Non-Hodgkin's lymphoma in northern Sweden. A retrospective analysis of morphologic diagnosis and stage in a material from the Swedish Cancer Registry

Morphologic diagnosis and clinical stage were studied in a retrospective material of non-Hodgkin's lymphomas comprising 352 patients diagnosed 1978 until 1982 and reported to a regional cancer registry. Classification was made according to the original Kiel classification. Patients who could be classified as belonging to low- (46%) or high-grade (47%) malignancy groups (n = 337) were further studied. The median age was high, 65 years, which probably reflects the low degree of selection in a regional register material compared to most hospital register-based materials. The proportion of stage I cases was rather high, in low-grade lymphomas 24%, and in high-grade 39%, which can be attributed to incomplete staging procedures in old patients. The aim of the study was to illustrate the distribution according to morphologic subclasses and clinical features in a material with a low degree of patient selection.

Non-Hodgkin's lymphoma in northern Sweden. Prognostic factors and response to treatment

A total of 352 cases of non-Hodgkin's lymphoma reported to the Cancer Registry of Northern Sweden during 1978-1982 were retrospectively analysed. After morphologic review, 327 cases classifiable as low (n = 162) or high-grade (n = 165) according to the Kiel classification remained for further study. The purpose of the study was to evaluate the interrelations between some variables and their bearing on prognosis in an almost unselected clinical material. Age, morphological grade of malignancy, clinical stage, systemic symptoms, bulk of disease and serum lactate dehydrogenase (LDH) level turned out to be associated with the clinical outcome in terms of response to treatment, disease-free survival and survival. In the heterogenous group of low-grade lymphoma, six pretreatment characteristics were negatively associated with survival in a univariate analysis, namely; stage II-IV, systemic symptoms, bone marrow infiltration, two or more extranodal sites, elevated LDH and age above 65 years. In high-grade lymphoma, stage II-IV, bone marrow infiltration and elevated LDH predicted a worse prognosis in a multivariate analysis. The impact of the number of these prognostic factors on survival in high-grade lymphoma was demonstrated.

Lengthening of anterior cruciate ligament graft. Roentgen stereophotogrammetry of 32 cases 2 years after repair

32 patients with old anterior cruciate ligament injuries were operated on with patellar tendon-prepatellar tissue-quadriceps tendon graft over the top without and with augmentation (Kennedy-LAD). The anteroposterior (AP) laxity was assessed preoperatively, and at 6, 12, and 24 months after the operation with roentgen stereophotogrammetry. 6 months postoperatively the instability had decreased 5.4 mm in the nonaugmented and 1.9 mm in the augmented group, but not to normal values. During the following 18 months the AP laxity increased and returned to the preoperative level. At 2 years, 28 of the 32 patients were considered good or excellent, according to the Lysholm score. There was a lack of correlation between AP laxity and functional tests.

Clusters in a cohort of untreated schizophrenia: prognostic importance, atypical cases and the familial versus sporadic distinction

In search of features of prognostic importance, a cohort of patients admitted to a mental hospital in 1925 was investigated by means of multivariate clustering techniques. Using K-means cluster analysis or Q-factor analysis, a group containing cases with unfavourable prognosis was isolated. Other groups derived were prognostically heterogeneous. One group of patients, in early phases similar to good prognosis schizoaffective psychoses, could be distinguished and characterized by non-symptom items. There was initial periodicity and onset was acute. They were, on average, younger than the other subjects and there was no personality deviation or emotional disturbance before onset of disease. A family history of mental illness was rare. Two of the factors were positively and negatively characterized by items covering familial history of mental illness, thus seemingly confirming the familial vs sporadic distinction in the subclassification of schizophrenia. Though the clinical pictures were distinctively different at the time when the ratings underlying the analysis were made, approximately the same proportion of cases in the two groups had independently been diagnosed as paranoid schizophrenia--also taking the course of illness into account. It could furthermore be shown that the population at risk--siblings and children of subjects--as well as the observed number of years at risk in these groups were significantly smaller in the sporadic group than in the familial group. This was a combined effect of a lower fertility in subjects and parents in the sporadic group and a higher rate of drop out due to mortality and other reasons among siblings of these subjects. The same tendency was indicated when subjects with and without family history irrespective of factor belongingness were compared. It cannot be concluded that the familial vs sporadic distinction is without relevance in the research on schizophrenia, but its essence may easily be obscured, if the population at risk is not taken into account.

