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Isolated systolic hypertension (ISH) is a major risk factor for cardiovascular complications. Nevertheless, data on the prevalence in a representative population do not seem to be available. The prevalence of ISH and the white coat effect was thus studied in a cross-sectional survey of 2806 inhabitants aged 70-80 years. In untreated subjects, the prevalence of ISH was 17.4% (95% CI 14.9-20.2) in women and 13.5% (95% CI 11.3-15.9) in men using clinic blood pressure at first visit. The prevalence increased significantly with age. The prevalence was reduced to 10.4% when using the average of all-visits clinic blood pressures. By a simulation model, it was demonstrated that his reduction mainly resulted from a regression towards the mean. Average all-visits clinic blood pressure was 172.6 +/- 10.4/81.1 +/- 6.0 mmHg. Less than one-third of those with all-visit ISH had sustained ISH. Identifying subjects with sustained ISH requires measurements in more than three visits.

The serum ferritin assays, Ferritin RIA Amersham™ and Abbott AxSYM™ Ferritin were compared in order to translate values from one assay to the other. Serum ferritin was analysed with both assays in 102 samples. Logarithmic transformation of the results was performed in order to stabilize the variance. The relationship between the untransformed values was most exactly expressed by a proportionality: AxSYM Ferritin = 0.873 * RIA Ferritin. Due to this proportionality, the numerical difference between the assays increases with the ferritin concentration, although the percentage difference between the assays remains constant.

Unlabelled: In this study, we compared the effect of prophylactic administration of ephedrine against the hypotensive effect of propofol in elderly female patients scheduled for minor gynecological procedures. Ninety patients aged 60 yr or older were randomly allocated to one of three groups of 30 patients each to receive either normal saline, ephedrine 0.1 mg/kg, or ephedrine 0.2 mg/kg i.v. 1 min before the induction of anesthesia. Anesthesia was induced and maintained with propofol and fentanyl. Hemodynamic variables were measured before and 2, 5, 10, 15, 30, and 60 min after induction. The decrease in blood pressure and heart rate (HR) was significantly less in each of the ephedrine groups (P < 0.001). Furthermore, the decrease was less in the large-dose group compared with the small-dose group (P < 0.05). Twelve patients in the control group experienced a decrease in systolic blood pressure to < 80 mmHg, compared with only one patient in the ephedrine groups (P < 0.001). In conclusion, the prophylactic injection of ephedrine significantly attenuated, but did not completely abolish, the decrease in blood pressure associated with induction of anesthesia with fentanyl and propofol. Ephedrine 0.2 mg/kg was slightly more effective than ephedrine 0.1 mg/kg., Implications: The prophylactic effect of ephedrine to counteract the hypotensive effect of propofol induction of anesthesia was investigated in three groups of elderly female patients given 0.1 or 0.2 mg of ephedrine or placebo before induction. Both ephedrine doses markedly attenuated, but neither of them abolished, the decrease in blood pressure.

A commercial ferritin kit (Abbott AxSYM Ferritin) was calibrated using the WHO Human Liver Ferritin International Standard 80/602. The reconstituted WHO freeze-dried standard was diluted to obtain six concentration levels ranging from 10-840 micrograms/l. In the analysis of the data, logarithmic transformation of the results was performed in order to stabilize the variance. The AxSYM kit yielded slightly higher values than the WHO Ferritin Standard (p < 0.05). The relation between the AxSYM kit and the WHO Ferritin Standard (untransformed values) was described by a proportionality: FerritinAxSYM = 1.057 x FerritinWHO. WHO Ferritin Standard values of 12 and 15 micrograms/l (used as cut-off values for absent or small body iron reserves) yielded calculated AxSYM values of 12.7 and 15.9 micrograms/l. A WHO Ferritin Standard value of 30 micrograms/l (used threshold value for the presence of stainable bone marrow haemosiderin iron) yielded a calculated AxSYM value of 31.7 micrograms/l.

