Spatial and Temporal Analysis of Populations of the Sudden Oak Death Pathogen in Oregon Forests.

Sudden oak death caused by the oomycete Phytophthora ramorum was first discovered in California toward the end of the 20th century and subsequently emerged on tanoak forests in Oregon before its first detection in 2001 by aerial surveys. The Oregon Department of Forestry has since monitored the epidemic and sampled symptomatic tanoak trees from 2001 to the present. Populations sampled over this period were genotyped using microsatellites and studied to infer the population genetic history. To date, only the NA1 clonal lineage is established in this region, although three lineages exist on the North American west coast. The original introduction into the Joe Hall area eventually spread to several regions: mostly north but also east and southwest. A new introduction into Hunter Creek appears to correspond to a second introduction not clustering with the early introduction. Our data are best explained by both introductions originating from nursery populations in California or Oregon and resulting from two distinct introduction events. Continued vigilance and eradication of nursery populations of P. ramorum are important to avoid further emergence and potential introduction of other clonal lineages.

Nitrate leaching, yields and carbon sequestration after noninversion tillage, catch crops, and straw retention.

Crop management factors, such as tillage, rotation, and straw retention, need to be long-term to allow conclusions on effects on crop yields, nitrate leaching, and carbon sequestration. In 2002, two field experiments, each including four cash crop rotations, were established on soils with 9 and 15% clay, under temperate, coastal climate conditions. Direct drilling and harrowing to two different depths were compared to plowing with respect to yield, nitrate N leaching, and carbon sequestration. For comparison of yields across rotations, grain and seed dry matter yields for each crop were converted to grain equivalents (GE). Leaching was compared to yields by calculating yield-scaled leaching (YSL, g N kg GE), and N balances were calculated as the N input in manure minus the N output in products removed from the fields. Direct drilling reduced yields, but no effect on leaching was found. Straw retention did not significantly increase yields, nor did it reduce leaching, while fodder radish ( L.) as a catch crop was capable of reducing nitrate leaching to a low level. Thus, YSL of winter wheat ( L.) was higher than for spring barley ( L.) grown after fodder radish due to the efficient catch crop. Soil organic carbon (SOC) did not increase significantly after 7 yr of straw incorporation or noninversion tillage. There was no correlation between N balances calculated for each growing season and N leaching measured in the following percolation period.

Migration patterns of the emerging plant pathogen Phytophthora ramorum on the West Coast of the United States of America.

Phytophthora ramorum (oomycetes) is the causal agent of sudden oak death and ramorum blight on trees, shrubs, and woody ornamentals in the forests of coastal California and southwestern Oregon and in nurseries of California, Oregon, and Washington. In this study, we investigated the genetic structure of P. ramorum on the West Coast of the United States, focusing particularly on population differentiation potentially indicative of gene flow. In total, 576 isolates recovered from 2001 to 2005 were genotyped at 10 microsatellite loci. Our analyses of genetic diversity and inferences of reproductive mode confirm previous results for the Oregon and California populations, with the strong majority of the genotypes belonging to the NA1 clonal lineage and showing no evidence for sexual reproduction. The high incidence of genotypes shared among populations and the lack of genetic structure among populations show that important large-scale, interpopulation genetic exchanges have occurred. This emphasizes the importance of human activity in shaping the current structure of the P. ramorum population on the West Coast of the United States.

Stream Monitoring for Detection of Phytophthora ramorum in Oregon Tanoak Forests.

Stream monitoring using leaf baits for early detection of Phytophthora ramorum has been an important part of the Oregon Sudden Oak Death (SOD) program since 2002. Sixty-four streams in and near the Oregon quarantine area in the southwest corner of the state were monitored in 2008. Leaves of rhododendron (Rhododendron macrophyllum) and tanoak (Lithocarpus densiflorus) were placed in mesh bags, and bags were floated in streams. Leaf baits were exchanged every 2 weeks throughout the year. Leaves were assayed by isolation on selective medium and by multiplex rDNA internal transcribed spacer polymerase chain reaction (ITS PCR). The two methods gave comparable results, but multiplex PCR was more sensitive. P. ramorum was regularly recovered at all seasons of the year from streams draining infested sites 5 years after eradication treatment. In streams with lower inoculum densities, recovery was much higher in summer than in winter. P. ramorum was isolated from streams in 23 watersheds. When P. ramorum was detected, intensive ground surveys located infected tanoaks or other host plants an average of 306 m upstream from the bait station. P. ramorum was isolated from stream baits up to 1,091 m from the probable inoculum source.