Posterior reduction of a pathologic spinal fracture. A case of indirect anterior dural decompression

In a patient with paraparesis resulting from a pathologic fracture of Th9, which was due to a breast cancer metastasis, indirect anterior decompression via posterior reduction was performed. The rationale for the operation technique was the similarity between a pathologic fracture of the thoracolumbar spine and a traumatic burst fracture. The method, which uses a transpedicular reduction and fixation device, is substantially less invasive than a formal anterior decompression.

'Aggressive' low grade lymphocytic lymphomas can be identified by flow cytometric S-phase determinations

Forty-five patients with low grade non-Hodgkin's lymphomas were studied with respect to the fraction of S-phase cells in fresh tumour material by flow cytometric analysis. Patients with stage I lymphomas were treated with radiotherapy, patients with stage II-IV lymphomas with Prednimustine (Sterecyt). Patients with lymphocytic lymphomas of CLL type were only treated if they had symptoms. Median S-phase fraction in the samples was 2.0 per cent. A significantly shorter survival was found for patients with lymphocytic lymphomas with S-phase fractions > 2.0 per cent compared with cases showing lower S-phase fractions. No significant difference in survival was found in the subgroups of immunocytic or follicular and follicular/diffuse centroblastic/centrocytic lymphomas. In a Cox multivariate analysis, in which also age, constitutional symptoms, stage and morphology were included, the fraction of S-phase cells was found to be a statistically significant, prognostic parameter for low grade lymphomas, mainly due to the result in the subgroup of lymphocytic lymphomas.

Outcome in untreated schizophrenia: a search for symptoms and traits with prognostic meaning in patients admitted to a mental hospital in the preneuroleptic era

A cohort of schizophrenic patients consecutively admitted to a mental hospital for the first time in 1925 was investigated in search of symptoms and traits with prognostic meaning. Since Leonhard's diagnostic system was applied, cases with mixed symptoms and a favourable outcome were excluded as being neither schizophrenic nor manic-depressive. Owing to the admission policy then prevailing, cases with clinically less striking and socially less deleterious features were underrepresented. The sample (n = 70), so demarcated, was still considered fairly appropriate for the purpose of a differential study of outcome in nuclear schizophrenia with a life-long follow-up. The best outcome group consisted of 33% of the sample; 24% formed an intermediate group, and 43% profoundly deteriorated with continuous psychotic symptoms and a total loss of social function. Marriage before index admission was the only characteristic related to a favourable outcome. Nuclear schizophrenic symptoms, thought disturbance, blunted affect and all catatonic symptoms listed in DSM-III were related to an unfavourable outcome. When prognostic subgroups were compared pairwise, no favourable trait was detectable, and there were no decisive differences between the group with the best outcome and the intermediate group. When these 2 groups were compared with the group with worst outcome, however, significant differences arose with respect to unfavourable characteristics. Predictions using a discriminant analytic procedure yielded the same results. The hypothesis that affective and atypical signs would also have prognostic meaning in nuclear schizophrenia was disproved.

Molecular characterization and expression of a gene encoding a Staphylococcus aureus collagen adhesin

Some strains of Staphylococcus aureus bind collagen with a high degree of specificity and affinity. This interaction can represent a mechanism of substrate adhesion and may be an important step in the pathogenesis of osteomyelitis and infectious arthritis. We now report on the cloning, sequencing, and expression of a gene name cna, encoding a S. aureus collagen adhesin. The cna gene was isolated from a lambda GT11 S. aureus genomic library and encodes an 1185 amino acid polypeptide. The deduced amino acid sequence reveals several structural characteristics similar to previously described Gram-positive bacterial cell surface proteins. Antibodies raised against the native collagen adhesin from S. aureus recognize the recombinant collagen adhesin. Collagen binding activity can be detected in a lysate obtained from Escherichia coli cells, which harbor the cloned cna gene on an expression plasmid. Collagen-binding proteins can be detected in the lysate when analyzed by a Western blot type assay in which the membrane-transferred proteins are probed with radioactively labeled collagen. Finally, the bacterial lysate containing the recombinant adhesin can effectively inhibit the binding of soluble collagen to cells of S. aureus.

