[Relevance of the 112-emergency calls among the clientele of the emergency department of the Herlev hospital admitting office]. / Relevansen af alarm 112-opkald blandt skadestueklientel i amtssygehuset i herlevs optagelsesområde.

It is a common view, shared by Emergency Department staff and ambulance crews, that a large number of patients unnecessarily use Emergency Service ambulances instead of transporting themselves to the hospital by other, more appropriate means. In this retrospective study, 528 consecutive Emergency Service calls to the Herlev Hospital Casualty/Emergency Department during a six week period were reviewed for relevance. Attention was solely aimed at the relevance of the use of Emergency Service ambulances in each case, but not on patient or health care providers' perception of urgency. All calls resulting in admission to hospital were pre-defined as being relevant. Seventeen point six percent of all calls were deemed irrelevant. Thirty-three percent of all calls not resulting in admission were deemed irrelevant. The results confirm Emergency Department health care providers' and ambulance crews' view that Emergency Service ambulances are used inappropriately by the public.

Immune complexes and the complement factors C4 and C3 in cerebrospinal fluid and serum from patients with chronic progressive multiple sclerosis.

Immune complexes (IC) have been found in both serum and cerebrospinal fluid (CSF) in multiple sclerosis (MS). The complement system is known to play a major role as a mediator of inflammation in immune complex disease. Therefore, we have investigated paired samples of serum and CSF from 32 patients with progressive MS for IC, the levels of the complement factors C4 and C3, and presence of their activation products (AP). IC was found in serum from 17 of the 32 MS patients (53%) and in CSF from 9 of 31 MS patients (29%). No correlation was found between the occurrence of IC in serum and in CSF. The levels of C3 in serum and CSF from the MS patients did not differ from the levels in a control group, whereas the levels of C4 in MS-serum were elevated and the C4 levels in MS-CSF reduced. A low level of CSF-C4 correlated significantly to the occurrence of CSF-IC. AP of C4 and C3 in serum were seen in 11 of the 32 patients (34%), appearing significantly more frequently among patients with circulating IC. No C4- or C3AP could be identified in CSF.

Evaluation of disability, incapacity and environmental status scales in multiple sclerosis.

From the Danish Multiple Sclerosis (MS) population a representative sample of 249 patients with a clinically definite diagnosis of MS has been tested by use of the Functional System Scale and Disability Status Scale of Kurtzke and the Incapacity and Environmental Status Scales of the IFMSS. Validity and reliability of the items and the properties of summed scales have been estimated. A statistical evaluation showed that generally the Incapacity and the Environmental Status Scales worked well. Problems encountered with the use of the Incapacity scale are mentioned and on statistical grounds a proposal of an incapacity scale with fewer items is presented.

Abnormal serum alpha 2-macroglobulin in multiple sclerosis.

Crossed immunoelectrophoresis (CI) of serum alpha 2-macroglobulin (alpha 2-M) of neurological patients revealed that alpha 2-M in serum of multiple sclerosis (MS) patients was abnormal. Thus the immunoprecipitate of alpha 2-M appeared asymmetric arguing for the presence in MS serum of two alpha 2-M of different electrophoretic mobilities but with (partially) identical immunological properties. In order to study if this abnormality could be used as a diagnostic tool, 50 coded serum samples were studied by CI. After the evaluation by CI, the decoding revealed that 85% of the MS patients possessed abnormal alpha 2-M as described. By employing the present method only 16% of the non-MS patients were mixed with the MS group. The pathogenic role of the present findings is discussed.

Partial purification of MS specific brain antigens.

The present study was devoted to an immunochemical elucidation of antigenic similarities and differences between cytoplasmic and microsomal fractions of six multiple sclerosis (MS) and seven non-MS brain autopsy specimens. The antigenic composition of the samples studied was traced by crossed immunoelectrophoresis using antibodies made by immunization of rabbits with the corresponding fraction. The following data were obtained: 1. A measles antigen (defined as an antigen formed in vero cells during measles infection) and two specific antigens have been purified more than 3000-fold from MS brains by means of molecular filtration and DEAE cellulose chromatography. 2. All three antigens have a molecular weight between 10(5)-10(6) daltons and isoelectric points between 3.5-6.0. 3. Measles antigen has also been found in three out of seven non-MS brains, however, it did not stimulate antibody formation in rabbits in contrast to measles antigen of MS brain. The significance of the above-mentioned data is discussed in view of the immunological abnormalities previously found in MS patients. It cannot be excluded that the antigens found represents one or more viral antigens.

The enhancing effect of multiple sclerosis brain homogenates on the active E-rosette forming lymphocytes in neurological disorders.

Peripheral blood lymphocytes from 23 out of 27 (85%) patients with multiple sclerosis responded to MS brain homogenates by increased formation of active E-rosettes. Lymphocytes from only six out of 78 (8%) patients with other neurological diseases responded to MS brain homogenates. The possible value of the test in the diagnosis of MS is discussed.

Relationships between abnormal IgG index, oligoclonal bands, acute phase reactants and some clinical data in multiple sclerosis.

