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Biomedical subjects

S Jonsson

Publications and source records attributed to S Jonsson.

At least 19 recordsLinked to original sources

Elderly patients' responses to preoperative autologous blood collection.

OBJECTIVE: To follow the haematological response in elderly patients to preoperative autologous blood collection. DESIGN: A prospective, randomised study. SETTING: Malmö General Hospital, Sweden. PATIENTS: Sixty patients with a mean age of 71 years (range, 60-82 years) who were to undergo total hip replacement were randomly divided into four groups of 15. One group served as control. Three units of blood were collected from patients in the other three groups, the first unit at least 30 days before the planned operation, with an average interval of 10 days between collections. Iron supplementation was given to one group as a substitution remedy, another group was given iron and folic acid and the third group was without supplementation during the collection period. MAIN OUTCOME MEASURES: Haematological and biochemical tests were performed on blood samples taken at the time of each collection, on the morning of the hip replacement operation, and ten days after and six weeks after the operation. RESULTS: No major complication was encountered with blood collection. The patients tolerated the procedure very well including the substitution remedies. Haematological and biochemical parameters remained within the normal range during the collection period and after the operation. No patient in the autologous groups needed homologous blood during the operation; three units of homologous blood were used after the operation in these patients. CONCLUSION: Preoperative blood collection from the elderly is safe and well tolerated. The procedure should be encouraged in elective orthopaedic operations regardless of age.

Aged

Reduced concentrations of galanin, arginine vasopressin, neuropeptide Y and peptide YY in the temporal cortex but not in the hypothalamus of brains from schizophrenics.

Postmortem investigations were performed in brains from 14 schizophrenic patients and 21 controls matched for age and autopsy latency. Concentrations of galanin, delta-sleep-inducing peptide (DSIP), corticotropin-releasing factor (CRF), arginine vasopressin (AVP), neuropeptide Y (NPY) and peptide YY (PYY) were determined in the hypothalamus and grey matter from the temporal cortex. A significant positive correlation between age and the concentrations of galanin and CRF was found in the controls. No sex differences were found except a higher mean of CRF in the hypothalamus of the women. In the temporal cortex of the schizophrenic brains, galanin, AVP, NPY and PYY were significantly reduced. DSIP reduction only bordered on significance. CRF was not reduced. Comparing neuroleptic-treated vs non-treated schizophrenics, the treatment factor could not explain the reduced concentrations of neuropeptides in the temporal lobe. A comparison of controls with schizophrenics showed no significant differences in hypothalamic neuropeptide concentrations.

Age Factors

Predonation autologous blood in hip arthroplasty.

In a prospective randomized study of elderly patients, a total of 130 units of blood were donated by 45 patients prior to a total hip arthroplasty. Fifteen patients served as controls (no phlebotomy). The average age was 71 (60-82) years. No major complication occurred with phlebotomy. All the patients were able to maintain their hematologic and chemical parameters within the normal range throughout the donation period. The autologous blood covered all the peroperative transfusion needs and 97 percent of the total transfusion requirements. There was less postoperative blood loss, as well as total blood loss, in the autologous groups compared with the control group. There was no difference in the rate of postoperative complications between the groups. The use of predeposited autologous blood in elective orthopedics, regardless of patient age, is feasible, cost effective, and avoids the risks associated with homologous blood transfusion.

Age Factors

IgG subclass response and opsonization of Streptococcus pneumoniae after vaccination of healthy adults.

Studies relating opsonization and IgG antibodies to Streptococcus pneumoniae have yielded contradictory results. This study compared changes in opsonization with IgG subclass response after vaccinating healthy subjects with a 23-valent pneumococcal vaccine. Total IgG and IgG subclass antibodies to pneumococcal polysaccharide types 8, 9, and 19 were measured by ELISA. Opsonic activity was assayed using 3H-labeled bacteria and polymorphonuclear leukocytes in different serum concentrations (5%-40%). A substantial postvaccination increase in total and subclass IgG antibody was observed in most subjects, although variations were seen. Postvaccination sera generally gave rise to enhanced opsonization, and a correlation was found between increases in antibody levels and opsonization. This correlation was closest for IgG1 and IgG4 and generally strongest at the lowest serum concentration, but weak or absent at the highest concentration. Thus, vaccination against S. pneumoniae stimulates a variable increase in specific opsonic activity in health persons that is best demonstrated when serum is a limiting factor in the opsonin assay.

Adult

Phagocytosis and killing of Haemophilus influenzae by alveolar macrophages: no difference between smokers and non-smokers.

