Effects of butter oil blends with increased concentrations of stearic, oleic and linolenic acid on blood lipids in young adults

OBJECTIVE

The aim of this present project was to evaluate a more satisfactory effect on plasma lipoprotein profile of spreads based on dairy fat.

DESIGN

This study was designed as a randomised cross-over experiment with a three-week treatment separated by a three-week wash-out period. Sixty five grams of the fat content of the habitual diets was replaced by either butter/grapeseed oil (90:10) (BG); butter oil and low erucic rapeseed oil (65:35) (BR) or butter blended in a 1:1 ratio with a interesterified mixture of rapeseed oil and fully hydrogenated rapeseed oil (70: 30) (BS).

SUBJECTS

Thirteen healthy free-living young men (age 21-26 y) fulfilled the study.

INTERVENTIONS

At the beginning and end of each diet period two venous blood samples were collected. Triacylglycerol and cholesterol concentrations in total plasma and VLDL, LDL, IDL and HDL fractions were measured, as were apo A-1 and apo B concentrations. Fatty acid composition of plasma phospholipids, plasma cholesterol ester and platelets was also determined.

RESULTS

Significantly (P < 0.05) lower total and LDL-cholesterol concentrations were observed after the BR and BS period, compared to BG. The effect of BR and BS did not differ. BG and BR resulted in equal concentrations of HDL-C, but significantly higher than BS. Consequently, a significantly lower LDL-C/HDL-C ratio was seen after the BR treatment compared to BG and BS. Apo A-1 concentrations were not significantly different, but Apo B was significantly increased after BG.

CONCLUSIONS

Partially replacing milk fat with rapeseed oil seems to yield a more healthy spread. Stearic acid had a HDL-C lowering effect compared to milk fat, but did not affect LDL-C significantly. The addition of stearic acid did not improve the plasma lipoprotein profile for young men with low cholesterol levels.

Effect of subclinical infection on maintaining immunity against measles in vaccinated children in West Africa

BACKGROUND

Despite a high coverage with measles vaccines in parts of west Africa, epidemics of measles occur with reduced severity in an increasing proportion of older children who have been vaccinated. We examined the effect of exposure to natural measles on immunity in vaccinated children.

METHODS

Our study was carried out in 1992 during an epidemic of measles in Niakhar, a rural area of Senegal with about 27,000 inhabitants who mostly live in compounds that include several households; within each household people live in different huts. Vaccine coverage in Niakhar was 81% at the time of our study. We measured haemagglutinin-inhibiting antibody at exposure and twice thereafter (after 4-5 weeks and at 6 months) in 36 vaccinated and 87 unvaccinated children. The frequency of measles and subclinical measles--defined as a four-fold or greater rise in antibody titre without clinical signs or symptoms--was related to intensity of exposure according to whether the index case was in the same hut, household, or compound.

FINDINGS

Clinical measles occurred in 20 (56%) of 36 unvaccinated children and in one (1%) of 87 vaccinated children. Subclinical measles occurred in 39 (45%) of 86 vaccinated children who were exposed to measles and in four (25%) of 16 unvaccinated children. The frequency was inversely related to pre-exposure antibody concentration (p<0.001 for trend) and directly related to intensity of exposure (p=0.002 for trend). Antibody concentrations in subclinical cases increased on average by 45-fold and remained raised for at least 6 months.

INTERPRETATION

Increased antibody titre after subclinical measles may be common in vaccinated children in West Africa where the intensity of exposure is high. As measles vaccination coverage increases, the circulation of wild measles will decrease, and vaccine-induced antibody is less likely to be boosted. Thus, new epidemics, albeit milder in form, may occur in vaccinated areas which should be recognised in campaigns to eradicate measles.

Increased long term mortality associated with rash after early measles vaccination in rural Senegal

OBJECTIVES

To examine whether clinical symptoms, including rash, were more common after measles immunization compared with placebo and to study the association between postvaccination symptoms and later mortality.

DESIGN

Examination of side effects in the 3 weeks after immunization in a trial of high titer and standard titer measles vaccines.

PATIENTS

Two hundred twenty-four children randomly selected to be included in the surveillance for diarrhea, fever and rash.

