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Background: YKL-40, a growth factor for fibroblasts and vascular endothelial cells, is secreted by macrophages and neutrophils. Elevated serum YKL-40 is found in patients with diseases characterized by inflammation, tissue remodelling and ongoing fibrosis. The aim was to evaluate whether macrophages and giant cells in the granulomatous sarcoid lesions of patients with pulmonary sarcoidosis produce YKL-40 and to determine whether serum YKL-40 in these patients were associated with disease activity. Methods: Serum YKL-40 was determined by radioimmunoassay in 27 patients with a histological diagnosis of pulmonal sarcoidosis. Immunohistochemical staining for YKL-40 antigen was performed in five biopsies with pulmonary sarcoid lesions. Serum YKL-40 was likewise measured in 173 healthy age-matched control subjects. Results: Mononuclear cells/macrophages and giant cells in pulmonary sarcoid granulomas expressed YKL-40 protein. Serum YKL-40 was higher in patients with pulmonary sarcoidosis compared to controls (P<0.001) and 63% had elevated serum YKL-40. There was a positive correlation between serum YKL-40 and serum angiotensin converting enzyme (rho=0.55, P=0.0053). Patients with serum YKL-40>median value in the patient group had lower carbon monoxide diffusion capacity corrected for alveolar volume (D"LCO/VA) than patients with serum YKL-40=

The aim of the study was to measure the content of zinc (Zn) in liver tissue samples from Greenlandic Inuit using X-ray fluorescence spectrometry, and compare the results with those obtained in liver samples from Danes. Normal liver tissue samples was obtained at autopsy from 50 Greenlandic Inuit (27 men) with a median age of 61 years (range 23–83) and from 74 Danes (44 men) with a median age of 60 years (range 15–87). In the entire series, liver zinc content in Inuit was not significantly different compared with Danes. There was no significant gender difference in liver zinc content either in Inuit or in Danes. The content of zinc given as median (5–95 percentile) was in Inuit 3.809 mmol/kg dry liver (2.355–7.406), and in Danes 3.992 mmol/kg dry liver (2.499–8.645). There was a significant, positive correlation between liver zinc content and age in Danish women (rs= 0.43, p = 0.02), which could not be demonstrated in Danish men or in Inuit. Median hepatic zinc index (zinc content in mmol/kg dry weight divided by age in years) in Inuit was 0.073, and in Danes 0.080 (p = 0.3) without any significant difference between the two genders. In Inuit and Danes there was an inverse correlation between hepatic zinc index and age both in the two genders and in the entire series: Inuit: rs= −0.62, p < 0.0001; Danes: rs= −0.70, p < 0.0001. The results indicate that Inuit have liver zinc levels, which are similar to those found in Danes.

Abstract:  Iron status, S-ferritin, and hemoglobin (Hb) were assessed in a population survey in 1994 (DAN-MONICA 10) comprising 1332 Caucasian Danish men equally distributed in age cohorts of 40, 50, 60 and 70 years. Blood donors (n=186) had lower S-ferritin, median 76 μg/l, than nondonors, median 169 μg/l (p<0.0001). S-ferritin in donors was inversely correlated with the number of phlebotomies (r s=–0.57, p<0.0001). S-ferritin in nondonors (n=1146) was similar in men 40–60 years of age, median 176 μg/l, and subsequently decreased at 70 years of age to a median of 146 μg/l (p=0.01). In the entire series, the prevalence of small iron stores (S-ferritin 16–32 μg/l) was 2.7%, that of depleted iron stores (S-ferritin <16 μg/l) 0.45%, and that of iron deficiency anemia (S-ferritin <13 μg/l and Hb <129 g/l) 0.15%. Among nondonors, the prevalence of iron overload (S-ferritin >300 μg/l) was 20%. S-ferritin in nondonors correlated with body mass index (r s=0.19, p=0.0001) and with alcohol intake (r s=0.26, p=0.0001). In the entire series, 28% of the subjects took supplemental iron (median 14 mg ferrous iron daily). Iron supplements had no influence on iron status. Nondonors (n=170) treated with acetylsalicylic acid had lower S-ferritin, median 136 μg/l, than nontreated, median 169 μg/l (p<0.001) and those treated with H2-receptor antagonists (n=30) had lower S-ferritin, median 142 μg/l, than nontreated, median 171 μg/l (p<0.04). Compared with the DAN-MONICA 1 iron status survey of Danish men in 1984, the prevalences of iron depletion and iron deficiency anemia are unchanged whereas the prevalence of iron overload has increased significantly. In Denmark, iron fortification of flour was abolished in 1987. This apparently had no negative effect on iron status in men.

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Chlamydia pneumoniae(C.pn.) is claimed to be of importance for the development of bronchial asthma in previously healthy individuals. This is a new and speculative theory. Earlier studies have mainly focused on C.pn. and exacerbation of asthma. If this new theory were true, one would expect titres of C.pn.‐specific IgG to be higher or more common in patients compared with controls. It would also seem probable that pathobiological mechanisms as found in connection with other microorganisms could be demonstrated, i.e. presence of C.pn.‐specific IgE and the capability of C.pn. to induce or enhance histamine release from basophil leukocytes. We therefore examined C.pn.‐specific IgE, IgG and IgM in sera from 22 adults with bronchial asthma and 25 healthy controls. IgE was verified by passive sensitization of basophils from umbilical cord blood. The prevalence of IgE was approx. 69% and IgG approx. 23% in both groups. IgG‐titres were between 1:16 and 1:64 in both groups. No IgM was found. Further, C.pn. could neither induce nor enhance histamine release from basophil leukocytes of patients or controls. We conclude that patients with bronchial asthma and healthy controls do not differ in relation to 1) C.pn.‐specific IgE in sera, 2) the capability of C.pn. to induce or enhance histamine release from basophil leukocytes, since no such effect was found, or 3) previous C.pn. infection judged by the presence of specific IgG antibodies. Our results cannot support the theory that C.pn. is a cause of adult‐onset asthma.

