An elevated pro-inflammatory cytokine profile in multiple chemical sensitivity.

BACKGROUND: Multiple chemical sensitivity (MCS) is a medically unexplained condition characterized by reports of recurrent unspecific symptoms attributed to exposure to low levels of common volatile chemicals. The etiology of MCS is poorly understood, but dysregulation of the immune system has been proposed as part of the pathophysiology. OBJECTIVE: To compare plasma levels of cytokines in Danish MCS individuals with a healthy, sex- and age-matched control group. METHOD: Blood samples were obtained from 150 un-exposed MCS individuals and from 148 age- and sex-matched healthy controls. Plasma concentrations of 14 cytokines, chemokines and growth and allergen-specific IgE were measured. All participants completed a questionnaire including questions on MCS, psychological distress, morbidities and medication use at the time of the study. RESULTS: Plasma levels of interleukin-1ß, -2, -4, and -6 were significantly (P<0.001) increased in the MCS group compared with controls, tumor necrosis factor-α was borderline significantly (P=0.05) increased and interleukin-13 was significantly decreased (P<0.001). CONCLUSION: MCS individuals displayed a distinct systemic immune mediator profile with increased levels of pro-inflammatory cytokines and interleukin-2 and inverse regulation of Th2 associated cytokines interleukin-4 and interleukin-13 suggestive of low-grade systemic inflammation, along with a deviating Th2-associated cytokine response not involving IgE-mediated mechanisms.

The capsaicin cough reflex in patients with symptoms elicited by odorous chemicals.

Patients with multiple chemical sensitivity and eczema patients with airway symptoms elicited by odorous chemicals have enhanced cough reflex to capsaicin when applying the tidal breathing method. The aims of the present study were to test whether the capsaicin induced cough reflex was enhanced when applying the single breath inhalation method in similar groups of patients with symptoms related to odorous chemicals e.g. other persons wearing of perfume; and to investigate to what extent the reporting of lower airway symptoms influenced the cough reflex. Sixteen patients fulfilling Cullen's criteria for multiple chemical sensitivity and 15 eczema patients with airway symptoms elicited by odorous chemicals were compared with 29 age-matched, healthy controls. We measured C5--the capsaicin concentration causing five coughs or more--using the single breath inhalation test. No difference was found between groups in age, body mass index or pulmonary function. The median C5 were 129 micromol/L (control group), 48 micromol/L (multiple chemical sensitivity patients), 32 micromol/L (eczema patients). The reporting of lower airway symptoms from odorous chemicals was significantly (p<0.05) correlated to increased cough reflex sensitivity to capsaicin, independent of patient group or co-existence of asthma. The results suggest that the C5 is not reliable for diagnosing MCS but C5 can be used to verify presence of lower airway symptoms related to odorous chemicals.

Vestibular autorotation test in primary selection of military student pilots using neural networks.

BACKGROUND: Selection of student pilots to the Royal Danish Air Force involves a physical examination including a vestibular test. Usually tests for selection proposes are not well documented. HYPOTHESIS: The result of the vestibular autorotation test (VAT) is correlated to the ability to learn to fly in a military context. METHODS: A Multi Layer Perception neural network with three layers configured as a Back Propagation Network was tested using data originating from horizontal VAT of 59 student pilot candidates, given the outcome of the pre-jet basic flight check. In the analysis the leave-one-out method was used. RESULTS: Based on horizontal data only the network correctly classified the student pilot candidates as having been passed or rejected within a verification error margin < 0.1. CONCLUSION: The result indicates that VAT performed at the initial physical examination is a powerful tool for the elimination of unfit student pilot candidates when data are analyzed in neural networks.

Craniofacial morphology in patients with Kallmann's syndrome with and without cleft lip and palate.

