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Objective: The aim was to establish the prevalence of eating disorders in psychiatric patients., Method: The total inpatient (n = 8,942) and outpatient (n = 10,125) Norwegian psychiatric population was investigated with a staff-report questionnaire., Results: The prevalence of eating disorders in the inpatient population was 3.8% for women and 1.6% for men. In the outpatient population, the differentiated diagnoses anorexia nervosa (AN), bulimia nervosa (BN), and the comorbidity of AN+BN was 5.7%, 7.3%, and 1.6% for women, and 0.8%, 0.7%, and 0.3% for men (this could be reduced to AN and BN prevalences of 7.3% and 8.9% for women and 1.0% and 1.0% for men)., Discussion: The level of the prevalence figures is in the expected area, thus the present study confirms earlier studies with smaller psychiatric populations.

Concept clarity is essential for instrument development and validity of research findings. The process of concept clarification can help rectify some of the issues in the measurement of patient satisfaction. This study presents a strategy, for concept clarification, for the purpose of refinement of an existing instrument for measuring patient satisfaction with nursing care in the hospital setting. The results of the exercise yielded a definition of patient satisfaction with nursing care, including a new framework, and provided guidance for rewarding two items, elimination of some items related to knowledge and skill of nurses, as well as generating new items not previously included in the original instrument.

An association between infectious mononucleosis (IM) and MS has been proposed. In a historical prospective study we used records from the Danish State Serum Institute on heterophile antibody (HA) tests for IM performed in all Danish patients over a number of years. Included in the analysis were 6853 HA-positive persons analyzed from 1968 to 1978 (except 1975) and 12,886 HA-negative per sons analyzed in the years 1968, 1969, 1970 and 1978. A search for these persons in the central nationwide Danish Multiple Sclerosis Registry (DMSR) was performed. Among the HA-positive persons 16 cases of MS which met the diagnostic criteria were found with onset of MS after the year of the HA test and before follow-up on 1 January 1991. The expected number for a Danish population, matched by sex, age and year at start of observation, was 5.70 (P < 0.05), the risk ratio being 2.81. No patient had developed MS before contracting IM. Among the HA-negative persons 12 were registered with onset of MS after the year of the HA test and before follow-up, the expected number being 10.47 (P > > 0.05). Although Epstein-Barr virus is not suggested in itself to be the cause of MS, we propose that it is a co-factor in the pathogenesis of this disease.

A case of adnexal tumor caused by Actinomyces Israelii is reported. The patient was a 39 year-old woman admitted because of persistent fever and a palpable tumor in the right fossa. She had used an IUD for 11 years. Nine months before admission a hysterectomy had been performed due to uterine fibromyomas.

To introduce antigen to the respiratory mucosa, killed Actinobacillus pleuropneumoniae with quil A as adjuvant was administered to pigs as an aerosol. Immunisation by this aerosol induced a marked IgA response in the bronchoalveolar and nasal fluids, and in the serum. Following challenge with live bacteria two weeks after the last exposure to the aerosol, the immunised pigs were protected from the severe pleuropneumonia which developed in non-immunised pigs. The immunised pigs had lower antibody titres in the mucosal fluids and serum after exposure to the challenge. The immune response after experimental infection of non-immunised animals was a weak IgA antibody response in the bronchoalveolar and nasal fluids, whereas the systemic immune response after challenge included both IgA and IgG antibodies.

This study investigated the number of blood culture-positive cattle among 215 animals clinically suspected of having bacterial endocarditis. For animals that were necropsied, the sensitivity, specificity and predictive value of the diagnosis of endocarditis were calculated on the basis of the isolation of the causative bacteria from blood. Furthermore, it was investigated whether the glutaraldehyde coagulation time, total leucocyte count, per cent neutrophil granulocytes, pulse rate and duration of disease could help to discriminate endocarditis from other diseases. Among 138 animals necropsied the sensitivity, specificity and predictive value of blood cultivation were 70.7 per cent, 93.8 per cent and 89.1 per cent, respectively. None of the other measurements could be used to discriminate between endocarditis and non-endocarditis cases.