Iron status was assessed by measurement of serum ferritin (S-ferritin), transferrin saturation and haemoglobin (Hb) in 270 healthy Faroese children (153 ?, 117 ?) 4, 8 and 13 years old. There were no significant differences between the three variables in boys and girls. Geometric mean S-ferritin increased from 16 µg/l in 4-year-old children to 21 µg/l in 8-year-old (P<0.01) and 25 µg/l in 13-year-old children (P<0.05). Likewise Hb displayed a gradual increase with age (P<0.001); the arithmetic mean Hb was 129 g/l in 4-year-old, 137 g/l in 8-year-old, and 143 g/l in 13-year-old children. Depleted iron stores (i.e. S-ferritin<12 µg/l) were present in 21.5% of 4-year-old, and in 12.7% of 8 and 13-year-old children. Latent iron deficiency (i.e. S-ferritin<10 µg/l and transferrin saturation<10%) was found in 3.1% of 4-year-old and in 0.5% of 8 to 13-year-old children. None of the children had iron deficiency anaemia. A high dietary intake of animal protein probably explains the low prevalence of iron deficiency.

Abstract:  The objective was to examine the relationships between serum ferritin, alcohol intake, and socioeconomic factors (school education, occupational education, occupation, income, marital status, cohabitation status, housing, social class) in a population survey performed in Copenhagen County during 1982–1984. The participants were selected at random from the census register and comprised 2235 healthy Danish individuals, non-blood donors (1044 men, 1191 women) in cohorts being 30, 40, 50, and 60 years old. The participants gave a detailed social and medical history and had a clinical examination including blood samples. In all age-groups, men had significantly higher serum ferritin and alcohol intake than women. In men, there was no relationship between serum ferritin and social class. Significant relationships were observed between ferritin and occupation (unemployed and self-employed men had higher ferritin than those with other occupations) and ferritin and income (in younger men, ferritin displayed a steady increase with income). None of the social variables were related to the prevalence of iron deficiency or iron overload. Alcohol intake was related to occupation and income, but not to social class. In women, none of the social variables showed any significant relationship to ferritin levels or iron overload. The prevalence of small iron stores (serum ferritin ≤30 μg/l) was lower and the intake of alcohol was higher in women from high social classes. In both men and women, serum ferritin displayed highly significant positive correlations with alcohol intake. Likewise, the prevalence of iron overload (serum ferritin >90th percentile) was closely correlated to alcohol intake. In conclusion, socioeconomic factors per se had a minor influence on serum ferritin levels and iron status in Danes. The distinct association between alcohol intake and serum ferritin levels should be considered in future iron status surveys.

Iron status was assessed by measurement of serum (S-) ferritin and hemoglobin (Hb) in 548 randomly selected healthy Danes (264 men, 284 women) with a median age of 25 years (range 16–31). S-ferritin values in men displayed a gradual increase with age, and at all ages, men had higher values than women. Iron deficiency (i.e., S-ferritin < 16 µg/l) was observed in 0.8%; none had iron deficiency anemia (i.e., S-ferritin <16µg/l and Hb<129g/l). Daily iron supplementation was used by 15.5%. The frequency of iron deficiency was 0% in supplement users vs 0.9% in nonusers. The frequency of preclinical hereditary hemochromatosis was 0.38%. There was a slight insignificant increase in S-ferritin values of women with age. Iron deficiency was observed in 14.7% of 16- to 19-year-olds, in 9.2% of 20- to 24-year-olds, and in 8.6% of 25- to 31-year-old women (p<0.01), and iron deficiency anemia (i.e., S-ferritin <16µg/l and Hb <121 g/l) in 14.7%, 3.4%, and 3.7%, respectively (p<0.01). Daily iron supplementation was used by 21.5%. The frequency of iron deficiency in users was 4.9% vs. 10.8% in nonusers, and the frequency of iron deficiency anemia 1.6% in users vs. 5.8% in nonusers. The results indicate a satisfactory iron status in young men. There is a high frequency of iron deficiency in young women, suggesting that preventive measures should be considered in this risk group.

Iron status including S-ferritin and haemoglobin (Hb) was assessed in a population survey comprising 1433 Danish males in age cohorts of 30, 40, 50 and 60 years. There was no significant difference in S-ferritin levels between the age groups. In the entire series, median S-ferritin was 126 μg 1-1, 5-95% tile 31-378 μg 1-1, range 5-3600 μg 1-1; 1.2% had values <15 μg 1-1 (i.e. depleted iron stores), 3.7% values from 15-30 μg 1-1 (i.e. small iron stores), and 95.1% values 30 μg 1-1 (i.e. replete iron stores); 73.8% had values from 61-300 μg l-1, and 9.5% values > 300 μg 1-1. Blood donors had lower S-ferritin than non-donors and a higher frequency of depleted iron stores (p<0.0001). Hb values showed no age variation; median values was 155 g 1-1 (9.6 mmol 1-1), 5-95% tile 137-171 g 1-1 (8.5-10.6 mmol 1-1). Hb values <129 g 1-1 (8.0 mmol 1-1) were observed in 1.7%, and values <121 g 1-1 (7.5 mmol 1-1) in 0.8%. Males with S-ferritin <15 μg 1-1(n=17) had lower Hb, median 148 g 1-1 (9.2 mmol 1-1), than those with S-ferritin =15 μg 1-1, median 155 g 1-1 (9.6 mmol 1-1) (p<0.05). Iron deficiency anaemia (S-ferritin <15 μg l_l and Hb<129 g 1-1) was seen in 0.14% of the males. There was no relation between S-ferritin and nutritional iron intake. The results indicate that iron intake and absorption was sufficient in 99.9% of the males to meet the requirements for erythropoiesis, and sufficient in 95% to establish appreciable iron reserves.

