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Surface mediated immune complement activation can be detected by a variety of antibody utilizing methods such as ELISA, fluorescence- or radiolabelling techniques, QCM, and ellipsometry. In the present work we investigated how the common anticoagulants heparin, dalteparin, fondaparinux and sodium citrate affected the binding of anti-complement factor 3c (anti-C3c) on a model complement activator surface, immobilised IgG, after incubation in human blood serum. The results show, as expected, that different anticoagulants affect the antibody binding differently. Increasing amounts of heparin, dalteparin and sodium citrate in normal serum resulted in a decreasing anti-C3c binding. The antibody deposition was not sensitive for the fondaparinux concentration. Surprisingly high concentrations of anti-coagulantia were needed to completely eradicate the antibody binding. Experiments in EGTA-serum showed that anticoagulants interfered directly with both the classical and alternative pathways. Control C3a-des arg ELISA measurements show that the lowered antibody surface binding was not a result of complement depletion in serum. Kallikrein generation by hydrophilic glass surfaces was not affected by high anticoagulant concentrations.

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The aim of this study was to describe a nurse-led rheumatology clinic's impact on empowering patients with rheumatoid arthritis (RA). Rheumatoid arthritis is a chronic, inflammatory disease that attacks many joints, causing considerable functional restrictions for patients. Consequently, these patients are dependent on a wide variety of health-care services. A descriptive, qualitative design inspired by phenomenography was chosen. The conceptions were collected through interviews with 16 strategically selected patients with RA. Three descriptive categories comprising eight conceptions emerged: teaching (gaining insight and receiving information), regular review (receiving security, realizing regularity, and achieving accessibility), and attention (getting a holistic assessment, receiving coordinated care, and getting sufficient time). A nurse-led rheumatology clinic can be a source for empowering patients with RA to adopt new stances to alternative actions and achieve a higher level of faith in their own abilities.

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BACKGROUND: To study whether plasma concentrations of procalcitonin (PCT), interleukin-6 (IL-6), complement 3a (C3a), C-reactive protein and white blood cell count (WBC) correlate with the presence of systemic inflammatory response syndrome (SIRS) during the early post-operative period after major colorectal surgery. METHODS: Prospective, observational study during the first 24 h post-operatively. The setting for the study was the operating theatre and the recovery unit at the university hospital. Fifty consecutive patients, operated on electively with major resection of the large bowel or rectum. PCT levels increased significantly to the maximum level 18 h postoperatively. PCT levels were significantly higher in the SIRS group in comparison to the non-SIRS group of patients 6 and 12 h after surgery (P < 0.05). The IL-6 levels were increased directly after the surgery and then decreased gradually in both study groups. Twenty-four hours after the surgery, C3a levels decreased and then returned to normal levels. Twenty-four hours post-operatively, patients with SIRS had a higher plasma concentration of C3a compared with patients without SIRS (P < 0.05). CRP and WBC increased during the study period in both groups (P < 0.05). CONCLUSIONS: During the early post-operative period after uncomplicated major abdominal surgery, SIRS was reflected by the increase in plasma PCT and C3a concentrations. IL-6, CRP and WBC increased to the same extend in both the SIRS and the non-SIRS group of patients.

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In the current study, colorectal distension (CRD) was performed in conscious mice, in order to study visceral (colon) sensitivity. Electrodes were chronically implanted into the external oblique muscle to obtain the electromyographic (EMG) response to CRD. CRD was performed using a computerized system, which inflated the balloon with air to the desired pressures. An increasing (10-80 mmHg) and a repeated (12 x 55 mmHg) phasic paradigm with distensions lasting 10 s and with 5-min intervals were used. The EMG recordings were linearly correlated to intracolonic pressures between 10 and 80 mmHg, which are characteristic of the visceromotor response (VMR). Repeated phasic distensions at 55 mmHg resulted in a stable VMR in female mice, but an increasing VMR in male mice. Interestingly, the duration of the VMR was about 5 s, which is shorter than the actual duration of the distension. U-69593 and fentanyl (selective kappa and mu opioid receptor agonists) significantly reduced the VMR at subcutaneous doses of 0.5 and 0.05 mg x kg-1, respectively. In conclusion, a CRD model for repetitive quantitative studies of colorectal sensitivity and evaluation of pharmacological modulation of visceral sensitivity in conscious mice is presented.

