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Mice were exposed to aerosols from Aspergillus versicolor extract by inhalation (for 15-20 min). Changes in respiratory function parameters were monitored during the exposure to evaluate acute effects on the upper and lower respiratory tracts and the conductive airways. The single inhalation exposure to A. versicolor aerosols at the range of 12-151 mg/m3 provoked upper respiratory tract irritation in the airways of mice. The higher the exposure concentration the higher was the increase in the sensory irritation (SI) response. No bronchoconstriction or pulmonary irritation was observed. The causative agents for the SI response in the fungal extract are not known.

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Acute effects on the upper and lower respiratory tract due to inhalation exposure to Stachybotrys chartarum (Sc) extract were investigated in mice. In addition, the capacity of the Sc exposure to activate immune system and cause inflammation in the respiratory tract was studied. The inhalation of Sc extract aerosols was observed to provoke sensory irritation in the airways of both naive and Sc-immunized mice. In contrast, exposure to aerosolized ovalbumin or phosphate buffered saline did not cause this effect. Exposure to Sc twice a week for 3 wk increased significantly the serum total immunoglobulin E (IgE) levels in BALB/c mice immunized with Sc as well as in nonimmunized mice. A slight presence of inflammatory cells was observed in the alveoli 3 days after the last exposure to Sc. In conclusion, Sc extract has the capacity to provoke sensory irritation in the murine airways and to activate the murine immune system.

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The objective of this study was to characterize preliminarily immunogenic components characteristic of Stachybotrys chartarum to be used later for the development of a detection method for the fungus in environmental samples. The procedure for S.chartarum extract preparation was first optimized related to the age of the culture, culture type, and growth medium, and the antigenic composition of S. chartarum cultured in two different media was then characterized by the sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) and immunoblotting method. Cross-reactivity of S. chartarum antigenic components with 10 other fungal species was identified by the inhibition immunoblotting method. The 10-day-old S. chartarum culture extract cultured in malt extract broth revealed a wider selection of proteins and antigenic components than the 30-day-old culture extract or the culture medium extracts. When cultured in cellulose broth, S. chartarum produced a higher number of proteins and antigenic components than in malt extract broth. The most dominant immunogenic components of S. chartarum cultured in cellulose broth were those of 65, 50, 37, and 27 kDa. The components of 65 and 50 kDa proved to be the most characteristic of this fungus according to the inhibition immunoblotting analyses. Several of the S. chartarum components were identified as glycoproteins. Carbohydrate moieties of the S. chartarum components also possessed an antibody binding activity.

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We determined the moisture levels, relative humidity (RH) or moisture content (MC) of materials, and concentrations of culturable fungi, actinomycetes and total spores as well as a composition of fungal flora in 122 building material samples collected from 18 moisture problem buildings. The purpose of this work was to clarify if the is any correlation between the moisture parameters and microbial levels or generic composition depending on the type of materials and the time passed after a water damage. The results showed an agreement between the concentrations of total spores and culturable fungi for the wood, wood-based and gypsum board samples (r > 0.47). The concentrations of total spores and/or culturable fungi correlated with RH of materials particularly among the wood and insulation materials (r > 0.79), but not usually with MC (r < 0.45). For the samples collected from ongoing damage, there was a correlation between RH of materials and the concentrations of total spores and culturable fungi (r > 0.51), while such a relationship could not be observed for the samples taken from dry damage. A wide range of fungal species were found in the samples from ongoing damage, whereas Penicillia and in some cases yeasts dominated the fungal flora in the dry samples. This study indicates that fungal contamination can be evaluated on the basis of moisture measurements of constructions in ongoing damage, but the measurements are not solely adequate for estimation of possible microbial growth in dry damage.

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The presence of indoor allergens in Finnish homes was studied for the first time. Dust samples (n = 30) were collected by vacuuming a 1 m2 area from a living-room carpet in 30 apartments divided into three groups: homes with cats (n = 10), homes with dogs (n = 10), and homes without pets (n = 10). The levels of major cat (Fel d 1), dog (Can f 1), and house-dust-mite (Der p 1) allergens were analyzed by two-site ELISA methods. Der p 1 levels were below the detection limit in all dust samples. In the homes with cats or dogs, Fel 1 d and Can f 1 levels ranged from 147 to 2800 micrograms/g (geometric mean 296 micrograms/g), respectively, 567 micrograms/g), and from 86 to 1400 micrograms/g (geometric mean 296 micrograms/g), respectively, being slightly higher than those reported elsewhere. Low allergen levels, mainly below 3 micrograms/g were also detected in the homes without pets, indicating the transfer of allergens from place to place. However, in 25% of these samples, allergen levels exceeded the proposed threshold levels for cat or dog sensitization. The presence of pets was the most significant factor affecting cat and dog allergen levels in the house dust, and other factors, such as the amount of dust collected, residential time, and cleaning habits, had no or only a weak effect on allergen levels.

