The present study was designed to examine the effect of physical exercise on human natural killer (NK) cells. Six healthy volunteers underwent two different acute physical exercise tests with an interval of at least 1 week: (1) 60 min bicycle exercise at 80% of maximal oxygen uptake (VO2max) and (2) 60 min back-muscle training at up to 29% of VO2max; blood samples were collected before and during the last few minutes of exercise, as well as 2 h and 24 h afterwards. The NK cell activity (lysis/fixed number of mononuclear cells) increased during bicycle exercise, dropped to a minimum 2 h later and returned to pre-exercise levels within 24 h. Back-muscle exercise did not significantly influence NK cell activity. Plasma levels of adrenaline, noradrenaline, and cortisol were elevated during bicycling, but not during back-muscle exercise, indicating that exercise intensity is a determinant of NK cell activity. During bicycle exercise the NK cell subset (CD16- cells) of mononuclear cells increased significantly. Furthermore an improved interleukin 2 (IL-2) boosting of the NK cell activity was found during work as compared to IFN-alpha and indomethacin-enhanced NK cell activity. These results indicate that NK cells with a high IL-2 response capacity are recruited to the peripheral blood during exercise. The decreased NK cell activity demonstrated 2 h after work was probably not due to fluctuations in size of the NK cell pool, since the proportion of CD16+ cells was normal. The finding that indomethacin fully restored the suppressed NK cell activity in vitro and the demonstration of a twofold increase in monocyte (CD20+ cells) proportions 2 h after work, strongly indicate that prostaglandins released by monocytes during the heavy physical exercise are responsible for the down-regulation of the NK cells.

Patients with osteoarthrosis suffer from disability and pain. We measured isokinetic and isometric peak torque in 20 women with gonarthrosis (GA) and in 26 healthy controls. Relationships between muscle strength, walking and stair climbing time, pain level and pain disability scores as assessed by the patients using an extensive questionnaire, radiological changes and subchondral sclerosis expressed as bone mineral density (BMD, g/cm2) of the proximal tibia were studied. Precision errors of the torque measurements in both GA patients and controls were approximately 6%. In the GA patients, isokinetic and isometric quadriceps strength was reduced by 40 and 15% (p < 0.01) respectively, and walking and stair climbing time was increased by 30% (p < 0.005). Isokinetic strength was a better predictor of pain level and pain disability scores than isometric strength and radiological stage. Walking time and stair climbing time were not associated with quadriceps strength, pain level, pain disability scores or radiological changes. Subchondral BMD was not predictive of pain. The study suggests that quadriceps strength assessed by isokinetic dynamometry in GA is a reliable measurement. Isokinetic strength was pronouncedly reduced compared to isometric strength and was a more important predictor of pain and pain disability than isometric strength. These findings should be taken into consideration when planning exercise studies and programmes in GA.

In a double-blind trial intravenous aminophylline was compared with placebo in 79 patients with acute cerebral infarction. Immediate improvement in the neurological evaluation score was significantly more frequent in patients receiving aminophylline (38 per cent) than in those on placebo (15 per cent); only patients with mild or moderately severe strokes responded to the injection. After 3 weeks, however, the treated patients did not fare significantly better than the controls in terms of neurological score and residual disability. Survival rate, length of stay in hospital, and social readaptation were similar in the two groups. It is concluded that intravenous aminophylline in patients with ischaemic strokes can bring about an immediate symptomatic relief, but without appreciably influencing the ultimate recovery.

Regional bone mineral density (BMD, g/cm2) of the proximal tibia including the subchondral plate was measured in vivo by dual photon absorptiometry (DPA). Twenty-one women and six men with gonarthrosis (GA) were examined. Twenty-four healthy women served as controls for the women. The precision error of the BMD measurements ranged from 1.4-3.7% depending on the region measured. Subchondral BMD correlated significantly to the radiologic stage (P < 0.05). Compared to the controls, BMD of the subchondral plate, BMD of the medial condyle, the medial to lateral distribution ratio of subchondral BMD and the ratio between BMD of the subchondral plate and of the immediately underlying region were significantly increased in patients with predominantly medial GA (P < 0.05-0.0001). The BMD of the lateral condyle was lower in GA patients than in controls (P < 0.05). In patients with unilateral GA, the above-mentioned changes were found in the affected tibia compared to the normal knee in the same individual (P < 0.05). In contrast to any of the patients with varus deformity, the two patients with valgus deformity had higher BMD of the lateral condyle than of the medial. No differences in BMD of the distal forearm or the ultradistal region of the proximal tibia were found between the GA patients and the controls. The study shows that regional bone changes of the proximal tibia in GA can be measured precisely and noninvasively in vivo by DPA.