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BACKGROUND: Alport syndrome (AS) is a hereditary disease of the glomerular basement membrane in the kidney characterized by progressive renal failure, sensorineural deafness, and/or ocular abnormalities. In contrast to the well-known X-linked phenotype, very little is known about the autosomal dominant form. Rare autosomal forms of AS have been described with mutations in COL4A3 and COL4A4 at chromosome region 2q35-q37, but there have been no descriptions of dominant forms due to a mutation in COL4A4. METHODS: We describe a Sardinian family with a classical AS-phenotype plus hypercholesterolaemia, a clinical feature also present in Fechtner syndrome (FS), a disease that segregates as an autosomal dominant trait. RESULTS: A suggestive linkage (LOD=2.7) between AS and the COL4A3/A4 locus at 2q35-q37 was identified. Other candidate collagen genes encoding basement membrane collagen (COL4A1/A2 and COL4A5/A6) were excluded by linkage analysis (13q33-q34 and Xq22), or by sequence (COL4A3). DNA sequence analysis of the COL4A4 gene revealed that the Lys325Asn mutation was present in all affected family members, but was absent in all unaffected members and in a random sample of the Sardinian population. A clear indication of a gene-dosage effect was seen in the most severely affected family member, since she carried the mutation in the homozygous form. CONCLUSIONS: These data confirm the importance of collagen 4A4 as a component in the structural integrity of the glomerular basement membrane and confirm the phenotypic and genetic heterogeneity of collagen disorders.

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Five mutations in the ligand-binding domain of the androgen receptor gene were identified in patients with complete (A765T, C784Y, R831X and M895T) or partial (R840G) androgen insensitivity. A765T and R831X have been reported previously whereas the other three mutations are novel. Receptors carrying these mutations were transiently expressed in COS-1 cells, and androgen binding and capacity to transactivate an androgen-responsive reporter gene were assayed. C784Y led to abolished androgen binding and transactivating capacity, R840G and M895T showed reduced specific binding and partial transactivation. The in vitro functions of the R840G and M895T mutants were improved with supraphysiological concentrations of steroid.

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Helicobacter pylori infection in humans has been shown to be associated with changes in gastric physiology, including exaggerated basal and meal-stimulated gastrin levels. This has been suggested to be due to the direct effects of the bacterium through inflammation and its urease enzyme. The gastric bacteria Helicobacter felis and Helicobacter heilmannii colonize the antrum of rats in large numbers and induce no significant inflammatory response. Thus, the direct effect of Helicobacter infection on gastric physiology, independent of gastritis, could be studied. Basal, freely fed and stimulated acid and gastrin levels were recorded from animals infected with H. felis, H. heilmannii or uninfected controls over a 30 week period. No significant difference was found between freely fed gastrin over 7 weeks or fasting gastrin over 24 weeks or basal and stimulated acid over 30 weeks between all three groups. Triple therapy did not alter gastrin or acid output. The antrum of all Helicobacter-infected rats was well colonized; triple therapy cleared H. felis but not H. heilmannii. Very little inflammation was seen in control or Helicobacter-infected animals. In conclusion, Helicobacter-induced effects on gastric physiology are unlikely to be due to direct bacterial effects, but are best explained by other factors (i.e. inflammatory damage).

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The purpose of this study was to monitor changes in preoperative routines following recommendations given in 1989 by the Swedish Council on Technology Assessment and by the Swedish Consensus Conference on Preoperative Routines, both suggesting a more individualized utilization of preoperative testing. This was a multicenter, prospective, repetitive study conducted at seven Swedish hospitals providing surgical care. The subjects included all patients presenting at the operating theaters for surgical interventions requiring general or regional anesthesia. The main outcome measures were the frequency of reports of performed preoperative ECG, chest x-ray, and analysis of serum concentration of potassium. Before general recommendations were issued in 1989, 47% of the patients had had a preoperative ECG, 26% had had a chest x-ray, and in 61% serum potassium concentration had been measured. In 1991 these frequencies had been reduced by 5, 6, and 9 percentage points, respectively (all figures given standardized for age and sex). Large differences were found between individual hospitals. Although recommendations suggesting a more restrictive and individualized utilization of preoperative testing have sparked important revisions in Swedish hospitals, there seems to be substantial potential remaining for further reduction of perfunctory use of preoperative screening.

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Although the experience of a surgical and anaesthesiological procedure is unique to every patient, many preoperative events and routines will to a certain extent be shared by a majority of patients. This review will be limited to this area of routine preoperative care and evaluation, as applied to and by the anaesthesia team before elective surgery. The word "routine" is used more in the sense of what is most commonly done; the notion of a mechanically performed act is totally inappropriate and dangerous in this context.

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BACKGROUND: The Project Perioperative Risk in Gothenburg is a prospective clinical-epidemiological study designed to elucidate factors affecting the perioperative risk in unselected adult patients undergoing elective general or orthopaedic surgery. In this report on postoperative adverse events of varying severity, the predictive ability of four simple classification systems, ASA physical status, patient age, surgical stress and a visual analogue scale for intuitively appreciated global risk (RISK-VAS), is described. METHODS: 1361 patients undergoing 1471 surgical procedures were subjected to a detailed and standardised preoperative assessment and classified according to ASA, age, procedure magnitude and RISK-VAS. Postoperative adverse events were prospectively registered during the entire hospital stay. RESULTS: The four classifications all correlated to postoperative adverse events. ASA physical status, RISK-VAS and patient age all appear to be more efficient in predicting severe than mild events, while surgical stress predicted severe events and mild ones equally well. CONCLUSION: The most efficient predictor of severe events appeared to be RISK-VAS, where a relative risk of 28.1 of acquiring a severe postoperative adverse event could be demonstrated for those who had a score of 4 or more compared with those who had scores less than 4.