Phytophthora Species Causing Tanoak Stem Cankers in Southwestern Oregon.

Tanoak (Lithocarpus densiflorus) is a principal host of Phytophthora ramorum, cause of sudden oak death (SOD), in the western United States (1). In the course of SOD surveys in southwestern Oregon, other Phytophthora species were encountered to be causing stem cankers on tanoak that were indistinguishable from those caused by P. ramorum. In Oregon, SOD is subject to quarantine and eradication. Aerial surveys are flown two or more times a year to locate symptomatic tanoaks, which are then examined from the ground to determine the cause of death. Isolations on selective media were attempted from all trees with stem cankers typical of Phytophthora. Phytophthora species were identified by morphological features and DNA sequencing of either internal transcribed spacer (ITS) or the mitochondrial COX spacer region. ITS sequences were compared with validated GenBank records, and COX spacer sequences were compared with known reference isolates in the OSU collection. From 2001 through 2006, Phytophthora spp. were isolated from 482 of 1,057 tanoak stem cankers sampled. P. ramorum was isolated from 359 cankers, P. nemorosa was isolated from 102 cankers, P. gonapodyides was isolated from six cankers, P. cambivora was isolated from four cankers (all A1 mating type), P. siskiyouensis was isolated from four cankers, P. pseudosyringae was isolated from two cankers, P. cinnamomi was isolated from one canker (mating type A2), and P. taxon "Pgchlamydo" was isolated from one canker. Three cankers yielded isolates that were not identified but were closely related to P. pseudosyringae based on ITS sequence. No Phytophthora spp. were cultured from the remaining cankers. One isolate from each species identified (except P. ramorum and P. pseudosyringae) was tested for pathogenicity on tanoak stems (11.4 to 16.0 cm DBH) in the field. A 5-mm-diameter plug from the margin of a V8 agar culture was placed in a hole in the bark, covered with wet cheesecloth, and sealed with aluminum foil and duct tape. Each isolate was inoculated into five different stems. Each stem received three different isolates and an agar control. After 4 weeks, bark was removed to reveal lesion development. Lesions were measured (length by width), and pieces from four points on the lesion margin were plated in selective media to reisolate. P. cambivora, P. cinnamomi, P. gonapodyides, P. nemorosa, P. siskiyouensis and P. taxon "Pgchlamydo" all caused substantial lesions in inoculated tanoak trees (average area 11.5 to 18.6 cm2). In all cases, the species used for inoculation was recovered on reisolation from lesion margins. Control inoculations caused necrotic areas averaging 0.2 cm2. Isolations from these areas were clean. Prior to the recent SOD epidemic, no species of Phytophthora were known as pathogens of tanoak. The discovery of P. ramorum as a pathogen of tanoak in California was quickly followed by the discovery that P. nemorosa and P. pseudosyringae were also associated with tanoak cankers (2). Six years of diagnostic support for survey and detection of P. ramorum in tanoak forests of southwest Oregon has revealed the occurrence, at very low frequency, of at least five additional species of Phytophthora causing stem cankers in tanoak. References: (1) D. M. Rizzo et al. Ann. Rev. Phytopathol. 43:309, 2005. (2) A. C. Wickland et al. For. Pathol. Online publication. DOI:10.1111/j.1439-0329.2008.00552.x), 2008.

Population dynamics of the sudden oak death pathogen Phytophthora ramorum in Oregon from 2001 to 2004.

