18F-fluorodeoxyglucose positron emission tomography for the assessment of endo-bronchial involvement in granulomatosis with polyangiitis.

Bronchial stenosis is an uncommon but potentially life-threatening complication of granulomatosis with polyangiitis (GPA). The development of lower respiratory tract stenoses in patients with GPA is thought to be the result of persistent inflammation of the cartilaginous tissue. New assessment methods for this severe GPA complication are highly needed. Herein, we show the value of 18F-fluorodeoxyglycose positron emission tomography/computed tomography (18F-FDG-PET/CT) in the diagnosis, prediction of progression to bronchial stenosis and response to treatment of endobronchial involvement in a patient with GPA.

Determining vestibular hypofunction: start with the video-head impulse test.

Caloric testing is considered the 'reference standard' in determining vestibular hypofunction. Recently, the video-head impulse test (vHIT) was introduced. In the current study we aimed to assess the diagnostic value of the vHIT as compared to caloric testing in determining vestibular function. In a cross-sectional study between May 2012 and May 2013, we prospectively analysed patients with dizziness who had completed caloric testing and the vHIT. For the left and right vestibular system we calculated the mean vHIT gain. We used a gain cut-off value of 0.8 for the vHIT and presence of correction saccades to define an abnormal vestibular-ocular reflex. An asymmetrical ocular response of 22 % or more (Jongkees formula) or an irrigation response with a velocity below 15°/s was considered abnormal. We calculated sensitivity, specificity, positive and negative predictive values with 95 % confidence intervals for the dichotomous vHIT. Among 324 patients [195 females (60 %), aged 53 ± 17 years], 39 (12 %) had an abnormal vHIT gain and 113 (35 %) had an abnormal caloric test. Sensitivity was 31 % (23-40 %), specificity 98 % (95-99 %), positive predictive value was 88 % (74-95 %), and negative predictive value 73 % (67-77 %). In case of vHIT normality, additional caloric testing remains indicated and the vHIT does not replace the caloric test. However, the high positive predictive value of the vHIT indicates that an abnormal vHIT is strongly related to an abnormal caloric test result; therefore, additional caloric testing is not necessary. We conclude that the vHIT is clinically useful as the first test in determining vestibular hypofunction in dizzy patients.

On development of functional brain connectivity in the young brain.

Our brain is a complex network of structurally and functionally interconnected regions, shaped to efficiently process and integrate information. The development from a brain equipped with basic functionalities to an efficient network facilitating complex behavior starts during gestation and continues into adulthood. Resting-state functional MRI (rs-fMRI) enables the examination of developmental aspects of functional connectivity (FC) and functional brain networks. This review will discuss changes observed in the developing brain on the level of network FC from a gestational age of 20 weeks onwards. We discuss findings of resting-state fMRI studies showing that functional network development starts during gestation, creating a foundation for each of the resting-state networks (RSNs) to be established. Visual and sensorimotor areas are reported to develop first, with other networks, at different rates, increasing both in network connectivity and size over time. Reaching childhood, marked fine-tuning and specialization takes place in the regions necessary for higher-order cognitive functions.

[Genital Chlamydia trachomatis infection in abortion seekers. Strategy of examination and treatment in order to reduce the sequelae of the infection]. / Genital Chlamydia trachomatis infektion hos abortsøgende. Undersøgelses- og behandlingsstrategi for at mindske infektionssequelae.

Among women applying for termination of pregnancy, 5-17% are infected with Chlamydia trachomatis. The prevalence is higher among women under 20 years of age (12-30%), in nulliparae and when Neisseria gonorrhoeae are found simultaneously. If women applying for termination of pregnancy with Chlamydia infection are not treated, 10-60% will develop pelvic infection after abortion. Salpingitis caused by Chlamydia runs a milder clinical course than salpingitis caused by gonococci or other etiology but salpingitis due to Chlamydia is regarded as one of the most important causes of tubal infertility and extrauterine pregnancy. The symptoms may be discharge and dysuria or objective findings such as cervicitis and pathological findings in wet smears of the cervical secretion. The majority of women applying for termination of pregnancy with Chlamydia infection have no symptoms. Only few investigations have analysed Chlamydia infection in connection with sexual behaviour and association between Chlamydia infection and the number of sexual partners has been demonstrated. Direct immune fluorescent microscopic examination or enzyme immune examination of material from the cervix and urethra may be employed in women applying for termination of pregnancy on account of the rapid results. Tetracyclines and erythromycin may be employed for treatment of demonstrated Chlamydia infection. Completion of treatment prior to abortion is probably not necessary. The sexual partners should be treated.

[Presence of genital Chlamydia trachomatis in abortion seekers--correlates with young age and nulliparity but not with previous genital infection]. / Genital forekomst af Chlamydia trachomatis hos abortsøgende--korrelerer med ung alder og nulliparitet, men ikke tidligere underlivsbetoendelse.

