Endometriosis: a clinically malignant disease

According to the literature this is the first patient with the primary diagnosis of an endometriosis (EMT) based on the cardinal symptom of an uremia in combination with a colorectal ileus. Operative removal of EMT was possible after hormonal suppression with Dienogest.

Health education pamphlets about smoking--their benefit to smokers and non-smokers

The aim of this present study was to compare the use by smokers and non-smokers of pamphlets about smoking as delivered from different settings. The study was a nation-wide cross-sectional survey of 1924 randomly selected, Danish men and women, aged 14-77 y, who had answered a mailed questionnaire in 1994. Of these 71% also participated in a telephone interview enquiring about the use of health education material, smoking status and socio-demographic variables, 39% of readers of household-delivered anti-smoking pamphlets reported having gained information from them and 22% reported having made changes in their own smoking behaviour such as avoiding smoking in the presence of non-smokers. In general practice settings, these percentages were higher among smokers. Smokers who were thinking of stopping smoking in the near future were in addition more likely to take and to read smoking related health education materials from other places. Non-smokers received (3 49%) and read pamphlets about smoking as frequently as did smokers who did not intend to quit. In conclusion, written health education material was well received by readers, but, when distributed in a more open setting it needs to be targeted towards smokers who are considering stopping smoking. In general practice, smokers not thinking of stopping were open to health education, and pamphlets used in this setting should also target this group. Non-smokers contribute indirectly to smokers quitting by providing support to smokers and pamphlets for non-smokers need to be more targeted towards this social role.

Ontogenetic scaling of foraging rates and the dynamics of a size-structured consumer-resource model

The ontogenetic scaling of foraging capacity strongly influences the competitive ability of differently sized individuals within a species. We develop a physiologically structured model to investigate the effect of different ontogenetic size scalings of the attack rate on the population dynamics of a consumer-resource system. The resource is assumed to reproduce continuously whereas the consumer only reproduces at discrete time instants. Depending on the ontogenetic size scaling, the model exhibited recruit-driven cycles, stable fixed point dynamics, non-recruit juvenile-driven cycles, quasiperiodic orbits, or chaotic dynamics. The kind of dynamics observed was related to the maintenance resource levels required of differently sized individuals. Stable fixed point dynamics was, besides at the persistence boundary, only observed when the minimum resource levels were similar for newborns and mature individuals. The tendency for large population fluctuations over a wide range of the parameter space was due to the consumer's pulsed reproduction. Background mortality and length of season were major determinants of cycle length. Model dynamics strongly resembled empirically observed dynamics from fish and Daphnia populations with respect to both patterns and mechanisms. The non-recruit juvenile-driven dynamics is suggested to occur in populations with size-dependent interference or preemptive competition like cicada populations.

[Magnetic tomography of the central nervous system in adults with myelomeningocele]

The Norwegian training and counselling centre for patients with rare disabilities is a national project with the aim of developing new models for services designed to improve the quality of life of these patients. As at 1 July 1997, 130 adults with myelomeningocele were registered users of the Centre. This article is a retrospective review of reports from MRI evaluations of the central nervous system of 61 (40%) of the centre's users, performed in seven departments of radiology. Caput, the craniocervical region and distal parts of the medulla were the most frequently examined areas; the thoracal medulla was examined in half of the cases. There were considerable differences with respect to the structures examined. Enlargement of the lateral ventricles was as frequent in patient without shunt (68%) as in patients with shunt (53%). Dysmorphology of the corpus callosum was seen in 39%. Intracranial structural abnormalities were often described without a report on the intracranial pressure. Herniation of the cerebellar tonsils was reported in 66% of patients, tethering of the spinal cord in 90%, and syringomyelia in 13%. In most cases, MT uncovered conditions with implications for management. We suggest that standard routines should be developed for examinations of the central nervous system of patients with myelomeningocele.