RESULTS

There was no difference in fever and diarrhea between recipients of high titer vaccines and recipients of placebo. However, high titer recipients tended to have more measles-like rashes than placebo recipients [relative risk, 2.12 (range, 0.90 to 5.03)]. Among recipients of high titer vaccines, children who presented a rash had higher mortality in the following 5 to 7 years than those who did not develop rash [mortality rate ratio, 3.85 (range, 1.52 to 9.79)]. High titer recipients without a rash had the same mortality as children in the placebo group who were given standard doses of measles vaccine at 10 months of age [mortality rate, 0.76 (range, 0.35 to 1.62)].

CONCLUSIONS

These observations suggest that in this particular study, rash after high titer measles vaccine may identify children who received a particularly high dose of vaccine or children with more severe and persistent postvaccination immunosuppression. Whether high titer vaccine is more likely than standard titer measles vaccine to provoke such reaction is not known, given that we did not compare side effects after different titers of measles vaccine. Future trials of live measles vaccine should monitor the development of rash.

Poor serologic responses five to seven years after immunization with high and standard titer measles vaccines

BACKGROUND

Few data exist on the persistence of measles antibodies after vaccination of West African infants. Therefore we examined measles antibody titers 5 to 7 years after children in rural Senegal had received high titer Edmonston-Zagreb (EZ-HT), high titer Schwarz (SW-HT) or standard titer Schwarz (SW-STD) measles vaccines in infancy.

METHODS

Children had received either high titer vaccines at 5 months of age or standard titer at 10 months of age. Finger prick blood samples were tested for measles antibody 5 to 7 years later by the hemagglutinin inhibition test.

RESULTS

Persistence of antibody after high titer vaccines was poor with the result that 39 and 50% of the EZ-HT and the SW-HT groups had low titers of hemagglutinin inhibition measles antibodies (< or =125 mIU/ml). Nineteen percent of the children in the SW-STD group had low titers which is a lower prevalence than in the high titer groups [relative risk (95% confidence intervals), 0.05 (0.28 to 0.88) vs. EZ-HT; relative risk, 0.38 (0.22 to 0.66) vs. SW-HT]. Geometric mean (95% confidence interval) antibody titers in children with detectable values were 616 (435 to 871) in the EZ-HT, 1106 (616 to 1866) in the SW-HT and 1271 (871 to 1741) mIU/ml in the SW-STD groups, respectively. Multivariant regression analysis showed that mean titers were 2.00 (1.03 to 3.89) times higher for children with low prevaccination antibody titers (< or =125 mIU/ml) and 3.06 (1.90 to 4.94) times higher if blood was collected in the rainy season.

INTERPRETATION

Given the rapid decline in antibody titers over a 5- to 6-year period in an area where measles vaccine coverage was high, it seems likely that multiple dose immunization schedules will be needed in the future to maintain protective antibody concentrations (>125 mIU/ml) in West Africa. The role of subclinical boosting by exposure to natural measles and the possible role of malaria, which increases immunoglobulin turnover, in influencing long term antibody persistence after vaccination deserve further investigation.

Mortality among human immunodeficiency virus type 2-positive villagers in rural Guinea-Bissau is correlated with viral genotype

We present the results of a 6-year study of 131 human immunodeficiency virus (HIV) type 2 (HIV-2)-infected individuals from a rural population in Guinea-Bissau. Proviral DNA sequences 1.3 kb in length were obtained from each individual and, together with clinical data, including proviral load and CD4 and CD8 levels, were used to assess whether viral genotype influences clinical outcome. With a phylogenetic model, a correlation was found between viral genotype and mortality; this correlation was not due to confounding factors, such as age-specific viral strains or cohabitation of patients. The data provide strong evidence for the involvement of viral genetic factors in determining HIV disease progression in vivo. The pattern of association found suggests that virulence factors are multiple and scattered throughout the HIV-2 genome and can be rapidly gained or lost by the virus through a combination of mutation and recombination. These findings may lead to the identification of viral determinants of HIV disease progression.

