Primary and secondary red ear syndrome: implications for treatment.

Approximately 57 patients with red ear syndrome have been reported in the literature since it was initially described in 1994. The clinical phenotype therefore continues to be defined and no consistent treatment response has been described. We report three new cases of red ear syndrome and suggest that the disorder may exist as a primary trigeminal or cervical autonomic cephalalgia, coexist with other rare trigeminal autonomic cephalalgias, or may be secondary. The pathogenesis in these different circumstances may be distinct, the triggers specific and, when secondary, the disorder may be more resistant to treatment.

Automated counting of mammalian cell colonies.

Investigating the effect of low-dose radiation exposure on cells using assays of colony-forming ability requires large cell samples to maintain statistical accuracy. Manually counting the resulting colonies is a laborious task in which consistent objectivity is hard to achieve. This is true especially with some mammalian cell lines which form poorly defined or 'fuzzy' colonies, typified by glioma or fibroblast cell lines. A computer-vision-based automated colony counter is presented in this paper. It utilizes novel imaging and image-processing methods involving a modified form of the Hough transform. The automated counter is able to identify less-discrete cell colonies typical of these cell lines. The results of automated colony counting are compared with those from four manual (human) colony counts for the cell lines HT29, A172, U118 and IN1265. The results from the automated counts fall well within the distribution of the manual counts for all four cell lines with respect to surviving fraction (SF) versus dose curves, SF values at 2 Gy (SF2) and total area under the SF curve (Dbar). From the variation in the counts, it is shown that the automated counts are generally more consistent than the manual counts.

The response of human glioma cell lines to low-dose radiation exposure.

PURPOSE: To examine the low-dose radiation response of a series of radioresistant human glioma cell lines and determine if low-dose hypersensitivity is a characteristic of these cells. MATERIALS AND METHODS: The clonogenic survival of six radioresistant human glioma cell lines was measured following exposure to graded, single, very low doses of X-rays in vitro. High resolution was achieved using either a Dynamic Microscopic Image Processing Scanner (DMIPS) or a cell sorter (CS). RESULTS: In five of the six cell lines tested, low-dose hypersensitivity (HRS) was demonstrated although in the sixth, a grade III astrocytoma line, it was not. These results are consistent with previous data indicating that low-dose hypersensitivity is more marked in more radioresistant cell lines although the difference between the glioblastoma cell lines with differing SF2 is not marked. CONCLUSION: Low-dose hypersensitivity is common in radioresistant glioma cell lines. This may have implications for the treatment of these tumours if further studies confirm that HRS translates to increased effectiveness per gray in vivo when very low doses per fraction are used.

Identification of a novel mutation in a non-Jewish factor XI deficient kindred.

The role of factor XI (FXI) in blood coagulation has been clarified in recent years by descriptions of FXI-deficient patients who are prone to excessive bleeding after haemostatic challenge. We have studied a large kindred of an Italian FXI-deficient patient with a previously undescribed mutation. The propositus, a 68-year-old woman, presented with a cerebral thromboembolic event but had no history of bleeding (FXI activity 1.6 U/dl). A sensitive ELISA failed to detect FXI antigen in the propositus. Sequence analysis of the entire FXI gene revealed a TGG to TGC transversion in codon 228 of exon 7 (FXI-W228C). This missense mutation results in a Trp to Cys substitution within the third apple domain of FXI. We conclude that this novel mutation occurred in a structurally conserved region and may therefore have interfered with either chain folding and secretion or stability of FXI and was responsible for the inherited abnormality seen in this kindred. It is unclear why this kindred does not exhibit a bleeding tendency but it may correlate with a FXI-like antigen and factor IX binding activity expressed on platelets.

Experimental intestinal hypersensitivity. Effect of four anti-allergic drugs on protein uptake, permeability to sugars and mucosal mast-cell activation.

The ability of four drugs with anti-allergic action to modulate the uptake of bystander protein, lactulose/rhamnose permeability ratios and mast cell activation was studied in rats presensitized with egg albumin in alum and challenged intraduodenally with the same antigen. Beclomethasone dipropionate (BDP) and nedocromil both significantly reduced the uptake of the bystander protein, bovine serum albumin (P < 0.002 and P > 0.02 respectively). BDP also significantly reduced sugar permeability (P < 0.01). In animals with elevated lactulose/rhamnose permeability ratios we confirmed our earlier observation of a significant correlation between levels of the specific mucosal mast cell protease Rat Chymase II (RChyII-previously known as RMCPII) and the sugar ratios. None of the drugs had any influence on the levels of mast cell protease II released following challenge and there was no correlation between the histological light microscopic appearance of the mast cells and the experimental treatment administered. Our results suggest that in the gut the pharmacological effect of anti-allergic drugs may be complex. Some, such as nedocromil, appear to act only on the mechanisms underlying increased protein uptake whereas others, such as BDP, appear to abrogate both increased protein uptake and increased sugar permeability.

Health considerations for pregnant child care staff.

Child care is a profession comprised predominantly of young women of child-bearing age. Yet the pregnancy of child care staff has been discussed only incidentally in the health literature on early childhood. Because nursing professionals serve in a number of roles in child care centers, this is an important topic to include for health in-services and consultations. This article reviews what is currently known and recommended for pregnant child care staff regarding illnesses, stress, and the ergonomics of the job. The occupational health research that included women employed in child care is examined. Guidelines and recommendations for staying healthy and managing classroom activities during pregnancy are suggested.

