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Background: Mast cells and basophils express the high-affinity IgE receptor FcepsilonRI. We have analysed the human mast cell line LAD2 and four subclones of the basophil cell line KU812 in order to reveal possible differences concerning the FcepsilonRI surface regulation, anti-IgE-triggered activation, FcepsilonRIalpha protein stability and the mRNA level of FcepsilonRIalpha-, beta- and the truncated beta-chain (beta(T)), and thereby determine the utility of these cell lines in investigations of the FcepsilonRI biology., Methods: The surface expression of FcepsilonRI was assessed by flow cytometry, using the monoclonal antibody CRA1. The FcepsilonRI-induced cellular activation (i.e. cross-linking of FcepsilonRI) was determined by changes in the intracellular level of Ca2+, which was measured by fluorescence of Fura-2. The level of the FcepsilonRIalpha protein was determined by a Western blot technique and by a radioimmunoassay. The mRNA level of FcepsilonRIalpha, beta- and beta(T)-chain was analysed using real-time PCR., Results: Two KU812 subclones and especially LAD2 had FcepsilonRI surface expression which was capable of inducing cellular activation. Both the FcepsilonRI expression and stability of the FcepsilonRIalpha protein were increased when IgE was present. All the cell lines expressed mRNA of FcepsilonRIalpha-, beta- and beta(T), with LAD2 tending to have the highest expression. However, a determination of the beta/beta(T) ratio demonstrated no difference between any of the cell clones., Conclusion: These cell lines are important tools in the investigation of both the FcepsilonRI molecule and the effects induced by its activation.

Introduction: The purpose of the investigation was to test selected methods for self-evaluation of health, the quality of life, and satisfaction with treatment. As part of this, to test their fitness as quality estimates in a psychiatric ward., Material and Methods: Four weeks after discharge questionnaires were sent to all patients and they were asked to participate. The methods used were SF-36 (short-form-36 questions), SIP (sickness impact profile), WHO-5, and a scale measuring patient satisfaction with treatment and care., Results: The response rate was almost 50%. Seventy-five per cent were feeling better or the same as they did one year before admission. Compared with average values in a healthy Danish population, the psychic health of the patients was much lower, as evaluated by the SF-36 and WHO-5. The functional level measured by the SIP was reduced 12-32% from the optimum. About 75% of the patients rated the treatment and care positively., Discussion: The applied methods of self-evaluation of health, quality of life, and satisfaction with treatment were found to be appropriate. For one year, it was possible to obtain and register important data from participating patients without using too many resources. Nevertheless, only 50% answered the questionnaire. It would be desirable to simplify the necessary questionnaires, thus encouraging more patients to respond. From the agreement between the methods, the use of the SF-36, WHO-5, and the satisfaction scale would be sufficient to obtain a qualified measure of the patients' health, quality of life, and satisfaction with treatment and care. Time spent on answering could be reduced to about 20 minutes. Resources spent on registration would be so small that the methods could be used for on-line quality surveillance.

Chronic wounds are a drain on health care resources, and as such, continue to challenge health care providers to define and create more effective intervention strategies. Wound assessment is the foundation for maintaining and evaluating a therapeutic plan of care. Without adequate baseline wound assessment and valid interpretation of the assessment data, the plan of care for the wound may be inappropriate or ineffective. This article discusses comprehensive assessment of the total patient as well as assessment of wound severity and wound status.

The purpose of the present study was to evaluate the results following surgical resection for cancer of the gastro-oesophageal junction. From 1. january 1988 to 1. april 1996 radical resection was intended in 107 patients at the Department of Thoracic and Cardiovascular Surgery at Odense University Hospital. Resection was possible in 75 patients. The operative mortality was 6.7% insufficiency of the gastro-oesophageal anastomosis was found in 6.7%. Five year survival was 24.1%. However in 52 patients where the resection was found to be radical the five-year survival was 35.3%. The results show that oesophago-gastrectomy could be performed with low mortality and morbidity. Long term survival is still low. To improve the results efforts should be directed toward earlier diagnosis, better selection and minimising post-operative complications.

Although the Pressure Sore Status Tool (PSST) was developed using expert panelists and its reliability has been previously reported, the patterns that seem to be forming based on the first few thousand PSST assessments have not been reported yet. This paper will focus on analyses of a subset of PSST assessments that were collected as a by-product of testing a computerized assessment and decision support system. Changes in wound characteristics that appear to serve as "lead indicators" of healing, preliminary factor analysis data, and a correlation of total PSST scores with recorded stage will be discussed. Due to the sample size and variability within the data, it is premature to draw firm conclusions from the data. However, analyses of the first few thousand assessments and over 100 healed pressure ulcers show promise in confirming some prior speculations about wound healing. The data also appear to suggest the possibility of surprises that are not necessarily part of current understanding of wound healing in pressure ulcers.