OBJECTIVE: Kallmann's syndrome is characterized by the association of hypogonadotropic hypogonadism and anosmia or hyposmia. The principal endocrine defect of hypogonadotropic hypogonadism is a failure to secrete luteinizing hormone-releasing hormone (LHRH), resulting in underdevelopment of the pituitary gonadotropes and an inability to synthesize and release luteinizing hormone and follicle-stimulating hormone. The purpose of the present investigation was to describe the dentition and the craniofacial morphology in patients diagnosed with Kallmann's syndrome. DESIGN: The sample consisted of 11 patients, 2 of whom also had bilateral cleft lip and palate. Radiographic investigations, including cephalometry, were performed. Comparisons were made to normal individuals and to cleft lip individuals without Kallmann's syndrome. RESULTS: Dentition: tooth agenesis occurred more frequently in patients with Kallmann's syndrome. Craniofacial morphology: Increased mandibular inclination and mandibular angulation were seen in Kallmann patients. When clefting also occurred, extreme retrognathism of both maxilla and mandible was seen, a deviation which seemingly worsened during growth. The anterior cranial base and the sphenoid bone showed an altered morphology in one of the patients with Kallman's syndrome. CONCLUSIONS: An early diagnosis of Kallmann's syndrome is very important because the prognosis for endocrine treatment thereby improves, and therefore, it is recommended that the sense of smell be evaluated in patients with the craniofacial morphology described.

[Bone-anchored auricular prosthesis]. / Knogleforankret aurikelprotese.

During the period February 1989-September 1991, 15 patients with absent or defective pinna were treated with a bone-anchored auricular prosthesis at the ENT-department, Rigshospitalet, Copenhagen. These patients were followed up from the hospital records and by means of a questionnaire. Altogether 40 titanium implants have been inserted, of which one implant was found not to be integrated at the time of the second-stage surgery. Five patients underwent additional surgery, one patient because of non-integration of a screw, and four patients on account of soft-tissue reactions. From the questionnaire replies it appears that all patients found the cosmetic result and the technique concerning mounting of the prosthesis very satisfactory. Nearly half the patients found that the care of the skin around the abutments caused considerable problems. Three patients had experienced unintended losses of the prosthesis. In conclusion, treatment with a bone anchored auricular prosthesis has considerable advantages compared to treatment with a prosthesis attached by adhesive. Furthermore the use of a bone-anchored prosthesis should be considered a viable alternative to surgical reconstruction because of the outstanding aesthetic result and because the surgical procedure puts less strain on the patient. The disadvantage of the method is the lifelong daily care of the skin and the dependence on the health services.

Clinical diagnosis of vestibular disorders. A system approach to dizziness.

During recent decades, vestibular research has emphasized that it is important to consider vestibular reflexes a part of the integrated balance system function. Vestibular diagnosis must be based on a system approach to vestibular dysfunction. The development of new balance system examination methods is based on computerization of the analysis of transfer functions. Using these methods, system dysfunction is more easily understood and a new universe of vestibular diagnosis might develop in the years to come.

A new and simple calibration of the electro-ocular signals for vestibulo-ocular measurements.

Reliable calculation of the gain of the vestibulo-ocular reflex depends on a reliable way of calibrating the eye movements. During the new calibration manoeuvre, the subject fixes the eyes at a point about 1 m away and moves the head either in pitch or yaw approximately +/- 30 degrees. The head movements are recorded by means of an angular rate sensor. The eye movements are recorded with standard surface electrodes. By integrating the angular rate signal the precise head position angle is calculated. The fixating eyes will compensate for this angle and, thus, the signal level of the eye movements is defined. A systematic error is introduced in this procedure. Because the distance to the fixating point is finite, the eyes must deviate more than the head movement. The extra angle is dependent on the distance to the target. In yaw, the angle is independent of the direction of the head movement. In pitch, the angle is both dependent on the distance to the target and on the direction of the head movement. Correction for the error must, in most cases, be performed directly on the eye recordings before calculating the VOR gain.

Heart rate responses to moderate linear body accelerations: clinical implications in aeromedical evacuation.

