[The effect of multidisciplinary group advice for patients with rheumatoid arthritis].
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Biomedical subjects
Publications and source records attributed to A Poulsen.
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In a randomised study of 558 children in an urban African community, the protective effect of the Edmonston-Zagreb (EZ) measles vaccine given in a dose of 40,000 plaque forming units from the age of 4 months was compared with the effects of a standard dose (6000 tissue culture infectious units) of Schwarz measles vaccine given from the age of 9 months. During two years of follow-up, all 14 clinical cases of measles occurred in the Schwarz group; 10 of the children contracted measles before vaccination and 4 after measles vaccination. Thus the EZ vaccine provided significant protection against measles both before and after the usual age of vaccination. Among the children who were exposed to measles at home, those given EZ vaccine were better protected than either unvaccinated children or those given the Schwarz vaccine.
Punch biopsies from syphilitic leukoderma lesions and from unaffected skin in 3 patients with secondary syphilis were studies in the transmission electron microscope. In one of the patients the pigment disorder was not preceded by any visible syphilids, and in the biopsy from the leukodermal skin in this patient Treponemata pallidium were demonstrated around vessels and inside nerve fibres in which the myelin sheaths of the axons showed evidence of degeneration. In the other 2 patients the depigmented areas appeared while macular and papular syphilitic lesions were healing. In the biopsies from the leukodermal lesions of these 2 patients and from unaffected skin of all 3 patients, no treponemes were demonstrated. The study indicates that syphilitic leukoderma is not invariably a post-inflammatory phenomenon, but the pigmented skin lesions may themselves represent stigmata of an active syphilitic infection.
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Treponema pallidum was isolated from various types of secondary syphilitic skin lesions. From moist genital papules and from condylomata lata several treponemes were isolated whereas few were isolated from dry papules of the trunk. One third of the observed treponemes were morphologically different from treponemes isolated from human chancres. Especially the nose-piece structures of the terminal parts of the treponemes were deviating. Some nose-pieces were coated by a fuzzily outlined electron dense substance, whereas others were degenerated or nearly separated from the cytoplasmic body. Other treponemes were missing their nose-piece as avirulent saprophytic treponemes. Recent studies have indicated that the nose-pieces are essential for the tissue attachment of treponemes and the treponemal virulence. The significance of the altered nose-piece structure observed is discussed.
The ultrastructure of biopsies from dry macular and papular secondary syphilitic skin lesions of 10 patients were studied by electron microscopy. In all biopsies few diffusely distributed treponemes were observed. This may explain the difficulties in demonstrating treponemes by darkfield examination of tissue fluid from dry secondary syphilitic skin lesions. The outlines of treponemes were less distinct as compared to those of primary syphilis. The periplastic membranes were almost invariably absent and the cytoplasmic membranes appeared in close contact with an enclosing layer of irregularly demarcated, electron dense amorphous substance. This substance may be a manifestation of the immune reaction of the host cells to the treponemes. Degenerations were noted in both unmyelinated and myelinated nerve tissue. This accounts for the fact that skin lesions in secondary syphilis are usually without symptoms. Also in the vessel walls treponemes were demonstrated. The vascular endothelial cells were proliferating and the basement membranes were multilaminated and split.
In biopsies obtained from syphilitic chancres of varying ages in 10 patients, a total of 766 ultrathin sections of Treponema pallidum were studied by electron microscopy. The course and number of axial filaments observed reveal that one bunch of 3-4 filaments without interruption entwine the whole cytoplasmic body. In 9.2% of the sections a trilaminar or a fragmentary trilaminar periplastic membrane was observed outside the cytoplasmic membrane and the axial filaments. The occurrence of the periplastic membrane decreased with advancing ages of the chancres. A protective function of the membrane is discussed. A peritreponemal fine reticular halo demonstrable in most fragments is supposed to be due to fixation induced shrinkage of treponemal hyaluronidase-influenced semifluid glycosaminoglycans. Peritreponemal reticular halos were also observed in collagen tissue. A destructive effect of the treponemes on collagen fibres could explain how the organisms penetrate through the collagen rich meninges into the central nervous system. A surface associated narrow border of electron dense amorphous substance, probably originating from the host organism, yields to tangentially cut treponemes a spiny caterpillar-like appearance.
The ultrastructure of treponema pallidum obtained directly from human chancres by biopsy was studied by electron microscopy. The treponemes were enveloped by a trilaminar cytoplasmic membrane and a trilaminar periplastic membrane. The central part of the periplastic membrane corresponds to the protective mucoid layer. In undamaged organisms bunches of axial filaments were seen to entwine the whole cytoplasmic body without any disruption or overlapping. The number of axial filaments varied between three and four. Identical nose pieces were demonstrable in both ends of the treponemes. Axial filaments and nose pieces seem to differ from those of Nichols' strain.
The incidence rate of acquired syphilis per 100 000 total population in Denmark increased by 70% from 6.8 in 1978 to 11.6 in 1982. In 1984 this incidence had decreased by 61.2% to 4.5. The fluctuation of the number of acquired syphilis predominated in the male population with an increase of 71.8% during the five year period 1978-1982 and a decrease of 63.2% during the years 1983 and 1984. In 1978, the incidence of acquired syphilis in males was 11.3 per 100 000 total population increasing to 19.5 in 1982, decreasing to 7.2 in 1984. The decreasing number of acquired syphilis cases during the past two years are correlated to a lower number of sexual contacts among homosexual men because of fear of AIDS.
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Previously we observed clinical and histological regression of Kaposi's sarcoma in the skin in a 38-year-old man with AIDS following treatment with Dapsone. This observation initiated the present study where 6 patients with Kaposi's sarcoma in the skin without clinical signs of systemic spreading were treated with Dapsone 100 mg daily for four months. During this treatment clinical and histological regression of Kaposi's sarcoma was found in three patients. In a further patient only clinical regression was found, while no regression was found in the remaining two patients with Kaposi's sarcoma.
The autoinoculation test has been used as a diagnostic procedure in patients with chancroid-suspected genital ulcerations. In four of 13 patients with a positive autoinoculation test, herpes simplex virus type 2 was isolated from the primary lesions. In two of the cases this virus was also isolated from the inoculation site, and one patient developed a recurrent herpetic eruption here. Two patients were proven to have chancroid. Three of the remaining seven patients developed recurrent herpes genitalis later. It is concluded that the autoinoculation test should be avoided as a diagnostic procedure because of lack of specificity and risk of inducing recurrent herpes simplex at the site of inoculation.
Correlations between the Bruininks-Oseretsky Test of Motor Proficiency (BOTMP) and the Southern California Sensory Integration Tests (SCSIT) were studied by using test results obtained from a sample of 49 learning-disabled children. It was found that those SCSIT tests with a motor component correlated significantly with the BOTMP battery composite scores. The fine motor composite scores of the BOTMP reflected the greatest percentage of significant correlation with SCSIT tests. These results suggested that the BOTMP would be useful for screening children for referral to occupational therapy by educators. In addition, the high correlation of the BOTMP with the SCSIT motor tests indicated that the BOTMP may be appropriate for use in clinical research to evaluate the effectiveness of sensory integrative procedures in relation to motor function.
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