With the current push to develop critical pathways for chronic wound patients, information on "normal" versus problematic wound healing is important. This descriptive study begins to define chronic wound healing time markers by examining clinicians' own healing expectations with pressure ulcers. A 30-item questionnaire concerning partial and full thickness pressure ulcers on the sacrum, trochanter and heel was sent to 272 wound/ET nurses. Total response rate was 32.3% with 74 analyzable questionnaires returned. Data was analyzed using descriptive statistics and correlations where appropriate. Results were: (1) The longer respondents thought it would take for wounds to heal, the more variable their responses. (2) Respondents viewed heel wounds as taking the longest to heal and were more certain about time to healing in sacral wounds. (3) Responses indicated longer healing times than those shown in recent studies looking at change in wound surface area. (4) Results on time of 3.2 weeks to autolytic debridement of wounds with black eschar does not differ greatly from published time for enzymatic debridement, in spite of guidelines stating that autolysis may take longer than other methods. This study demonstrates that there remains variability in wound nurses' perceptions of time to healing and, therefore, recent attempts at defining critical pathways may be premature.

Electrolyte changes in right atrial and skeletal muscle pre- intra- and postoperatively, and their relationship to the development of postoperative atrial fibrillation or flutter were evaluated in 31 patients with coronary artery bypass grafting (CABG). Such postoperative arrhythmias occurred in 14 patients (45%). Before CABG the skeletal muscle potassium concentration was lower in these patients than in the others: median 261.4 (range 148.2-329.5) vs 298.6 (167.1-416.4) mumol/g dry weight, p = 0.017. The right atrial potassium concentration was normal, but sodium levels were higher in the patients with, than in those without postoperative arrhythmias: median 340.3 (263.7-454.9) vs 296.3 (203.9-355.0) mumol/g dry weight, p = 0.008, indicating disturbed transmembrane electrolyte transfer. During CABG the potassium levels fell and sodium increased in both right atrium and skeletal muscle, and on postoperative day 2 the potassium content in skeletal muscle was not yet restored. Magnesium levels showed no changes in right atrium or skeletal muscle, but serum magnesium declined postoperatively. As the observed electrolyte derangements may be important in the development of postoperative arrhythmias, concomitant potassium and magnesium supplement postoperatively may be beneficial in restoring cellular potassium concentration.

There is general agreement regarding the need for pressure ulcer assessment methodology which more discretely reflects relevant aspects of wound status than does the commonly used staging system. The Pressure Sore Status Tool (PSST) is one such instrument which was developed with consensual expert input. While the psychometric properties of the PSST have been reported in the literature, the instrument was validated using ET nurses, highly trained wound care specialists, and existed only in manual form. This paper reports results from attempts to establish reliability estimates for healthcare practitioners without extraordinary wound care training or experience. The paper further describes the automation of the PSST and provides examples of pressure ulcer profiles tracked over time. Results indicate that inter-rater reliability with general healthcare practitioners was .78 and intra-rater reliability was .89. The practitioners were able to use the PSST for over six months and the automated system allowed analysis of wound healing profiles that would have been difficult using a manual system. These results imply that movement toward an automated system which makes discriminations regarding the effects of various treatment and intervention strategies is possible and practical.

The diagnostic accuracy for colorectal cancer (CRC) of rigid sigmoidoscopy and faecal occult blood test (Hemoccult-II) (H-II) was investigated in patients with irritable bowel syndrome in general practice in a three year period and the results were compared with those of the previous three years, where rigid sigmoidoscopy and double contrast barium enema (DCBE) were the initial preferred examinations. Colonoscopy was recommended in patients with positive H-II, but also in patients with repeated negative H-II within three months, provided that the symptoms persisted. CRC was detected in 141 of 630 patients with positive H-II and in 52 of 8697 with negative H-II. The number of CRC's in the two study periods was similar, in spite of a pronounced reduction in DCBE's from 12,196 to 5656 and a small increase in colonoscopies from 3053 to 4127. It was concluded that the new strategy was no worse than the previous one and the major savings in DCBE's could be used to exchange the rigid sigmoidoscopy with a 60 cm flexible sigmoidoscopy, increasing diagnostic accuracy, shortening delay of diagnosis and removing more adenomas, which eventually may reduce the future incidence of CRC and thereby the mortality from CRC.

A total of 151 postmenopausal women were randomly allocated to 3 groups for treatment with hormone replacement therapy. One group received combined therapy (2 mg oestradiol (E2) and 1 mg norethisterone acetate (NETA) daily), the second group was placed on sequential therapy (2 mg E2 for 12 days, 2 mgE2 and 1 mg NETA for 10 days and 1 mg E2 for 6 days), while the third was given placebo. Treatment was administered over 24 cycles of 28 days. The two active treatments were equally effective in relieving climacteric symptoms. In the combined therapy group, 62% of the women experienced spotting and/or breakthrough bleeding during the first 3 cycles; thereafter this proportion decreased to between 3 and 18% in each of the following three-cycle periods. Sixty-four percent (64%) of these women had no more bleeding after the first 3 cycles. Endometrial atrophy was detected in 93% of the women in this group after 24 cycles of therapy. Bleeding irregularities occurred during the first 3 cycles in 27% of the patients treated with sequential therapy and in 21% of those receiving placebo. In the subsequent 3-cycle periods these figures fell to below 10% in the 2 groups. In all 3 groups weight remained stable but blood pressure increased equally in the actively treated groups and the placebo group. The levels of follicle-stimulating hormone (FSH), sex-hormone-binding globulin (SHBG) and the free fraction of E2 in serum were significantly lower in the combined therapy group than in the sequential therapy group. The higher level of free E2 in the latter group may have been caused by a decrease in metabolism associated with the increased SHBG concentration. It was concluded that combined treatment with E2 and NETA might provide an alternative to sequential treatment in postmenopausal women willing to tolerate the initial high risk of breakthrough bleeding/spotting in order to avoid subsequent regular bleeding. In the subgroup of women in whom bleeding irregularities continue, sequential treatment should be considered.