[The significance of associated malformations of the central nervous system in myelomeningocele]

Neural tube defects are the most frequent congenital structural malformations in Norway. Approximately half of these are myelomeningocele. Infants with myelomeningocele frequently have hydrocephalus at birth. Problems with intracranial pressure may as well develop later. There are several reports on pathological corpus callosum and an increasing number of reports on cognitive problems in patients with myelomeningocele. Most patients with myelomeningocele have a tethered spinal cord, and some have syringomyelia. Chiari malformation type II is a malformation of the skull and brainstem which is frequently observed in individuals with myelomeningocele. Chiari malformation may cause severe respiratory problems in infants. Chiari malformation, tethered cord as well as syringomyelia are associated with a range of neurological problems which may progress in adulthood. Surgical intervention may improve the situation. Anaesthesia may induce neurological complications in individuals with Chiari malformation or syringomyelia. Since pregnancy and childbirth are associated with complications, women with myelomeningocele should be examined before they become pregnant. Children and adults with myelomeningocele should routinely undergo MRI examinations of caput and the spinal cord to clarify their anatomical situation.

[New diagnostic criteria in Marfan syndrome]

Marfan's syndrome is a relatively frequent autosomal dominant condition which is due to structural or quantitative changes in a connective tissue protein, fibrillin. The syndrome is associated with life-threatening changes in the aorta and serious manifestations in many different organ systems. Unclear diagnostic criteria and lack of use of the criteria in clinical practice may have led to overdiagnosing this syndrome in individuals with a long and slender habitus. This in turn can lead to negative consequences for both the individual and his or her family. Failure of diagnosis may cause even more harm, in particular because of the risk of sudden cardiac events. In 1996 an international group of experts proposed a set of revised criteria for Marfan's syndrome which takes into account molecular findings and family history (the Gent criteria). It is important that all practising physicians are aware of these criteria in order to prevent over- and underdiagnosing. A correct diagnosis is of major importance for medical follow-up, genetic counselling, habilitation, and counselling with regard to education and occupation.

A second genetic polymorphism in methylenetetrahydrofolate reductase (MTHFR) associated with decreased enzyme activity

A common mutation in methylenetetrahydrofolate reductase (MTHFR), C677T, results in a thermolabile variant with reduced activity. Homozygous mutant individuals (approximately 10% of North Americans) are predisposed to mild hyperhomocysteinemia, when their folate status is low. This genetic-nutrient interactive effect is believed to increase the risk for neural tube defects and vascular disease. In this communication, we characterize a second common variant in MTHFR (A1298C), an E to A substitution. Homozygosity was observed in approximately 10% of Canadian individuals. This polymorphism was associated with decreased enzyme activity; homozygotes had approximately 60% of control activity in lymphocytes. Heterozygotes for both the C677T and the A1298C mutation, approximately 15% of individuals, had 50-60% of control activity, a value that was lower than that seen in single heterozygotes for the C677T variant. No individuals were homozygous for both mutations. Additional studies of the A1298C mutation, in the absence and presence of the C677T mutation, are warranted, to adequately address the role of this new genetic variant in complex traits. A silent genetic variant, T1317C, was identified in the same exon. It was relatively infrequent (allele frequency 5%) in our study group, but was quite common in a small sample of African individuals (allele frequency 39%).

[Molecular biology diagnostics of hereditary metabolic diseases]

Metabolic diseases are often a result of monogenic inheritance and are suitable subjects for molecular diagnosis. Much progress has been made on research into this group of diseases, and further advances are expected after the completion of the Human Genome Project (HUGO) and as a consequence of improved molecular genetic methods. Although it is possible to diagnose many metabolic disorders by biochemical analyses of enzyme function, the underlying molecular genetic defects must be identified in order to be able to make accurate diagnoses of patients and their relatives. A molecular diagnosis is also a pre-condition for gene therapy. It is of paramount importance that more knowledge is gained of the correlation between genotype and phenotype for the genetic counselling of patients and their families. Important challenges at the present time are how to achieve a better understanding of the molecular and metabolic basis for the way in which diseases manifest themselves clinically and the factors which modify the phenotype.