This study shows the association between smoking and both office and ambulatory blood pressure. By means of stratification, a uniform number of subjects of both sexes and spanning 6 decades (aged 20 to 79 years) were recruited randomly from the local community register. A total of 352 subjects participated, including 161 smokers. Smokers (both sexes and all age groups summed), as compared with nonsmokers had statistically significant lower office blood pressure as follows (mean systolic +/- SED/mean diastolic +/- SED): (systolic and diastolic, -6.8 +/- 2.1/-3.9 +/- 1.3); day ambulatory blood pressure (diastolic, /-2.8 +/- 1.0); and night ambulatory blood pressure (systolic and diastolic, -4.2 +/- 1.8/-3.9 +/- 1.1). The intraperson variability of the day ambulatory blood pressure (as measured every 15 min) was identical for the smokers and the nonsmokers. Smokers were found to have a diminished "white coat" effect; this diminished white coat effect has not previously been described. The major white coat effect was seen in the older nonsmokers, whereas the diminished white coat effect was most pronounced in the older male smokers and in the younger female smokers. Smokers seem to have a diminished white coat effect, as well as a lower ambulatory blood pressure throughout the day (diastolic) and at night (systolic and diastolic). The similar intraperson variability found in the smokers' and nonsmokers' blood pressure further speaks for a consistently lower blood pressure in smokers as compared with nonsmokers.

The aim of this study was to establish reference values for 24-hour ambulatory blood pressure in a Danish population stratified for gender and age in the decades from 20 to 79 years of age. A sample of 352 persons, 179 men and 173 women randomly selected from the local community register, age 20-79 years underwent 24-h ambulatory blood pressure monitoring. For men age < 50 daytime ambulatory blood pressure (median) was 125/79 mmHg and night time was 106/65 mmHg, for women the respective pressures were 113/77 mmHg and 97/64 mmHg. For men age > or = 50 daytime ambulatory blood pressure was 133/83 mmHg and night time was 124/86 mmHg, for women the respective pressures were 122/83 mmHg and 105/65 mmHg. Presently, we can only relate cardiovascular risk to clinic blood pressure. Therefore we have calculated corresponding ambulatory blood pressure values to WHO's upper limit 160/90 mmHg for normal blood pressure in the clinic and found 154/87 mmHg for daytime and 134/74 mmHg at night. For a clinic pressure of 95 mmHg the corresponding daytime value was 91 mmHg, for 100 mmHg it was 95 mmHg.

Forty Pseudomonas aeruginosa strains, previously characterized by pulsed-field gel electrophoresis, were ribotyped with EcoRI, BamHI, ClaI, and PvuII. Ribotyping with PvuII proved to be as discriminatory as pulsed-field gel electrophoresis with XbaI or DraI while EcoRI and BamHI were not. ClaI contributed further ribotypes, some of which might be due to a transposable element.

Unlabelled: The study was conducted to determine age and sex stratified normal values for 24-h ambulatory blood pressure. A sample of 352 healthy subjects (all white) were randomly selected from the community register and stratified by sex and age groups in decades from 20 to 79 years of age. Persons with a history of hypertension, cerebral apoplexy, diabetes, myocardial or renal disease, and who were taking blood pressure-influencing medication were excluded. Ambulatory blood pressure was recorded over 24 h, with measurements taken every 15 min from 07:00 to 22:59, and every 30 min from 23:00 to 6:59. Systolic blood pressure increased only slightly with age and was significantly higher in men than in women. The diastolic blood pressure increased only slightly with age in both sexes until the 50 to 59 years age group and declined thereafter. The diastolic blood pressure was not different for the two sexes. Both systolic and diastolic blood pressure were approximately 15% lower during the night regardless of age or sex. Ambulatory blood pressure during the daytime was on an average of 5 mm Hg lower than office blood pressure, but the mean difference between the two measurements increased with age. The variability of the difference also increased with age., In Conclusion: Normal values for ambulatory blood pressure are presented in a randomly selected age- and gender-stratified population. Differences between office blood pressure and ambulatory blood pressure increased with age suggesting that the previously observed higher blood pressure seen in the elderly partly might be explained by a greater impact of white coat hypertension in older people.