There is not yet a universal system for describing the status of pressure sores. The purpose of this study was to assess the validity and reliability of an instrument developed by the researchers for evaluation of pressure sores, the Pressure Sore Status Tool (PSST). This study was part of a larger study, which included development of a theoretical model for creation of items for the PSST. A nine-member expert judge panel established content validity of items on the instrument. Data were analyzed using a content of validity index (average index for tool = .91) and judges' comments were used to modify two items on the PSST. Two Enterostomal Therapy (ET) nurses independently used the revised tool to rate 20 pressure sores on ten adult medical-surgical patients, at two observation times. Interrater reliability was established at r = .91 for first observation and r = .92 for the second observation (p < .001). Intrarater reliability was r = .99 for rater one and r = .96 for rater two (p < .001). Future research will focus on refinement and further reliability testing of the instrument.

Interval cancers, which are cancers diagnosed in spite of one or more negative screening tests, were studied in a randomized population with Hemoccult-II for colorectal cancer in 61,938 persons between 45 and 74 years old. Three biannual screenings were performed from 1985 to 1991, and 52% of all the cancers detected after doing at least one Hemoccult-II test were interval cancers (81 persons). These were more advanced than cancers diagnosed after a positive Hemoccult-II test, of larger size, less frequently of Dukes stage A, more often invading neighboring organs, and less often resectable for cure. They were located in the rectum more often than cancers diagnosed by screening and cancers in controls. Otherwise, interval cancers did not differ from cancers in controls or cancers in non-responders, and all characteristics suggested that no delay in diagnosis resulted from one or more negative Hemoccult-II tests, compared with controls. However, even if screening with Hemoccult-II demonstrates a reduction in mortality from colorectal cancer, the present high number of interval cancers makes it necessary to look for other methods of screening populations for colorectal cancer.

Insulin-dependent diabetes is associated with other autoimmune diseases and subclinical hypothyroidism has been reported in pregnant diabetic women. We studied the thyroid function of 85 women with diabetes during pregnancy and after delivery, as well as various autoantibodies. During pregnancy, thyroid microsomal antibodies were present in 17/85, antibodies against thyroid peroxidase in 16/85, thyroglobulin antibodies in 2/85, parietal cell antibodies in 23/85, adrenal antibodies in 4/77, rheumatoid factor in 15/85, and thyroid-stimulating antibodies in 43/85. Presence of antibodies was not combined with thyroid dysfunction, but TSH and HbA1c was increased (p less than 0.005) in women with thyroid antibodies. The gestational age of the infants was lower (p less than 0.01) in women with positive thyroid-stimulating antibody titre, whereas the ponderal index was only lower in those with peroxidase antibodies (p less than 0.05). After delivery, microsomal and peroxidase antibodies were positive in 10 (17.5%) of 57 patients followed. Six women developed postpartum thyroiditis (10.5%), of whom 5 were positive for both microsomal and peroxidase antibodies; two of those showing a hyperthyroid phase also had positive thyroid-stimulating antibody titre. We conclude that autoantibodies occur with increased incidence in pregnant diabetic women. Thyroid antibodies are related to a slightly reduced thyroid capacity and involve a high risk of postpartum thyroiditis. Further, thyroid antibodies seem to influence the nutritional status of the infant.

In a retrospective study of femoro-popliteal bypass surgery in Denmark during the period 1983 to 1987, a total of 1,532 operations were performed. Approximately 2/3 of the patients were operated upon for limb salvage, the remainder for severe disabling claudication. The perioperative lethality was below two per cent in all departments. Early occlusion rate was found to be between 21 and 11 per cent, leading to major amputation in about half of the patients.

Nine cases of thoracic actinomycosis treated in the period 1966-1987 are reported. Three of the patients presented with a clinical picture of empyema and six were admitted for suspected primary pulmonary neoplasm. No case was correctly diagnosed preoperatively. The final diagnosis was based on direct microscopy (2) or culture (1) of drained pus in the empyema cases and on histologic examination of resected tissue in the others. In one case the correct diagnosis was missed when a palpable tumour mass was not extirpated at exploratory thoracotomy, and was made only when clinical deterioration necessitated a second operation. Good clinical results can be expected from surgical eradication of an intrathoracic focus of actinomycosis in conjunction with appropriate antibiotic therapy.