[Luteal defect in pregnancy as the cause of habitual abortion]

About 15 of all women in the reproductive age are involved by recurrent abortions. The pathophysiology is different; chromosomal, infectious, immunologic and endocrine reasons and anomalities of the uterine cave are discussed. Though there is a discrepancy between the regular secretory phase needed for implantation and low progestins in early pregnancy inducing abortion, the theory of recurrent abortions induced by ovarian malfunction is critically discussed in literature. Basing on the knowledge of the regulation of ovarian function and a delayed pregnancy without ovarian function in early pregnancy in a patient with recurrent abortions, a defect of the corpus luteum-rescue is the most probable explanation. This defect characterized by regular beta-HCG- and pathological decreased progestin and estradiol levels should be treated by substitution of progestin and estradiol. Though a defect of the HCG-receptor is possible a HCG-substitution seems to be an inadequate therapy.

Hearing instruments and health technology--an evaluation

This contribution compares a currently worn hearing instrument (i.e. R-HI) with a programmable multiband full-dynamic range compression behind-the-ear HI (i.e. T-HI), based on subject preference for HI, and, in addition, compares the preference for a linear/ non-linear amplification-mode (i.e. L-mode/C-mode). Finally, it evaluates some health technology aspects related to the devices. N = 34 experienced HI-users at a median age of 72 years (range 22-84) completed the trial, n = 5 being monaurally, and n = 29 being binaurally fitted. The trial comprises an unblinded comparative study of the R-HI and T-HI, in either C-mode or L-mode amplification, and a double-blind crossover study evaluating the C-mode versus the L-mode amplification. The results of the unblinded study showed that 94% (n = 32/34) preferred the T-HI, whereas two subjects preferred their current HI. The double-blind crossover study concerning the preference for the C-mode and L-mode, respectively, in the T-HI, showed that 72% (n = 23/32) had a significant preference for the non-linear amplification, whereas 28% (n = 9/32) preferred the linear amplification. Provided that the price of the T-HI is kept unchanged, a health technology evaluation may imply an estimate of 30 mill. DKR added costs on a national basis, which should be taken into account within the national hearing services.

A double-blind cross-over study of a non-linear hearing aid

New hearing aids are usually introduced after clinical trials. These are mostly based on subjects reports, in which it is possible that the subject's judgment of the acoustic performance might be influenced by the awareness that it is a new hearing aid which is being investigated. To examine the benefit of a new non-linear amplification circuit, a double-blind cross-over study was conducted. Two 'new' hearing aids were developed; they were identical in external appearance and differed only in that one involved ordinary linear amplification while the other employed compressive amplification (the K-amp circuit). Forty-five experienced users with sensorineural hearing loss, aged 60-80 years, used each of the aids for ten weeks, in balanced order. The subjects' need for hearing aid ranged from listening to radio and television to extensive use in all kinds of demanding listening situations. The results, using a structured questionnaire concerning real-life settings, speech reception tests and subject preferences for a particular hearing aid, showed little difference between the two hearing aids. Twenty-three subjects selected the non-linear amplification circuit, 20 subjects preferred the linear hearing aid and two chose to return to their previous aid. No consistent differences between those preferring the linear circuit and those preferring compression were found. It can be concluded that this compression amplification circuit is not significantly preferred to the traditional linear hearing aid.

A p47-phox pseudogene carries the most common mutation causing p47-phox- deficient chronic granulomatous disease

The predominant genetic defect causing p47-phox-deficient chronic granulomatous disease (A47 degrees CGD) is a GT deletion (DeltaGT) at the beginning of exon 2. No explanation exists to account for the high incidence of this single mutation causing a rare disease in an unrelated, racially diverse population. In each of 34 consecutive unrelated normal individuals, both the normal and mutant DeltaGT sequences were present in genomic DNA, suggesting that a p47-phox related sequence carrying DeltaGT exists in the normal population. Screening of genomic bacteriophage and YAC libraries identified 13 p47-phox bacteriophage and 19 YAC clones. The GT deletion was found in 11 bacteriophage and 15 YAC clones. Only 5 exonic and 33 intronic differences distinguished all DeltaGT clones from all wild-type clones. The most striking differences were a 30-bp deletion in intron 1 and a 20-bp duplication in intron 2. These results provide good evidence for the existence of at least one highly homologous p47-phox pseudogene containing the DeltaGT mutation. The p47-phox gene and pseudogene(s) colocalize to chromosome 7q11.23. This close linkage, together with the presence within each gene of multiple recombination hot spots, suggests that the predominance of the DeltaGT mutation in A47 degrees CGD is caused by recombination events between the wild-type gene and the pseudogene(s).