Linear accelerations during take-off and landing were measured in both civilian and military aircraft usually involved in aeromedical evacuations in Denmark. Accelerations of similar durations and magnitudes were induced in six healthy subjects transported in an ambulance in different supine positions. Heart rate responses recorded depended significantly on the position of the subject. It was concluded that seriously ill patients must be positioned transversely to the axis of acceleration during aeromedical evacuation.

Acquired intolerance to organic solvents and results of vestibular testing.

Among 160 consecutive patients referred to the Clinic of Occupational Medicine, Rigshospitalet, for symptoms connected with exposure to organic solvents, 20 exhibited symptoms of acquired intolerance to minor amounts of organic solvents. Later, an additional 30 consecutive patients with symptoms of acquired intolerance were included, yielding a total of 43 men and 7 women. The characteristics of the clinical syndrome described are complaints of dizziness, nausea, and weakness after exposure to minimal solvent vapor concentrations. After having tolerated long-term occupational exposure to moderate or high air concentrations of various organic solvents, the patients became intolerant within a short period of time. Since dizziness was a frequent complaint, we tried to obtain a measure of the patients' complaints using vestibular tests. As a diagnostic test the combined vestibular tests had a sensitivity of 0.55 and a specificity of 0.87. No differences between patients with and without intolerance could be detected by the vestibular tests used. We conclude that acquired intolerance to organic solvents is a new but characteristic and easily recognizable syndrome, often with severe consequences for the patient's working ability.

Caloric testing with small temperature gradients. Caloric zero.

Caloric nystagmus was investigated in 50 normal subjects with stimulation of the temperatures 30, 33, 35, 39, 41, and 44 degrees C. Mean values of the duration and the eye speed of the slow phase of adjacent temperatures were significantly different. No difference could be demonstrated between the equidistant temperatures 30/44 and 35/41 degrees C, but the response was significantly stronger with 35 than with 39 degrees C. This indicates that the caloric zero, i.e., the theoretical neutral temperature, is higher than 37 degrees C. The caloric zero was determined by extrapolation of the regression lines of the mean values for the six temperatures investigated. Determination by means of maximum eye speed of the slow phase values showed to be more accurate than with the duration, probably due to smaller interindividual variations of the responses.

Spontaneous nystagmus in central nervous disease.

Over a 10 yr period, 23,899 patients from the neuromedical and neurosurgical departments were examined for spontaneous nystagmus. A central spontaneous nystagmus was found in 281 patients (1.2%).

Treatment of pulmonary Pseudomonas aeruginosa infection in cystic fibrosis with cefsulodin.

20 patients with cystic fibrosis and chronic pulmonary Pseudomonas aeruginosa infection underwent a total of 23 courses of treatment with a new cephalosporin, cefsulodin. The patients were given 100-150 mg/kg/day in 3 divided doses for 14 days, alone or in combination with tobramycin. Maximum serum levels were around 150 microgram/ml and 6-h levels above 5 micrograms/ml. 90% of the infecting strains were sensitive to 5 micrograms/ml in vitro. Apart from discomfort in direct relation to intravenous bolus injection the drug was well tolerated. Clinical improvement was pronounced, and in 5 cases. P. aeruginosa disappeared from bronchial secretions. Patients allergic to carbenicillin tolerated cefsulodin without signs of allergy. Cefsulodin thus appears to be an effective alternative to carbenicillin in the treatment of severe P. aeruginosa infections.

Computer analysis of electronystagmographic data.

Manual calculation of the parameters of nystagmus is imprecise and time consuming. Therefore, a computer program for analysis of nystagmus has been built up in our laboratory. The program is based on automatic extraction of the minimum and maximum values nystagmus. These values are stored for calculations of duration, amplitude and velocity of the fast and slow phase. The distinction between the slow and fast phase is based on the duration of the phases. The program is thus able to accept nystagmus in different directions.