Phytophthora ramorum (Oomycetes) is an emerging plant pathogen in forests in southwestern Oregon (Curry County). Moreover, since 2003 it has been repeatedly isolated from plants in Oregon nurseries. In this study, we analysed the genetic diversity of the P. ramorum population in Oregon from 2001 to 2004 by using microsatellites. A total of 323 isolates (272 from the infested forest; 51 from nurseries) were screened at 10 loci. The overall P. ramorum population in Oregon is characterized by low genetic diversity and has all the hallmarks of an introduced organism. All isolates within the A2 mating type belonged to the same clonal lineage and no recombinant genotypes were found. The forest population (24 genotypes) was dominated by a single multilocus genotype which persisted over years, indicating that eradication efforts in the forest have not completely eliminated inoculum sources. In contrast, genotypic evidence suggests that eradication was effective in nurseries. In 2003 and 2004, a total of 11 genotypes were found in the nurseries (one belonged to the European lineage of P. ramorum) but no genotype was recovered in both sampling years. Significant differentiation and low gene flow were detected between nursery and forest populations. Only two nursery genotypes were also found in the forest, and then at low frequency. Thus, the nursery infestation is not caused by the genotypes observed in Curry County, but likely resulted through introduction of novel genotypes from nurseries out-of-state. This highlights the continued importance of sanitation and quarantine in nurseries to prevent further introduction and spread of P. ramorum.

Phytophthora ramorum Colonizes Tanoak Xylem and Is Associated with Reduced Stem Water Transport.

ABSTRACT Isolation, detection with diagnostic polymerase chain reaction (PCR), and microscopy demonstrated the presence of Phytophthora ramorum in the sapwood of mature, naturally infected tanoak (Lithocarpus densiflorus) trees. The pathogen was strongly associated with discolored sapwood (P < 0.001), and was recovered or detected from 83% of discolored sapwood tissue samples. Hyphae were abundant in the xylem vessels, ray parenchyma, and fiber tracheids. Chlamydospores were observed in the vessels. Studies of log inoculation indicated that P. ramorum readily colonized sapwood from inoculum placed in the bark, cambium, or sapwood. After 8 weeks, radial spread of P. ramorum in sapwood averaged 3.0 to 3.3 cm and axial spread averaged 12.4 to 18.8 cm. A field study was conducted to determine if trees with infected xylem had reduced sap flux and reduced specific conductivity relative to noninfected control trees. Sap flux was monitored with heat-diffusion sensors and tissue samples near the sensors were subsequently tested for P. ramorum. Adjacent wood sections were excised and specific conductivity measured. Both midday sap flux and specific conductivity were significantly reduced in infected trees versus noninfected control trees. Vessel diameter distributions did not differ significantly among the two treatments, but tyloses were more abundant in infected than in noninfected trees. Implications for pathogenesis, symptomology, and epidemiology are discussed.

Comparison of naturally and synthetically baited spruce beetle trapping systems in the central Rocky Mountains.

We compared naturally baited trapping systems to synthetically baited funnel traps and fallen trap trees for suppressing preoutbreak spruce beetle, Dendroctonus rufipennis Kirby, populations. Lures for the traps were fresh spruce (Picea spp.) bolts or bark sections, augmented by adding female spruce beetles to create secondary attraction. In 2003, we compared a naturally baited system ("bolt trap") with fallen trap trees and with synthetically baited funnel traps. Trap performance was evaluated by comparing total beetle captures and spillover of attacks into nearby host trees. Overall, the trap systems did not significantly differ in spruce beetle captures, although bolt traps caught 6 to 7 times more beetles than funnel traps during the first 4 wk of testing. Funnel traps with synthetic lures had significantly more spillover than either trap trees or bolt traps. The study was repeated in 2004 with modifications including an enhanced blend synthetic lure. Again, trap captures were generally similar among naturally and synthetically baited traps, but naturally baited traps had significantly less spillover. Although relatively labor-intensive, the bolt trap could be used to suppress preoutbreak beetle populations, especially when spillover is undesirable. Our work provides additional avenues for management of spruce beetles and suggests that currently used synthetic lures can be improved.

Susceptibility of Oregon Forest Trees and Shrubs to Phytophthora ramorum: A Comparison of Artificial Inoculation and Natural Infection.