Acute and long-term changes in T-lymphocyte subsets in response to clinical and subclinical measles. A community study from rural Senegal

To investigate the possibility of long-term suppression of T-lymphocyte subsets, we examined children exposed to measles at home during an epidemic in rural Senegal, at time of exposure and 1 and 6 months later. The measles case fatality ratio was 1%. Subclinical measles was common among vaccinated children exposed to measles (45%). Both clinical and subclinical cases of measles showed a significant rise in absolute CD4 count in the incubation period. In the prodromal phase and the first week after the rash, the lymphocyte percentage, the white blood cell count and the absolute CD4 cell numbers were significantly reduced. There was no persistent decrease of absolute CD4 or CD8 numbers at 1 or 6 months after exposure. Measles infection was followed by significant changes in the subset composition, both CD4 and CD8 percentages being significantly higher in the second month after measles than among non-seroresponders. These changes were more marked among girls, since they had significantly higher CD4 percentages and CD4/CD8 ratios than boys in the convalescence phase. In conclusion, measles infection is not associated with a long-term suppression of CD4+ or CD8+ T-lymphocytes.

[Delivery of extremely large infants]

The purpose of this retrospective study was to find out if more effort should be applied to the diagnosis of extremely large infants, with a birth weight of 5,000 grams or more, and if elective caesarean section can be recommended. In the Department of Obstetrics, Herning Central Hospital, Denmark, 67 mothers delivered an infant with a birth weight of 5000 g or more over a ten year period. This index group was compared with a matched group with infants of normal weight. The result showed significantly more caesarean sections in the index group (24% versus 5%, p = 0.002). Shoulder dystocia and Duchenne-Erb's palsy were more frequent as well. Sixteen percent in the index group were admitted to the paediatric department, but the Apgar scores were not significantly lower. Except for one, all the infants showed complete recovery. In conclusion, elective caesarean section can not be generally recommended for an estimated birthweight exceeding 5,000 g, if a trained obstetrician is present at delivery.

Anophthalmia-microphthalmia-oblique clefting syndrome: confirmation of the Fryns anophthalmia syndrome

We describe a patient with bilateral extreme microphthalmia with bilateral congenital glaucoma, bilateral medial oblique facial cleft ending in lid colobomas, bilateral stenosis of the choanae, bifid uvula, frontal encephalocele, and premature craniosynostosis. The cause is unknown, but the phenotype resembles the Fryns anophthalmia-plus syndrome, which may be a recessive trait, although intrauterine environmental factors cannot be excluded.

Risk factors for diarrheal disease incidence in early childhood: a community cohort study from Guinea-Bissau

To determine risk factors for diarrhea, the authors followed an open cohort of 1,314 children from Guinea-Bissau by weekly diarrhea recall interviews between April 1987 and March 1990. Data on feeding practices and measles infection were available for all children and, for 531 children, comprehensive data on explanatory variables were recorded. Of 57 variables, seven were independently associated with an increased incidence of diarrhea. These were a recent (in the past 14 days) diarrheal episode, male sex, being weaned from breast milk, not being looked after by the mother, head of the household being < 30 years old, eating cold leftovers, and drinking water from an unprotected public water supply. In breastfed children, only three variables were associated with diarrhea, including prior diarrhea, male sex, and not being looked after by the mother. Among weaned children, six variables delineated increased rates of diarrhea, including unprotected public water supply, eating of cold leftovers, and lack of maternal education. Major determinants of persistent diarrhea included weaning, lack of maternal education, and having pigs in the home. It is concluded that, in addition to the promotion of breastfeeding, important interventions against diarrhea include improvements in water supply, hygiene, and food handling. However, because of effect modification by breastfeeding, the largest effects of these interventions will probably be among weaned children.

9-year HIV-2-associated mortality in an urban community in Bissau, west Africa

BACKGROUND

Community studies with 1-3 years of follow-up have reported four to five times higher mortality in HIV-2-infected than in uninfected adults. In a cohort study of HIV-1, an increasing difference in mortality rates of HIV-1-infected and uninfected individuals is expected over time, because of rising mortality with advancing HIV-1 infection. We therefore investigated long-term survival of HIV-2-infected adults.

METHODS

Adults enrolled in 1987 in a community study of HIV-2 infection in Guinea-Bissau were followed up with serological surveys in 1989 and 1992. Survival was assessed in 1995, 9 years after enrollment.

