Increase in plasma calprotectin during long-distance running.

Running leads to biochemical and hematological changes consistent with an inflammatory reaction to tissue injury. We report changes in the plasma concentration of the leukocyte-derived protein calprotectin after long-distance running. Blood samples were collected from runners before and after a marathon, half-marathon, a 30-km cross-country run, a military ranger-training course and short-term maximal physical exercise until exhaustion, VO2max. Leukocyte counts, plasma calprotectin concentration and calprotectin per neutrophilic granulocyte were assayed using a new method. During the marathon, half-marathon, the 30-km run, the ranger-training course and the VO2max exercise, calprotectin levels increased 96.3-fold, 13.3-fold, 20.1-fold, 7.5-fold and 3.4-fold, respectively. These changes may reflect damage to the tissues or vascular endothelium, causing microthrombi with subsequent activation of neutrophils. These cells are known to phagocytose platelets in microthrombi and may contribute to the prevention of clinical thrombosis. The half-life of calprotectin in plasma was about 5 h. The content of calprotectin per neutrophil remained unchanged during exercise at a level similar to that in healthy blood donors: mean: 25 pg/cell, range 18.8-33.6. A reference interval (mean +/- 2 SD) of 18.6-31.4 pg/cell is suggested.

[Professional or private? Physician's role between success and vulnerability]. / Profesjonell og personlig? Legerollen mellom vellykkethet og sårbarhet.

This article discusses the role of the doctor in relation to the patient. How can the doctor succeed in presenting himself of herself as both professional and personal? It is argued that these two aspects need not be in conflict but may complement each other. The appreciation of this dual dimension of being a doctor is, however, threatened by exaggerated emphasis on the doctor as a particularly successful person. Contemporary medical education does not sufficiently counter the widespread perception of doctors as in some way "above" other people, including their patients. In contrast, the significance of vulnerability, understood as a deep-seated, non-optional feature of being human, is brought to bear on the way the doctor should be perceived--by himself and by society--as no less vulnerable than other people. Correctly understood, the vulnerability that doctors share with patients is a prerequisite for relating to the patient's ills and concerns.

[Paroxysmal nocturnal hemoglobinuria--diagnosis with the help of flow cytometry]. / Paroksystisk nattlig hemoglobinuri--diagnostikk ved hjelp av vaeskestrømscytometri.

Paroxysmal nocturnal haemoglobinuria is a clonal, acquired disease affecting the membrane of the blood cells, arising from a somatic mutation at the haematopoietic stem cell level. It results in clones of blood cells deficient in membrane bound proteins, such as the complement regulating molecules Decay Accelerating Factor (DAF = CD55) and Membrane Inhibitor of Reactive Lysis (MIRL = CD59). For many years, Ham's test has been essential for diagnostic testing of erythrocytes for paroxysmal nocturnal haemoglobinuria. We present a 3-colour flowcytometry method used for quantification of CD59-negative erythrocytes and CD55/CD59-negative leukocytes. The results from analysis of blood samples from six patients suffering from paroxysmal nocturnal haemoglobinuria and six healthy blood donors, using the flowcytometry method, Ham's test and a microtyping gelcard method are compared. Our flow cytometric method, using directly conjugated monoclonal antibodies to test both erythrocytes and leukocytes, is the most sensitive method. It is specific and delivers fast results. The method involves a minimum of manipulation of the fragile cells and can be recommended as an alternative to Ham's test and the gelcard test.

[Utilization of the National Hospital 1985-89. How many beds should there be in a new National Hospital?]. / Bruk av Rikshospitalet 1985-89. Hvor mange senger bør det vaere i et nytt rikshospital?

The Norwegian Parliament (Stortinget), has approved a proposal for construction of a new national hospital in Oslo. White Paper no. 38 (1987/88) proposes a hospital with 610 beds. The number of inpatient days at the present Rikshospitalet (The National Hospital) has declined by 19.4% during the period 1985 to 1989. In 1989 the use of inpatient services was equivalent to 530 beds with an occupancy rate of 80%. Based on an assumed further reduction in hospital use in the years to come, we estimate the need for beds to be 340 at the new national hospital. This lower number is assumed to cover local hospital functions (54 beds), regional hospital functions (220 beds) and national services (65 beds). The authors assert that the White Paper is based on outdated assumptions. The construction of a 610-bed national hospital involves a health care structure which could obstruct the reorganization of hospital care (more use of outpatient services) elsewhere in Norway. The County Councils responsible for financing hospitals will be forced to fund a hospital use that is motivated essentially by teaching and research rather than by caring for patients.