Phytophthora ramorum is an invasive pathogen in some mixed-hardwood forests in California and southwestern Oregon, where it causes sudden oak death (SOD) on some members of Fagaceae, ramorum shoot dieback on some members of Ericaceae and conifers, and ramorum leaf blight on diverse hosts. We compared symptoms of P. ramorum infection resulting from four different artificial inoculation techniques with the symptoms of natural infection on 49 western forest trees and shrubs; 80% proved susceptible to one degree or another. No single inoculation method predicted the full range of symptoms observed in the field, but whole plant dip came closest. Detached-leaf-dip inoculation provided a rapid assay and permitted a reasonable assessment of susceptibility to leaf blight. Both leaf age and inoculum dose affected detached-leaf assays. SOD and dieback hosts often developed limited leaf symptoms, although the pattern of midrib and petiole necrosis was distinctive. Stem-wound inoculation of seedlings correlated with field symptoms for several hosts. The results suggested that additional conifer species may be damaged in the field. Log inoculation provided a realistic test of susceptibility to SOD, but was cumbersome and subject to seasonal variability. Pacific rhododendron, salmonberry, cascara, and poison oak were confirmed as hosts by completing Koch's postulates. Douglas-fir was most susceptible to shoot dieback shortly after budburst, with infection occurring at the bud.

Comparison of Biochemical, Molecular, and Visual Methods to Quantify Phaeocryptopus gaeumannii in Douglas-Fir Foliage.

ABSTRACT A recent epidemic of Swiss needle cast along the Oregon coast has prompted efforts to quantify foliar infection and colonization of the causal agent Phaeocryptopus gaeumannii. In this paper, we compare four methods to quantify colonization of Douglas-fir foliage by P. gaeumannii: fruiting body abundance, ergosterol content, dot blot analysis, and TaqMan based real-time quantitative polymerase chain reaction (PCR). Results from the four techniques were all significantly correlated. Fruiting body density and quantitative PCR are two methods least affected by the presence of other needle fungi and had the highest correlation. The methods also were used to compare foliage colonization in nine field sites exhibiting a range of disease severity. All four methods provided evidence that sites differed in the degree of fungal colonization, but only quantitative PCR consistently separated sites with moderate to severe levels of disease from sites with low disease estimated by foliage color, canopy density, and growth measurements.

First Report of A1 Mating Type of Phytophthora ramorum in North America.

Phytophthora ramorum is known in Europe and the western United States (1). In Europe, it is found in nurseries and landscape plantings. In the United States, it has been confined to coastal forests, and in California, it is found in a few horticultural nurseries. All European isolates tested have been A1 mating type, while all North American isolates were A2 mating type (2). Amplified fragment length polymorphism markers also indicated that the populations on the two continents are distinct, and nearly all North American isolates are from one clone (Kelly Ivors, unpublished). In June 2003, P. ramorum was isolated from diseased Viburnum and Pieris spp. cultivars from a Clackamas County nursery in northern Oregon and diseased Camellia sp. cultivar from a Jackson County nursery in southern Oregon. Representative isolates were submitted to the American Type Culture Collection, Manassas, VA. As part of the effort to determine the origin of these new infestations, we tested the nursery isolates for mating type. Seven Oregon nursery isolates, three Oregon forest isolates (from the predominant North American clone), and two European isolates were paired. Agar plugs from 3-day-old colonies were placed in close proximity on carrot agar plates, and then the plates were examined for oogonia after 3 and 10 days as advised by C. M. Brasier (personal communication). Oogonia and antheridia typical of P. ramorum (2) formed when isolates from the Clackamas County nursery were paired with the Oregon forest isolates and also when isolates from the Jackson County nursery were paired with the European isolates. Gametangia also formed in pairings between Oregon forest isolates and European isolates, but not in any other combinations. We developed polymerase chain reaction (PCR) primers for four microsatellite loci and determined allele sizes for the same set of isolates (unpublished). Microsatellite alleles of the Clackamas County isolates were identical to the European tester isolates, and alleles of the Jackson County isolates were identical to the Oregon forest isolates. These results indicate that the recent Oregon nursery infestations are of separate origins. The Clackamas County isolates are A1 mating type and have microsatellite alleles like the European testers, but according to shipping records, the nursery has received no host nursery stock directly from Europe. However, host nursery stock has been received from a Canadian nursery. The Jackson County isolates are of A2 mating type and have microsatellite alleles like the forest isolates of Oregon, which is consistent with the reported origin of these plants from a California nursery. These preliminary microsatellite results need to be validated against a larger isolate set but are congruent with the mating type results. The Oregon nursery infestations highlight the dangers of unregulated or underregulated transport of host nursery stock from infested areas to noninfested areas. All host plants from infested nursery blocks at the affected Oregon nurseries have been destroyed by incineration, and a monitoring program has been implemented. Other host nursery stock on site has been taken "off-sale" pending verification that it is disease free, per the United States Department of Agriculture, APHIS requirements. References: (1) J. M. Davidson et al. On-line publication. doi:10.1094/PHP-2003-0707-01-DG. Plant Health Progress, 2003. (2) S. Werres et al. Mycol. Res. 105:1155, 2001.