The concept of cycloid psychosis: the discriminatory power of symptoms

Records of all 154 psychotic patients first admitted to a psychiatric hospital in 1925 were rated according to a checklist of 33 dichotomous items expected to characterize cycloid and schizoaffective psychosis; 64 cases satisfied 5 or more items. Among them, 34 were globally judged as cycloid and showed a favourable outcome when followed up. The remaining 30 cases were used as a contrast sample, consisting of schizoaffective psychotics with an unfavourable outcome and schizophrenics and affective patients who shared some symptoms with the experiment group. Six symptoms significantly more frequent in the cycloid group were all characteristic for confusional and anxiety or happiness psychoses in the sense of Leonhard. Happiness-ecstacy and global altruism were exclusively recorded in cycloid psychosis. A discriminant analysis yielded a significant proportion of correct predictions. The result was thought to be relevant for differential therapeutic strategies.

Trends in cancer incidence, survival and mortality in northern Sweden 1960-1986

The impact of cancer on a population may be measured in several ways. Incidence, relative survival and mortality are frequently utilized for this purpose. Incidence and relative survival are, however, often influenced by changes in the diagnostics of incident cancer, particularly by an altered rate of detection of non-fatal cancer. Mortality, as traditionally studied, is often influenced by changes of death causes diagnostics or of coding routines. In an attempt to overcome some of these difficulties, the concept of excess mortality was suggested, which is independent of death cause diagnoses or coding routines, as well as of the rate of detection of non-fatal cancer. In order to elucidate time trends in the overall effects of cancer we analysed incidence, survival and mortality from all cancer in the northern region of Sweden 1960-1986. An increasing age-adjusted cancer incidence was paralleled by an improvement in relative survival, whereas age-adjusted cancer mortality was mainly unchanged, at least when studied as excess mortality. We interpreted these findings as due mainly to an increased detection of non-fatal cancer, and to an unchanged occurrence rate of fatal cancer.

The concept of cycloid psychosis: sensitivity and specificity of syndromes derived by multivariate clustering techniques

A total of 154 patients admitted for the first time to hospital for a psychotic or affective disorder in 1925 were rediagnosed in accordance with DSM-III and Leonhard's diagnostic system. Symptoms were rated in accordance with a rating protocol containing 33 items based on Leonhard's descriptions of cycloid psychoses. The patients were followed up through parish registers and hospital records. Of 42 cases considered to be cycloid psychosis at index admission, 34 were prognostically verified. The symptom ratings of the 154 patients were analysed by K-means cluster analysis to test whether the patients with cycloid psychoses would separate from the rest of the material. With a 2-cluster solution, 30 of 34 cases (88%) were contained in the same cluster. The sensitivity of the ratings was therefore judged to be acceptable. Specificity was low, however, since 19 cases in the cluster were differently diagnosed. A subcohort of 64 patients, satisfying at least 5 items of the rating protocol, was then analysed by Q-factor analysis to test whether nuclear cases of cycloid psychosis differ from symptomatically related syndromes. No such differences could be statistically verified; no symptom profile specifically indicating cycloid psychosis could be found. Prominent confusion symptoms appear, however, to be prognostically favourable, whereas motility symptoms without confusion seem to indicate an unfavourable course.

Predicting long-term outcome in schizophrenia

Prediction of 14- to 17-year outcome from symptoms present at admission and psychological and personality data was attempted among the 92 survivors of a group of 110 first-admitted schizophrenic patients. Three different outcome criteria were used and the correlations between these varied from low to high. Using a discriminant analytical approach where all 107 predictor variables were used to predict a combination of outcome criteria, 23% of outcome variance could be explained, which should be compared with 49% in a previous 5- to 9-year outcome study on the same material. At least one outcome variable--economic self-support--could not at all be predicted. "Atypical" symptoms were associated with favourable outcome and longitudinal variables indicative of "high-risk personality", or duration and severity of illness, were related to bad prognosis. Overt psychotic symptoms had no significant correlation with outcome.