Few food diets in the treatment of atopic eczema.

Sixty six children with severe atopic eczema were treated with highly restricted ('few food') diets followed, if they improved, by serial reintroduction of excluded foods. Twenty four patients (36%) improved considerably during the few food phase of the diet. Fifteen of these (23% of the study group) maintained this improvement on dietary treatment, of whom three abandoned the diet after periods ranging from six to 10 months, despite continued benefit, because they found the dietary restrictions too arduous. Thus 12 out of 66 children (18%) with severe eczema experienced prolonged and useful benefit from this dietary manoeuvre. Double blind food challenges performed in 10 patients failed to establish that parental identification of provoking foods is reliable. A search for historical and in vitro predictors of diet responsiveness was unsuccessful in this series.

Intestinal hypersensitivity reactions in the rat. I. Uptake of intact protein, permeability to sugars and their correlation with mucosal mast-cell activation.

We have confirmed previous observations that intestinal anaphylaxis induced in rats previously sensitized to ovalbumin (OVA) is associated with an increased uptake of an unrelated 'bystander' protein, bovine serum albumin (BSA) fed 1 hr previously. In this study, this enhanced protein uptake was associated with an increased lactulose/rhamnose excretion ratio after administration of these sugars, although there was no correlation between the two measurements. One hour after antigen challenge the serum levels of rat mast-cell protease II (RMCPII), a specific marker for mucosal mast-cell secretion, were significantly higher than both the pre-challenge levels and those of sham-challenged controls (P less than 0.002). There was a significant positive correlation between the serum levels of RMCPII and the lactulose/rhamnose excretion ratios (P less than 0.05), but no such correlation existed between RMCPII and BSA levels in the challenged rats. In other studies the urinary lactulose/rhamnose ratios of rats with cetrimide-induced gut damage were found to be significantly increased, although BSA uptake into the serum remained unaltered. We conclude that there is no simple correlation between gut permeation of low-molecular weight sugars and and the uptake of macromolecular proteins.

Improvement of abnormal lactulose/rhamnose permeability in active Crohn's disease of the small bowel by an elemental diet.

Intestinal permeability to sugar has been used as an objective measure of small bowel integrity to assess the efficacy of an elemental diet as the sole treatment or Crohn's disease of the small bowel. Fourteen children aged 11-17 years with active small bowel Crohn's disease were given an elemental diet for six weeks. Investigations with iso-osmolar oral test solutions before and after this treatment showed that all 14 children had abnormally raised lactulose/L-rhamnose permeability ratios, which fell significantly after the elemental diet. This change coincided with marked clinical improvement, as assessed by a disease activity index score.

Intestinal malabsorption in cystic fibrosis.

An oral solution containing lactulose and L-rhamnose was administered to six patients with cystic fibrosis. Intestinal absorption of both sugars was assessed by measurement of their urinary excretion. The lactulose: L-rhamnose excretion ratio was raised, supporting the hypothesis of an intestinal component to the malabsorption of cystic fibrosis.

Increased intestinal permeability in atopic eczema.

We have investigated gastrointestinal permeability in children with atopic eczema by measuring the relative urinary excretion rates of the inert di- and monosaccharides lactulose and rhamnose following their oral administration. The median lactulose/rhamnose ratio was greater in 26 children with atopic eczema than in a control group of 29 children which included both healthy individuals and others with various noneczematous dermatoses. This increased permeability may be a primary abnormality of the gut or may reflect intestinal mucosal damage caused by local hypersensitivity reactions to food antigens.

Critical evaluation of an indirect enzyme-linked immunosorbent assay for IgG antibodies to Dactylis glomerata.

Experiments are reported for the evaluation of an indirect ELISA using peroxidase conjugate for the detection of IgG antibodies to Dactylis glomerata (DG), a grass pollen antigen frequently responsible for allergic rhinitis and asthma. When optimized, the test proved to be useful in clinical practice for a semiquantitative, cheap and simply-performed determination of IgG antibodies to DG. The advantages and disadvantages of this method, compared with those of elaborate antigen-binding assays, are discussed.

Toxic oil syndrome, clinical and immunological characteristics: a review.

In May 1981 a new disease, with epidemic characteristics, appeared in Spain. Initially it was thought that an infectious agent was responsible for the disease, a theory that was later discarded when the disease was found to be associated with the ingestion of adulterated olive oil contaminated with potentially toxic chemicals. More than 20 000 people have been affected, and whilst official reports put the death toll at 250, the true figure may exceed 300. The disease is multi-systemic in presentation, affecting several organs and systems of the body. The disease has a poor prognosis in its chronic stages, which affect approximately 10% of victims, and its ultimate natural history is still to be observed. The pathogenesis of the disease remains to be elucidated, despite considerable efforts already made in this direction.

Studies of the allergens of Olea europea pollen.

Allergens of Olea europea have been prepared by isoelectrofocusing and tested by RAST, RAST inhibition and skin tests. The major allergen was found to be an acidic protein of pI 6, consisting of two polypeptide chains of molecular weight 15000 and 17000 daltons, possibly non-covalently associated into a dimer. Most other allergens were acidic proteins, but basic proteins were also observed with allergenic activity. The RAST inhibition studies show a considerable degree of allergic cross-reactivity between the isoelectrofocusing fractions.