Out of 432 women applying for termination of pregnancy, 7.9% (34/428) had cervical Chlamydia trachomatis and 0.7% (3/431) genital Neisseria gonorrhoeae. The prevalence of Chlamydia was 19.2% among the women applying for termination who were under 20 years and 12.8% among those aged 21-25 years. The finding of Chlamydia among nulliparae was 14.5%. Only 2.8% of the women with Chlamydia had previously had pelvic infections. Women with Chlamydia did not have significantly greater frequency of previous venereal diseases. It is concluded that women under the age of 25 years and nulliparae who apply for termination of pregnancy should be examined for Chlamydia and should be treated in connection with the intervention. Previous pelvic infections are observed significantly more rarely in women with Chlamydia applying for termination and thus do not constitute an indication for examination for Chlamydia. It is not yet elucidated whether women with previous venereal diseases should be examined for Chlamydia. On account of the low prevalence, there are no indications for performing routine smears in women applying for termination of pregnancy for gonococci but, on the other hand it appears relevant to examine women with Chlamydia for gonococci as double infections are frequently present.

Outer membrane antigens of Neisseria meningitidis group B serotype 2 studied by crossed immunoelectrophoresis.

This study shows that the capsular polysaccharide, protein, and lipopolysaccharide antigens from the outer membrane of Neisseria meningitidis group B serotype 2 may be identified by crossed immunoelectrophoresis. By using this technique, seven precipitates were resolved when outer membrane preparations were reacted against goat anti-whole cell group B type 2 antiserum. Most of these precipitates were identified by comparison with purified reference preparations. Different outer membrane preparations, reflecting different growth conditions, varied in their compositions of lipopolysaccharide, protein, and polysaccharide. Detergent treatment altered the protein and lipopolysaccharide precipitation patterns. In the presence of detergent, the lipopolysaccharide did not precipitate, and the electrophoretic migration of the protein antigens decreased. Crossed immunoelectrophoresis is a useful qualitative method for analysis of the antigenic components of the meningococcal outer membrane. The crossed immunoelectrophoresis with intermediate gel technique is presently being used to measure the human immune response to the different cell surface components.

Form variation in Escherichia coli K1: determined by O-acetylation of the capsular polysaccharide.

The chemical basis for the alternating antigenic change called form variation noted for the Escherichia coli K1-capsular polysaccharide has been shown by 13C nuclear magnetic resonance to be a result of random O-acetylation of C7 and C9 carbons of the alpha-2-8-linked sialic acid homopolymer. A serologic method (antiserum agar) was developed to identify and isolate the form variants. The O-acetyl positive and O-acetyl negative K1 polysaccharides had unique biochemical and immunologic properties. The O-acetyl-positive variants resisted neuraminidase hydrolysis in contrast to the susceptibility of the O-acetyl negative variant to this enzyme. In addition, O-acetylation altered the antigenicity of the O-acetyl polysaccharides. When injected as whole organisms, O-acetyl positive organisms produced anti-K1 -antibodies in rabbits specific for this polysaccharide variant. O-acetyl negative organisms were comparatively less immunogenic; however, antibodies induced by these organisms reacted with both K1 polysaccharide variants. Burros, injected with either variant, produced antibodies reactive with both K1 polysaccharides.

Precipitating antibodies against Neisseria meningitidis in normal sera and their possible origin.

Crossed immunoelectrophoresis was used to study precipitating antibodies against Neisseria meningitidis in sera from 214 normal persons and in human gammaglobulin. A polyspecific meningococcal antigen preparation and a corresponding rabbit antiserum constituted the reference system. All the sera contained one to five precipitins against N. meningitidis which could be identified and quantified by means of the reference system. The precipitin score, which expresses the number and titre of precipitins in each serum, increased with age. More than 25 precipitins were found in the gammaglobulin preparation, including antibodies against the groupspecific polysaccharides A, B and C. Absorption of three of the five normally occurring precipitins (nos. 4, 19, 22) with antigens from various bacteria showed that precipitins nos. 4 and 19 could be completely absorbed by antigens from other Neisseria species, but not by antigens from other genera. This indicates that these two precipitins may have been induced by non-pathogenic Neisseria species or by meningococci. The finding of protective antibodies in gammaglobulin might indicate the possibility of its use in prophylaxis or therapy meningococcal infections.

Cross-reactions between Neisseria meningitidis and twenty-seven other bacterial species.