Remission rate and survival in acute myeloid leukemia: impact of selection and chemotherapy

113 patients with acute myelogenous leukemia (AML), representing 82% of the total cohort of AML patients within the geographical area of northern Sweden, were recorded. The total complete remission (CR) rate was 47.8%, and median survival was 4 months. The probability of long-term survival for all patients without exclusions was only 5%. Thus, the results from this study differ strongly from data on patient outcome in most therapy studies in AML, where the influence of patient selection on the results is larger. The median age in our patients was 63 years, which is also higher than in most other studies. Elderly patients had a low CR rate (24% in patients greater than or equal to 70 yr), but remission duration was similar in the different age groups. Patients treated according to "high-dose" protocols had a CR rate of 64%, while only 14% of less aggressively treated patients achieved remission. A better response rate after more aggressive chemotherapy was evident also in elderly patients. CR rate was 81% in patients below 60 yr of age who had no antecedent blood disorder and who had had symptoms for less than 3 months. Other variables with prognostic implications were: cytogenetic subgroup, antecedent hematological disease, and level of serum ferritin. High serum ferritin was associated with short CR duration. Ferritin is produced by the leukemic cells and could be regarded as a marker for leukemic activity.

C1 subcomponent complexes and C2 cleavage in active systemic lupus erythematosus

We studied the activation and C1 inactivator-dependent dissociation of the first component of complement, the C1q(C1r-C1s)2 complex, in relation to recruitment of the classical activation pathway in the circulation of 24 patients with systemic lupus erythematosus (SLE). The patients were divided into three groups on a clinical basis, and were investigated during flares of disease activity. Group I had mild symptoms, group II major extrarenal manifestations, and group III manifest renal disease. High serum concentrations of trimer complexes containing C1 inactivator, activated C1r and zymogen C1s(C1 IA-C1r-C1s) were found in the majority of the patients. Some patients with high C1 IA-C1r-C1s concentrations showed no evidence of classical pathway activation, indicating that C1 activation was controlled by the action of C1 IA at the C1r level. By contrast, formation in serum of tetramer complexes in which C1 IA was firmly bound to both C1r and C1s (C1 IA-C1r-C1s-C1 IA) was associated with C2 and C3 cleavage in EDTA plasma, and with manifest hypocomplementemia. Low C1 IA-C1r-C1s-C1 IA values were observed in conjunction with substantial C2 cleavage in a few patients. Thus, C1 IA-C1r-C1s-C1 IA may not always be a sensitive indicator of classical pathway activation. Efficient recruitment of the classical pathway was related to disease severity, with some overlap between the clinical groups. In conclusion, C1 dissociation with formation of C1 IA-containing complexes was consistently found in patients with active SLE. The results suggested that C1 IA-dependent control of C1 activation was of biological significance in the disease.

Homozygous C4A deficiency in systemic lupus erythematosus: analysis of patients from a defined population

Homozygous C4A deficiency was found at a prevalence of 16% (13/80 patients) in systemic lupus erythematosus (SLE). The patients represented all diagnosed cases retrieved from a defined population in Southern Sweden, which minimizes the influence of patient selection. Photosensitivity was more common among C4A-deficient patients than among other SLE patients (p less than 0.05). Otherwise, clinical features were similar in the two groups. In addition, no differences were found with regard to presence of various autoantibodies (anti-dsDNA, anti-Sm, anti-RNP, anti-SSA, anti-SSB, rheumatoid factors and anti-cardiolipin). In patients expressing both C4A and C4B isotypes, C4B/C4A quotients were fairly stable in plasma irrespective of disease activity. This argues against preferential break-down of either isotype during complement activation in the disease. The increased photosensitivity of C4A-deficient patients partly resembles the findings in patients with complete deficiencies of classical pathway components.

Recurrent cerebral infarction and the antiphospholipid syndrome: effect of intravenous gammaglobulin in a patient with systemic lupus erythematosus

A 23 year old woman with systemic lupus erythematosus and antiphospholipid syndrome developed severe thrombocytopenia (5-10 X 10(9)/l) and cerebral infarction. Treatment with high doses of corticosteroids and cytostatic drugs was not effective. The condition was successfully treated only when three courses of intravenous gammaglobulin at 400 mg/kg daily was added. A clear relation was found between the immunoglobulin infusions and rising platelet counts, whereas an effect on the levels of anticardiolipin antibodies could not be recorded. The findings suggested that the mechanisms responsible may be modification and solubilisation of immune complexes or interference with anticardiolipin binding to platelet membranes, or both.

