Clinical scoring system in the evaluation of adult pharyngitis.

OBJECTIVE: To compare results of a clinical scoring system for diagnosis of group A streptococcal pharyngitis with microbiologic results, when several different pharyngeal pathogens were tested simultaneously. DESIGN: Evaluation of clinical manifestations of 106 adult patients with pharyngitis of different microbial origin. SETTING: General private practice; Health Center Pulssi, Turku, Finland. PATIENTS: Adult patients whose chief complaints were sore throats. MAIN OUTCOME MEASURE: A symptom score that was assigned to each patient according to the total number of certain signs and symptoms that are postulated to increase the probability of group A streptococcal pharyngitis and blood measurements for infection. RESULTS: The highest symptom scores, 3 and 4, were found in 21 patients. These patients had pharyngitis due to group A streptococcus (four patients), group C streptococcus (four patients), group G streptococcus (two patients), group F streptococcus, Mycoplasma pneumoniae, Chlamydia pneumoniae, influenza A virus, influenza B virus, herpes simplex type 1 virus (two patients), and coxsackie B4 virus. No pathogen could be identified from three of the 21 patients. The C-reactive protein values and the leukocyte counts were raised significantly more often in streptococcal infections than in infections of other origin; the P values were .00016 and .028, respectively. CONCLUSION: Use of a clinical scoring system alone for diagnosis of pharyngitis may lead to improper use of anti-microbial agents. There is a need for accurate microbiologic diagnostic procedures in general practice to determine proper treatment of pharyngitis as well as to test the effect of antibacterial and, in the future, antiviral treatment in respiratory tract infections.

Pharyngitis in adults: the presence and coexistence of viruses and bacterial organisms.

STUDY OBJECTIVE: To determine the presence and coexistence of viruses and bacterial organisms causing pharyngitis in adults. DESIGN: Open study using diagnostic methods, including rapid antigen-detection techniques, to test for the presence of viruses of the respiratory tract, as well as Mycoplasma pneumoniae. Chlamydia trachomatis, the Chlamydia species strain TWAR, and beta-hemolytic streptococci. SETTING: Open health care. PATIENTS: One hundred six consecutive adult patients, 15 to 65 years old, whose chief complaint was sore throat. MAIN RESULTS: Of the 106 patients, beta-hemolytic streptococci were found in only 24 patients (5 patients with group A streptococci, 13 with group C, 5 with group G, and 1 with group F); M. pneumoniae was found in 10 patients, the Chlamydia species strain TWAR in 9 patients, and viruses in 27 patients. Two microbes were simultaneously isolated in 3 patients, and no microbial findings were detected in 33 patients. CONCLUSION: Because 19 patients were infected with the Chlamydia species strain TWAR and M. pneumoniae, and 24 patients were infected with beta-hemolytic streptococci, the diagnostic procedures and therapies for adult patients with pharyngitis need to be reconsidered. The results of our study also confirm earlier suggestions that the Chlamydia species strain TWAR alone is a causative agent for pharyngitis in adults.

Zinc and cadmium concentrations in whole tissue and in separated epithelium and stroma from human benign prostatic hypertrophic glands.

Prostate tissues from patients with benign prostatic hypertrophy were separated into epithelial and stromal components and the concentrations of zinc and cadmium were determined in these two fractions and in whole tissue by atomic absorption spectrophotometry. The concentrations of testosterone and 5 alpha-dihydrotestosterone (5 alpha-DHT) were determined by radioimmunoassays. The concentration of zinc was found to be significantly greater (P less than .001) in epithelial than in stromal preparations: 17.32 +/- 1.15 vs. 7.29 +/- 0.53 mumol/g dry weight (SEM, n = 15). The concentrations of cadmium in epithelium, 9.55 +/- 1.31 nmol/g dry weight (SEM, n = 15) and in stroma, 6.65 +/- 1.06 nmol/g dry weight (SEM, n = 15), did not differ significantly. The concentrations of zinc and cadmium in whole tissues were 13.88 +/- 1.70 mumol/g dry weight and 8.85 +/- 1.53 nmol/g dry weight, respectively (SEM, n = 15). In epithelial preparations, cadmium and testosterone were inversely correlated, but no other correlations were noted between metal and androgen concentrations in whole tissue, stroma, or epithelium. The results of the present study indicate that zinc preferably resides in the epithelium of human prostatic tissue, particularly in BPH, although the stroma also contains significant amounts of this metal. Cadmium appears to be more evenly distributed between the epithelium and stroma of prostatic tissue and previous findings of high cadmium concentrations in hypertrophic and carcinomatous prostatic tissue were not confirmed.

Androgen concentrations in epithelial and stromal cell nuclei of human benign prostatic hypertrophic tissues.