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OBJECTIVE: To evaluate the dose response of inhaled nitric oxide (NO) on gas exchange and central haemodynamics in patients with early acute lung injury (ALI). DESIGN: Prospective, multicentre clinical study. SETTING: General ICUs in university and regional hospitals. PATIENTS: 18 Patients with early ALI according to specified criteria. INTERVENTIONS: During controlled ventilation an inhalation system was used to deliver NO (1000 ppm in N2) and O2/air to the low pressure fresh gas inlet of a Siemens 900C ventilator. Haemodynamics and pulmonary gas exchange variables were measured at baseline and at stepwise increased inspiratory NO concentrations of 0.1, 0.3, 1, 3, 10, 30 and 100 ppm, each dose being maintained for 15 min. Dose testing was repeated the next day, and the response to prolonged (2 h) NO inhalation at 1 and 10 ppm was also tested. MEASUREMENTS AND RESULTS: Inhalation of NO produced a significant increase in PaO2 (P < 0.0025). The degree of response, as well as the optimal NO dose varied in individual patients and between different days. Venous admixture (QVA/QT) was reduced (P < 0.02) from 38% (31-46%) to 33% (26-41%). In our patients with early acute lung injury and only a moderate elevation in pulmonary arterial pressure NO inhalation did not reduce mean pulmonary artery pressure significantly, being 27.0 (21-30) mmHg at baseline and 26.0 (21-30) mm Hg at 100 ppm. CONCLUSIONS: This study shows that improvements in arterial oxygenation in response to inhaled NO may show great inter- as well as intraindividual variability, and that improvements in arterial oxygenation occur without any measurable lowering of the pulmonary artery pressure.

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The risk of gastric stump carcinoma is increased 15-20 years after gastric resection for benign disease. Reflux of duodenal juice, bacterial overgrowth and formation of N-nitroso compounds are possible etiological factors. There is a geographical variation in the incidence of gastric cancer, possibly explained by differences in food intake. Experimentally it is possible to induce gastric stump carcinoma in rats without the addition of exogenous carcinogens. The aim of this study was: 1) to find the incidence of gastric carcinoma in rats subjected to BII resection and followed for 10 months, and 2) to examine if acetic acid, a common dietary factor, could influence the development of gastric carcinoma. Amongst BII-operated male Wistar rats, infiltrating carcinoma was found in 5/20 on a normal diet and in 5/24 exposed to acetic acid (NS). Benign mucosal changes were seen in 12/20 and 16/24 respectively (NS). With the exception of a profound inflammation in one sham-operated animal, no mucosal pathological changes were found in 24 sham-operated and 24 control animals where no operation was performed.

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All anaesthetic and surgical procedures impose a certain risk of complications. However, reliable estimates of this risk from prospective studies are rare. This study is a prospective clinical epidemiological study of 1361 consecutive patients subjected to elective general and orthopaedic surgery. These patients were followed from an extensive preoperative assessment to three months after the operation. In this report the peroperative and early postoperative period in the postoperative care unit or intensive care unit is described. General anaesthesia was given to 59% and regional/local anaesthesia to 41%. Adverse peroperative events occurred in 19%. The most common were circulatory events (11%), respiratory (4%), and allergic events (1%). Most events were of minor severity. However, with the official registration system, only 1 out of 8 events was detected. In the postoperative unit one or more adverse event was noted in 47% of the cases. These were dominated by circulatory (18.4%) and respiratory events (5.0%). CNS depression was noted in 6.8% of the cases. Most per- and postoperative event variables were highly correlated to the degree of surgical stress. In conclusion, a new concept for preoperative assessment and the registration of events during and after surgery was used. In this way, a large number of events of importance, not least for quality assurance, were found that would be missed with the official coding system. In a previous report we could show that even minor events affected the cost of care substantially.

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The Gothenburg study of Perioperative Risk is a prospective clinical-epidemiological study designed to elucidate factors affecting the perioperative risk in unselected adult patients undergoing elective general or orthopaedic surgery. In this report reference data regarding preoperative characteristics and postoperative complications are presented. 1770 adult patients scheduled for elective general, urological, peripheral vascular or orthopaedic operative procedures were invited to a preoperative clinic. 81% agreed to participate and were assessed in a standardised way by means of questionnaires, interview, physical examination and laboratory screening. 82% had a previous or present condition in the medical history of some concern to the assessor. 71% had a finding of significance on physical examination. In 8% the assessment prompted further investigations or precautions. Throughout their hospital stay, all the 1361 participating patients were visited daily by an especially trained nurse with the task of registering the occurrence of complications. In 30% an untoward event occurred postoperatively--in 1% a severe one, in 21% a mild event, and in 8% an intermediate one. The complication rate was higher in vascular surgery (69%) than in orthopaedic (33%) and general/urological surgery (26%). Not only the severe and intermediate but also the mild complications affected the number of days in hospital.

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