Setting: Jizan region, Saudi Arabia., Objective: To test methodology for studies of tuberculin sensitivity and effectiveness of BCG vaccination programme., Design: School children (n = 315) aged 6-12 years simultaneously tested intradermally with PPD tuberculin RT23, 2TU and 0.1 microgram Mycobacterium avium or M. scrofulaceum sensitin. Presence of BCG scar as evidence of previous BCG vaccination. Cervical lymph nodes palpated., Results: BCG coverage was 75%. The prevalences of positive reactions (induration > or = 6 mm) were higher among children with than without scar. Prevalences of positive reactions to PPD and M. scrofulaceum sensitin were higher among girls than boys. In children with scar, the mean size of positive reactions to PPD was larger among girls than boys, and the prevalence of positive reactions was smaller in this group among children with than without palpable cervical lymph nodes. The sizes of reactions both to M. avium and to M. scrofulaceum sensitin were correlated to the size of the tuberculin reactions. Previous admission to hospital was reported less often by children with than without scar., Conclusions: The technique applied and training of staff was satisfactory. In further studies, however, we will apply three simultaneous tests to each person.

A commercial ferritin kit (Amersham Ferritin RIA (A)) was calibrated using the WHO human liver ferritin international standard 80/602 (W). The reconstituted WHO freeze-dried standard was diluted to obtain five concentration levels ranging from 10-800 micrograms/l. Logarithmic transformation of the values was performed in order to stabilize the variance, yielding the regression equation: logA = 0.0235 + 1.0022 logW. The slope of the regression line (being very close to, and not significantly different from, one) was set to one, and the relation between the untransformed values then became a proportionality: A = 1.067 x W. A WHO standard ferritin value of 15 micrograms/l (often used as cut-off value for absent iron reserves) and of 30 mu/l (often used as threshold value for the presence of stainable marrow haemosiderin iron) yielded calculated Amersham Ferritin RIA values of 16.0 micrograms/l and 32.0 micrograms/l.

Setting: Since 1986 we have tested approximately 7000 non-BCG-vaccinated Swedish children with tuberculin and with Mycobacterium avium or M. scrofulaceum sensitin. In Göteborg, an urban coastal area, 25% of 8-9-year-old school children reacted to M. avium sensitin and 32% of M. scrofulaceum sensitin using a 6 mm cut-off., Objective: To evaluate if geographical factors have an influence on the prevalence of children reacting to tuberculin and sensitins., Design: 2000 schoolchildren of the same age as those in Göteborg but living in an inland rural area were Mantoux-tested in a similar way (simultaneously on separate arms with PPD RT23 and either of the two sensitins)., Results: 15% reacted to PPD RT23, 9.7% to M. avium and 13.9% to M. scrofulaceum sensitin. None of the children with a PPD RT23 reaction > = 6 mm showed signs of tuberculosis or had any known exposure. A reaction to PPD RT23 was usually combined with a still larger sensitin reaction., Conclusion: There was a considerable geographic difference in sensitin reactivity, low in an inland rural area compared to a coastal urban area. Children reacting to PPD RT23 had probably not been infected by M. tuberculosis but more likely by atypical mycobacteria. The reactions should be interpreted as cross-reactions.

Two commercial ferritin kits, Phadebas Ferritin PRIST (kit B) and Ferritin RIA Amersham (kit A) were compared in order to "translate" ferritin values from one kit to the other. Ferritin levels in 222 sera were determined with both kits in the concentration range 5-838 micrograms/l. Regression analysis disclosed a parabolic regression between the logarithmically transformed results obtained with the two kits. Measured kit B values of 10, 12, 15, 30 and 300 micrograms/l corresponded to calculated kit A values of 15, 17, 20, 34 and 321 micrograms/l, respectively. In kit A, storage of sera for two years at -25 degrees C in combination with freeze-thawing three times produced a minor fall (p < 0.0001) in ferritin levels with a median percent decline of 16%.