FINDINGS

The annual incidence of HIV-2 was 0.7% for adults and tended to be higher for older individuals than for participants aged 15-44 years (relative risk 3.21 [95% CI 0.91-11.37]). With control for age, HIV-2-infected adults had twice as high mortality as uninfected individuals (mortality ratio 2.32 [1.18-4.57]); the mortality ratio was highest in the first year of the study (4.50 [1.31-15.43]). The difference between infected and uninfected individuals was stronger for adults under 45 years of age (mortality ratio 4.72 [1.86-11.97]) than for older people (1.35 [0.51-3.56]). HIV-2-infected individuals living with an infected spouse had significantly higher mortality than HIV-2-infected individuals living with an uninfected spouse (p = 0.027).

INTERPRETATION

HIV-2-associated mortality is not increasing with length of follow-up. Mortality in HIV-2-infected adults is only twice as high as that in uninfected individuals. In the majority of adults, HIV-2 has no effect on survival.

Distinct differences in partial oxygen pressure at micrometer ranges in the rat hippocampal region

A mapping at micrometer ranges of the partial oxygen pressure in the rat hippocampus was performed. The oxygen tension in the rat hippocampal region was measured using a glass oxygen microsensor in 30-microm steps along straight lines at a set of stereotactic coordinates. In the hippocampus the pattern of the oxygen tensions reflected the autometallographic zinc sulphide (AMG(ZnS)) pattern, i.e. the pattern of zinc enriched (ZEN) terminals. The highest levels of oxygen tension were recorded in the areas that are most heavily stained with the autometallographic zinc sulphide (AMG(ZnS)) method, like hilus fasciae dentatae. The zinc ions located in synaptic vesicles of the ZEN terminals can also be demonstrated by AMG silver amplification in brains from animals in vivo treated with sodium selenite. This method depends on the presence of a substantial reduction capacity of the tissues as selenite ions (SeO(2)(3)-) must to be reduced to selenide ions (Se2-) before the catalytic zinc selenide crystals can be formed. At some point, either during the transport from the infusion site to the actual target tissue or in the target tissue itself, selenium is reduced from Se(+ IV) to Se(- II). The importance of the reduction capacity of the target tissue in this process is demonstrated by the fact that areas found to have the highest concentration of zinc ions, e.g. hilus fasciae dentatae and the mossy fibres of CA3, are almost unstained after 1 h of i.p. Na2SeO3 exposure. An explanation of this phenomenon could be that the reduction process Se(+ IV) <==> Se(- II) leading to the formation of Se2- is moved to the left by the presence of oxygen, thus inhibiting the precipitation of ZnSe crystals. It is suggested that the subtle oxygen pressure pattern found in the rat hippocampus might also reflect essential biological zinc-related mechanisms vital to brain function.

The influence of infant birth weight on post partum stress incontinence in obese women

One hundred ninety four women with a Body Mass Index (BMI) of at least 30 kg/m2 who were delivered vaginally between 01 10 93 and 30 09 95 at the obstetric department, Herning Central Hospital, were sent a postal questionnaire about stress incontinence. The response rate was 89.2%. In the heavy birth weight group (n = 4000 g or more) stress incontinence increased from 10.6% before pregnancy to 34.0% post partum. In the low birth weight group 6.9% suffered from stress incontinence before pregnancy increasing to 30.6% post partum. There was no difference in the reporting of mixed or urge incontinence between the two groups.

T-lymphocyte subsets in West African children: impact of age, sex, and season

OBJECTIVE

There has been no reference material for T-lymphocyte subsets for normal children in developing countries. We therefore used T-lymphocyte subset determinations among children in three different studies in Guinea-Bissau to construct age-related reference material and to examine possible determinants of T-lymphocyte subset levels.

METHODS

A total of 803 healthy West African children younger than 6 years were included in the three community studies of T-lymphocyte subsets among twins and singletons, after measles infection and after measles immunization. We used the immunoalkaline phosphatase method to determine T-lymphocyte subsets.