In a prospective study of 102 outpatients with histologically proven lung cancer, the prevalence and prognostic significance of microalbuminuria (urinary albumin excretion >20μg/min) were analysed. 65 consecutive outpatients with benign lung disorders served as controls. An immunoturbidimetric assay, sensitive at low concentrations, was used to quantify the albumin excretion rate in timed overnight urine samples. Patients with malignancies had a significantly higher frequency of microalbuminuria (32.4% compared with controls, 13.8%, P<0.01) and median urinary albumin excretion rate (13.4 versus controls, 8.9μg/min, P<0.003). Urinary albumin excretion was significantly higher in lung cancer patients with TNM stage III and IV. Patients with malignancies and microalbuminuria had a significantly lower survival rate than patients with normoalbuminuria (probability of survival 1 and 3 years after diagnosis 66% and 16% versus controls, 22% and 4%, P<0.00001). In a multivariate model, which adjusted for age, sex, performance status, histological type and TNM stage, microalbuminuria continued to be a significant predictor of survival. In conclusion, an increased prevalence of microalbuminuria has been demonstrated in patients with lung cancer. The presence of microalbuminuria was associated with advanced disease stage and poor survival.

Iron status, including serum (S-) ferritin and hemoglobin (Hb) was assessed in a population survey of 469 old subjects (70 years of age; 254 men, 215 women); 7.9% of the participants had abnormal laboratory tests indicating diseases which might be connected with inappropriately high S- ferritin levels. Men had a median S- ferritin of 114 µg/L, 5–95 percentile 28–373 µg/L; 2.4% had values <15 µg/L (i.e., depleted iron stores), 3.5% values from 15–30 µg/L (i.e., small iron stores), and 94.1% values >30 µg/L (i.e., replete iron stores); 74.4% had values from 61–300 µg/L, and 8.7% values >300 µg/L. Median Hb was 142 g/L (8.8 mmol/L), 5–95 percentile 124–158 g/L (7.7–9.8 mmol/L); Hb values <129 g/L (8.0 mmol/L) were observed in 7.5%. Iron deficiency anemia (i.e., S- ferritin <15 µg/L and Hb <129 g/L) was seen in 0.39% of the men. Women had lower S- ferritin than men (p<0.0001), median 81 µg/L, 5–95 percentile 20–273 µg/L; 3.3% had values <15 µg/L, 9.3% values from 15–30 µg/L, and 87.4% values >30 µg/L; 63.2% had values from 61–300 µg/L, and 3.7% values >300 µg/L. Hb was lower in women than in men (p<0.0001, median 132 g/L (8.2 mmol/L), 5–95 percentile 118–145 g/L (7.3–9.0 mmol/L); Hb values <121 g/L (7.5 mmol/L) were seen in 6.5%. None of the women had iron deficiency anemia (i.e., S-ferritin <15 µg/L and Hb <121 g/L). (Aging Clin. Res. Exp. 6: 97- 103, 1994)

The content of iron, copper, zinc and selenium was measured by energydispersive X-ray fluorescence (XRF) spectrometry in normal liver tissue obtained at autopsy from 16 females and 12 males 46–87 years old. The precision of the XRF analysis, expressed by the coefficient of variation was: iron, 1.8; copper, 3.2; zinc, 1.0; and selenium, 26.7. In large liver samples, mean amountof-substance contents of elements in dry liver tissue were: iron, 16.95 mmolkg (range 7.90–27.31 mmolkg); copper, 0.33 mmolkg (0.08–0.76 mmolkg); zinc, 5.12 mmolkg (2.92–9.47 mmolkg); selenium 0.02 mmolkg (<0.004–0.04 mmolkg).Furthermore the amounts of iron, copper and zinc were measured in wet-ashed Menghini needle biopsy specimens taken from the centre of 20 large liver samples. There was good agreement between results obtained in biopsy specimens and large samples concerning iron (r 0.96, P<0.001) and zinc (r 0.97, P<0.001), but not concerning copper (r 0.66, P<0.01). XRF analysis appears to be a convenient method for element analysis in liver tissue and for measurement of iron and zinc in needle biopsy specimens.

The purpose of this study was to measure the content of the elements Sulphur (S), Chlorine (Cl), Potassium (K) and Bromine (Br) in normal liver tissue samples from Greenlandic Inuit using X-ray fluorescence spectrometry, and compare the results with those obtained in normal liver tissue samples from Danes. Liver tissue samples were obtained at autopsy from 50 Greenlandic Inuit (27 men, 23 women) with a median age of 61 years (range 20–83) and from 74 Danes (44 men, 30 women) with a median age of 52 years (range 15–87). In Inuit, the content of elements given as median and (5–95 percentile) was: sulphur, 108.07 mmol/kg dry liver (86.78–169.44); chlorine, 92.16 mmol/kg dry liver (45.39–128.42); potassium, 181.66 mmol/kg dry liver (146.41–236.35); bromine, 0.0901 mmol/kg dry liver (0.0563–0.1589). In Danes, the corresponding values were: sulphur, 147.58 mmol/kg dry liver (70.41–236.81); chlorine, 96.95 mmol/kg dry liver (54.01–162.52); potassium, 198.40 mmol/kg dry liver (150.68–256.37); bromine, 0.1101 mmol/kg dry liver (0.0701–0.4203). None of the elements displayed any significant gender difference, neither in Inuit nor in Danes. Inuit had a lower liver content of sulphur (p < 0.0001), potassium (p < 0.008) and bromine (p < 0.002) as compared with Danes.