Among 3394 patients with Staphylococcus aureus bacteraemia from the years 1986-89, 88 patients were found whose intravenous catheter and blood grew organisms of the same phage type. Strains of phage type 95 were more frequent among the patients with confirmed catheter-related bacteraemia than among other bacteraemia cases. Strains with particular phage-type patterns occurring with increasing frequency in Denmark during recent years also occurred with significantly higher frequencies among the confirmed catheter-related bacteraemias. No major differences in antibiotic resistance were observed. Patients with catheter-related bacteraemia had, in spite of a higher frequency of underlying diseases, a lower mortality compared with other bacteraemia patients, and endocarditis occurred less frequently (2% vs. 6%). Among 201 S. aureus isolates from catheters in 1988 only strains of group I occurred with increased frequency. The possible role of catheters as selection pressure on the S. aureus population is discussed.

A collaborative study was carried out to establish a replacement for the International Standard for Rabies Vaccine, the stocks of which are exhausted. Three rabies vaccines for human use derived from different rabies virus strains and prepared on different cell culture substrates were compared with the International Standard for Rabies Vaccine using in vivo and in vitro assay methods in a collaborative study involving 14 participants. The proposed fifth International Standard (PISRAV) which was derived from the same virus strain as the present international standard preparation, the Pitman Moore (PM) strain, was found to be approximately twice as potent relative to the International Standard in immunogenicity assays as in antigenicity assays. On the other hand another vaccine, derived from the LEP strain, was considerably more potent in antigenicity assays than in immunogenicity assays. The glycoprotein of the proposed replacement standard measured in antigenicity assays appeared to be stable at +37 degrees C for 245 days, whereas the immunogenicity of the proposed replacement vaccine was sensitive to this heat treatment and the vaccine lost 66% of its immunogenic potency. The results of this study indicate that the NIH protection test should continue to form the primary basis for potency assay of rabies vaccine as glycoprotein content does not appear to correlate with immunogenic potency for different types of vaccine. The vaccine coded PISRAV has been established as the fifth International Standard for Rabies Vaccine and a potency of 16 International Units of Rabies Vaccine (based on the immunogenicity assays) assigned to the contents of each ampoule. Each ampoule has also been assigned a unitage of 10 IU of PM Rabies Virus Glycoprotein and 135 IU of PM Rabies Virus Ribonucleoprotein.

Urinary excretion of the tubular enzymes NAG and AAP was investigated during gentamicin treatment of 105 newborn infants. The values found for NAG and AAP show a significant positive correlation. The urinary excretion of NAG was on the average 92% higher during gentamicin treatment as compared with non-treatment periods in the same newborn infant (33 infants). The same tendency applied to AAP. Newborn infants receiving continuous intravenous infusion of gentamicin were not found to be at greater risk of nephrotoxicity than those receiving intermittent gentamicin treatment, using NAG and AAP as an index of nephrotoxicity. The changes in NAg and AAP within treatment periods were studied. During gentamicin treatment an insignificant average increase in the urinary excretion of NAG occurred, whereas a significant decrease was found during non-treatment periods. A significant negative correlation was found between urinary excretion of NAG and birth weight/gestational age. The long-term effect of the higher excretion of NAG and AAP in newborn and adult patients during aminoglycoside treatment is unknown.

The measurement of antibodies to the capsular polysaccharide (PRP) of Haemophilus influenzae type b (Hib) is important because vaccines inducing such antibodies are now available. We developed and evaluated an enzyme-linked immunosorbent assay (ELISA) for detection of these antibodies based on direct coating of the plates with tyraminated PRP. The assay fulfilled the requirements for parallel line assays; it was sensitive, specific, and reproducible with a coefficient of variation between days of 19%. Results from the ELISA were compared with results from radioimmunoassay and a correlation coefficient of 0.93 was found. Results obtained by the two methods were proportional and the relation was independent of the antibody level. The relation between them was also unaffected by the contribution of different antibody isotypes, indicating that these were measured to the same extent by both methods. ELISA employing direct coating of the plates with tyraminated PRP represents a useful alternative for detection of antibodies when studying immunogenicity of Hib vaccines.

