiable by the participants as EQA-M tests), but two were also simultaneously distributed as "blind" tests (not identifiable by the participants as EQA-M tests). The EQA-M in 1983 has revealed some problem areas concerning the isolation, identification and reporting procedures, the more important being: The clinical information given seems often to be ignored The reported priorities of different microorganisms recovered from one specimen often seem to be accidental rather than the results of thorough considerations The isolation rates of Shigella sp and Yersinia enterocolitica from faecal specimens are too low A great number of laboratories seem to overestimate the quantities of bacteria in dip-slide cultures.

The occurrence of sequelae 3-15 years after meningococcal disease has been investigated in a study on 71 patients and 64 controls. The patients were young men, aged 18 to 24 years at the time the disease was contracted. Participants filled in a questionnaire on possible symptoms. Audiometry and EEG were also carried out. The response rates were 84% among patients and 75% among controls. We found that 61% of the patients had one or more symptoms of possible sequelae compared to 20% in the control group (p less than 0.001). The symptoms were generally light and of mental or neurological type. Among the patients 13% stated that they had obvious complaints commonly attributed to meningococcal disease, compared to 2% only in the controls (p less than 0.05). Twenty-nine per cent of the patients stated that the disease had affected their education or working capacity. No statistical differences between patients and controls were demonstrated by audiological or EEG examinations. In only one single ear could deafness unequivocally be attributed to the disease.