Both ventilation and perfusion scintigraphy are accurate predictors of post-operative ventilatory function. Previous attempts to predict post-operative exercise capacity after lung resection using radioisotope scintigraphy are few and results are conflicting. We studied 32 patients before and 6 months after pulmonary resection for bronchogenic carcinoma to assess the value of lung perfusion scintigraphy for the prediction of post-operative forced lung volumes and parameters on maximum exercise, including maximum ventilation and maximum oxygen uptake. Nine patients were lost to follow-up, and these patients differed from the reinvestigated patients only in the staging of the pulmonary carcinoma and not in preoperative lung function or exercise capacity. We found a clear relationship between the values predicted from a preoperative perfusion scintigraphy, spirometry and a maximum exercise study and the observed values measured 6 months post-operatively. The method underestimated the postoperative values of both spirometric and exercise measurements, especially in the higher range. Only in a few cases were the post-operative observed values less than the predicted values, and in these cases the difference was without clinical significance. Unexpected post-operative respiratory insufficiency was not observed. In conclusion, in patients in whom a pulmonary resection was performed, not only the post-operative spirometric values, but also the more functional related maximum exercise data can be predicted through the knowledge of a preoperative perfusion scintigraphy.

Iron stores were evaluated by serum ferritin determinations in 948 menstruating and 141 non-menstruating female blood donors. Blood donation was associated with a decrease in ferritin. First-time donors (n=163) had a geometric mean ferritin of 24 µg/l and multiple-time donors a value of 19 µg/l (p<0.01). In the donating population 31.5% had ferritin values < 15 µg/l (i.e. depleted iron stores). Menstruating donors had lower mean serum ferritin than non-menstruating donors (p<0.001), and a higher frequency of ferritin values < 15 µg/l (p<0.05). There was no relationship between ferritin levels and the number of pregnancies. The frequency of donations was more predictive of ferritin levels than the number of donations. Mean ferritin displayed a moderate fall up to the 2nd donation, and was hereafter relatively constant, whereas an increase in donation frequency was accompanied by a significant decrease in ferritin. Female donors, especially when phlebotomised =3 times per year, should have their iron status checked at appropriate intervals by measurement of serum ferritin and should be advised regular iron supplementation.

Abstract:  The aim of the present study was to evaluate the influence of menstruation, method of contraception, and iron supplementation on iron status in young Danish women, and to assess whether iron deficiency could be predicted from the pattern of menstruation. Iron status was examined by measuring serum (S-) ferritin and hemoglobin (Hb) in 268 randomly selected, healthy, menstruating, nonpregnant Danish women aged 18–30 years. Iron deficiency (S-ferritin <16 μg/l) was observed in 9.7% of the women, iron deficiency anemia (S-ferritin <13 μg/l and Hb <121 g/l) in 2.2%. Iron supplementation, predominantly as vitamin-mineral tablets containing 14–20 mg of ferrous iron was used by 35.1%. The median serum ferritin was similar in non-iron users and in iron users, whereas the prevalence of iron deficiency was 12.6% in nonusers vs. 4.3% in users, the prevalence of iron deficiency anemia 3.4% in nonusers vs. 0% in users (p=0.17) In non-iron-supplemented women, S-ferritin levels were inversely correlated with the duration of menstrual bleeding (r s=–0.25, p<0.001) and with the women's assessment of the intensity of menstrual bleeding (r s=–0.27, p<0.001), whereas no such correlations were found in iron-supplemented women. The results demonstrate that even moderate daily doses of ferrous iron can influence iron status in women with small iron stores. Women using hormonal contraceptives had menstrual bleeding of significantly shorter duration than those using intrauterine devices (IUD) or other methods. There was a high prevalence of small and absent body iron stores in young women, suggesting that preventive measures should be focused on those women whose menstruation lasts 5 days or longer, who have menstrual bleeding of strong intensity, who use an IUD without gestagen, and who are blood donors.

Ferritin was analysed with an immunoradiometric assay using anti-spleen ferritin antibodies, in pleural effusions (PI) from 28 patients with malignant effusions (18 carcinoma, 10 mesothelioma), 15 patients with non-malignant exudative effusions of unknown aetiology, and from 12 patients with transudative effusions due to congestive cardiac failure. Geometric mean Pl-ferritin was 617 μg/l in carcinoma, 1301 μg/l in mesothelioma (p<0.01 against carcinoma), 931 μg/l in non-malignant exudates, and 178 μg/l in transudates (p<0.0001 against malignant and non-malignant exudates). There was no correlation between Pl-ferritin and Pl-protein, Pl-albumin or Pl-cell count. Pl-ferritin displayed a wide overlap between the various groups, and was of no value in the discrimination between malignant and non-malignant exudates. In the differentiation between exudates and transudates, the diagnostic accuracy of Pl-ferritin was only slightly lower compared to Pl-protein and Pl-albumin. With the present method, analysis of Pl-ferritin appears to be of limited value in the routine diagnostic evaluation of pleural effusions.

Milman N, Andersen HC, Pedersen NS. Serum ferritin and iron status in 'healthy' elderly individuals. Scand J Clin Lab Invest 1986; 46: 19-26.Iron status, including S-ferritin. S-iron, S-transferrin, transferrin saturation and haemoglobin, was assessed in 267 selected elderly subjects (128 male, 139 female) with a median age of 79 years (range 60-93 years) not suffering from diseases connected with inappropriately high S-ferritin. In both sexes, S-ferritin levels were practically constant over the examined age range. Males had a geometric mean ferritin of 75 μg/l and females a value of 60 μg/l (p<0.001). Levels of S-ferritin < 15 μg/l (i.e. depleted iron stores) were found in 7.8% of males and in 10.1% of females. An S-ferritin level < 15 μg/l and transferrin saturation <15% (i.e. latent iron deficiency) was observed in 2.3% of males and in 2.2% of females. None had iron deficiency anaemia. In subjects (n=232) without iron deficiency [i.e. S-ferritin ≥1.5 μg/l. mean red cell volume ≥79 fl and haemoglobin ≥ 121 g/l (7.5 mmol/l)], the arithmetic mean of S-iron was 18 μmol/l. S-transferrin 28 μmol/l and transferrin saturation 33%. The levels of S-iron, S-transferrin and transferrin saturation were not significantly different in males and females.