The cell mediated immune response (CMI) against pertussis antigens following vaccination with the traditional Danish whole cell pertussis vaccine (WC-P) and the Japanese acellular pertussis vaccine (A-PV) JNIH-3 was studied in four adult human volunteers. Vaccination with the A-PV induced an in vitro proliferative response of peripheral blood lymphocytes to pertussis toxin (PT) subunits S2-S4, S3-S4 and S5 and the filamentous hemagglutinin (FHA), and a better serological response to native PT, detoxified PT (dPT) and FHA than the WC-PV. The induced CMI and serological response were followed over a period of 17 weeks, and were not seen to decline during this period. Further, an in vitro proliferative response to Bordetella pertussis agglutinogen 2 and 3 were demonstrated using lymphocytes from recently and not-so-recently pertussis-vaccinated adults.

The aim of this study was to determine whether simultaneous and sequential skin testing with tuberculin and sensitins give consistent results. A total of 475 8- or 9-year-old schoolchildren were skin tested sequentially, at an interval of 3 days, with PPD tuberculin and with either Mycobacterium scrofulaceum or M. avium sensitin. The results were compared with those of 470 simultaneously tested children chosen from the same living area. There were no statistically significant differences between the frequencies of the reactions of sequentially and simultaneously tested children. When the sequential testing procedure was employed, 3.1% reacted to tuberculin, 19% to M. avium sensitin and 30% to M. scrofulaceum sensitin, taking a 6 mm cut-off. The corresponding figures for the simultaneously tested children were 4.7, 21 and 36%, respectively. Thus, there was no indication that the simultaneous testing procedure in itself influenced the results, neither was there any sign of a booster effect when testing in sequence with an interval of 3 days in non-BCG-vaccinated children.

We have developed monoclonal antibodies (MoAb) reactive with a protein from Mycobacterium tuberculosis of apparent molecular mass 24 kDa. This protein was shown to be identical with MPB 64 (Harboe et al.,) MoAb bound to four different epitopes of which two were restricted to the 'tuberculosis complex' and two were also found in mycobacteria not belonging to the 'tuberculosis complex'. The cross-reactive MoAb demonstrate that MPB 64 is present in more mycobacterial species than previously assumed. MPB 64 was shown to induce strong delayed type hypersensitivity (Dth) reactions in outbred guinea pigs immunized with M. tuberculosis and M. bovis bacille Calmette-Guérin (BCG). No reaction was observed in animals immunized with mycobacteria not belonging to the 'tuberculosis complex'. The Dth-inducing capacity of MPB64 was compared with that of another 24 kDa protein purified from M. tuberculosis and of the previously described 38 kDa protein. The Dth responses to these three antigens were further analysed in four inbred guinea pig strains. A genetic restriction of the ability of the animals to respond to MPB 64 as well as to the 38 kDa protein was observed.

The study was based on a computerized card index of 9161 patients who had at least one positive blood specimen in the Mycoplasma pneumoniae complement fixation test. A total of 12,562 specimens from these patients had been sent to Statens Seruminstitut from hospitals and general practitioners during a 10.5-year period. The period encompassed a previously described endemic period in a 30-year study of the epidemiological pattern of M. pneumoniae infection in Denmark. The serological data presented support the hypothesis advanced here that a more than sixfold increase of children in day care might have contributed to a change in the epidemiological pattern. The correlation between age and level of specific antibodies, as well as persistence of seropositivity, were also investigated.

Of the 15,170 cases of bacteremia due to Staphylococcus aureus that occurred in Denmark between 1959 and 1988, we review 525 cases of acute hematogenous osteomyelitis and 185 cases of septic arthritis that developed subsequent to the bacteremia and 134 cases of contiguous osteomyelitis in which the bacteremia developed secondarily. The pattern of acute infections of bones and joints has changed over the three decades studied. The frequency of secondary bone or joint infections due to S. aureus bacteremia has changed, as have the phage-type pattern and antibiotic resistance of the infective strains. The prevalence of hospital-acquired cases has increased and the age distribution of patients has changed, as is reflected in an increasing number of older patients. The localization of hematogenous osteomyelitis has shifted, and the vertebral column is now the most common site of infection. The rate of chronic cases of osteomyelitis that occur following acute hematogenous osteomyelitis has been reduced from 34% to 6%. The mortality associated with S. aureus bacteremic infections of bones or joints is low compared to that associated with other cases of S. aureus bacteremia.

