University of Manchester sports injury clinic.

This paper reviews the work of the sports injury clinic based at the Student Health Centre, University of Manchester during its first eighteen months. A total of 852 patients including 46 Centre of Excellence athletes were treated. The results indicate that the establishment of such a specialised clinic is worthwhile, that the injured sportsmen should be treated by individuals trained and interested in the treatment of injured patients in general and that the commonest injuries are soft tissue injuries to the knee of ankle joint. A record card, designed for future computer analysis, is illustrated. It includes details of the sport, training, mechanism of injury, pathology and treatment.

Asthma due to industrial use of chloramine.

Seven brewery workers developed asthmatic symptoms after using chloramine (chloramine-T) powder as a sterilising agent. They gave positive weal and flare reactions to skin-prick tests with solutions of chloramine at strengths that caused no reactions in unexposed controls. The symptoms did not recur once the men had been removed from areas in which chloramine was handled. As well as causing irritant effects, inhaling dry or liquid aerosols of chloramine may cause sensitisation, with workers being prone to allergic asthma on reexposure. In view of this, measures should be taken to ensure that chloramine is not inhaled.

Specific immunoglobulin responses after varicella and herpes zoster.

The indirect immunofluorescence technique has been used to titrate the specific immunoglobulins in 200 sera from 64 patients with varicella, and 195 sera from 67 patients with herpes zoster. IgG and IgM antibodies were detected in all patients with varicella, and IgA in 59 (92%). All three classes of antibody appeared 2--5 days after the onset of the rash, increased virtually simultaneously and reached maximum titres during the second and third weeks. IgG then declined slowly, but never became undetectable and was still present in five subjects who were retested after 2--4 years; it was present in 88 out of 100 healthy young adults and probably persists indefinitely after varicella. IgA and IgM antibodies declined more rapidly and were not detected in specimens taken more than a year after the illness. IgA, however, may possibly persist in some cases since low titres were found in 8 out of 88 young adults who possessed IgG antibody and had presumably had varicella in the past. IgA responses were significantly weaker in children under the age of 6 years than in older children and adults. Six out of 67 patients with zoster were tested at various times before the onset of the rash: IgG antibody was detected in all. IgG was present in all sera taken after the onset of the rash, increased rapidly after 2--5 days, reached maximum titres during the second and third weeks and then declined slowly. IgA antibody was detected in 66 patients (99%) and IgM in 52 (78%); both types of antibody followed transient courses, as in varicella. Maximum titres of IgG and complement-fixing antibodies were greater after zoster than after varicella, but the differences were not significant. IgA and IgM titres in young adults with zoster were significantly lower than in older patients, and also lower than in young adults with varicella. Increases in varicella-zoster antibody in patients with herpes simplex virus infections consisted mainly of IgG, sometimes IgA, but never IgM.

Specific immunoglobulin responses in serum and nasal secretions after the administration of attenuated rubella vaccine.

The indirect immunofluorescent technique has been used to study the specific immunoglobulin responses in the sera of 63 non-immune adult women who received either Cendehill rubella vaccine subcutaneously, RA27/3 rubella vaccine subcutaneously, or RA27/3 vaccine intranasally. IgG, IgA and IgM antibodies increased virtually simultaneously, starting about 2 weeks after vaccination. IgG antibody appeared in all subjects and reached maximum titres 4-6 weeks after vaccination. The mean IgG titres elicited by the three different methods of vaccination did not differ significantly. IgA and IgM antibodies reached their highest titres between 21 and 28 days after vaccination and then declined to low or undetectable titres within about 9 weeks. The maximum IgA titres observed after intranasal administration of RA27/3 vaccine were significantly higher than those which occurred when the same vaccine was given subcutaneously, but no significant difference in IgM titres was observed. When unfractionated sera were examined IgA antibody was detected in 57 cases (91%) and IgM in 51 (81%). Fluorescent examination of fractions obtained by centrifugation on sucrose density gradients frequently revealed small amounts of IgA and IgM antibody which could not be detected by staining unfractionated serum, and with the inclusion of these results IgA antibody was detected in 61 cases (97%) and IgM in 59 (94%).When 39 adults with pre-existing serum antibody were challenged with vaccine a definite IgA response was detected in only one subject and in no case was there any evidence of the appearance of IgM antibody.Nasal antibody, consisting of IgG or IgA or both, was detected in 17 out of 23 non-immune subjects (74%) who received RA27/3 vaccine, either subcutaneously or intranasally. Titres were much lower than those which occur in the natural disease and there was no evidence that nasal antibody was elicited more readily by intranasal than by subcutaneous vaccination.

Nasal immunoglobulin responses in acute rubella determined by the immunofluorescent technique.

The indirect immunofluorescent technique has been used to study the specific immunoglobulin responses in nasal secretions from ten adults with acute rubella. Titres of IgA antibody in nasal washings usually exceeded those of IgG, but both types of antibody were detected in all patients. They appeared a few days after the rash, reached maximum titres during the second week and then declined. IgA antibody was no longer detectable after 47 days and was not detected at all in nasal washings from adults who had experienced rubella in the past. Low titres of IgG antibody persisted in some patients for longer than IgA and traces of IgG were found in nasal washings from a minority of adults with a past history of rubella. Nasal antibodies in acute rubella are therefore transient and unlikely to take part in resistance to reinfection.In sucrose-density gradients nasal IgA antibody sedimented more rapidly than IgG and there was little overlap between these two types of antibody. IgA antibody in serum was more heterogeneous; it was found in nearly all the fractions which contained IgG antibody and in many of those which contained IgM.

IgG, IgA and IgM responses in acute rubella determined by the immunofluorescent technique.

The indirect immunofluorescent technique has been used to study the specific immunoglobulin responses in twelve adult cases of acute uncomplicated rubella. IgG, IgA and IgM antibodies increased virtually simultaneously. IgG antibody persisted throughout the period of study but showed a slight tendency to fall in titre after 7 months. IgM antibody was detected in nine cases. In these patients it was present in high titre 5-15 days after the rash but was not detected after 20 days. IgA antibody was detected in all cases. It was present in high titre 5-20 days after the rash but was no longer detectable after 29 days except in one patient who had a very low titre at 78 days. The presence of specific IgA and IgM indicates recent rubella in uncomplicated cases, and if the immunofluorescent method is used both types of antibody should be sought.