RESULTS

We found differences by age, sex, and season, whereas there were no significant differences by birth order, twinning, or ethnic group. The CD4+ percentage declined from birth to age 2 years, at which time it started to increase to higher levels at age 4 to 5 years. The CD8+ percentage increased gradually from early infancy to age 2 to 4 years. The leukocyte count peaked at age 12 to 23 months and declined thereafter, whereas the lymphocyte percentage peaked at age 1 to 5 months and declined gradually thereafter. Compared with dry-season results, the lymphocyte percentage, the absolute lymphocyte count, the absolute CD4+ T-lymphocyte count, and the CD4+/CD8+ ratio were significantly lower during the rainy season, whereas the CD8+ percentage was increased during the rainy season. Girls had higher CD4+/CD8+ ratios and lower CD8+ percentages than did boys.

CONCLUSIONS

Compared with the limited data on T-lymphocyte subsets available from healthy children in developed countries, Guinean children have markedly lower CD4+ percentages and CD4+/CD8+ ratios and higher lymphocyte percentages during the first 2 years of life, when the pressure of infections is particularly high in Africa.

[Food consumption of the population. Trends followed via telephone interviews]

This study aimed at establishing and evaluating a simple method for surveilling trends in consumption of 10 nutritionally important foods. The method is based on food frequency questions combined with questions on the previous days intake, collected through telephone interviews. Participants (461 men, 546 women, 15-60+ yrs) came from a population sample. Between 22 and 69% consumed the foods in question as frequently as prescribed by the Danish food recommendations (lowest for fish and for vegetables, highest for potatoes/rice/pasta). Characteristic sex and age differences were observed, similar to findings from traditional, quantitative food surveys in Denmark. The food frequency results were confirmed by results from the previous day's intake. Crossing of frequencies for different foods gave additional information on consumption patterns. The results indicate that this very simple method may be a useful supplement to traditional quantitative dietary surveys for surveilling trends in food consumption. The Danish Nutrition Council therefore aims at doing similar surveys every other year.

Age of wife as a major determinant of male-to-female transmission of HIV-2 infection: a community study from rural West Africa

OBJECTIVE

To examine whether proviral load is important for transmission between spouses, since we have previously found that the proviral load of HIV-2 predicts the severity of infection.

DESIGN

Proviral load was examined in 121 HIV-2-infected adults in a rural area of Guinea-Bissau. For the 68 subjects who had a spouse of known HIV status the risk of the spouse being infected was examined.

METHODS

Statistical methods for dependent data were used, because several couples were polygamous.

RESULTS

Twenty-seven HIV-2-infected men had 52 current wives of whom 17 (33%) were HIV-2-seropositive. Forty-one HIV-2-infected women had 36 current husbands of known HIV serostatus; nine (25%) were HIV-2-positive. In univariate analyses, concordance of female partners of HIV-2-infected men increased with a previous history of prostitution, age of wife, lack of age difference between the spouses, number of previous husbands, number of wives of the man, and the proviral load. The only significant predictor of concordance in multivariate analyses when wives with a history of prostitution were excluded was an age of 45 years or older [odds ratio (OR), 8.68; 95% confidence interval (CI), 2.34-32.22]. This tendency was not explained by the length of current marriage. Although husbands with a high proviral load were more likely to have concordant spouses than those with a low proviral load (< 20 copies/10(5) CD4 cells), this association was not statistically significant (OR, 2.59; 95% CI, 0.90-7.46). Among spouses of HIV-2-infected women, none of the examined factors, including previous prostitution or proviral load in the woman, predicted whether the husband was HIV-2-infected.

CONCLUSIONS

Women appear to be more susceptible to HIV-2 infection after 40-45 years of age. The apparent change in susceptibility may be a major reason for the distinctive age pattern of HIV-2 infection observed in West Africa.

[Prolapse of the salpinx after hysterectomy]

Prolapse of the fallopian tube through the vaginal vault is a rare, but possible complication after hysterectomy, and a tubal prolapse may be mistaken as granulation tissue or an adenocarcinoma. A possible treatment is vaginal extirpation with simultaneous laparoscopy. A case is presented and the relevant literature is reviewed.

Myopia in teenagers. An eight-year follow-up study on myopia progression and risk factors

A prospective 2-year study on myopia progression was commenced in 1984/85, with special attention to the rate of progression in a representative group of school children aged 9 to 12 years. A follow-up investigation of this group of myopic persons (now aged 17-20 years) was performed after 8 years, in order to describe the refractive error and possible risk factors for myopia progression over the period. The refractive error increased from -2.77 D to -5.14 D (mean values).