A total of 460 Neisseria gonorrhoeae isolates from patients seen at three clinics in Dakar, Sénégal, 1982-1986, have been investigated. In this period a significant change in antimicrobial susceptibility was observed: the percentage of strains susceptible to penicillin (MIC less than or equal to 0.08 micrograms/ml) fell from 61 to 18 (p less than 0.0001) and the percentage of resistant strains (MIC greater than or equal to 1.2 micrograms/ml) increased from 18 to 46. Among penicillin-resistant strains the proportion of penicillinase-producing strains (PPNG) was fairly constant (range 35-55%). The determination of susceptibility to anti-microbial agents performed locally allowed detection of approximately all PPNG strains whereas the increase in the occurrence of strains with chromosomally determined resistance was not revealed. The study comprised 70 PPNG strains of which 19% (13/70) carried the 7.4 kb Asian plasmid and 81% (57/70) the 5.3 kb African plasmid. None of these strains possessed the 38 kb conjugative plasmid, whereas it was found in 4.5% of the 376 non-PPNG strains available for plasmid analysis; 92% (410/446) of all strains had the small 4.2 kb plasmid and 5.4% (24/446) did not contain any plasmid. Overall, auxotype zero and proline-requiring strains were predominant, accounting for 53% (244/460) and 28% (131/460), respectively. In general, PPNG strains carrying the 5.3 kb plasmid were auxotype zero (49/57 = 86%) and those carrying the 7.4 kb plasmid were proline-requiring (9/13 = 69%).

An infection model of human tuberculosis was established with C57BL/6J mice. The lymphocyte proliferative responses to antigens from Mycobacterium tuberculosis were investigated during the course of infection and compared with results obtained with a group of mice immunized with large amounts of killed bacteria. The two groups responded similarly to a number of mycobacterial antigens, but marked differences in responses against secreted antigens were found; only infected mice responded vigorously to these. The responding lymphocyte subpopulation was made up of L3T4+ T lymphocytes under restriction of the Ia molecule.

Non-BCG-vaccinated preschool children (4 or 5 years of age) were simultaneously tested on separate arms with a 2 IU PPD RT23 and 0.1 microgram Mycobacterium avium sensitin RS10 or 0.1 microgram Mycobacterium scrofulaceum sensitin RS95. None of the 762 children had any known exposure to tuberculosis. A total of 8.8% reacted with an induration (greater than or equal to 3 mm to PPD RT23 while 2% reacted with greater than or equal to 6 mm. Half the children were tested with M. avium sensitin: 18.9 and 7.8% reacted when 3 and 6 mm cut-off points, respectively, were taken. The remaining children were tested with M. scrofulaceum sensitin: 18.4 and 6.3%, respectively, reacted. In a previous study of schoolchildren aged 8 or 9 years, reactions to sensitins were considerably more frequent. Thus, sensitisation by atypical mycobacteria seems to increase from the preschool to the early school age. This finding probably reflects a continuous exposure of the children to atypical mycobacteria from various sources. The preschool children with a reaction to PPD RT23 greater than or equal to 6 mm were examined and chest X-rays were performed. All children were healthy but one child had enlarged lymph nodes in the mediastinum and abdomen. It cannot be excluded that these pathological findings were caused by atypical mycobacteria.