Prostate tissues removed from patients with benign prostatic hypertrophy were separated into epithelial and stromal components and nuclei purified from these. The concentrations of testosterone, 5 alpha-dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, 4-androstene-3,17-dione, 5 alpha-androstanedione and androsterone in pooled preparations of the purified nuclei were determined by radioimmunoassays after the purification of solvent steroid extracts by Lipidex-5000 column chromatography. The most abundant androgen measured was 5 alpha-dihydrotestosterone and it was significantly (P less than 0.05) more concentrated in the stromal nuclei than in the epithelial nuclei. The mean concentration of androsterone was also significantly (P less than 0.05) greater in the stromal nuclei whereas that of testosterone was equal in the two nuclear types. The concentrations of 5 alpha-androstane-3 alpha,17 beta-diol, 4-androstene-3,17-dione and 5 alpha-androstanedione were below the sensitivity limits of the assays in the majority of cases, but the results indicated that when detectable the first two were more concentrated in the stromal than the epithelial nuclei. The results emphasize the importance of the prostatic stroma in androgen metabolism, and the relative concentrations of 5 alpha-dihydrotestosterone and testosterone indicated identical 5 alpha-reductase activities in the nuclei in comparison with respective whole cell epithelial and stromal preparations. 5 alpha-Dihydrotestosterone concentrations were clearly higher than the nuclear androgen receptor levels previously reported from this laboratory.

Nuclear androgen receptors in the epithelium and stroma of human benign prostatic hypertrophic glands.

Androgen receptors have been characterized and quantified in nuclear extracts of separated epithelium and stroma from human benign prostatic hypertrophic (BPH) glands. Tritiated dihydrotestosterone was used as the ligand and incubation was carried out at 15 degrees C for 18-20 hr before separation of bound and free ligand using dextran-coated charcoal. The results were analysed by Scatchard-type analysis. The concentration of receptor was found to be significantly (p = 0.022) greater in stromal than in epithelial nuclei: 1765 +/- 152 vs 1030 +/- 227 fmol/mg DNA (SEM, n = 6). Fourteen competitors were tested and the results indicated the presence of specific androgen receptors rather than contaminating sex-hormone-binding globulin. This was also borne out by the results of agar gel electrophoresis and sucrose gradient ultracentrifugation studies. The results are in line with current opinion that prostatic stroma is an important androgen-sensitive tissue, particularly in human BPH.

Androgenic control of polysomal poly(A)-containing RNA in the cultured rat ventral prostate.

Testosterone stimulated, at the concentration of 10-7 M and independently of other hormones, the accumulation of polysomal poly(A)-containing RNA (mRNA) in cultured explants of rat ventral prostate and concomitantly also protein synthesis. The hormone-induced accumulation of polysomal mRNA, which reached its maximum at 24 h after testosterone addition, paralleled the preferential labeling of high molecular weight RNA demonstrable with the electrophoretic analysis of the double-isotope labeled RNA after a short pulse (30 min). These findings are consistent with the idea that testosterone activated the synthesis of precursor mRNA leading to an increased amount of polysomal mRNA and eventually an activated protein synthesis. The synthesis and maturation of rRNA appeared to proceed even in the absence of testosterone, which is in contrast to the vivo findings on castrated rats. This partial uncoupling of RNA synthesis from androgenic control may account for the slow and less marked hormonal responses found in protein synthesis and glucose metabolism in cultured explants from normal animals. Because of the lack of uniformity in the suture, routine light microscopic control to assess the viability of cultured explants was found to be a prerequisite for successful biochemical work on prostate culture.

Distribution and concentrations of androgens in epithelial and stromal compartments of the human benign hypertrophic prostate.

Prostate tissues removed from patients with benign prostatic hypertrophy were separated into epithelia and stromal components and the concentrations of testosterone, 5 alpha-dihydrotestosterone, 5 alpha-androstane-3 alpha,17 beta-diol, 4-androstene-3,17-dione, 5 alpha-androstanedione and androsterone in these two fractions were determined by radioimmunoassays after the purification of solvent steroid extracts by Lipidex-5000 column chromatography. On a 'per cell' basis (i.e. relative to DNA), testosterone was equally distributed between the two components, while the other androgens measured were more abundant in the stroma. The observation that 5 alpha-reduced androgens (especially 5 alpha-dihydrotestosterone) were more concentrated in the stroma, and that significant correlations between concentrations of metabolically related androgens were more common in the stroma than in the epithelium, indicate that the stroma is an important site of androgen metabolism in benign prostatic hypertrophic tissues. The present data also support the suggestion that 5 alpha-dihydrotestosterone produced in the prostatic stroma may be transferred to the epithelium by way of sex hormone binding globulin in the extracellular spaces of the prostate.

Androgens and prostate-specific acid phosphatase in whole tissue and in separated epithelium from human benign prostatic hypertrophic glands.

The concentrations of prostate-specific acid phosphatase (PAP), testosterone, 5 alpha-dihydrotestosterone (5 alpha-DHT), 5 alpha-androstane-3 alpha, 17 beta-diol, androstenedione, 5 alpha-androstanedione, and androsterone were measured by specific radioimmunoassays in whole pieces and in separated epithelium from human benign prostatic hypertrophic (BPH) tissues. Significant correlations were noted between the concentrations of PAP and 5 alpha-DHT, and PAP and 5 alpha-androstane-3 alpha, 17 beta-diol in the epithelium, and between PAP and androstenedione, and PAP and testosterone PAP is androgen dependent, particularly as regards 5 alpha-DHT, whereas 5 alpha-androstane-3 alpha, 17 beta-diol may operate after conversion to 5 alpha-DHT. There is no obvious explanation for the correlations noted in whole tissue, but is suggested that circulating androgens, representing the androgen source for the prostate, primarily determine the production of PAP. The majority of the PAP in BPH tissues is located extracellularly.