Simultaneous one-tube quantification of host and pathogen DNA with real-time polymerase chain reaction.

ABSTRACT Phaeocryptopus gaeumannii is a widespread foliar parasite of Douglas-fir. Although normally innocuous, the fungus also causes the defoliating disease Swiss needle cast in heavily infected needles. The extent of P. gaeumannii colonization in Douglas-fir foliage was estimated with real-time quantitative polymerase chain reaction (PCR) using TaqMan chemistry. In order to derive a normalized expression of colonization, both pathogen and host DNA were simultaneously amplified but individually detected by species-specific primers and TaqMan probes labeled with different fluorescent dyes. Detection of host DNA additionally provided an endogenous reference that served as both an internal positive control and adjusted for variation introduced by sample-to-sample differences in DNA extraction and PCR efficiencies. The genes employed for designing the TaqMan probes and primers were beta-tubulin for the pathogen and a LEAFY/FLORICAULA-like gene involved in floral development for the tree host. Both probe/primer sets exhibited high precision and reproducibility over a linear range of 4 orders of magnitude. This eliminated the need to analyze samples in multiple dilutions when comparing lightly with heavily infected needles. Quantification of the fungus within needles was successful as early as 1 month after initial infection. Real-time PCR is the only method currently available to quantify P. gaeumannii colonization early in the first year of the colonization process.

Sudden Oak Death Caused by Phytophthora ramorum in Oregon.

Sudden oak death, caused by Phytophthora ramorum (1,2), has been found for the first time in Oregon, killing tanoak, Lithocarpus densiflorus, trees. To our knowledge, this is the first report of the disease outside of the San Francisco to Monterey area in California, (300 km to the south). Nine areas of infestation, all within a 24-km2 area, were discovered on forest lands near Brookings, in southwest Oregon. Mortality centers ranged in size from 0.2 to 4.5 ha and included 5 to approximately 40 diseased trees. P. ramorum was isolated from stem cankers using Phytophthora-selective medium. Isolates had distinctive morphological features characteristic of P. ramorum, including abundant production of chlamydospores and caducous, semipapillate sporangia on solid media. Internal transcribed spacer (ITS) sequences of isolates of P. ramorum from Oregon were identical to ITS sequences of isolates from California (1). The pathogen also was isolated from necrotic lesions on leaves and stems of native Rhododendron macrophyllum and Vaccinium ovatum growing beneath diseased tanoaks. In July 2001, the disease was located by an aerial survey conducted cooperatively by the USDA Forest Service and Oregon Department of Forestry. All lands within 1.6 km (1 mile) of the mortality centers are subject to Oregon quarantine, which bars the transport of any host plant materials. An eradication effort is currently underway. Symptomatic plants and all known host plants within 15 to 30 m of symptomatic plants are being cut and burned in the first phase of this operation. The total treated area is approximately 16 ha. References: (1) D. M. Rizzo et al. Plant Dis. In press. (2) S. Werres et al. Mycol. Res. 105:1155, 2001.

Incidence and Impact of Swiss Needle Cast in Forest Plantations of Douglas-fir in Coastal Oregon.