The IgG-index and acute phase reactants were measured and oligoclonal bands were looked for in 30 patients with clinically definite multiple sclerosis (MS) and were compared with the clinical data. IgG-index was found elevated in 77% against 22% in a comparable material of patients with other neurological diseases. Oligoclonal bands were found in 74 and 17%, respectively. No correlation was found between these parameters and age, duration of illness, disability, coefficient of progression or age of onset. A statistical evaluation defines the specificity, sensitivity and validity of the methods used. CRP could no be demonstrated in 28, the rest had normal values. C3A was normal in all cases, but appeared to be elevated a little with increasing age, and to be positively correlated to the albumin-index, indicative of a defective blood-brain barrier. No correlation was found between CRP, C3A and the clinical data.

Multiple sclerosis specific antigens in MS brains.

Antigens in MS and non-MS brains were investigated by means of crossed immunoelectrophoresis. Two MS specific antigens were found: a measles antigen which was present in microsomes and cytosole, and an unidentified antigen present only in cytosole.

Long-term transfer-factor treatment for multiple sclerosis.

In groups of 16 patients with multiple sclerosis, 13 months' double-blind treatment with transfer factor from random normal donors differed from placebo treatment only in producing a temporary restoration of lymphocyte reactivity to measles virus antigen, and did not arrest the degeneration of nerve tissue.

Lymphocyte stimulation in multiple sclerosis patients untreated and treated with transfer factor. Long-term studies on the effect of different stimulants on myo-(2-3H)inositol incorporation into phosphatidylinositol of lymphocytes.

The lymphocytes from controls, untreated MS and MS patients treated with transfer factor were stimulated with PHA, PWM, PPD, LPS and MA and the increased incorporation of myoinositol into phosphatidylinositides was determined. As compared with controls, the untreated MS patients revealed significantly lower index of stimulation with PHA, LPS, PPD and MA. The response of lymphocytes from MS patients treated with transfer factor was intermediate. No correlation between disease progression and stimulation of inositol incorporation was observed. Analysis of variance showed that the myoinositol test is not applicable in long-term studies to distinguished single subjects, however it is useful to determine differences between MS patients and controls.

Oligoclonal IgG and measles antibody in CSF of multiple sclerosis patients.

Cerebrospinal fluid (CSF) was obtained from 50 neurological patients, 26 of whom suffered from multiple sclerosis (MS). Agar gel electrophoresis and determination of anti-measles antibody titre were performed on the CSF samples. The frequency of elevated measles antibody titre was higher among the MS patients than among the patients with other neurological diseases. Furthermore, oligoclonal IgG in CSF occurred more often among the MS patients than among the other neurological patients. An association between high measles antibody titre and the presence of oligoclonal IgG was observed in CSF from both the MS patients and the patients with other neurological diseases. However, the nature of the correlation between occurrence of oligoclonal IgG and high measles antibody titre remains to be explained.

Immunological in vitro parameters in patients with multiple sclerosis and in normal individuals.

The general immunological capacity of 40 patients with multiple sclerosis has been evaluated with lymphocyte transformation test including both mitogens (PHA and PWM) and antigens (PPD, Candida albicans, Staph. aureus and E. coli). Determination of T and B cells was performed by E-, EAC-rosetting and immunofluorescence for surface immunoglobulins. Compared with the results obtained in 42 normal individuals only minor differences were found.

Lysolecithin fusion of cells from multiple sclerosis patients with Vero cells.

Investigations were performed on cell cultures derived from patients with multiple sclerosis (MS) in order to trace a possible virus infection as a cause of the disease. Cell cultures were established from one brain autopsy specimen and four lymph node biopsies from MS patients. Lymphocytes from 28 MS patients and six healthy controls were used for fusion or cocultivation experiments, either immediately after isolation or after mixed lymphocyte cultures (MLC). Lysolecithin fusion and cocultivation experiments were made with Vero cells and with, respectively: cultured brain cells, lymph node cells and lymphocytes from MS patients. Electron microscopical examination revealed intranuclear filamentous structures in 5 per cent of the cells in primary cultures of MS brain and lymph node and in control skin organ cultures. Multinucleated cells were found in six out of 19 cocultures of Vero cells and MS lymphocytes preincubated for 2 days at 37 degrees C. The cultures were tested for the presence of viruses, i.e. measles virus and virus producing hemadsorption with human type O and/or guinea pig erythrocytes and virus against which the MS patients showed serum FA-antibodies. No virus antigen could be demonstrated in the cells.

Transfer factor treatment of patients with multuple sclerosis. I. Preliminary report of changes in immunological parameters.

In five patients with definite multiple sclerosis and lack of cell-mediated immunity to measles and parainfluenza virus antigens, various immunological parameters were studied before and during transfer factor treatment. The study showed that cell-mediated immunity to measles virus antigen, as evaluated by the leukocyte migration agarose test, could temporarily be restored, using repeated injections of transfer factor pooled from unselected, normal blood donors.

Correlation between incorporation of myo-(2-3H)inositol into the phosphatidylinositol of lymphocytes and disability degree, stage and duration of multiple sclerosis.

The present study revealed a positive correlation between the degree of disability of MS patients and the rate of incorporation of myo-(2-3-H)inositol into phosphatidylinositol of lymphocytes stimulated with basic protein (BP) and phytohemagglutinin (PHA). No correlation could be found between the response of lymphocytes to measles antigen (MA) and the degree of disability, stage and duration of multiple sclerosis. No correlation could be observed between the response of lymphocytes to the stimulants studied and the duration of the disease.