The mortality from ischemic heart disease in Denmark has changed from a steady increase towards a decrease also in younger males during the 1980s. During this period, the Glostrup Population Studies have registered the incidence of myocardial infarction, risk factor changes and changes in medical care in Copenhagen county (320,000 inhabitants) as part of WHO MONICA, which compares 39 centres in 26 countries. The incidence of myocardial infarction during the first three years, 1982-1984, of the Heart Register, DAN-MONICA at Glostrup Hospital, is reported. The register is complete and valid. If the age specific incidence of myocardial infarction in Denmark was as in this survey, the results indicate an age standardized incidence for the Danish population including all age groups over the age of 25 of 5.58 per 1000 per year (7.48 per 1000 adult males and 3.99 per 1000 adult females).

Mucosal and serum antibodies against Actinobacillus pleuropneumoniae serotype 2 were demonstrable in an ELISA which used whole bacterial cells as antigen. Following experimental infection of pigs with A pleuropneumoniae serotype 2, specific antibodies against the bacteria were demonstrated in saliva and fluid obtained by bronchoalveolar lavage. There was a good correlation between the IgA antibody titre in this fluid and serum. As a result of natural infection, IgA antibodies were also demonstrable in the saliva at an early stage of infection when no serum antibodies were detectable. Later in the infection, when antibodies were present in the serum, salivary IgA antibodies were undetectable. The data suggest that the mucosal IgA antibody response arises before the systemic response. Measuring mucosal antibodies in saliva or nasal or bronchoalveolar fluid might therefore open the possibility of identifying pigs infected with A pleuropneumoniae at an early stage of infection.

Experimental trickle inoculations of pigs with low doses (2 x 25 eggs/week) and high doses (2 x 500 eggs/week) of Ascaris suum were followed by enzyme-linked immunosorbent assay (ELISA) during a 14-week period. Three antigens were employed for coating: hatching fluid of embryonated eggs, excretory/secretory antigens from in vitro-cultivated infective larvae (L2/L3-ES), and adult body fluid. Seroconversion times (week 2 for the high-dose group and week 4 for the low-dose group) were essentially identical for the three antigens. The assay employing L2/L3-ES, however, produced significantly higher readings. Specific serum antibody in the IgA and IgG classes showed very similar time courses in both groups. A weak and transient, specific IgM response was recorded in the high-dose group. Mean ELISA responses to L2/L3-ES did not differ significantly between the groups at the termination of the experiment. Specific antibody correlated weakly with the number of liver milk spots recorded at slaughter.

The development, implementation, and evaluation of a program that incorporates a registered nurse and licensed vocational nurse partnership model into the critical care practice setting is described. This model can be used by nurse executives to alleviate some of the immediate consequences of the nursing shortage and potentially to achieve a longer-range solution by expanding the pool of registered nurses. Evaluation of the program revealed statistically significant increases in nurse job satisfaction; perceptions of reduced workload and stress; a perception by registered nurses and physicians of increased nursing care quality; decreased registered nurse turnover and sick time; and a positive perception of the role of the licensed vocational nurse in the critical care unit.

Commercially reared growers, finishers, and sows of Danish Landrace x Yorkshire crossbred were inoculated orally with Ascaris suum at 50 eggs kg-1 body weight. White spots on the serosal surface of livers and total larval recoveries from lungs were recorded 7 days later. The response in pigs originating from a specific pathogen free and parasite free herd (parasite naïve) was observed in the three different age groups and compared with age-matched pigs from a herd maintained in a facility contaminated with A. suum (naturally exposed). The pre-inoculation immune status of the various groups was characterized serologically using antigen preparations derived from various stages of A. suum. Inoculation of all age groups of parasite naïve pigs with A. suum eggs produced relatively high liver white spots and lung larvae, although expression of these counts as a percentage of the inoculum showed a moderate age-related resistance from growers to finishers to sows. In contrast, pigs naturally exposed to A. suum expressed strong immunity to a challenge infection as few or no larvae were detected in the lungs. In addition, growers, finishers, and sows from the naturally exposed herd had significantly higher levels of serum IgG/IgA to several different A. suum antigens compared with pigs from the parasite nave herd. Liver white spots, expressed as a percentage of the inoculum, were highest in growers from the naturally exposed herd but were markedly reduced in finishers and sows from that herd. In fact, few or no white spots were observed in naturally exposed sows, while sows from the parasite-naïve herd had in excess of 300 liver white spots following challenge. These results indicate that commercially raised pigs that are exposed to A. suum develop a strong protective immunity that ultimately produces a complete pre-hepatic barrier to larval migration, while pigs raised parasite free remain susceptible to infection.