An epidemic of Swiss needle cast, caused by the ascomycete Phaeocryptopus gaeumannii, is causing defoliation and growth reductions in Douglas-fir forest plantations along the Oregon Coast. The area of symptomatic plantations has been monitored annually since 1996 by aerial survey; in spring 1999, 119,500 ha were affected. Pathogen and symptom development have also been monitored on nine permanent plots in stands of differing disease severity. Infection levels and symptom severity are greatest in low elevation plantations close to the coast. In areas of severe disease, trees retain only current year needles. Defoliation is proportional to the number of stomata occluded by pseudothecia of the fungus, with needles being shed when about 50% of stomata are occupied, regardless of needle age. Fungus sporulation and premature needle abscission are greatest on the upper branches of trees. Annual application of fungicides increases needle retention significantly. Tree height and diameter growth and total tree volume are reduced by disease, and tree volume is significantly correlated with needle retention on our plot trees. The epidemic continues to be most severe in Douglas-fir plantations established on sites where Sitka spruce and western hemlock or red alder predominated in earlier times.

Phellinus Weirii and Other Native Root Pathogens as Determinants of Forest Structure and Process in Western North America.

The population structure and ecological roles of the indigenous pathogen Phellinus weirii, cause of laminated root rot in conifer forests of western North America, are examined. This pathogen kills trees in slowly expanding mortality centers, creating gaps in the forest canopy. It is widespread, locally abundant, and very long-lived. It is among the most important disturbance agents in the long intervals between stand-replacing events such as wildfire or harvest in these ecosystems and shapes the structure and composition of both wild and managed forests. Trees are infected and killed regardless of individual vigor. Management of public lands is changing dramatically, with renewed emphasis on natural forest structures and processes but pathogens, especially root rot fungi, remain a significant challenge to "ecosystem management."

First Confirmation of Phytophthora lateralis in Europe.

Phytophthora lateralis, a pathogen of Chamaecyparis lawsoniana (Port-Orford cedar or Lawson's cypress), was confirmed in France, but isolates from Germany identified as P. lateralis or "similar to" P. lateralis proved to be P. gonapodyides. Previously, P. lateralis was known only from western North America, where it has been destructive in nurseries, ornamental plantings, and the forest since its introduction about 1920 (1). Reports from other locations have proved to be misidentifications or impossible to confirm. In France, P. lateralis was isolated and identified from C. lawsoniana on two occasions (1996 and 1998) in different parts of the country, probably stemming from a single original infestation of young, potted, greenhouse-propagated cedars in a commercial nursery. German isolates were from an old culture collection and from irrigation water in a nursery growing a wide range of woody ornamentals. Identifications were confirmed by comparison (2) with authentic isolates. P. lateralis isolates from France and Oregon formed laterally proliferating, elongated obpyriform sporangia that under the conditions of our tests could be dislodged by agitation, leaving a short pedicel. Also, brown chlamydospores formed laterally on the hyphae or terminally on a short stalk and oospores were not formed on standard media. Radial growth was about 2 mm per day. In contrast, sporangia of German isolates and known P. gonapodyides isolates were similar. They exhibited nested pro liferation, were broader than P. lateralis sporangia, and were not readily dehiscent. Some P. gonapodyides isolates, including those from Germany, formed chlamydospores, but these were nearly all catenulate and not lateral, and isolates grew faster (3 to 4 mm per day). Pathogenicity was tested by stem inoculation of C. lawsoniana. P. lateralis from France and Oregon produced lesions averaging 4.7 cm after 2 months (range 2.0 to 8.1 cm, six replicates per isolate, five isolates) while the six replicates of the two German isolates averaged 1.2- and 1.6-cm lesion lengths. Furthermore, sequences of internal transcribed spacer (ITS) DNA from French and Oregon P. lateralis isolates were identical, while sequences of German isolates were similar to P. gonapodyides (J. Duncan and D. Cooke, personal communiation). P. lateralis is a dangerous pathogen of C. lawsoniana and is also pathogenic to Taxus spp. (1), although less aggressive on this host. If established, it would be a serious threat to the widespread ornamental plantings and scattered forest plantations of C. lawsoniana in Europe. References: (1) E. M. Hansen and K. J. Lewis. Compendium of Conifer Diseases. American Phytopathological Society, 1997. (2) C. M. Tucker and J. A. Milbrath. Mycologia 34:94, 1942.

Cementless AGC revision of unicompartmental knee arthroplasty.