Anterior stabilization of pathologic dens fractures

By an anterior approach, six pathologic dens fractures were stabilized with screws and methyl methacrylate cement. All the patients had immediate pain relief and could be mobilized without external support. Using the anterior approach, the tumor can be removed and the instability neutralized at the site of the lesion.

Autoantibodies against neutrophil cytoplasm components in systemic lupus erythematosus and in hydralazine-induced lupus

Anti-neutrophil cytoplasm antibody (ANCA) has been shown to be no marker of systemic lupus erythematosus (SLE) including lupus nephritis or of progressive systemic sclerosis (PSS). Antibodies against myeloperoxidase (anti-MPO) and elastase, two granulocyte lysosomal enzymes, were found in patients with SLE but not in those with PSS, except for one patient who had anti-MPO. Anti-MPO was present in 21% of patients with SLE, and at low concentrations in about 80% of these cases. Anti-elastase was found in four patients with SLE. In another group of six patients with a SLE-like syndrome induced by anti-hypertensive treatment with the anti-hypertensive hydralazine, anti-MPO antibodies occurred in all six, and anti-elastase antibodies in five. Monitored during a 2-year follow-up period, anti-MPO antibodies were found to persist, whereas anti-elastase antibodies were rapidly eliminated, after withdrawal of the drug.

Brace effects on the unstable knee in 21 cases. A roentgen stereophotogrammetric comparison of three designs

Three designs of knee braces were investigated in 21 knees with arthroscopically verified old tears of the anterior cruciate ligament. Anterior-posterior and rotatory instability with and without anterior traction were recorded with roentgen stereophotogrammetric analysis. Two of the designs examined reduced the anterior-posterior instability (ECKO, modified Lenox Hill), but not to normal levels. At 20 degree of flexion, none of the braces decreased the internal rotatory instability, whereas one type (modified Lenox Hill) reduced the external rotatory instability.

Static and flow cytometric DNA analysis compared to histologic prognostic factors in a cohort of stage T2 breast cancer

DNA analysis with static and flow cytometry was performed on archival smears and tissue sections in 99 patients with T2 breast cancer (Stage II). Tumour size, histologic grade and axillary node metastases were significant prognostic predictors. Static cytometry revealed 63% aneuploid tumours, and ploidy was significantly correlated to histologic grade and survival. DNA measurements obtained by static and flow cytometry were strongly correlated. According to flow cytometry 53% of the tumours were aneuploid. Flow cytometric DNA analysis correlated to histologic grade and survival and gave prognostic information among the lymph-node negative patients. Ploidy seems to be a significant, although not an independent prognostic indicator for T2 breast cancer.

Estimating the incidence of systemic lupus erythematosus in a defined population using multiple sources of retrieval

We studied the age-specific incidence of SLE in a defined population in southern Sweden during 1981-86. Female incidence was 5.4/100,000/year and male incidence 1/100,000/year. In comparison with previous studies, incident cases were characterized by a high age at diagnosis with the highest incidence in age groups 55-64 and 65-74, approximately 7.5/100,000/year. The incidence was low in children under 15 years of age, 0.4/100,000/year, and unexpectedly so in the 15-24 decade, 1.2/100,000/year. Patient retrieval was based on four separate sources: a computerized diagnosis register; referrals from both public health care physicians and private practitioners; and records of ANA positive individuals from the single laboratory serving the area. All incident patients were present in at least two of these sources and 11 patients were present in three. We interpret the high amount of overlap between retrieval sources, without patients detected in only one source, as evidence for a high degree of completeness in our retrieval of SLE patients.

A novel assay for neutrophil clustering activity of human sera: relation to disease activity and neutropenia in systemic lupus erythematosus

A simple and reproducible method for the measurement of serum neutrophil clustering activity was developed. High clustering activity was found in 19/30 patients with active systemic lupus erythematosus (SLE), and 14/20 of those with severe disease flares. In contrast, 0/10 patients with quiescent SLE and 2/20 patients with rheumatoid arthritis had high neutrophil clustering activity. Particularly high clustering activity was found in patients with SLE with lupus glomerulonephritis and in certain patients with central nervous system disease. An inverse correlation was found between neutrophil clustering activity and peripheral blood neutrophil count in patients with SLE not treated with glucocorticoids, and clustering activity was high in all patients with low neutrophil counts in this group. A moderate correlation was found between neutrophil clustering activity and C1q binding circulating immune complexes. Non-steroidal anti-inflammatory drugs and glucocorticoids had little direct effect on neutrophil clustering activity.