The susceptibility of smokers to pneumonia caused by Haemophilus influenzae may result from impairment of phagocytic or bactericidal function of pulmonary alveolar macrophages (PAM). We compared ingestion and killing of non-typable H. influenzae and H. influenzae type B by alveolar macrophages from asymptomatic smokers and non-smokers. Three times as many cells were recovered from bronchoalveolar lavage of smokers. Non-typable H. influenzae (NTHI) were phagocytosed and killed readily by PAM from both groups of subjects, while H. influenzae type B were resistant to phagocytosis. No difference in uptake of bacteria was detected between PAM of smokers and non-smokers. PAM from smokers had a slightly greater bactericidal activity than PAM from non-smokers. These results suggest that other host factors, such as impaired tracheobronchial clearance or the presence of conditions that favor bacterial growth rather than damage to alveolar macrophages, are responsible for the susceptibility of smokers to Haemophilus infections.

Adult

Natural and vaccine-related immunity to Streptococcus pneumoniae.

To investigate the protective effects of pneumococcal vaccine, we assayed serum from healthy adults and from elderly bronchitics for antibody and opsonic activity against nine serotypes of S. pneumoniae. Before vaccination, there was no relation between opsonization and the level of antibody measured by RIA. Some serotypes were well opsonized in the absence of detectable antibody to capsular polysaccharide; others were not, despite modest levels of antibody. These in vitro studies did not support the concept that a certain level of antibody (e.g., greater than or equal to 250 ng of antibody nitrogen/ml) was specifically associated with the capacity to opsonize pneumococci. Nearly all postvaccination sera had increased antibody and opsonic activity against all serotypes, but the lack of correlation in any individual serum persisted. RIA showed that pre- and postvaccination levels of antibody in elderly adults with chronic lung disease were similar to those of younger adults. In elderly bronchitics, opsonizing activity for six of the nine serotypes was lower after vaccination, a result of suggesting a possible explanation for the failure of pneumococcal vaccine to be fully protective in these subjects. Elderly subjects had higher levels of antibody to phosphocholine, but when isolated, this antibody did not opsonize any of the vaccine strains of pneumococci. These results suggest that alternative strategies are needed to maximize the protective effect of pneumococcal vaccine in the population at greatest risk.

Adult

Human alveolar lining material and antibacterial defenses.

To investigate the possible antibacterial properties of human alveolar lining material (ALM), we obtained ALM and pulmonary alveolar macrophages (PAM) by bronchoalveolar lavage of healthy nonsmokers. Alveolar lining material was isolated by centrifugation or micropore filtration; electron microscopy revealed lamellar bodies, and lipid analysis showed that 98% of the lipid fraction was phospholipid. No free fatty acids were detected. Streptococcus pneumoniae and non-typable Haemophilus influenzae (NTHI) died spontaneously in PBS at a mean rate of log10 0.75 and 0.95 in 90 min, respectively; the addition of ALM appeared to exert a slight protective effect, and at higher concentrations supported replication of NTHI. There was no difference in the uptake of the bacteria by PAM when ALM was present. Phagocytosed NTHI were killed rapidly and completely within 60 min by PAM with or without ALM. A greater proportion of S. aureus were killed by PAM alone than in the presence of ALM. Alveolar lining material from healthy humans thus appears to have no demonstrable effect on host defense against these bacteria. The differences between our results and those of earlier studies using ALM from rats may relate to interspecies differences in the composition of ALM.

Cholesterol

Recurrent Nocardia pneumonia in an adult with chronic granulomatous disease.

The diagnosis of chronic granulomatous disease was made for the first time in a young adult when he presented with Nocardia asteroides pneumonia. Treatment with trimethoprim/sulfamethoxazole for 10 wk brought about an apparent cure of the infection. Two and one half years later N. asteroides pneumonia recurred and resulted in death from respiratory failure. Antibiotic susceptibility studies suggested that both episodes were caused by the same organism. This suggestion was supported by endonuclease restriction analysis, which showed that the plasmids from both Nocardia isolates were identical. Late recurrence of pneumonia caused by N. asteroides occurs only rarely. In this patient, recurrent infection appeared to be related to persistence of colonizing organisms in the host.

Adult

Development of bactericidal antibody during Branhamella catarrhalis infection.