Prenatal detection of chromosome aneuploidies by fluorescence in situ hybridization: experience with 2000 uncultured amniotic fluid samples in a prospective preclinical trial

Successful rapid prenatal detection of selected numerical chromosome abnormalities by using fluorescence in situ hybridization (FISH) on uncultured amniotic fluid samples has been described by Klinger et al. (1992) and Ward et al. (1993, 1997). Using essentially the same FISH protocol and identical probes specific for chromosomes 21, 18, 13, X, and Y, we prospectively compared the results of FISH and conventional cytogenetics on 2000 amniotic fluid cell samples. The 1-day FISH assay yielded discrete differences in the signal profiles between cytogenetically disomic, i.e., normal, and trisomic samples. Due to intermittent absent Y-signals, the assay differentiated less well between samples with cytogenetically normal and abnormal sex chromosome complements. The assay efficiency, and thus the clinical utility, was affected by (1) unsuccessful hybridizations (7 per cent of all hybridizations), (2) hybridizations with less than 50 scorable nuclei (19 per cent of all hybridizations), and (3) visibly contaminated samples with possible maternal cell contamination (14 per cent of all samples). As a result, we were not able to reproduce the results of Klinger et al. (1992) and Ward et al. (1993, 1997).

Correlation of a common mutation in the methylenetetrahydrofolate reductase gene with plasma homocysteine in patients with premature coronary artery disease

Mild hyperhomocysteinemia, a risk factor for occlusive arterial disease, can be caused by disruptions of homocysteine metabolism. Methylenetetrahydrofolate reductase (MTHFR) catalyzes the synthesis of 5-methyltetrahydrofolate, the methyl donor for homocysteine remethylation to methionine. A common mutation in MTHFR, an alanine-to-valine substitution, may contribute to mild hyperhomocysteinemia in coronary artery disease (CAD). To test this hypothesis, we studied 152 patients with CAD by mutation analysis, MTHFR enzymatic assays, and measurements of plasma homocysteine and several vitamins. The MTHFR mutation was associated with reduced enzymatic activity and increased enzyme thermo-lability in these patients. The difference in the prevalence of the homozygous mutant genotype between the CAD patients (14%) and an unmatched group of healthy subjects (10%) was not significant. However, individuals with the homozygous mutant genotype had higher plasma homocysteine, particularly when plasma folate was below the median value. This genetic-environmental interaction is proposed to be a risk factor for CAD.

Hearing in the elderly > or = 80 years of age. Prevalence of problems and sensitivity

This article is part of an epidemiological study on hearing in an urban population > or = 80 years of age, and concentrates on the prevalence of hearing problems and hearing sensitivity as a function of age and gender. Prior to the study, 2915 residents aged 80+ from the Valby area in Copenhagen were selected for investigation and subdivided into two groups. The first group, comprising n = 859 subjects previously provided with HA, and the second group, resulting from an invitation mailed to n = 565 subjects, were matched according to the age and gender distribution of the population, i.e. 24% males and 76% females. Among these, only 41% at a median age of 84 years, range 80-96, accepted the invitation, being significantly younger than the non-attenders. The estimated prevalence of self, reported hearing problems ranged between 33 and 66%, increasing with increasing age. Significant differences were found in the hearing sensitivity as a function of gender, i.e. the hearing in the low-frequency area < 1 kHz is better, whereas the hearing sensitivity at > 2 kHz is significantly worse in males compared with females. The speech recognition score (SRS) was significantly higher in females compared with males, and a comparison between ears supports the finding that the right ear speech recognition score is better than the left. The study demonstrates the difficulties in obtaining reliable epidemiological data on the hearing in the elderly > or = 80 years, which represents an obstacle for the planning of appropriate hearing health services directed towards this age group, and collaborative studies are suggested in order to accumulate more knowledge.