Single cell DNA cytophotometry in clinical stage I malignant melanoma. Relationship to prognosis

Histological sections of 50 clinical stage I cutaneous melanomas were analyzed by single cell DNA cytophotometry. Forty-two percent of the melanomas had diploid modal values. Ploidy was not significantly related to the level of invasion, melanoma thickness or prognosis. These results are contradictory to published data from flow cytophotometry which, however, differ inter alia concerning patient materials and follow-up times. Mean nuclear area was in our study significantly correlated to the prognosis.

Lung function in patients with systemic lupus erythematosus and persistent chest symptoms

Twelve consecutive patients with systemic lupus erythematosus (SLE) and chest symptoms of at least 3 months' duration were investigated with spirometry, lung mechanics at rest and exercise, diffusion capacity and right heart catheterization. Vital capacity (88% of predicted, p less than 0.05), and FEV1 (84%, p less than 0.01) were decreased in the study group, but spirometric and diffusion capacity abnormalities were moderate compared with previous studies. The single breath CO2 test showed, in six patients, ventilation-perfusion mismatch with patterns typical for either bronchial obstruction or vascular disease. Non-respiratory factors were responsible for reduction of working capacity (on average 68% of predicted normal values (p less than 0.001]. Two patients with pulmonary hypertension were identified by right heart catheterization. One of them had overlap features with the CREST syndrome. Both these patients had abnormal SBT-CO2 test and diffusion capacity, along with diffuse perfusion defects on perfusion scintigraphy. The low frequency of pulmonary function abnormalities in this study suggests that irreversible pulmonary damage is uncommon in SLE.

Flow DNA-cytometric findings of paraffin-embedded primary cutaneous melanomas related to prognosis

In a retrospective study flow cytometry was performed in 82 paraffin-embedded clinical stage I cutaneous melanomas. A significant correlation of ploidy to melanoma thickness was found. Using a log rank test ploidy was found significant for prognosis. However, using the Cox's proportional hazard test the influence of ploidy vanished and melanoma thickness or Clark level of invasion together with sex and location were the factors most important for prognosis.

Kinematics of active knee extension after tear of the anterior cruciate ligament

Three-dimensional movements of the knees in 13 patients with unilateral old tears of ACLs were studied during extension. Roentgen stereophotogrammetric methods were used to measure tibial movements in the injured and the intact knees. Reduced internal rotation and adduction were recorded at the end of extension on both sides. The injured knees displayed increased anterior and distal displacements of the tibial intercondylar eminence. Abnormal tibial displacements in our patients indicate that the absence of the ACL is not completely compensated for during active extension past 30 degrees; close to the extended position, the tibial movements tend to normalize.

Outcome in systemic lupus erythematosus: a prospective study of patients from a defined population

All adult patients with systemic lupus erythematosus (SLE) (greater than or equal to 15 years old, n = 86) from a defined population (approximately 160,000 population at risk) were followed prospectively over 6 years. The study area comprised 2 health care districts served by only 1 hospital. Retrieval was based on clinical case finding and computerized diagnosis and laboratory registers. The incidence of the disease was 4.0 cases/100,000 adults/year and was stable during the 6 years, suggesting that completeness of retrieval was high. Point prevalence by the end of 1986 was 42 cases/100,000 population at risk and 5-year survival in the prospective group 97%. Immunologically the group was characterized by a high frequency of positive anti-dsDNA (73%), and a low frequency of rheumatoid factor positivity (10%). The frequency of ARA criteria (median, 6) was comparable with previous larger series of selected patients. Sixteen percent of the patients were males, and they had more serositis and renal manifestations than females. In view of the low mortality we studied the more sensitive outcome measures: disease activity, irreversible organ damage, and functional impairment. After the diagnosis year, disease flares occurred with a constant frequency of 0.2 flares/year/patient, even after long duration of disease. Patients with neuropsychiatric disease, history of drug reactions, and immunological abnormalities such as persistent hypocomplementemia, antibodies to dsDNA, and cardiolipin had a high frequency of relapse. In contrast, elderly patients with serositis during their first flare seldom relapsed. The number of gainfully employed individuals was normal. Neuropsychiatric disease and joint involvement were principal causes of long-standing functional impairment. Notably, patients with renal disease usually fared well, as reflected by preserved renal function and little functional by preserved renal function and little functional impairment. Disease duration and glucocorticoid treatment were major denominators for morbidity due to infections and vascular disease with the incidence of myocardial infarctions being 9 times more common than that in a Swedish control population. Prolonged glucocorticoid treatment was also related to mortality, which was predominantly due to cardiovascular or central nervous system disease. The present prospective and epidemiologically based study of outcome in SLE was made possible by a uniquely coordinated health care system, enabling complete identification of the patients within the study area.(ABSTRACT TRUNCATED AT 400 WORDS)