The recent observation that Branhamella catarrhalis may cause a variety of infections in humans has stimulated interest in human host defenses against this organism. We encountered 21 patients with B. catarrhalis infection: seven with pneumonia, 13 with a purulent exacerbation of chronic bronchitis, and one with purulent sinusitis. Normal human serum (NHS) demonstrated no bactericidal activity against 20 of the 21 isolates. In contrast, 7 of 19 acute and 18 of 20 convalescent sera demonstrated significant bactericidal effects against the corresponding B. catarrhalis isolate. Heating convalescent sera to 56 C for 30 min abolished bactericidal activity. This activity was restored by NHS but not by complement-rich guinea pig serum. Selective blockage of the classic complement pathway eliminated bactericidal activity, whereas selective blockage of the alternative pathway did not. IgG isolated from convalescent serum plus NHS was bactericidal for the corresponding B. catarrhalis isolate. These results suggest that most patients with pulmonary infections due to B. catarrhalis develop a convalescent IgG antibody response that mediates serum bactericidal activity by the classic complement pathway.

Acute Disease

Phagocytosis and killing of common bacterial pathogens of the lung by human alveolar macrophages.

To investigate factors that determine susceptibility of the lungs to infection with common respiratory pathogens, we studied phagocytosis and killing of nontypable Haemophilus influenzae, H. influenzae type b, Streptococcus pneumoniae types III, VI, and XIV, an unencapsulated variant of S. pneumoniae type III, and Staphylococcus aureus Cowan I, by using human alveolar macrophages obtained by bronchoalveolar lavage of healthy nonsmokers. After opsonization with 10% pooled human serum, mean uptake (+/- standard deviation) of nontypable H. influenzae (67.5% +/- 15.0%), unencapsulated S. pneumoniae type III (71.2% +/- 4.8%) and S. aureus (79.1% +/- 10.2%) was significantly greater (P less than .01) than that of H. influenzae type b (40.1% +/- 15.0%), and S. pneumoniae types III (4.4% +/- 3.1%), VI (11.8% +/- 9.6%), or XIV (8.7% +/- 7.0%). Nontypable H. influenzae was ingested after opsonization with much less pooled human serum than was H. influenzae type b, and uptake of encapsulated S. pneumoniae was not enhanced by as much as 80% pooled human serum. Intracellular killing of unencapsulated S. pneumoniae type III and nontypable H. influenzae was rapid and complete and corresponded to the degree of phagocytosis, but despite a high uptake, S. aureus were killed slowly and incompletely. The virulence of S. pneumoniae and H. influenzae as lung pathogens is thus determined jointly by encapsulation and the inadequate opsonizing effect of normal human serum, whereas that of S. aureus may be related to the organism's relative resistance to intracellular killing by alveolar macrophages.

Antibodies, Bacterial

Specific absorption of human serum albumin, immunoglobulin A, and immunoglobulin G with selected strains of group A and G streptococci.

Five gram-positive bacterial strains were selected for absorption studies of human serum samples. Strain AR1 (group A, M-type 1) and G148 (group G), with strong immunoglobulin G (IgG) binding capacities, and strain AW43 (group A, M-type 60), binding both IgA1 and IgA2, were compared with Staphylococcus aureus Cowan I and with Staphylococcus epidermidis L603. Both AR1 and G148 were capable of completely absorbing out serum IgG. In contrast, S. aureus Cowan I left a fraction unabsorbed, as expected from its known lack of IgG3 binding. Strain AW43 absorbed out all serum IgA, using a 10-microliter bacterial pellet for 20 microliter of serum. Serum IgM levels were slightly reduced by S. aureus Cowan I absorption. On the basis of the experiments, a bacterial mixture was designed consisting of S. aureus Cowan I and group A streptococcus strains AR1 and AW43, with absorption characteristics suitable for use in discriminating between early IgM and late IgG and IgA immune responses in routine serological work. A new type of bacteria-mammalian protein binding was discovered. Human serum albumin was completely absorbed out by strain G148 and to a lesser extent by strain AR1 and AW43. S. aureus Cowan I and S. epidermidis were negative. The binding capacity of G148 for albumin equalled that of Cowan I for IgG. The binding pattern of albumin to the strains was different from those of IgG, IgA, IgM, fibrinogen, haptoglobin, or aggregated beta 2-microglobulin and therefore seems to represent another type of bacterial-mammalian interaction with a specific albumin receptor on the surface of streptococci.

Absorption

Non-equilibrium enzyme immunoassay of gentamicin.

We describe a fast, accurate non-equilibrium enzyme immunoassay for serum gentamicin. With use of isokinetic conditions an assay takes a total of 12 min, including regeneration of the immunosorbent. The coefficient of correlation between the present method and conventional microbiological assays was 0.98.

Catalase