This experimental study on pigs was designed to simulate natural, long-term exposure to Ascaris suum under modern management conditions. Parasite kinetics were followed in pigs receiving A. suum eggs as repeated trickle inoculations at two dose levels beginning at a body weight of 25 kg until their slaughter at 90 kg (baconers). In pigs inoculated twice weekly with 500 eggs, there was an initial marked rise in the numbers of hepatic milk spots, but as early as around week 6 after the start of inoculations and until week 16, at which time the last pigs were slaughtered, the numbers of spots diminished drastically. In pigs receiving only 25 eggs twice weekly, low and moderately fluctuating numbers of spots were seen throughout the experiment. Larvae recoverable from the livers and lungs were observed mainly during the beginning of the experiment. Before patency, immature intestinal worms were found in moderate numbers that showed a rough positive correlation with the dose levels, but at the time at which adult worms started to appear, immature parasites could practically no longer be found. In all, only 10 of 40 pigs harbored adults, and 4 of these 10 pigs harbored 80% of the total worm population. The results show that acquired dose-dependent host responses to A. suum play an important role in regulating the worm population along the migratory route of the parasite and that the final burden of worms in the small intestine is dose-dependent and highly variable.

In an experiment including 8 groups of 15 mice, the effect of migrating Ascaris suum larvae in the lungs on the establishment and pathogenicity of aerosol exposure to Pasteurella multocida was investigated. Following aerosol exposure to P. multocida, mice with migrating A. suum in their lungs developed more severe pneumonia and septicaemia than did parasite-free mice. The parasite-induced effect on bacterial pathogenicity was more marked for a non-toxin-producing P. multocida as compared with a toxin-producing strain of P. multocida, possibly due to the higher spontaneous pathogenicity of the non-toxigenic strain of P. multocida. The present results should encourage controlled experiments on possible interactions between A. suum and various airborne microbial infections in pigs.

This retrospective study analyzed the pattern of injury among rear seat occupants in automobile collisions and compared the incidence and type of injury with that of front seat occupants. During a 2-year study period, 253 persons involved in automobile collisions were admitted to our hospital. Among these patients 168 were drivers, 54 were front seat passengers, and 24 were rear seat occupants. Injuries were classified into the following categories: neurologic, orthopedic, soft tissue, thoracic, and abdominal. No significant differences were observed in the type or extent of injury, in the incidence of permanent disability, or in the mortality rate based on the location of the passengers within automobiles involved in these crashes.

A study on the histamine release test (HR) for the demonstration of infections with Trichinella spiralis in pigs was carried out on 18 pigs, six infected with 200 larvae, six infected with 5000 larvae and six non-infected (control group). The results obtained by HR during a 7 week infection were compared with those of the enzyme-linked immunosorbent assay (ELISA). All inoculated pigs were found to be positive on Day 40 post-inoculation (p.i.) by necropsy examination of selected muscle groups, with mean recoveries of 7.9 and 225 larvae g-1 of tissue in the low- and high-dose group, respectively. At this time, all animals of the high-dose group and five out of six animals of the low-dose group were antibody positive in ELISA with any of three coating antigens employed (a crude muscle larva extract, an excretory/secretory (ES) antigen and a purified 45 kDa antigen). HR performed on whole blood was positive in four out of six pigs of the high-dose group and one out of six pigs of the low-dose group. The earliest ELISA seroconversions took place at Day 15 p.i. with crude and ES antigens. The earliest measurable reaction in HR performed on whole blood was found on Day 19 p.i. There was considerable individual variation regarding which test was the most sensitive for the early detection of infection. Washing of the blood cells prior to antigen provocation led to a markedly improved sensitivity of HR, all animals of the high-dose and three out of six animals of the low-dose group being positive by Day 40 p.i. The time course of the development of ELISA titres and HR reactivity indicated that this effect is due to the removal of blocking antibodies.

The consequences of the implementation of diagnosis-related groups (DRGs) include increased patient acuity level, shortened length of stay, and decreased quality of nursing care. The findings of this study did not support the expected changes in patient acuity level or quality of nursing care. In this study, technological changes and organizational variables may have buffered the expected negative consequences of the implementation of DRGs in a group of cardiovascular surgery patients.

Nurse executives use many strategies to manage nurse absenteeism. Nurses in this study voiced dissatisfaction with a policy requiring progressive disciplinary action after three absence incidents. To alleviate this dissatisfaction, supervisors were allowed to use their discretion in deciding when to initiate disciplinary action regarding the use of sick leave. The authors discuss the effect of the policy change on use of absence time and excused and unexcused leave.