Fraction of S-phase cells in blood mononuclear cells in non-Hodgkin's lymphomas--correlation with clinical features and prognosis

A consecutive material of 111 untreated patients with non-Hodgkin's lymphoma was studied with respect to fraction of S-phase cells in blood mononuclear cells in relation to presence of monoclonal B cells in blood (MBCB). Fraction of S-phase cells was determined by flow cytometry and estimation of MBCB was performed by kappa:lambda analysis. The fraction of S-phase cells was significantly higher (p less than 0.001) in MBCB-positive cases (median 1.2%) than in the MBCB-negative (median 0.7%). MBCB-positive patients with S-phase values greater than or equal to 1.5% had a less favourable prognosis compared to those with less than 1.5% cells in S-phase (p = 0.01). In a Cox multiparameter analysis, advanced clinical stage, high-grade morphology and high fraction of S-phase cells in blood in MBCB-positive cases were independent, statistically significant, negative prognostic indicators. The results indicate that an elevated S-phase value in blood in non-Hodgkin's lymphoma constitutes a negative prognostic factor, probably reflecting proliferating tumour cells in blood.

Three-dimensional instability of the anterior cruciate deficient knee

Using roentgen stereophotogrammetry we have recorded the three-dimensional movements of the knee during an anteroposterior laxity test in 36 patients with torn anterior cruciate ligaments and in three cadaver knees. At 30 degrees of knee flexion and before loads were applied the tibia occupied a more laterally rotated position if the anterior cruciate ligament had been injured. When the tibia was pulled anteriorly knees with cruciate deficiency rotated more laterally and were more abducted than normal knees. Posterior traction induced lateral rotation in the injured knee and medial rotation in the intact one. Precise knowledge of the three-dimensional instability of the anterior cruciate deficient knee may be important when the laxity is evaluated only in relation to one of the three cardinal axes.

Enzyme-linked immunosorbent assay for Escherichia coli heat-stable enterotoxin type II

The gene for Escherichia coli heat-stable enterotoxin type II (STII) was fused to the genes for protein A from Staphylococcus aureus and beta-galactosidase in two different expression systems. Antibodies raised in rabbits against the protein A-STII fusion protein recognized the beta-galactosidase-STII fusion protein. The latter fusion protein was used as the immobilized antigen in an enzyme-linked immunosorbent assay (ELISA) for detection of STII. The correlation between the results of the ELISA and the intestinal loop test in piglets was 95%, suggesting that the ELISA can be used to reliably detect STII.

Complement fixation by solid phase immune complexes. Reduced capacity in SLE sera

We describe an ELISA for assessment of complement function based on the capacity of serum to support fixation of complement components to solid phase immune complexes (IC). Microplates were coated with aggregated bovine serum albumin (BSA) followed by rabbit anti-BSA IgG. The solid phase IC were reacted with human serum. The uptake of C3b, C4b and properdin was measured using biotinylated F(ab)2 antibodies to each of the proteins, avidin alkaline phosphatase, and paranitrophenyl phosphate. Serial samples obtained from 15 patients with systemic lupus erythematosus were investigated. Out of 72 sera, 24 showed a reduced capacity to support incorporation of C4b into solid phase IC. Thirty-one of the sera showed low C3b binding and 59 of the sera a reduced uptake of properdin. The incorporation into solid phase IC of C3b and C4b as well as of C3b and properdin were closely correlated at high disease activity. In general, patients with severe disease manifestations showed low values in the uptake assays. Judging from the results obtained by analysis of serial samples, the uptake of C3b, C4b and properdin, complement mediated solubilization of fluid phase IC and the concentrations of C1q binding IC were useful indicators of disease activity in the patients. The concentrations of circulating C4, C3 and properdin varied less consistently according to disease activity. The concentrations of serum properdin were never found to be low, which was in contrast to the finding of reduced properdin uptake by solid phase IC in most of the samples.