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Rheumatoid forefoot deformities were treated originally at the Rheumatism Foundation Hospital by metatarsal head resection (II-V) and resection of the base of the proximal phalanx of the great toe. Recurrent great toe deformity with pain in numerous cases led to a comparative series of arthrodesis of the first metatarsophalangeal joint with resection of lesser metatarsal heads. At an average followup period of 3 years, the clinical evaluation and patient assessments were slightly in favor of arthrodesis. However, the patients' evaluation at 14 years was slightly in favor of resection. Measured in the plane of the first metatarsophalangeal joint, the recommended fusion position is 15 degrees valgus and 30 degrees dorsiflexion (females) and 25 degrees dorsiflexion (males). The position of the fusion is critical for a successful surgical outcome. Although both surgical methods give good pain relief and patient satisfaction, there is a risk of reoperation in the long term.

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The degradation of 3H-thymidine under various cell culture conditions was analysed. It was found that a half of 3H-thymidine was degraded to 3H-thymine during 24 hours in PHA stimulation of blood lymphocytes. A control culture in which PHA was not added also caused 3H-thymidine degradation. 3H-thymidine degradation was prevented by adding 5-nitrouracil to the incubation medium at a concentration of 0.577 mg/ml. At the same time 5-NU increased 3H-thymidine incorporation into lymphocytes by 47%. 5-NU also eliminated the inhibitory effect of rheumatoid arthritis synovial tissue eluate on PHA stimulation. In addition 5-NU and nonradioactive thymine increased the 3H-thymidine labelling index of fresh rheumatoid arthritis synovial membrane biopsies, and also more of the isotope was accumulated in the individual cells of the membrane. These studies demonstrate that 3H-thymidine degradation is an important phenomenon in cell cultures and that it can be prevented effectively by using 5-nitrouracil with 3H-thymidine.

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One hundred and twenty definite or classical rheumatoid arthritis (RA) patients with an average duration of the disease of 12.1 years were studied. Sixty-two patients had distinct atrophy of the first dorsal interosseous of the hand without definite signs of carpal, cubital, or ulnar tunnel syndrome (group A); 43 patients showed neither distinct atrophy nor sensory disturbance of either hand (group B). Other patients had sensory and/or motor disturbances due to carpal, cubital, or ulnar tunnel syndrome and other neuropathies. Electrodiagnostic examinations revealed that there were differences in the distal latency to the first dorsal interosseous muscle from the wrist between 24 group-A patients and 14 normal controls (P less than 0.05), and between the group-A patients and 12 group-B patients (P less than 0.1). The results of this study indicate that some RA patients with atrophy of the thumb web space may have compression neuropathy of the most distal branches of the ulnar nerve.

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Synovectomy of II-V mtp-joints was performed on 33 feet in 28 patients. The average follow-up time was 15 months. The results were evaluated with respect to pain, radiographic changes, and the patients' own estimate. Radiographic appearances were compared with the unoperated joints in the other foot. The radiographic changes were also correlated with changes in the general activity of the disease.

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Tritiated-thymidine incorporating cells in synovial tissue samples from ten patients with definite or classic rheumatoid arthritis (RA) were studied by combining two techniques. Tritiated-thymidine-labelled cells were seen in autoradiography and simultaneously the subtype of them was determined with immunoperoxidase staining using monoclonal antibodies. Tritiated-thymidine-labelled cells comprised 0.8 +/- 0.4% of all the inflammatory cells in RA synovial membrane. Of all 3H-thymidine-labelled cells 34 +/- 17% were positive for OKT8 and 19 +/- 8% for OKT4 monoclonal antibodies. OKM1-positive cells comprised 7 +/- 3% of all 3H-thymidine labelled cells, whereas only a few (3 +/- 4%) of them were positive for pan-B monoclonal antibody. This study emphasizes the importance of activated OKT8 lymphocytes in RA synovial membrane.

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After the introduction of modern artificial joints the classical operation methods, such as osteotomies, arthrodeses and auto-arthroplasties, have been forced aside little by little. Irrespective of the late complications following replacement surgery, the patients today expect a movable, painless endoprosthesis, which at it best seems to benefit the patient. The question arises whether the classical methods still have a role in the surgical treatment of rheumatoid arthritis. The reply is "yes", they do have a fair share of rheumatoid surgery, indeed. They still compete with the modern endoprosthetic surgery for the place of the primary operation in many cases. To give instances, tarsal reconstruction by subtaloid arthrodesis is superior to other methods and arthrodesis of the wrist is often only reasonable way to get a strong, painless key joint to the hand. Even the shoulder arthrodesis may successfully compete with an endoprosthesis. Also classical auto-arthroplasties such as resection arthroplasties of the metacarpophalangeal and elbow joints are serious rivals of respective endoprostheses. The practice of Rheumatism Foundation Hospital (RFH) in the golden mean between the endoprosthesis enthusiasts and their opponents will be described in this article. The practice varies greatly from clinic to clinic and is progressing--and regressing--all the time.