Purpurins are modified chlorins with photodynamic properties. Their strong absorption in the red region of the visible spectrum makes them candidates for use in photodynamic cancer therapy. A series of metal derivatives of the free base purpurins have been synthesized and shown to cause tumor necrosis in transplantable tumors when exposed to visible light. In the following set of experiments, the effects of two metallo-derivatives (tin and zinc) of two purpurins, octaethylpurpurin (NT2) and etiopurpurin (ET2), and light on the N-[4-(5-nitro-2-furyl)-2-thiazolyl] formamide transplantable tumors in Fischer CDF(F344)/CrlBr rats were studied. The photodynamic activity was assessed by a short term assay using tumor dry weight 12 days after purpurin-PDT as a criterion of response. From these experiments it appears that SnET2 greater than SnNT2 greater than ZnET2 greater than ZnNT2 in photodynamic activity. SnET2 was further characterized by attempting to determine the time interval after systemic injection at which maximum therapeutic effect occurred. These studies shown that 24 h after metallopurpurin injection was the optimum time for treatment of tumors with visible light. In a final set of experiments, the effect of solar light on the skin of hairless mice injected with SnET2 was found to be much less injurious than with hematoporphyrin derivative.

In this follow-up study 76 inpatient alcoholics who had stayed at a Treatment Centre for Alcoholism for at least 12 weeks were invited to participate. Five had died, seven were not found, and the remaining 64 were interviewed nine to 30 months after discharge. Laboratory tests for liver functioning were also obtained. Only one reported total abstinence, but 30 clients (47%) reported less drinking. Most of them had a better social and economic situation than before the period of treatment.

Surveillance of development in the incidence of heart disease, particularly acute myocardial infarction (AMI) requires a valid system of registration of all cases of the disease. During the period 1972-1981, all admissions with the diagnosis AMI to hospitals in Greater Copenhagen and Arhus were registered in the Heart Register. From 1978, admissions to all Danish somatic hospitals were registered in the National Patient Register. In order to assess the validity of the two registers as regards registration of AMI, the two registers were compared for the years 1979 and 1980. This investigation includes computerized comparison of the registered admissions with AMI and also re-assessment of the diagnosis based on the summaries for a random sample of the admissions. Comparison of the two registers revealed considerable disagreements. Among the individuals who had been admitted with AMI according to the National Patient Register, only approximately 2/3 were registered with this diagnosis in the Heart Register, while almost all persons registered in the Heart Register could be found again in the National Patient Register with the same diagnosis. Technical problems in coding and electronic data analysis in the National Patient Register only appear to explain a lesser fraction of the disagreements as the diagnoses which were summed up in the upper part of the summaries showed reasonably good agreement with the diagnoses in the National Patient Register. Re-assessment of the diagnoses revealed that approximately 90% of the admissions with AMI could be verified, without modification, by reviewing the text of the summaries.(ABSTRACT TRUNCATED AT 250 WORDS)

The object of this investigation is to assess the incidence of suicide and attempted suicide in children and young adults (less than 25 years) and to describe the therapeutic possibilities available for young people with suicidal behaviour in the social and health sectors. The investigations consisted partly of interviews with representatives for the leaders for the institutions who accept persons with threatened suicide in the Municipality of Copenhagen and partly by a questionnaire sent to all general practitioners in the Municipality of Copenhagen (percentage of replies 67, n = 215). These investigations revealed that about half of all the doctors had been in contact with a young person with threatened suicide and that casualty departments and the social institutions admit approximately one threatened suicide per week. There are no taboos which prevent doctors from working with suicidal thoughts but only half feel competent to cope with these young people alone. Simultaneously, half of the doctors find that their possibilities for referring persons in crisis are unsatisfactory. They refer these cases primarily to their own profession. In the Municipality of Copenhagen, only the social sector can offer genuine help to young people in crisis although the supply cannot meet the needs to any extent.

Ascaris suum eggs were collected from pig faeces or dissected from worms obtained from the same pigs. Eggs from the two sources were allowed to embryonate in 0.1 N H2SO4, in 1% buffered formalin or in tap water. The embryonation of the sulphuric acid and water cultures occurred at the same speed, while the formalin cultures developed slightly more slowly. By experimental inoculation of helminth-free pigs and subsequent counting of white spots in the livers and larvae in the lungs day 7 p.i., the infectivity of eggs dissected from worm uteri and embryonated in sulphuric acid (a normal laboratory procedure) was compared with that of eggs collected from faeces and embryonated in water (i.e. more naturally developed eggs). The results suggest that the two types of eggs were equally infective. For this reason the common practice of using Ascaris eggs dissected from worms for experimental infections might be acceptable.