Cross-reactions between antigens from N. meningitidis and antigens from 27 other bacterial species from clinical isolates representing 20 different genera were studied by quantitative immunoelectrophoretic methods. A water-soluble N. meningitidis antigen preparation and a corresponding pooled rabbit antiserum regularly presenting 48 immunoprecipitates were used as reference system. Antigens from 16 other bacterial genera cross-reacted with one to four N. meningitidis antigens, whereas antigens from six other Neisseria species cross-reacted with 37 to 48 N. meningitidis antigens. Antigens from only three bacterial genera (Streptococcus, Staphylococcus and Bacteroides) did not show any cross-reactions. The degree of cross-reactivity between the antigens were 25--100%, as judged by absorption of antibodies. Three of the cross-reacting antigens reacted with normally occurring precipitating antibodies in serum from humans and rabbits.

Crossed immunoelectrophoretic analysis of Neisseria meningitidis antigens and of corresponding antibodies in patients with meningococcal disease.

Sixty-three different antigens of Neisseria meningitidis groups A, B and C were demonstrated by means of crossed immunoelectrophoresis against rabbit antiserum. The group-specific polysaccharides A and C were identified in the immunoprecipitate pattern. The majority of the remaining antigens were common to all three groups of meningococci. A clearcut rise in antibodies was found in all of 27 patients with meningococcal meningitis or septicaemia. These antibodies were directed against both group-specific antigens and common antigens. No such rise was seen among the 22 patients with purulent meningitis of non-meningococcal etiology. Altogether 15 precipitins were detected in the patients with meningococcal disease. Nine of these antibodies could be identified by comparison with the rabbit antiserum. The antibody rise was semiquantified by means of a scoring system. The rise in the precipitin score of antibodies against common antigens in patients infected with group B meningococci was significantly higher than in patients infected with group A meningococci.

Neutrophilic granulocytes in acute bacterial infection. Sequential studies on lysozyme, myeloperoxidase and lactoferrin.

The changes in intraneutrophilic and plasma concentrations of the three antibacterial proteins lysozyme, lactoferrin, and myeloperoxidase were studied sequentially during acute bacterial infection in nine patients. Intraneutrophilic concentrations of the three proteins were decreased by more than 50% during the 1st week of infection, followed by a slow increase over the following 2 weeks. Nadir values coincided with maximal toxic granulation of the neutrophils. The data suggest that neutrophilic granulocytes are deficient during early bacterial infection, possibly because of deficient synthesis of antibacterial proteins in the bone marrow, and that neutrophil toxic granulation is the visual counterpart of this defect. The plasma concentrations of the three proteins showed considerable differences: whereas plasma lysozyme did not show any sequential changes, plasma myeloperoxidase was high at the start of infection and quickly decreased towards normal values, and plasma lactoferrin, high in the first samples, showed a secondary peak 1 week after onset of disease, before normalization was seen. These differences may result from differences in the signals are specific for the individual antibacterial protein and not for the different types of neutrophil granules.

Serological types of Diplococcus pneumoniae isolated from the respiratory tract of children with cystic fibrosis and children with other diseases.

The distribution of serological types of D. pneumoniae was investigated in 40 strains isolated from 26 children with cystic fibrosis and 57 strains isolated from 39 children with other diseases. All strains were isolated from sputum or tracheal secretion. The strains from cystic fibrosis patients belonged to 14 different serological types, the most prevalent were 19F, 19A and 3. The strains from the other group of children belonged to 20 different serological types, the most prevalent were 23F, 19F and 11A. The differences between the two groups of patients as to the prevalences of types were small, and it is concluded that no special serological types of D. pneumoniae are associated with cystic fibrosis.

Staphylococcus aureus in cystic fibrosis: antibiotic sensitivity and phage types during the latest decade. Investigation of the occurrence of protein A and some other properties of recently isolated strains in relation to the occurrence of precipitating antibodies.

During the recent decade, 1651 isolates of Staphylococcus aureus from 111 patients with cystic fibrosis have been tested for antibiotic sensitivity and half of the isolates have been phage typed. All the patients were followed in one clinic and the policy of antibiotic treatment was consistent during this period. The results show a dynamic situation where "epidemic" phage types during recent years have been gradually replaced by other types and, during the same period, the prevalence of strains resistant to more than one antibiotic decreased. Multiresistant strains including strains resistant to methicillin were infrequent in these patients. From 23 per cent of the patients, the same strains were repeatedly isolated for more than 1 year despite an apparently successful chemotherapy. Recently isolated strains were found to produce cellbound as well as extracellular protein A. Ninety-one per cent of the strains produced extracellular lipase and only 8 per cent were resistant to mercury chloride. Eighty-one per cent of the patients produced precipitating antibodies agains S. aureus as judged by crossed immunoelectrophoresis. The investigated properties of S. aureus were not significantly correlated with the occurrence of precipitating antibodies against these bacteria. The possible significance of protein A in the pathology of the respiratory tract infection is discussed.