Non-BCG-vaccinated schoolchildren (8 or 9 years of age) were simultaneously tested on separate arms with 2 IU PPD RT23 and 0.1 microgram Mycobacterium avium sensitin RS10 or 0.1 microgram Mycobacterium scrofulaceum sensitin RS95. None of the 2819 analysed children had any known exposure to tuberculosis. A total of 3.4% reacted with an induration greater than or equal to 6 mm to PPD RT23. Half the number of children were tested with M. avium sensitin and 25.4% reacted while the remaining were tested with M. scrofulaceum sensitin and 32.4% reacted when the cut-off was 6 mm. For about 90% of the children the sensitin reaction was larger than or equal to the tuberculin (PPD RT23) reaction. Correlation analyses showed that moderate and high PPD RT23 values were combined with still higher sensitin values, indicating that the tuberculin reactions were mainly cross-reactions due to the antigenic similarity between tuberculin and sensitins. The presence of birds, dogs and cats in the homes was combined with an increased frequency of children reacting to the sensitins used. The children with reactions to PPD RT23 greater than or equal to 6 mm were examined and chest X-rays were performed. None of them showed any signs or symptoms of mycobacterial disease. In non-BCG-vaccinated Swedish schoolchildren without clinical signs of tuberculosis and without known contact with a contagious tuberculous person, indurations less than 12 to 14 mm on tuberculin testing are probably caused by atypical mycobacteria. In such cases sensitin tests should be performed to verify the suspicion.

This study compares the T-cell-stimulating ability of different mycobacterial antigens. The responses to crude culture filtrates and seven affinity-purified antigens were investigated in eight strains of inbred mice. Large differences in the stimulating abilities of the antigens were observed, and four antigens were found to give a powerful T-cell stimulation. Some antigens divided the strains into high and low responders, while a 17-kDa antigen was found to be exceedingly T-cell stimulatory in mice of all tested haplotypes. The responses of the eight strains were analyzed by comparing the response patterns of the strains. Using a statistical model based on antigen ranking, five strains were found to have a similar response pattern; three strains were found to differ. These results demonstrate the significance of the choice of mouse strain in studies of mycobacterial immunology and, furthermore, indicate that when research is conducted to develop new mycobacterial vaccines, it is important to include panels of antigens.

In order to facilitate epidemiological investigations a subdivision of Staphylococcus aureus strains belonging to the 94,96 complex by means of two experimental phages, 16 and 47A, was performed. These phages were selected from the nine experimental phages initially examined because they gave the greatest discrimination. On the basis of reactions with these two phages, 2199 isolates which reacted with phages 94 and 96, and 773 isolates which reacted with phage 96 alone, were each subdivided into two major and two minor groups. Strains with different phage patterns were in a few cases (2/64) isolated from the same deep body site in a patient, and lysogenisation experiments suggested that differences in phage patterns were determined by the presence of prophages. Strains with the phage patterns 94/96 and 96 were found to be unevenly distributed throughout Denmark. This regional distribution suggested that particular strains might predominate in some areas. The extended phage patterns with the experimental phages did not give any retrospectively useful epidemiological information. It is proposed that in future phages 16 and 47A be used for specific investigations into the sources and relatedness of strains involved in small incidents.

We have studied the distribution of phage-type patterns among strains of Staphylococcus aureus isolated from patients in a burns unit. From 51 patients the same phage-type was isolated from succeeding swabs during the observation period. In 20 patients new types were introduced, but the original strain remained. In 23 patients the first strain was replaced by one other strain, in eight patients two or more. Strains of type 95 seemed to have a high colonization priority, whereas strains of group III had a low one. In 1986 phage-typing was performed on two or more S. aureus strains from the same patient, in 4561 instances. Recurrence of strains of the same phage-type pattern was demonstrated in 70% of the patients when the first and the fourth sample were compared. The "newer epidemic" strains of phage-type 95 and of the 94,96 complex had the highest percentage of recurrence (more than 80%) when adjacent samples were compared, and 68-69% when the first and the fourth sample were compared. The good colonization capacity of these strains might be one of the explanations why they occur frequently today although they are resistant only to penicillin.