The excretion of position isomers of penta- and hexa-carboxylated porphyrins type III in the urine in a case of congenital erythropoietic porphyria characterized by the excretion of large amounts of penta-, hexa- and hepta-carboxylated porphyrins type III together with isocoproporphyrins both in the urine and faeces, and a simple method for the synthesis and separation of such position isomers has been described. The implications of the finding of position isomers type III have been discussed and it is suggested that the decarboxylation of uroporphyrinogen III both in the present case and under physiological conditions is a random process.

An outbreak of listeric meningo-encephalitis occurred in a population of 1800 fallow deer (Dama dama) in a park during the winter and early spring of 1985 to 1986. Listeriosis was diagnosed in 41 of 42 fallow deer that showed the typical central nervous system signs of circling disease or were found dead. The diagnosis was verified by bacteriological examination of the brains of 35 animals. In five of the seven remaining cases listeriosis was diagnosed by histological examination, and in one animal by clinical signs alone. Listeria monocytogenes was isolated in three of 23 soil samples taken from the park. In addition, L monocytogenes was isolated from the intestinal contents of apparently normal fallow deer. Fifty isolates from animals and soil were serotyped and all of them belonged to serovar 4b except one from brain (serovar 1/2b) and three from intestinal contents (serovar 1/2a). In phage typing of 54 isolates, the 35 isolates from the brain and spleen of diseased animals belonged to the same lysovar, as did most isolates from other sources, but strains from intestinal contents belonged to three other phage types. No external source of L monocytogenes was demonstrated in the outbreak and stress due to the poor beech-mast crop, an increased stocking rate and a sudden change in the weather are suspected as predisposing factors.

A patient with a biochemically "new" type of congenital erythropoietic porphyria has been studied under various therapeutic trials. Splenectomy had no demonstrable effect on porphyrin excretion or clinical picture. Vitamin E caused a moderate fall in porphyrin excretion, however, there was no significant improvement in light tolerance and tendency to hemolysis. Beta-carotene reduced skin photosensitivity appreciably, while total porphyrin excretion remained unchanged and the tendency to develop hemolytic anemia showed only slight improvement. Red cell transfusion caused a rapid, dramatic fall in prophyrin excretion (in 4-5 days) and a transient increase in light tolerance, while the distribution of the different porphyrins excreted remained unchanged. These observations indicate that all or nearly the abnormal porphyrins excreted are of erythropoietic origin, and that the overwhelming part of the porphyrins originate from an abnormal population of shortlived red cells. Findings on fluorescence microscopy of blood and bone marrow support this view. Meticulous protection against light of the shorter wavelengths caused a similar rise in hemoglobin level as produced by red cell transfusion, however, in this instance the total excretion of porphyrins did not fall. It is suggested that the inhibitory effect of transfusion on erythropoiesis (and thereby porphyrin excretion) might be due partly to a depression of erythropoietin formation, partly to the presence of an erythropoiesis inhibiting factor (chalone) in the transfused red cells.

The existence of conditioned abstinence symptoms in 16 abstinent alcoholics was investigated by comparing their subjective, physiological, and behavioral responses while viewing slides of alcohol-related and non-alcohol-related stimuli. The alcoholics were randomly assigned to one of two groups. The first group viewed a set of six alcohol-related slides the first day and a set of six non-alcohol-related slides the following day. The second group looked at the same slides, but the order of presentation was reversed. Alcohol-related slides produced significantly greater increases in subjectively reported alcohol craving and anxiety scores. There were no differences between the two sets with regard to physiological measures or subjective reports of heart rate. The global observations showed significant differences between the alcohol-related and non-alcohol-related slides.

A novel procedure to obtain high rates of follow-up information is presented in this study. After discharge, 24 alcohol abusers were asked to complete and mail a self-report information sheet every other week. To check the reliability of the data obtained, significant others in the clients' environment were asked to report on the same behaviors. The clients and the significant others were informed that every returned information sheet was a lottery ticket. There were two prizes of 1000 NOK ($ 150), one every 6 months. The 1-year follow-up results show that 96% of the clients' self-report sheets were returned. The lottery procedure therefore seems an inexpensive and easy way to ensure the receipt of follow-up data and consumes little time.