[Differential diagnosis of cystic adnexa processes. A comparison of the value of sonography, puncture cytology and color and biochemical biopsy analysis with histology]

The histological diagnoses of 109 cystic adnexal masses were compared with the results of ultrasound examination, color, cytology and biochemical analyses of cystic fluid. In cases with suspicious results by ultrasound examination most of the malignant tumors but only a small number of benign cystic masses were found. Macroscopic and cytologic examinations gave no further informations. By biochemical analyses functional cysts could be detected with 86% of sensitivity and 100% of specificity by a combination of estradiol, progesterone and Ca 12-5. Endometrioma and malignant tumors could be separated from other adnexal masses (specificity 95%, sensitivity 100%) with a combination of Tag 72-4 and CASA.

The Valby Project: a survey of hearing in the elderly > or = 80 years of age not provided with hearing aids

This contribution forms part of an epidemiological study of hearing in the elderly > or = 80 years of age, living in an urban area. The study concentrates on the prevalence of self-reported hearing problems in a sample of subjects not provided with hearing aids (HAs), hearing level, and knowledge of and attitudes to HAs. Among the total population of 2915 > or = 80 years of age, an age- and sex-matched sample of 565 subjects was invited to attend an extensive audiological evaluation, including a questionnaire, giving information on knowledge about and attitudes to HAs. Forty-one percent (n = 231) attended, and dividing the attenders into 5 or 10 year age bands showed that the better and worse ear hearing levels, averaged across 0.5-4 kHz (BEHL/ WEHL0.5-4 kHz), deteriorate significantly with increasing age, and that no differences as a function of gender could be found. The prevalence of self-reported hearing problems was 44% (n = 101), and among these 30% (n = 30) indicated the potential need for a HA. A significantly poorer BEHL0.5-4 kHz was found in these subjects compared to those without hearing problems and/or need of a HA. In the total sample, 63% reported that a HA can ameliorate a hearing problem; however, 62% indicated that the HA should be invisible, and 28% that a HA 'makes you old'.

Human methionine synthase: cDNA cloning and identification of mutations in patients of the cblG complementation group of folate/cobalamin disorders

Methionine synthase catalyzes the remethylation of homocysteine to methionine in a methylcobalamin-dependent reaction. We used specific regions of homology within the methionine synthase sequences of several lower organisms to clone a human methionine synthase cDNA by a combination of RT-PCR and inverse PCR. The enzyme is 1265 amino acids in length and contains the seven residue structure-based sequence fingerprint identified for cobalamin-containing enzymes. The gene was localized to chromosome 1q43 by the FISH technique. We have identified one missense mutation and a 3 bp deletion in patients of the cblG complementation group of inherited homocysteine/folate disorders by SSCP and sequence analysis, as well as an amino acid substitution present in high frequency in the general population. We discuss the possibility that a mild deficiency of methionine synthase activity could be associated with mild hyperhomocysteinemia, a risk factor for cardiovascular disease and possibly neural tube defects.

Severe and mild mutations in cis for the methylenetetrahydrofolate reductase (MTHFR) gene, and description of five novel mutations in MTHFR

Methylenetetrahydrofolate reductase (MTHFR) catalyzes the synthesis of 5-methyltetrahydrofolate, a methyl donor in the conversion of homocysteine to methionine. Patients with severe MTHFR deficiency have hyperhomocysteinemia, hypomethioninemia, and a range of neurological and vascular findings with a variable age at onset. We have previously described nine mutations in patients with severe MTHFR deficiency. A mild form of MTHFR deficiency, associated with a thermolabile enzyme, has been proposed as a genetic risk factor for cardiovascular disease and for neural tube defects. We have shown that a common missense mutation (an alanine-to-valine substitution) encodes this thermolabile variant. We now report an additional five mutations causing severe MTHFR deficiency and an analysis of genotype (alanine/valine status) and enzyme thermolability in 22 patients with this inborn error of metabolism. Six of these patients have four mutations in the MTHFR gene-two rare mutations causing severe deficiency and two mutations for the common alanine-to-valine mutation that results in thermolability. Even in severe MTHFR deficiency, the thermolabile variant is frequently observed, and there is a strong relationship between the presence of this variant and increased enzyme thermolability.