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The acute-phase serum protein response induced by arthroplasty of the knee was compared with that induced by arthroplasty of the hip in patients with rheumatoid arthritis (RA). Total replacement of the knee (n = 13) caused a markedly greater serum amyloid A protein (SAA) (P less than 0.001) and C-reactive protein (CRP) (P less than 0.001) elevation that did total replacement of the hip (n = 13). This effect was not merely due to the use of tourniquet in the knee arthroplasties, since synovectomy of the knee, matched for the duration of the use of tourniquet, induced an SAA response that was significantly lower (P less than 0.001) than that caused by replacement of the knee; the SAA response after knee synovectomy was similar to that after hip arthroplasty. The kinetics and magnitude of the SAA response in patients with reactive amyloidosis were similar to those found in RA patients without amyloidosis. The results show that replacement of the knee is a stronger stimulator of SAA and CRP elevation than replacement of the hip. Thus, total replacement of the knee, possibly due to the performance of the arthroplasty under ischaemic conditions, appears to be more traumatic to the organism than total replacement of the hip.

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The purpose of this study was to determine whether any of a number of factors studied correlated with the incidence of postoperative infection in rheumatoid patients, which is regarded as high. Data relating to all early postoperative infections between 1975 and 1978, 136 cases in all, were analysed together with data relating to two control series, one matched for sex, age and operation type, the other randomly chosen. The infection rate overall was 1.7%. The type of antirheumatic medication used did not influence the incidence of infection. Unrelated post-operative infections in the past correlated with risk of infection. Highly significant differences in the incidence of infection between the various types of operation were demonstrated.

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The sequential changes in the concentration of specific serum proteins and their relation to amyloid A degrading activity were studied in ten patients with rheumatoid arthritis undergoing arthroplasty of the knee or hip. Serum amyloid A protein increased from a preoperative level of 78 +/- 20 gm/l (mean +/- SEM) to a peak level of 623 +/- 93 mg/l on the third postoperative day (P less than 0.001). The serum amyloid A protein response was greater than that of any other protein including C-reactive protein, to which it was closely related (r = 0.84, P less than 0.001). The concentrations of alpha 1-antitrypsin and alpha 1-antichymotrypsin were highest on the fourth postoperative day (mean changes + 35%, P less than 0.01, and +44%, P less than 0.05, respectively). Serum albumin, pre-albumin and alpha 2-macroglobulin behaved like negative acute phase reactants; the concentrations of albumin and alpha 2-macroglobulin were significantly decreased from the second to sixth and seventh postoperative days, respectively, and the concentration of pre-albumin was significantly decreased on the third and fourth postoperative days. A significant fall in the amyloid A degrading activity of serum occurred during the acute phase reaction. The degradative activity was lowest on the third and fourth postoperative days (P less than 0.001). The results show that the acute phase state in patients with rheumatoid arthritis induces a rise in the concentration of serum amyloid A protein, the putative serum precursor of tissue amyloid A fibrils, and a concomitant reduction in the ability of serum to degrade these fibrils. These factors together may be important in the development of inflammation-associated amyloidosis.

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Twenty-eight arthroplasties performed during a period of three and a half years during 1976-1980 were evaluated after an average follow-up period of 21 months. All patients had advanced rheumatoid arthritis. The Richard's prosthesis was used in 22, the ICHL prosthesis in five and St. George prosthesis in one instance. The results were in general satisfactory, particularly as to pain relief, yet there was only limited improvement in the actual range of movement. All ankles were stable: nevertheless loosening could be demonstrated radiologically and clinically in 5 out of 56 prosthetic components. No revisions have been warranted so far. In strictly selected cases, replacement arthropolasty seems a worthwhile alternative to arthrodesis in patients with severe rheumatoid arthritis in many weightbearing joints.

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Forty-one arthrodeses of the shoulder in thirty-nine patients suffering from rheumatoid arthritis (thirty women, nine men) have been reviewed. Using internal fixation and external splints the position of the shoulder was maintained in 55 degrees of abduction, 25 degrees of horizontal flexion and enough internal rotation to allow the patient to reach the mouth. The mean period of immobilisation in a thoracobrachial splint was nine weeks, and 90 per cent of the shoulders had solid bony fusion at review. After arthrodesis the total range of scapulothoracic movement improved by about 60 per cent, giving results rated as excellent in fifteen cases (36 per cent), as good in thirteen (32 per cent) and as fair in thirteen (32 per cent). Arthrodesis can be recommended as an easy, cheap and reliable method of treating a shoulder which has been severely destroyed by rheumatoid arthritis.

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The results of 59 Charnley low friction arthroplasties in 41 patients with juvenile rheumatoid arthritis are presented. Mean follow-up was 30 months and mean age at operation 30.5 years. At review 90 per cent had an excellent result and 10 per cent a good result as regards pain relief. Mobility was significantly improved in all but two patients. These two patients developed severe ectopic bone formation. With few exceptions, the results remained constant after 6 months. Intraoperative complications were the most common. Careful selection of patients, advance planning of surgery and appreciation of the developmental abnormalities in these hips are essential features in avoiding complications and achieving a good result.

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