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Between 1982 and 1989 we identified 47 subjects with spuriously increased concentrations of free thyroxin (FT4) or free triiodothyronine (FT3) related to autoantibody interference in analog FT4 and (or) FT3 methods. The incidence of autoantibody interference observed during one year (1988) was 1 in 2460. In the subjects identified, 51% and 11%, respectively, showed an increased binding of radiolabeled T4 or T3 analog alone; 38% had an increased binding of both. Of 36 patients tested, 71% had autoantibodies to thyroglobulin and microsomal fraction of the thyroid, 19% to microsomal fraction alone, and 9.5% to thyroglobulin alone. In eight subjects, spuriously increased FT4 concentrations were reported with the following FT4 methods (in decreasing order of interference): Coat-A-Count, Amerlex-M, Amerlite, Seria, Magic Lite, Amerlex-MAB. In the same eight subjects, Amerlex-M and Seria reported spuriously increased concentrations of FT3.

Eighty cases of typhoid fever occurred in San Antonio, Texas, with dates of onset from August 18, 1981, to October 26, 1981. Preliminary epidemiological investigations of the first 24 cases suggested a Mexican food takeout restaurant as the common source. A case-control study confirmed this association (P less than or equal to .001). Barbacoa , a mixture of muscle, lips, ears, tongue, and eyes from steamed bovine heads, was identified as the source of Salmonella typhi (P = .03). S typhi was cultured from the stool of one of 31 restaurant employees. Closure of the restaurant resulted in termination of the outbreak within a single incubation period. The restaurant was allowed to reopen after the remaining employees had demonstrated lack of excretion of S typhi in stools. This outbreak represents the largest restaurant-associated typhoid fever outbreak reported in the United States in greater than 50 years.

We measured thyrotropin (TSH) with an enhanced luminometric assay ("Amerlite"; Amersham International). The detection limit of the assay is 0.02 milli-int. unit/L. Within-assay precision was 6.7 and 7.8% at 3.77 and 12.1 milli-int units/L, respectively, and between-assay precision was almost identical, whether singleton or duplicate samples were assayed. TSH measured in 132 euthyroid subjects ranged from 0.06 to 4.13 milli-int. units/L (mean 1.52, SD 0.86). Similar concentrations were found in 20 healthy pregnant women and 19 of 20 healthy post-menopausal women (one of whom had undetectable TSH). In 17 patients with primary hypothyroidism, TSH concentrations ranged from 9.34 to greater than 200 milli-int. units/L; and in 53 of 59 patients with hyperthyroidism, TSH concentrations were undetectable, ranging in the remaining six from 0.03 to 0.06 milli-int. unit/L. Results for TSH in 28 patients stimulated with thyroliberin were consonant with the results of the thyroliberin test in 25 cases. Thus, for most patients, measurement of a basal TSH concentration evidently will predict their thyroidal status and also the response to thyroliberin, but a few will require additional tests of thyroid function.

We evaluated a two-site enhanced luminescence immunoenzymometric assay (Amerlite; Amersham International) for alpha-fetoprotein (AFP) in maternal serum and amniotic fluid. The assay is rapid, involving two incubations totalling 4 h. The working range of the assay for serum AFP is 5.5 to 750 kilo-int. units/L (CV less than 10%), with a sensitivity of detection of 0.2 kilo-int. unit/L. The regression equation for the Amerlite assay (y) and our in-house RIA procedure (x) was y = 0.816x + 2.9 (n = 142, r = 0.96). Analytical recovery of added AFP (code 72/227) at three concentrations was 86.7%. Serum AFP concentrations were measured at 15 to 18 weeks of gestation in subjects with normal pregnancies and in subjects whose pregnancies resulted in open neural tube defects; all of the latter had serum AFP concentrations greater than 2.5 multiples of the median. We find the Amerlite system to be an efficient, reliable system for screening for open neural tube defects without use of hazardous radioactive labels.

We assessed the use of a new strategy for detecting thyroid disorders, utilizing a sensitive assay for concentrations of thyrotropin (TSH) and free thyroid hormone in serum as follow-up tests. Of 1279 patients who were not on thyroxin (T4) replacement treatment, 82% could be classified as euthyroid and would require no further tests. In patients who were on T4 replacement, 41% fell into the euthyroid category and would require no further tests. Using this strategy to replace our existing strategy of free thyroxin as a "first-line" test would reduce the proportion of patients who would require one or more follow-up tests from 49% to 24%.