Twenty-eight patients (29 knees) who had revision of a failed unicompartmental knee arthroplasty to total knee arthroplasty were evaluated. All revisions were made with cementless technique using the AGC prosthesis (Biomet, Warsaw, IN). Major osseous defects were found in 20 knees, and bone-grafting was used to fill the defects. Aseptic loosening and progression of osteoarthrosis were the main reasons for revision. The median follow-up period was 38 months. Twenty knees were excellent or good, four fair, and five poor. One tibial component had been revised because of loosening. Three knees with instability had been reoperated with a thicker polyethylene component, but one of these patients still suffered from instability, and revision with a constrained prosthesis was planned. One was revised after a deep infection. Two tibial components were suspected to be loose because radiographs exposed fluoroscopically revealed a complete radiolucent line under the component. The results with cementless revision and bone-grafting are comparable to the results achieved after cemented revision, and cementless revision is recommended in young patients and in patients with major bone loss.

First-time operation for lumbar disc herniation with or without free fat transplantation. Prospective triple-blind randomized study with reference to clinical factors and enhanced computed tomographic scan 1 year after operation.

STUDY DESIGN: This prospective triple-blind randomized study of 99 patients concerned the use of free fat transplantation for operation for lumbar disc herniation. OBJECTIVE: To subsequently examine the patients after median 376 days who were subjected to enhanced computed tomographic scan. SUMMARY OF BACKGROUND DATA: In studies on experiments with animals, the degree of intraspinal scar tissue has shown to be reduced in connection with free fat transplantation. Scar tissue is seen frequently after operation for lumbar disc herniation, but it is uncertain whether the scar tissue can lead to symptoms. METHODS: The clinical outcome was scored using the Low Back Pain Rating Scale. Enhanced computed tomographic scan was assessed regarding the degree of scar tissue and survival of fat transplant. RESULTS: There was no different in the clinical outcome between the two groups. Significantly fewer patients had dural scarring in the group who had a fat transplantation, but there was no difference regarding the degree of radicular scarring. The transplant was shown on computed tomographic scan at the follow-up examination in 66% of the patients who had a fat transplantation. CONCLUSIONS: Free fat transplantation can reduced the degree of dural scar tissue after operation for lumbar disc herniation but does not result in a clinically better outcome.

[Insulin pumps and drop in pressure]. / Insulinpumper og trykkfall.

Do insulin pumps deliver more insulin at lower environmental pressures and, if so, is this due to pump dysfunction or to formation of bubbles in the insulin solutions? H-TRON V-100 (Hoechst Infusor V-100), MRS-1 (Disetronic), Nordic Infusor MK II (Novo Nordisk) and Minimed 504-S (Minimed Technology) insulin pumps were studied at 0.9 ATA and 0.8 ATA with constant infusion 2.0 I.U./hour. H-TRON V-100 was also studied at 0.7 ATA at the same infusion rate and with the motor in stop position. The results indicated that all pumps delivered slightly more insulin than the set rate during decompression (max. single value 2.68 I.U. extra delivered at 0.7 ATA, max. average value 1.32 I.U. extra delivered at 0.8 ATA). An equivalent amount of insulin (1.72 I.U.) was delivered at 0.7 ATA without running the motor. This implies that the extra insulin supplied was caused by physically dissolved nitrogen and oxygen in the insulin solution, and was not due to dysfunction of the pumps.

[Arthrosis of the lower limb and running]. / Underekstremitetsartrose og motionsløb.

In order to assess whether running training for many years predisposes to arthrosis in the lower limbs, the hips, knees and ankle joints of 30 runners who began running training at the beginning of the nineteen fifties were examined. Three of these runners were no longer active. One of these had given up late in the nineteen seventies on account of arthroses in the upper and lower limbs i.e. changes which can scarecely be attributed to the stresses of running. The remaining 27 (90%) had run 20-40 km/week throughout 40 years. Subjective, objective and radiological data were compared with data from 27 non-active control persons who were comparable as regards age, weight/height and occupational stress with the runners. We found no differences in joint mobility, axial deviations or complaints of pain between the two groups. Radiologically, the distances between the osseous joint surfaces in the hip and ankle joints and the degrees of degeneration in the knees were assessed according to Ahlback's classification without any differences being found between the groups. Our results suggest that running training to a moderate extent for many years does not predispose to arthrosis in the lower limbs in healthy individuals.