Oral retinoic acid has been therapeutically beneficial for three patients with congenital ichthyosiform erythroderma and one with congenital bullous ichthyosifrom erythroderma. Response to therapy was slow but definite with suppression of scale formation, marked reduction of painful cracking of the underlying epidermis and disappearance of skin irritation. Side effects have not occurred. Therapy had to be maintained to prevent recurrence of symptoms.

The present study shows that N. brasiliensis infection in thymus-bearing mice results in resistance against a subsequent A. suum infection. In contrast thymus-deficient mice do not develop this heterologous resistance. Thymus-deficient mice, on the other hand, develop resistance to homologous challenge although to a lesser degree than thymus-bearing mice. Further, it is shown that A. suum infection in thymus-bearing mice yields resistance against a subsequent N. brasiliensis infection. The underlying mechanism of the cross resistance between A. suum and N. brasiliensis in mice may be both shared antigens and tissue reactions such as fibrosis and macrophage activation.

Blood eosinophils were determined in eight 7--13-month-old calves that had been reared under parasite-free conditions. Eosinophil counts were obtained by three methods, a) a direct count, b) a differential count and c) an indirect count (i.e. differential count x total leucocyte count). Methodological errors of these methods were determined. Upper limits of 1,000 eosinophils/micronl (direct count) and 9.5 per cent eosinophils (differential count) have been estimated an suitable working standards for calves of this age group. The distribution of eosinophils was skew, most direct counts being below 700 cells/micronl and most differential counts being below 7.5 per cent. A high degree of correlation was found between results obtained by either method, but an even higher correlation was found between direct and indirect counts.

A 5-year-old girl with the classical clinical features of congenital erythropoietic porphyria (CEP) is described. Different types of CEP are discussed based on varying excretion patterns of porphyrins.

In an experimental comparison, 24 inpatients at an Alcoholism Treatment Center with the DSM-III diagnosis alcohol dependence (alcoholism) were randomly assigned to a Social Skills Training Group (SSTG) or a Control Group (CG). Both groups received, in addition, the traditional treatment program at the institution. Self-report questionnaires, as well as questionnaires for significant others, were used to get biweekly information after discharge on current drinking habits, working days, and nights slept home. A lottery procedure ensured an extremely high return rate of questionnaires during 1 year follow-up (23 of 24 clients returned all questionnaires). SSTG clients drank on the average 2/3 of the amount of pure alcohol or its equivalent (740 cl, that is 14.2 cl/week) that the CG clients did (1196 cl, that is 23.0 cl/week) during 1 year follow-up after discharge. SSTG clients had twice as many sober days (281 or 77% compared to 116 or 32%) and working days (223 or 97% compared to 104 or 45%). The average length of abstinence period after discharge were 51.6 days for SSTG and 8.3 for CG clients. All SSTG clients had drunk after 143 days, and all CG clients after 31 days. During drinking days, however, SSTG had drunk almost twice as much as CG clients. The average number of nights slept home were 345 (95%) for the SSTG versus 316 (87%) for the CG. In addition to group data, detailed individual data are also presented.

Liver pathology during experimental Fasciola hepatica infection was compared in thymus-deficient (nu/nu) mice and in thymus-bearing (+/+) mice, (back ground strain to nu/nu mice) and thymus-reconstituted nu/nu mice. Thymus deficiency resulted in unrestricted liver damage during the migration of the parasite in the liver. In nu/nu mice the migratory tracks were infiltrated by very few eosinophils and mononuclear cells, haemorrhages and liver cell necroses were extensive. Portal area reaction and bile duct hyperplasia were depressed. Regeneration of liver tissue, parenchymal and periportal fibrosis and plasma cell proliferation were reduced. The possible causal mechanisms involved in fluke induced liver pathology are discussed. It is suggested that a thymus-dependent cellular reaction modulates the tissue damage produced by F. hepatica.