Summary Bone marrow hemosiderin iron was assessed in 48 patients with alcoholic, and in 34 patients with nonalcoholic liver disease (53 men, 29 women, median age 55 years, range 18–84) and correlated to serum (S)-iron status markers (iron, transferrin, ferritin), as well as to histochemical hepatocyte iron and chemical liver iron content. In a control group of 53 healthy subjects (23 men, 30 women, median age 28 years, range 18–90) marrow hemosiderin iron and iron status markers were evaluated as well. Among liver patients, the marrow iron grade was higher in men than in women (p=0.03). Correlations were found between marrow iron and histochemical liver iron (rho=0.38,p=0.0001) as well as chemical liver iron (rho=0.33,p=0.01). Marrow iron was correlated to S-ferritin (rho=0.53,p=0.0001), mean red cell volume (rho=0.34,p=0.003), and S-transferrin (rho=-0.24,p=0.02). Alcoholics had a higher marrow iron grade than nonalcoholics (p=0.001) and controls (p=0.0001). Among controls, the marrow iron grade was likewise higher in men than in women (p=0.01). Correlations were found between marrow iron and ferritin (rho=0.64,p=0.0001), transferrin saturation (rho=0.56,p= 0.001), transferrin (rho=-0.53,p=0.001), S-iron (rho= 0.37,p=0.01), and hemoglobin in women (rho= 0.38,p=0.05). The results indicate that alcoholics either have increased marrow hemosiderin iron stores, or display a redistribution of iron in reticuloendothelial cells from soluble ferritin-bound iron to insoluble hemosiderin iron. Among patients with absent marrow hemosiderin iron, 81% had absent hepatocyte hemosiderin iron as well. Among patients with absent hepatocyte hemosiderin iron, 23% had absent and 77% normal or increased marrow hemosiderin iron. Therefore, in patients with iron depletion, assessment of marrow hemosiderin iron yields more relevant information of iron status than assessment of hepatocyte hemosiderin iron.

Summary Iron status was assessed by measuring serum (S-) ferritin and hemoglobin (Hb) in a population survey comprising 1359 nonpregnant Danish women, in age cohorts of 30,40, 50, and 60 years; 809 were premenopausal and 550 postmenopausal. Median age for menarche was 14 years, for menopause (artificial and natural) 48 years. Premenopausal women had lower S-ferritin (median 37?g/l) than postmenopausal women (median 71?g/l;p<0.0001). Of the premenopausal women, 17.7% had S-ferritin < 15?g/l (i.e., depleted iron stores), and 23.1% S-ferritin of 15–30?g/l (i.e., small iron stores). Corresponding figures in postmenopausal women were 3.3% and 10.3%. Hb values in premenopausal women were mean 137±10 (SD) g/l (8.5±0.6 mmol/l) vs. 140±10 g/l (8.7±0.6 mmol/l) in postmenopausal women (p<0.0001); 4.1% of pre- and 3.3% of postmenopausal women had values < 121 g/l (7.5 mmol/l). Iron deficiency anemia (i.e., S-ferritin < 15?g/l and Hb < 121 g/l) was found in 2.6% of pre- and 0.36% of postmenopausal women. Premenopausal multipara had lower S-ferritin than nulli- and unipara (p<0.04). The use of oral contraceptives had a marked influence on iron stores; premenopausal women taking the pill had higher S-ferritin and a lower frequency of depleted iron reserves than nonusers (p<0.01). Postmenopausal estrogen treatment had no influence on S-ferritin or Hb.

Summary Iron status, including serum (S-)ferritin and hemoglobin (Hb), was assessed in a population survey comprising 1359 nonpregnant Danish women in age cohorts of 30, 40, 50, and 60 years. S-ferritin levels were similar in 30- and 40-year-old women; they displayed a significant increase in 50-year-old women and a further significant increase in 60-year-old women. In the 30- and 40-year-old women, median S-ferritin was 38µg/l, 5–95 percentile 6–135µg/l; 17.2% had values < 15,µg/l (i.e., depleted iron stores), 22.7% values from 15 to 30µg/l (i.e., small iron stores), and 60.1% values > 30µg/l (i.e., replete iron stores). In the 50-year-old women, median S-ferritin was 54µg/l, 5–95 percentile 10–164µg/l; 10.3% had values < 15µg/l, 16.5% values from 15 to 30µg/l, and 73.2% values > 30µg/l. For the 60-year-old women, median S-ferritin was 84µg/l, 5–95 percentile 25–249µg/l; 1.6% had values < 15µg/l, 8.6% values from 15 to 30µg/l, and 89.8% values > 30µg/l. Blood donors (n=180) had lower S-ferritin than nondonors in all age-groups (p<0.001). In the entire series, Hb levels were similar in 30- and 40-year-old women, median 137 g/l (8.5 mmol/l), 5–95 percentile 121–152 g/1 (7.5–9.4 mmol/l), and higher in 50- and 60-year-old women, median 140 g/l (8.7 mmol/l), 5–95 percentile 123-158 g/l (7.6–9.8 mmol/l) (p<0.0001). Hb values < 121 g/l (7.5 mmol/l) were observed in 3.8% of the women. Women with S-ferritin < 15 µg/l (n=161) had lower Hb, median 134 g/l (8.3 mmol/l), than those with S-ferritin > 15 µg/l, median 139 g/l (8.6 mmol/l) (p<0.001). Iron deficiency anemia (S-ferritin < 15 µg/l and Hb < 121 g/l) was seen in 2.3% of 30- and 40-year-old women, and in 1.1% of 50- and 60-year-old women.