PARAMETERS

age at début, degree of myopia, intraocular pressure, changes at the fundus, status of phoria, nearpoint of convergence and accommodation were all measured at the start and related to the refractive error measured 8 years later. No single parameter, apart from age at début, indicated that the individual would reach a high degree of myopia. The refractive error among the children with a début below 7 years of age was -6.60 D, but only -3.72 D among those with a début after 10 years. The change in refractive error over the 8-year period was not statistically related to the age at début, neither did the rate of progression depend on the degree of myopia, the changes at the fundus, nor the intraocular pressure. However, children could be found who had a high rate of progression, by using a combination of these parameters.

[Molecular genetics of red-green color blindness]

Normal colour vision is trichromatic and is mediated by the blue, green and red visual pigments present in the corresponding blue, green, and red cone cells of the retina. The red and green pigment genes have evolved from an ancestral pigment gene and reside in a head-to-tail tandem array on the long arm of the X chromosome. This arrangement and a high degree of homology predispose to illegitimate recombination between the red and green pigment genes explaining the various forms and the high frequency of red-green colour vision defects.

[Molecular genetic examination in sex-linked color blindness]

The molecular structure of the X-linked colour-vision locus was studied in a family where mild red-green colour-vision deficiency (deuteranomaly) segregated, and in a male with complete absence of red and green colour-vision (blue cone monochromasy). In individuals with normal colour-vision the red and green pigment genes had normal molecular structure whereas individuals with deuteranomaly, in addition to normal red and green genes, also had an abnormal hybrid gene consisting of parts of the green and red pigment genes. The individual with blue cone monocromasy had only a red-green hybrid gene inactivated by a critical mutation in codon 203. Thus, the phenotypes predicted from the individual genotypes were in complete accord with the observed phenotypes.

Duchenne muscular dystrophy: negative electroretinograms and normal dark adaptation. Reappraisal of assignment of X linked incomplete congenital stationary night blindness

Aland Island eye disease (AIED) and X linked congenital stationary night blindness (CSNB) have been mapped to Xp11.3. Patients have been described with deletions of the Duchenne muscular dystrophy (DMD) gene who also had a negative electroretinogram (ERG) similar to that seen in patients with CSNB and AIED. This seems to confirm that some cases of AIED and CSNB map to Xp21. We examined 16 boys with DMD/BMD (Becker muscular dystrophy) of whom 10 had negative ERGs, eight of them having deletions downstream from exon 44. Normal dark adaptation thresholds were observed in all patients and there were no anomalous visual functions. Hence, CSNB cannot be assigned to Xp21 and negative ERG in DMD/BMD is not associated with eye disease. Six boys with DMD/BMD had normal ERGs. We speculate that a retinal or glial dystrophin may be truncated or absent in the boys with negative ERGs.

Low-fading immunofluorescence with propidium iodide contrast compared with immunogold light microscopy in whole cells and semi-thin cryosections

Conventional immunofluorescence produces excellent labeling but has drawbacks such as fading and the need for phase-contrast. Silver-enhanced colloidal gold probes allow counterstaining and permit permanent preparations with no fading if mounted correctly, but the most common limits of this technique are steric hindrance and the artifacts produced by silver enhancement. Our goal was to investigate Herpes simplex virus type 1 (HSV-1) morphogenesis by immunogold cryosection electron microscopy. We therefore needed a sensitive and reproducible immunocytochemical light microscopic method to confirm the immunofluorescence results in whole cells and to screen the cryopreparations before the time-consuming electron microscopic studies. We report data showing that the use of p-phenylenediamine to retard fading and propidium iodide to provide counter-staining results in brilliant fluorescence and contrast, minimal autofluorescence, and invisible fading at least for 5 min exposures, even in preparations with weak antigen presentation. Storage at -20 degrees C provides stable fluorescence. This method is superior to silver-enhanced colloidal gold light microscopy in our investigations.