Ampicillin and gentamicin were administered continuously intravenously to 88 newborn infants using individually calculated dosages. For infants with a mean value of plasma clearance of the antibiotics, it was calculated that the serum ampicillin and gentamicin concentrations would be between 35-55 and 3-5 micrograms/ml, respectively, using the dosages for intermittent treatment. These dosages are therefore recommended as fixed dosages for continuous intravenous infusion initiated by a bolus dosage. Serum gentamicin concentration should be assayed about three half-lives after start of infusion and the dosage adjusted for values outside 3-5 micrograms/ml.

The peroperative flora of 499 patients undergoing cataract extraction was studied with local bacterial cultures taken at the beginning and end of surgery and compared with the preoperative flora examined previously (Fahmy et al. 1975 b) on admission the day prior to surgery. The local application of a single dose of oxytetracycline - polymyxin B, approximately 18 hours before surgery, significantly reduced the incidence of bacteria at the time of surgery. However, 92% of the conjunctivas examined immediately before operation proved to harbour one or more kinds of microorganisms. Futhermore, 61% of the wound sites were found to be contaminated with bacteria at the conclusion of surgery. The reasons are discussed. The origin of Staphylococcus aureus isolated peroperatively from the conjunctiva and wound site was studied. The great majority of strains could be traced to the patient's own conjunctiva preoperatively. In a few cases S. aureus was traced to the patient's own nose, skin of face or to the surgeon's nose. The air of the wards and operating theatre as well as the hands and gloves of surgeons and assistant nurses apparently did not play any role as a source of S. aureus infection.

Based on a 2-year controlled double-blind trial of levamisole, penicillamine, and azathioprine (L, P, and A), a computer aided search for predictive factors of outcome was instituted. Already at month 4 several indicators of synovitis activity were able to discriminate between patients staying in the trial for 24 months and patients whose treatment was discontinued before that time. Patients who had previously received gold therapy responded less favourably to L, P, and A than those who had not received gold. This reduction of response was more pronounced in gold resistant patients than in patients whose gold treatment had been discontinued for other reasons. The only phase protein (of several) with a predictive value was haptoglobin. If, after 4 months of treatment, haptoglobin did not normalize, this finding indicated a lack of response to treatment or a deterioration of synovitis activity during the following 4 months. The response to treatment was not influenced by HLA-types, sex, age, or clinical synovitis, disease duration, functional or anatomical aberrations at the start of treatment. The shape of the response curve as reflected by means of monthly measurements of serum-albumin and ESR was not related to disease duration, HLA-types, or previous gold treatment.

A functional assay for the quantitative estimation of suppressor cell (SC) activity in guinea pigs has been developed. Cultures of antigen-stimulated peripheral blood lymphocytes (PBL) from sensitized guinea pigs develop SC activity. The suppression of proliferation can be demonstrated in antigen-stimulated autologous co-cultures of precultured and freshly isolated PBL. The extent of suppression is dependent on the preculture antigen concentration but not the preculture period and it consists, as demonstrated with PBL from doubly sensitized guinea pigs, of an antigen-specific and a non-specific component. The observed SC activities were not due to an alteration of the kinetics of the co-cultures. The estimates of suppression are highly dependent on corrections for the values of the control cultures. The present method may prove useful in immunological studies of mycobacterial infections in guinea pigs.

Eight weeks after the onset of immunization with living BCG vaccine or with heat-killed, dried Mycobacterium tuberculosis in paraffin oil (TB), guinea-pigs were skin tested with small doses of tuberculin PPD. Three weeks later the effect of these tests on skin reactions and on lymphocyte transformation (LT) responses of lymph node lymphocytes (LNL) or peripheral blood lymphocytes (PBL) was estimated by a comparison with non-tested groups. For both immunogens, the skin test after 8 weeks significantly enhanced skin reactions, particularly to low tuberculin doses. In the BCG-vaccinated guinea-pigs the LT responses of both cell types were significantly enhanced by the skin test after 8 weeks, whereas the LT responses from the TB-immunized guinea-pigs were not affected. Therefore, in the planning and interpretation of in vitro tests of cellular immunity, possible effects from previously applied skin tests should be taken into consideration.