Summary The general impact of blood donation on iron status was studied in a population survey comprising 1359 nonpregnant Danish women in age cohorts of 30, 40, 50, and 60 years; 809 were premenopausal and 550 postmenopausal; 180 (13%) were blood donors. Iron stores were assessed by serum (S-)ferritin and hemoglobin (Hb). Hb levels were not significantly different in donors: mean 137±10 (SD) g/l (8.5±0.6 mmol/l) compared with nondonors, 139±11 g/l (8.6±0.7 mmol/l). Values < 121 g/l (7.5 mmol/l) were observed in 3.3% of donors vs 3.8% of nondonors. Correlations between S-ferritin and Hb were without practical relevance:rs=0.29,p<0.0001 in donors vsrs=0.22, p<0.0001 in nondonors. Blood donation had a profound influence on iron status, especially in the premenopausal women population. Donors had lower S-ferritin than nondonors in all age-groups and in pre- and postmenopausal groups (p<0.001 in all groups). Premenopausal donors had a median S-ferritin of 31µg/l vs 39µg/l in nondonors, postmenopausal donors of 47µg/l vs 72µg/l in nondonors. S-ferritin values < 15µg/l (i.e., depleted iron stores) were observed in 31.7% of premenopausal donors vs 15.2% of nondonors, and in 7.0% of postmenopausal donors vs 2.9% of nondonors. Iron deficiency anemia (i.e., S-ferritin < 15µg/l and Hb < 121 g/l) was seen in 2.8% of donors vs 1.5% of nondonors. Donors using oral contraceptives had higher S-ferritin, median 33µg/l compared with nonusers, 22µg/l, and a lower frequency of depleted iron stores, 29% vs 39%. Ideally, the frequency of phlebotomy should be adjusted according to S-ferritin as well as Hb levels. If Hb is used as single criterion for donation, only donors with predonation values = 124–125 g/l should be allowed to undergo phlebotomy.

Iron status, including S-ferritin, S-iron, S-total iron binding capacity (TIBC), TIBC saturation, haemoglobin (Hb) and dietary iron intake, was assessed in a population study comprising 92 healthy 85-year-old subjects (32 males, 60 females). S-iron, S-TIBC, TIBC saturation and S-ferritin values were not significantly different in the two sexes. Males had a geometric mean S-ferritin of 130 (ig/1, females of 98 (ig/1. Ferritin levels <15 (j.g/1 (i.e. depleted iron stores) were found in one female (1.6%); and in one male (3.1%), who in addition had iron deficiency anaemia. None of the females displayed latent iron deficiency (i.e. S-ferritin <15 (ig/1 and S-TIBC saturation <15%) or iron deficiency anaemia. Arithmetic mean Hb was 145 ±± 13 (SD) g/1 (9.0±±0.8 mmol/l) in males and 139 ±± 11 g/1 (8.6±±0.7 mmol/l) in females (p<0.02). Median nutritional iron intake was 10 mg/day (range 3-17), higher in males (median 12) than in females (median 9) (p<0.0001). Iron intake showed significant correlations to S-iron, S-TIBC and TIBC saturation, but not to S-ferritin.

Serum lactoferrin was measured by a solid phase radioimmunoassay in 271 healthy Faroese children 4, 8, and 13 years old and in 141 Norwegian children (50 umbilical cord blood samples), 91 aged 5 days to 14 years. Faroese children displayed no sex or age difference in serum lactoferrin levels. Serum lactoferrin was correlated to total leucocyte count (rs = 0.24, p<0.0001), blood neutrophils (rs = 0.22, p< 0.001) and eosinophils (rS = 0.15, p < 0.02). The Norwegian children had a median umbilical serum lactoferrin of 17 mg/l which later dropped to 7.5 mg/l (16 neonates) and remained at that level. Serum lactoferrin values in Faroese children were significantly higher (p <0.01) (median 11 mg/l and arithmetic mean 36 mg/1. Children, granulocytes, lactoferrin, leucocytes, lysozyme

Acquired immunodeficiency syndrome (AIDS) is an increasing problem in the pediatric population. Beta-2-microglobulin is part of the HLA structure, being especially abundant in the lymphoid celis and the most useful nonspecific indicium of AIDS. Serum beta-2-microglobulin assayed in 271 healthy children had a geometric mean of 1.398 mg/L and a 5-95 percentile interval of 0.925-2.202 mg/L; thus, values above 2.202 mg/L may be indicative of active disease.

This paper reviews current knowledge of childhood sarcoidosis with regard to the epidemiology in Danes, clinical presentation, diagnostic procedures, treatment and prognosis. Sarcoidosis is a granulomatous disease of unknown aetiology, with multiorgan involvement. The diagnosis is confirmed by the demonstration of epitheloid cell granulomas in tissue biopsy specimens. During the period 1980‐92, three cases of childhood sarcoidosis were recorded in Copenhagen County, which has a total population of 610,000. The approximate incidence of clinically recognized sarcoidosis in Danish children younger than 15 y of age was 0.22–0.27/100,000 children per year, corresponding to approximately three new cases in Denmark each year. The true incidence is unknown, since the disease is often asymptomatic and resolves without a clinical diagnosis being made. In children younger than 5 y of age, the disease is characterized by involvement of skin, eyes and joints, whereas in older children involvement of lungs, lymph nodes and eyes predominate. The mainstay of treatment consists of oral corticosteroids. The risk/benefit ratio of using long‐term corticosteroids needs to be evaluated in each individual patient. Some patients may benefit from additional therapy with methotrexate. The long‐term prognosis is not well established, but it seems to be poorer in children younger than 5y. Older children appear to have as favourable a prognosis as young adults.