Prenatal detection of chromosome aneuploidies in uncultured chorionic villus samples by FISH

We developed a 1-d FISH assay for detection of numerical chromosome abnormalities in uncultured chorionic villus samples (CVS). Probes specific for chromosomes 13, 18, 21, X, and Y were used to determine ploidy by analysis of signal number in hybridized nuclei. Aneuploidy detection using this assay was directly compared with the results obtained by conventional cytogenetic analysis in a consecutive, clinical study of 2,709 CVS and placental samples. The FISH assay yielded discrete differences in the signal profiles between cytogenetically normal and abnormal samples. On the basis of these results, we generated FISH-assay cutoff values that discriminated between karyotypically normal and aneuploid samples. Samples with mosaicism and a single sample with possible heritable small chromosome X probe target were exceptions and showed poor agreement between FISH results and conventional cytogenetics. We conclude that the FISH assay may act as a more accurate and less labor-demanding alternative to "direct" CVS analysis.

Induction of blister-causing antibodies by a recombinant full-length, but not the extracellular, domain of the pemphigus vulgaris antigen (desmoglein 3)

Pemphigus vulgaris (PV) is mediated by autoantibodies to desmoglein 3, the pemphigus vulgaris antigen (PVA). PVA and an extracellular domain of PVA-Ig fusion protein (PV-Ig) can completely adsorb the blister-causing Abs from PV patient sera, suggesting that the extracellular segment of PVA might be sufficient to induce pathogenic Abs. To test this, we immunized rabbits with either PVA or its extracellular domain (EPVA) expressed in insect cells in our laboratory. When Igs were passively transferred from these rabbits into neonatal mice, anti-PVA, but not the anti-EPVA, induced blisters. To understand the basis for their differential pathogenic effects, we examined the properties of these sera. Both sera showed comparable ELISA titers and indirect immunofluorescence reactivity against monkey esophagus, a source of native PVA. Moreover, EPVA, like PVA adsorbed blister-causing Abs from sera of PV patients and rabbits immunized with PVA. In contrast, when IgG preparations were incubated with fura-2-AM (acetyloxymethyl ester)-loaded human keratinocytes in culture, only IgG from anti-PVA serum induced intracellular calcium mobilization. These data showed that PVA but not EPVA can elicit Abs that induced blisters in neonatal mice and mediate intracellular signaling through calcium mobilization.

Induction of blister-causing antibodies by a recombinant full-length, but not the extracellular, domain of the pemphigus vulgaris antigen (desmoglein 3)

Pemphigus vulgaris (PV) is mediated by autoantibodies to desmoglein 3, the pemphigus vulgaris antigen (PVA). PVA and an extracellular domain of PVA-Ig fusion protein (PV-Ig) can completely adsorb the blister-causing Abs from PV patient sera, suggesting that the extracellular segment of PVA might be sufficient to induce pathogenic Abs. To test this, we immunized rabbits with either PVA or its extracellular domain (EPVA) expressed in insect cells in our laboratory. When Igs were passively transferred from these rabbits into neonatal mice, anti-PVA, but not the anti-EPVA, induced blisters. To understand the basis for their differential pathogenic effects, we examined the properties of these sera. Both sera showed comparable ELISA titers and indirect immunofluorescence reactivity against monkey esophagus, a source of native PVA. Moreover, EPVA, like PVA adsorbed blister-causing Abs from sera of PV patients and rabbits immunized with PVA. In contrast, when IgG preparations were incubated with fura-2-AM (acetyloxymethyl ester)-loaded human keratinocytes in culture, only IgG from anti-PVA serum induced intracellular calcium mobilization. These data showed that PVA but not EPVA can elicit Abs that induced blisters in neonatal mice and mediate intracellular signaling through calcium mobilization.