The effect of age on clinical and serological manifestations in unselected patients with systemic lupus erythematosus

In a unique series of 80 patients with systemic lupus erythematosus constituting all identified cases in a defined population, the effect of age, at onset and at diagnosis, on disease expression was examined. Contrary to current views, the incidence of the disease was similar among all age groups. The proportion of patients with serositis, secondary Sjögren's syndrome, and anti-SSA antibodies gradually increased with age, while that of cutaneous symptoms, antibodies to native DNA, and hypocomplementemia decreased. Serositis was common as the initial symptom in the elderly and serositis or musculoskeletal manifestations were the initial symptom in 88% of patients over 50 at onset of disease.

Karyometric findings and prognosis of stage I cutaneous malignant melanomas

A material consisting of 82 stage I cutaneous melanomas was analysed clinically, histopathologically and karyometrically. High age, deep Clark level of invasion and thick melanomas were associated with a negative prognosis. There was a good correlation between the nuclear area and the melanoma thickness. By applying Cox's proportional hazard method to clinical, histopathological and karyometric data, it was demonstrated that karyometry provided both prognostic and biological information. Both a large variation (percentile 90-percentile 50) in nuclear area and a large standard deviation of form factor was related to a negative prognosis (p less than 0.0003 and p less than 0.04 respectively).

Prognostic factors in locally advanced breast cancer (T3, T4) with special reference to tumor cell DNA content

The prognostic value of DNA analysis was studied retrospectively in 91 patients with locally advanced breast cancer (T3, T4) and a follow-up time of 3-7 years. Tumor cell DNA analysis was performed by static cytometry on aspiration biopsy specimens in 42 cases and on tissue sections in 49 cases. The tumors were classified as euploid or aneuploid. Sixty-four percent of the tumors were aneuploid. DNA pattern correlated significantly to histologic grade and axillary perinodal growth and also to survival. DNA pattern, histologic grade and axillary node metastases correlated significantly to disease-free survival (DFS). In this series of patients with locally advanced breast cancer DNA determinations gave important prognostic information.

Intimal rupture and arterial thrombosis in revisional hip arthroplasty. Case report

Revisional arthroplasty of the hip was complicated by ipsilateral arterial thrombosis. At vascular reconstruction an intimal rupture was disclosed as the only possible mechanism.

Attempt at predicting paraphrenic outcome in young, first admitted schizophrenic patients

A sample of 110 consecutive first admission young schizophrenic patients treated between 1964 and 1967 was rediagnosed in 1981. Among 92 survivors, 27 could be labelled as paraphrenics. From information available at inception 97 variables were coded covering such areas as personality, previous disturbances, age and type of onset, and symptoms around admission. Sixty-three out of 97 variables were hypothesized to differentiate, at admission, future paraphrenics from the rest of the sample. Paraphrenics were found to have had less contact disturbance, better self-esteem, less neurotic symptoms in adolescence and childhood, and less complaints of unhappiness when growing up. They had more regressive and paranoid symptoms at admission, were older at onset of the disease, which was more acute, more often connected with precipitating events, and confusion. Certain non-regressive symptoms such as brooding, anhedonia and concentration difficulties were less common. A discriminant analysis yielded a proportion of correct predictions = 0.64 (p less than 0.05). The results are in accordance with the theory of more favourable energetic and organizational capacity in paranoid schizophrenics as compared with non-paranoids.

Non-regressive schizophrenia: prediction of regressive course

Regressive course during a 14-17 year follow-up in 54 non-regressive (pseudoneurotic, borderline, latent) schizophrenic subjects was predicted from about 100 variables studied on first admission. A significant prediction could not be achieved. This finding lends additional support to our previous interpretation that patients with a non-regressive syndrome are schizophrenics. A large number of them will run a typical schizophrenic course, but we are unable to predict from initial data who will do so. The few possibly predictive variables seemed to be of an unspecific, quantitative and longitudinal nature. They may act in a cumulative manner to increase the vulnerability to psychotic decompensation.