A longitudinal study of iron status markers (haemoglobin (Hb), serum (S-) iron, S-transferrin, transferrin saturation, S-ferritin) was performed in 31 chemotherapy treated patients with small cell lung cancer. At discovery, eight patients were anaemic (Hb less than 121 g l-1). Hb, S-iron and transferrin saturation were lower (P less than 0.01), and S-ferritin higher (P less than 0.01) than in healthy subjects. Chemotherapy induced an immediate fall in Hb (P less than 0.003), increase in S-iron (P less than 0.003) and transferrin saturation (P less than 0.001). Later in the disease a fall in S-transferrin (P less than 0.006) and an increase in S-ferritin (P less than 0.02) occurred. Thirty patients died during the 2 years observation. S-ferritin at discovery was correlated to performance status score (r = 0.57, P = 0.01) and to survival (r = -0.63, P less than 0.0002). Patients with S-ferritin less than or equal to 400 micrograms l-1 (n = 13) had longer survival than those with S-ferritin greater than 400 micrograms l-1 (n = 18) (P = 0.004).

Iron stores were evaluated by serum ferritin measurements in 1348 male blood donors. Blood donation was associated with a decrease in serum ferritin concentrations. First‐time donors (n = 21) had a geometric mean serum ferritin concentration of 52 micrograms per l, and multiple‐ time donors (n = 1327) of 36 micrograms per l (p less than 0.01). In the donating population, 6.0 percent had serum ferritin values less than 15 micrograms per l (i.e., depleted iron stores), 33.9 percent had values from 15 to 30 micrograms per l (i.e., reduced iron stores), 52.5 percent had values from 31 to 90 micrograms per l, and 7.6 percent had values greater than 90 micrograms per l (i.e., normal iron stores). The frequency of donations per year was more predictive of decreased iron stores than the number of lifetime donations. Serum ferritin showed a moderate fall up to the fourth donation (p less than 0.001); thereafter serum ferritin levels showed only minor insignificant changes. An increase in donation frequency was accompanied by a significant decrease in serum ferritin; values less than 15 micrograms per l were found in 1.3 percent of donors bled two times per year, in 6.0 percent bled three times per year, and in 7.9 percent bled four times per year. Regular monitoring of iron stores by serum ferritin in blood donors seems justified in order to identify those with depleted iron stores who will benefit from iron supplementation.

Zinc absorption was measured by whole-body counting in 10 patients with compensated alcoholic cirrhosis without steatorrhoea and in 8 healthy subjects. After oral administration of 65Zn the absorption was measured at regular intervals until a straight time/activity retention curve was obtained in a semilogarithmic system, whereafter it was calculated by extrapolation to time zero. Cirrhotic patients had a median absorption of 69 (27–90), compared with 42 (25–67) in healthy subjects (P < 0.01). Median T of 65Zn as calculated from the retention curve was 156 days (83–280 days) in cirrhotic patients and 103 days (72–132 days) in healthy subjects (P < 0.05). Median serum zinc value was 11 μmol/l (9–17 μmol/l) in cirrhotic patients and 16 μmol/l (12–17 μmol/l) in healthy subjects (P < 0.01). Median erythrocyte zinc value was 224 μmol/l (205–281 μmol/l) in cirrhotics and 223 μmol/l (188–275 μmol/l) in healthy subjects (P > 0.1). Six cirrhotic patients, of whom four took diuretics, had increased urinary zinc excretion (>15 μmol/24 h). Zinc absorption seems intact in compensated alcoholic cirrhosis. The increased absorption and prolonged T of 65Zn might be compensatory to a moderate zinc depletion.

Iron status (haemoglobin, S-ferritin, S-iron, S-transferrin, and transferrin saturation) was evaluated in an epidemiological survey comprising a representative sample of 118 (4%) of the 40- to 49-year-old Faroese male population. All had normal haemoglobin, (mean ±±SD 153±±9 g/1; 9.5±±0.6 mmol/1). Median S-ferritin was 151 ng/1, 5-95 percentile 46-588 u.g/1, observed range 33-1166 Hg/1. None had depleted iron stores (S-ferritin ≥≥20 ng/1), 2.5% had ‘‘small’’ iron stores (S-ferritin 21-40 ng/1), 80.5% had ‘‘normal’’ iron stores (S-ferritin 41-300 ng/1) and 17% had ‘‘increased’’ iron stores (S-ferritin ≥≥300 ug/1). Transferrin saturation values were ≥≥16% in all males; high values ≥≥50% were found in 9.3%, and the combination of high transferrin saturation and S-ferritin ≥≥300 μμ/l was found in 3.4% of the males. Median P-ascorbic acid was 26 μμmol/1, 5-95 percentile 7-67 μμmol/1; significantly higher in subjects taking vitamin supplements (n=35, median 50 μμmol/1) than in those not taking supplements (n=81, median 23 μμmol/1) (p<0.0001). There was no correlation between P-ascorbic acid and iron status markers. The results indicate a high frequency of ample iron reserves in the Faroese male population.

In nine kidney-transplanted patients, receiving prednisone as part of the im-munosuppression, serum zinc and urinary zinc excretion were measured for a period of 5––7 weeks after the transplantation. Serum zinc decreased significantly from normal pretransplant values to subnormal values 1––5 days after the transplantation. Thereafter, the serum zinc rose again, and after 2––3 weeks, before start of reduction of prednisone, the serum zinc had risen to a level that was not significantly lower than the pretransplant level. Urinary zinc excretion was generally elevated, especially just after the transplantation. In patients with initially good kidney function the zinc clearance to creatinine clearance ratio was significantly higher during the first week after the transplantation than in the rest of the observation period. Similar findings have been reported after major surgery, and no correlation between serum zinc and the corticosteroid dose was demonstrable. Therefore, in renal allotransplantation, no special supplementation of zinc seems necessary beyond what may be justified by the effect of the surgical trauma.