At an Alcoholism Treatment Center which was under restructuring, the Ward Atmosphere Scale (WAS) was used to study the effect of changes on the climate of two wards. Before implementation, after the first phase of changes one year later, and after the second phase changes a year later, patients (n1 = 19, n2 = 16, n3 = 23) and staff members (n1 = 21, n2 = 24, n3 = 25) filled out WAS forms. The patients were divided into two groups according to a quasi-experimental design. In a Short-term intensive inpatient unit all of the restructuring was implemented, whereas only some were in a Half-way house. The Short-term intensive patients reported significant improvements between the second and the third assessment (p less than .05) and between the first and the third year (p less than .02), but not from the first to the second year. The Half-way house patients showed no significant improvements. The patients altogether reported significant improvements in six subvariables of the eight hypothesized. The total WAS score of the staff increased significantly each year (p less than .01), and there was a clear improvement between the first and third assessment (p less than .001). The staff reported significant improvements from the first to the third assessment in seven subvariables of the eight hypothesized.

Seventeen detoxified alcoholics were randomly assigned to a waiting list group or an inpatient treatment group. The waiting list group members were informed that they had to wait some time until there was a vacant place. By their discharge from the Detoxification Unit they were told to complete a self-report form every day with regards to drinking, working, sleeping home and use of disulfiram orally. Two weeks later they had an outpatient appointment in which the self-reports were collected and reviewed. This was repeated once for everybody so that they all had to wait 4 weeks. By discharge from further inpatient treatment, the inpatient treatment group was instructed to record the same four behaviors daily as the waiting list group did, and they, too, got an outpatient appointment with a 2 week interval. No significant differences between the groups were observed in the three main variables of drinking, working and sleeping home, but the waiting list group used significantly more disulfiram than the inpatient treatment group.

Experimental oral inoculation of pigs with infective A. suum eggs resulted in eosinophilia in the peripheral blood and a serum antibody response. When pigs were inoculated at 3 days of age the antibody response was depressed which is suggested to be due either to a protective effect of colostral antibodies or to an immunologic incompetence of the young pigs. Despite the use of isolated pens and strict hygienic measures it was difficult to obtain an Ascaris free environment for the experimental animals. The pathogenesis of white spots in the liver is assumed to represent an immune reaction by the host. Multiple white spots were demonstrated when pigs were inoculated with several egg doses provided the livers were examined 1--3 weeks after last inoculation. The rapid healing of white spots implies that the finding of many white spots in the liver at slaughter indicate a recent uptake of infective A. suum eggs. The finding of low intestinal worm burdens in the experimental pigs after repeated oral inoculations indicates a specific, acquired resistance. Resistance to A. suum in pigs is suggested to involve co-operation of the humoral and the cell mediated immune system and the parasite is eliminated both during migration by white spot formation in the liver and during the early prepatent period by expulsion from the gut.

The excretion of position isomers of type III porphyrins, not only in porphyric disorders in which the enzymatic decarboxylation of uroporphyrinogen III to coproporphyrinogen III is known to or suspected to play a role, but also in normal man and in conditions like erythropoietic protoporphyria and lead-intoxication, in which no such changes have ever been reported, or would be expected for theoretical reasons, has been described. The implications of these and other findings have been discussed and it is suggested that the enzymatic decarboxylation of uroporphyrinogen III to coproporphyrinogen III is normally a random process. It is, however, not excluded that one of the many routes which could be followed might be energetically more favourable than the others and that most of the coproporphyrinogen III which is formed under physiological conditions might be formed via such a 'prefered' pathway.

The urinary excretion of porphyrins in two cases of porphyria cutanea tarda (PCT) has been followed during a period in which various treatments have been tried. In one patient pyridoxal-5-phosphate (P-5-P) injections lead to a dramatic increase in porphyrin excretion. In another P-5-P treatment was followed by a significant decrease in porphyrin excretion. p-Aminobenzoic acid (PABA) apparently had no effect on porphyrin excretion, while repeated phlebotomies had the expected effect. In both patients all variations in the total amount of porphyrins excreted were almost exclusively due to the variations in the amounts of heptacarboxylic porphyrin type III and uroporphyrin I. A secondary finding was an increase in hexa- and penta-carboxylic porphyrins type III without a concomitant increase in coproporphyrin III.

Pleomorphic adenoma of the human breast is a rare, benign tumor for which the literature is sparse. A local recurrence has been reported only once before. The diagnostic challenge of this cancer-imitating lesion is emphasized in this report. Although local excision of the tumor is the treatment of choice, almost 50% of the patients reported have undergone fairly extensive surgery, i.e., simple or radical mastectomy. A paraffin secretion of the excised tumor is mandatory to confirm the benign nature of the lesion to avoid an unnecessary mastectomy for a benign condition.