Læknaneminn - 01.10.1995, Blaðsíða 140

ABSTRAKTAR
treatments, as some cancers overexpress the bcl-2 gene through
translocation. Also the research might provide insight into the role of
NO in DNA damage and carcinogenesis. Furthermore, it may
contribute to the steady flow of new information regarding the role and
mechanism of BcI-2 in the apoptotic process. It could thus help to
elucidate the esoteric balance between life and death in which cells
perpetually exist.
I»VAGLEKI OG ÞVAGFÆRASÝKINGAR
HJÁ KONIJM Á ALDRINUM 70-89 ÁRA.
Lilia Þ. Biörnsclóttir1.
Pálmi V. Jónsson 1,2, Reynir T. Geirsson
1 LHl, 2Öldrunarlœkningadeild Borgarspítalans , 3Kvennadeilci
Landspítalans.
Lykilorð: urinaiy incontinence, urinary tract infection, estrogen
replacement therapy.
Inngangur: Stór hluti gamalla kvenna er með þvagleka og
þvagfærasýkingar meðal annars vegna aldurstengdra breytinga í
þvagfærum. Konum er mun hættara við þessu en körlum vegna stuttrar
þvagrásar og skaða eftir barnsburð, en lækkun östrógena í blóði eftir
tíðahvörf eru einnig talin hafa áhrif. Meðal elstu kvenna hafa þessi
vandamál aðeins verið könnuð í takmörkuðum mæli.
Efniviður og aöferðir: Viðtal var tekið við 120 konur varðandi
þvagleka og óþægindi frá þvag- og kynfærum og upplýsingar um
þvagfærasýkingar og östrógenlyf voru fengnar úr sjúkraskrám á
clliheimilunum og heilsugæslu. Konurnar voru á aldrinum 70-89 ára,
70 bjuggu á elliheimilum og 50 í heimahúsum.
Niðurstöður: Alls voru 47.5% kvennanna með þvagleka og 23%
láku daglega eða oft á dag. Bráðaleki var algengastur (39%), því næst
blandleki (32%) og loks áreynsluleki (26%). Bráða- og blandleki ollu
marktækt meiri óþægindum en áreynsluleki. Af konunum höfðu 35%
fengió þvagfærasýkingu síðastliðin tvö ár og 11% fengið > 5 sýkingar.
Mestur fjöldi einstakra sýklalyfjakúra var 22 og þrjár konur voru
samfleytt á sýklalyijum. Konur með þvagleka fengu marktækt oftar
sýklalyf en þær sem ekki láku. Á östrógenmeðferð voru 27 konur, oftar
þær sem dvöldu á stofnunum (p<0.001). Konur á östrógenmeðferð voru
marktækt oftar með þvagleka, þvagfærasýkingar og önnur óþægindi en
aðrar konur. Talsverö eða mikil óþægindi frá þvag- og kynfærum voru
hjá 21% kvennanna en hjúkrunarfræðingar töldu þaö hlutfall vera 30%.
Þriðjungur kvennanna, marktækt fleiri inni á elliheimilum, höfðu rætt
um þvagfæraóþægindi við lækni eða hjúkrunarfræðing nýlega.
Efnisskil: Þvaglekavandamál eru algeng meðal elstu kvenna á
íslandi og þau eru undirmeöhöndluö. Östrógenlyf eru helst notuð hjá
þeim sem eru meö mikil vandamál. Ástæöa er til að ætla aö læknar geti
bætt meðferðina með forvörnum, virkri eftirgrenslan eftir einkennum
og aukinni greiningarvinnu og þannig bætt lífsgæði elstu kvenna.
EVALUATION OF A SOLID-PHASE IMMUNOASSAY
FOR THE DETECTION OF IgAl PROTEASE-PRODUCING
BACTERIA FROM BIOLOGICAL SAMPLES
Margrét Agnarsdóttir'.
Mogens Kilian2, Jesper Reinholdt2.
'LHÍ, 2Department ofMedical Microbiology and Immunology,
Bartholin Building, University of Aarhus, DK-8000 Árhus C,
Denmark.
Introduction: IgA is one of the five immunoglobulin isotypes
found in humans and is the principal mediator of humoral immunity at
mucosal membranes. There are two subclasses of IgA, IgAl and IgA2.
A 13 amino acid insert in the hinge region of the IgAl molecule
includes the susceptible sites for certain extracellular bacterial
endopeptidases called IgAl proteases which cleave the IgAl molecule.
The IgAl proteases are produced by a limited group of bacteria that
successfully colonize or infect mucosal membranes of humans and have
been proposed to be an important virulence factor of these bacteria.
Previous studies of the prevalence of IgAl protease-producing bacteria
in biological samples have been based on isolation and identification of
a large number of bacterial isolates followed by detection of enzyme
activity by immunoelectrophoresis. The initial aim of the research was
to apply a solid-phase immunoassay developed by Brown and Leak
(1988) to the examination of biological samples collected from the nose
to determine to proportion of IgAl protease-producing bacteria.
Materials and methods: Substrate IgAl purified from plasma of
a myelomatosis patient was coupled to Fractogel beads which were
suspended in agarose poured over an agar plate with growing bacterial
colonies. A nitrocellulose disk coated with rabbit anti-Iight chain
antibody was placed on top of this agarose layer. During subsequent
incubation, Fab fragments released from the bound substrate, by the
activity of IgAl proteases excreted by bacterial colonies, became bound
the anti-light chain antibodies. These fragments were then visualized
using biotinylated anti-light chain antibody, streptavidin conjugated to
alkaline phosphatase, and a chromogenic enzyme substrate. As the
Immunobeads employed by Brown and Leak are no longer available
each step of the assay was carefully evaluated. The evaluation
experiments included demonstration of the cleavage susceptibility of
IgAl bound the the beads, optimization of reagents and incubation
periods, and estimation of specificity and sensitivity of the assay using
comparisons with the immunoelectrophoresis technique. After
evaluation the assay was applied to the examination of nasal rinses.
Serial dilutions of nine nasal rinses were spread on three different agar
media: blood agar for determination of total counts, and selective media
for streptococci and Haemophilus species, respectively. Froni each
individual selected plates of each of the three agar types were tested
with the assay.
Results: The evaluation experiments revealed that the Fractogel
beads can be employed in the assay. The specificity of the assay was
high whereas the comparison of results obtained by the assay and the
traditional immunoelectrophoresis method demonstrated problems with
sensitivity. Some colonies recorded as negative by the plate assay were
positive by the immunoelectrophoresis assay. The proportion of IgAl
protease-producing bacterial colonies on the blood agar plates ranged
from 19% to 100% of the total amount of bacterial colonies counted.
Two individuals showed growth of Haemophilus species on the
chocolate agar plates but none of them produced IgAl protease. Five
individuals showed growth of streptococci on the selective medium.
Two contained IgAl protease-producing streptococci, 58% in one case
and all the colonies in the other case.
Discussion: The solid-phase immunoassay was originally
developed to aid detection of IgAl protease positive colonies in
biological samples but has not been employed in large-scale
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