Entre 1986 et 1989, 1 323 fibroscopies bronchiques ont été réalisées chez 1 186 patients, 696 hommes, 490 femmes, d'âge moyen de 61 ans. Les indications étaient respectivement à visée diagnostique dans 94,5 % des cas et thérapeutiques dans 5,5 % des cas. L'anesthésie locale a été utilisée au cours de 96,3 % des examens et l'anesthésie générale dans 3,7 %. Sur les 229 patients présentant des radiographies thoraciques normales et des symptômes bronchopulmonaires, un diagnostic concluant a été posé dans 93 % des cas. Parmi les 772 patients porteurs de lésions pulmonaires localisées, le diagnostic a été obtenu dans 68 % des cas, et chez les 179 patients atteints de lésions pulmonaires diffuses, dans 63 % des cas. Chez 14 patients immunodéprimés atteints de pneumonie, le diagnostic microbiologique a été posé dans 50 % des cas. Sur les 478 patients porteurs d'un cancer pulmonaire primaire, 67 % d'entre eux furent diagnostiqués par bronchoscopie contre 45 % des 58 patients porteurs de métastases pulmonaires. Sur 13 patients porteurs de lésions pulmonaires bénignes, 46 % furent diagnostiqués par bronchoscopie. Dans la totalité de la série, le diagnostic final a été obtenu par fibroscopie bronchique chez 70 % des patients. Les complications furent les suivantes : un décès dû à une cardiopathie ischémique, un pneumothorax dans 5,4 % des examens où furent pratiquées des biopsies transbronchiques. In 1986-1989, 1,323 fiberoptic bronchoscopies were performed in 1,186 patients, 696 men, 490 women, with a median age of 61 years. The indication was diagnostic in 94.5 % and therapeutic in 5.5 % of the examinations. Local anaesthesia was used in 96.3 % of the procedures and general anaesthesia in 3.7 %. Out of 229 patients with a normal chest X-ray and bronchopulmonary symptoms, a conclusive diagnosis was obtained in 93 %. Among 772 patients with circumscribed pulmonary lesions, the diagnosis was obtained in 68 %, and among 179 patients with diffuse pulmonary lesions in 63 %. In 14 immunocompromised patients with pneumonia, the microbiological diagnosis was obtained in 50 %. Out of 478 patients with primary lung cancer, 67 % were diagnosed by bronchoscopy, compared to 45 % of 58 patients with metastatic lung cancer. Among 13 patients with benign pulmonary tumours, 46 % were diagnosed by bronchoscopy. In the entire series, the final diagnosis was obtained by fiberoptic bronchoscopy in 70 % of the patients. Complications consisted of one death due to ischaemic heart disease, and pneumothorax in 5.4 % of the examinations when transbronchial biopsies were performed. [ABSTRACT FROM AUTHOR]

Blood lead (B-Pb) and erythrocyte zinc protoporphyrin (ZPP) were measured in 78 mothers at delivery and in cord blood from 48 infants living in an area with low atmospheric Pb pollution. Median B-Pb was 35 µg/l (range 6–63) in mothers and 20 µg/l (range 6–50) in infants (P<0.001), and the values were significantly correlated (rs=0.73, P<0.0001). Mean B-Pb infant/B-Pb mother ratio was 0.7 (range 0.2–1.4). Mothers had lower ZPP (median 1.6 µg/g Hb) than infants (median 2.9) (P<0.0001). ZPP in mothers showed a stronger relation to iron status (serum transferrin, serum ferritin) than to B-Pb (rs=0.22, P<0.05). B-Pb was correlated to serum iron both in mothers (rs=0.28, P<0.02) and infants (rs=0.33, P<0.03). The present B-Pb levels are lower than previously reported in Scandinavia, probably due to the general decline in atmospheric Pb pollution.

Mediator release was examined from superficially lying cells in the airway epithelium obtained by bronchoalveolar lavage (BAL) in 13 non-atopic individuals. The BAL-cells were incubated (20 min, 37°C) withStaphylococcus (Staph.) aureus or with human influenza A virus.Staph. aureus was found to release histamine from cells from 7 of the 13 individuals and influenza A virus in 3 of 5 persons. Furthermore,Staph. aureus stimulated the BAL-cells to release leukotriene B4 in 7 of 11 subjects, whereas no release was found by influenza A virus in 7 examined persons. When cells from 4 persons were stimulated withStaph. aureus no release of leukotriene C4 was found. The mediator release caused by bacteria and virus might be of importance for the exacerbation of bronchial asthma in upper respiratory tract infections, since histamine is assumed to increase the epithelial permeability with entrance of allergens and other insulting particles, and leukotriene B4 facilitates airway inflammation.

Serum iron, serum transferrin and transferrin saturation were studied in 253 healthy, non-anaemic children 4, 8 and 13 years old, and in 60 healthy, non-anaemic adults having serum ferritin values =15 µg/l. One hundred and ninety-six children had serum ferritin values =15 µg/l (i.e. replete iron stores), 35 had intermediate ferritin values from 10–14 µg/l and 22 had ferritin values <10 µg/l (i.e. depleted iron stores). Iron replete children showed a gradual rise in serum iron and transferrin saturation values with age. Serum iron and transferrin saturation values were lower (P<0.001, P<0.0001) and transferrin values high (P<0.0001) in iron replete children compared to adults. Iron replete children had a 2.5 centile transferrin saturation value of 5%; 19.9% of these children had saturation values <15% and 8.2% had values <10%. In iron depleted children a transferrin saturation value <7% yielded the highest diagnostic efficiency as regards exhausted iron stores, although with a low predictive value of a positive test. The transferrin saturation is unsuitable as a single diagnostic criterion in the evaluation of iron deficiency in children and should always be combined with other indicators of iron status.

A method of endoscopic ultrasonography (EUS) with guided needle aspiration biopsy for conclusive diagnosis of a mediastinal mass lesions is described. The technique might prove useful for diagnosis of solid mass lesions in the mediastinum including diagnosis of lymph nodes for preoperative staging of lung cancer.