Background and purpose Over the last 5 years, there has been increasing interest in reducing length of hospitalization (LOS) through accelerated programs. We examined the clinical outcome of patients undergoing a unicompartmental knee replacement (UKR) in an accelerated care program (A group) compared to a conventional care program (C group).Methods 40 patients randomized into 2 groups were included (A group: 17 patients; C group: 23 patients). Nausea, micturition problems, lower limb dysfunction, pain (VAS), opiate consumption, Knee Society score (KSS), day of discharge, rehospitalization within 3 months, contact with a general physician or nurse, and level of satisfaction were registered. Patients in the A group attended an information meeting. An intraarticular infiltration with Marcaine and adrenaline was used peroperatively. Patients in the C group had an epidural pump for 2 or 3 days. Patients in the A program were treated with NSAID and paracetamol postoperatively. Opiates were used in both groups in the case of breakthrough pain. The patients were considered ready for discharge when they were able to climb stairs to the second floor within 5 min.Results The median length of stay was 1 (1–3) day in the A group and 6 (4–7) days in the C group. The median pain score (VAS) at day 0 was 1 (0–3) in the A group and 5 (0–8) in the C group (p < 0.001). 11/23 of the patients in the C group had weakness of the lower limbs on day 1 due to the epidural; all patients in the A group were exercising on the day of the operation. Micturition problems necessitating intermediate catherization were more frequent in patients in the C program (19/23) than in patients in the A programme (3/17) (p = 0.001). There were no statistically significant differences between the two groups concerning nausea, average pain on days 1 and 2, use of opioids (during the first week postoperatively), KSS, contact with primary sector, level of satisfaction, or level of confidence.Interpretation We achieved a reduction in LOS of 5 days without affecting the clinical outcome.

Forty patients with definite or classical active rheumatoid arthritis were stratified by the minimization procedure to auranofin (6 mg/day) or penicillamine (go slow and low regime). This investigation is a prospective planned 3 year patient and 'doctor-open' as well as 'doctor-blind' clinical trial. This article describes the results after 12 months. Both drugs decreased disease activity and improved the functional capacity in a similar way. Two patients in the auranofin group and 5 in the penicillamine group stopped treatment due to major side effects. Four other patients in the auranofin group left treatment: 2 due to death from unrelated cause and 2 according to the Helsinki II Declaration. After one year a further patient in the auranofin group and 2 in the penicillamine group stopped treatment due to lack of clinical effect. Side effects due to auranofin were statistically more frequent distal in the gastrointestinal tract (loose stools/diarrhoea) than with penicillamine. In contrast, penicillamine produced significantly more side effects in the oral cavity (mainly taste disturbances) than auranofin. Other side effects were about equal in the two groups, but 2 cases of severe proteinuria and one with obstructive lung disease were observed in the penicillamine group. Only 3 patients did not complain of any untoward effect during the 12-month period. We conclude that on the basis of this one year investigation it is an open question whether one should select auranofin or penicillamine for the treatment of clinical active rheumatoid arthritis.

It is well known that there is a relationship between muscle strength and bone density, but it is uncertain whether this relationship is site specific. The aim of this study was to assess the relationship of quadriceps strength to site-specific bone mineral density (BMD) of the tibia and to BMD of the forearm. In 66 healthy women, aged 21-78 years, BMD was measured in the proximal tibia and the distal forearm by dual-photon absorptiometry. Isometric and isokinetic strength of the quadriceps was measured using an isokinetic dynamometer (Cybex II). Highly significant correlations between BMD of the proximal tibia and quadriceps strength were found (RS ranging from 0.79 to 0.84, p < 0.0001). Also, BMD of the distal forearm was correlated with quadriceps strength (RS ranging from 0.59 to 0.62, p < 0.0001). In a stepwise multiple regression analysis, quadriceps strength was a better predictor of tibial BMD than age, body height, or weight. However, age, height, and weight were more predictive of forearm BMD than quadriceps strength. When studying the pre- and postmenopausal women separately, quadriceps strength was correlated with BMD of the proximal tibia but not to forearm BMD. In conclusion, the study provides support for a site-specific relationship between muscle and bone.

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