Low power Ga-Al-As laser treatment of painful osteoarthritis of the knee. A double-blind placebo-controlled study

The aim of this double-blind study was to evaluate the effect of low power Ga-Al-As laser treatment on chronic pain related to osteoarthritis of the knee with periarticular tender points. Twenty-nine out-patients with uni- or bilateral osteoarthritis of the knee were included and randomly assigned to treatment with either laser or placebo laser. Fourteen patients received active laser treatment and all patients included completed the study. The effect variables were daily levels of pain, analgesic requirements, palpation tenderness and isokinetic quadriceps strength. Each patient participated in the study for 9 weeks and registered daily level of pain and consumption of analgesics. In weeks 4, 5 and 6 the patients received a total of nine treatments, each of 15 min and administered to periarticular tender points. The dose per treatment was 22.5 joule. No significant differences in any of the effect variables were found between the two groups before, during or after treatment. With regard to the patients' overall assessment there was a clearly demonstrable positive effect of treatment in both groups. This is likely to be due to a placebo effect.

Incidence of invasive cervical cancer preceded by negative screening in high-risk Alaska Native women

BACKGROUND

Alaska Native women experience higher invasive cervical cancer incidence and mortality rates than US whites despite a long-standing cancer screening programme including recommendations for annual Pap smears.

METHODS

To determine the frequency and results of cytological screening preceding their diagnoses, a histological and medical record review was completed for 44 of 46 Alaska Native cases of invasive cervical cancer from a defined population. An interval cancer (no prior dysplasia and a negative screening report within 3 years of diagnosis) was determined for 23 women. Mean number of negative reports during the 3- and 5-year intervals before diagnosis was 1.7 and 2.6 respectively. The age-adjusted incidence rate for all cervical cancer was 24.0/100,000 women/year and for interval cancer with single and multiple negative reports during the 3-year interval before diagnosis it was 11.6, and 9.6 respectively. Sensitivity of a Pap smear to demonstrate dysplasia during the year before diagnosis was 51%.

CONCLUSIONS

Annual cytological screening of all Alaska Native women with current methods would provide earlier diagnoses for only an additional 15% of cervical cancer cases. Plausible but unproven explanations include rapid progression through precursor stages of neoplasia or random screening errors. Improved or ancillary screening methods appear necessary.

Prevalence of HPV in premalignant and malignant cervical lesions in Greenland and Denmark: PCR and in situ hybridization analysis on archival material

Archival formalin-fixed paraffin-embedded cervical specimens from 125 women in Greenland and 139 women in Denmark who had CIN I-III or cervical cancer diagnosed between 1983 and 1987 were analysed for human papillomavirus type 16 (HPV-16) by in situ hybridization and for HPV-16, 18, 31, 33, 35 and 45 by PCR. In situ hybridization analysis showed an HPV-16 prevalence of 17% (16/95) and 23% (24/105) in the premalignant lesions from Greenland and Denmark, respectively. The HPV-16 prevalence rate in the cancer specimens was 10% (3/30) in the samples from Greenland and 29% (10/34) in the Danish specimens. A total of 82 Greenlandic and 107 Danish specimens were beta-globin-positive by PCR reaction. HPV-16-specific PCR on these samples showed 63% (34/54) of the Greenlandic and 68% (50/74) of the Danish preinvasive lesions to be positive. The corresponding HPV-16-positive rates for the invasive cancers were 82% (23/28) for Greenland and 70% (23/33) for Denmark. This study of patient samples supports our previous population-based studies in which similar HPV-detection rates were found among random samples of women from Greenland and Denmark, although Greenland has a 4-5-fold higher cervical cancer incidence.

Cervical cancers in Greenlandic women diagnosed after negative results on cervical cytology: perspectives in a high-risk population

A total of 160 indigenous Greenlandic women had incident cervical cancer diagnosed during 1976-1991, and 41 of these women (27%) had had at least one negative smear reported during the 10 years preceding the diagnosis of cancer. Thirteen patients had previously had abnormalities of the cervix. Of the remaining 28 patients, 17 had so-called interval cancer diagnosed within three years after a negative smear result. In seven of these cases, representing 4% of all incident cancers during the period, there had previously been two or more negative smears. Suboptimal sampling of negative smears was suggested in roughly one out of two interval cancers. The results suggest that rapid biological development of cervical cancer is infrequent among Greenlandic females and that efforts should be aimed at increasing the smear test's sensitivity and providing a better follow-up of women with cervical abnormalities rather than shortening the three-year rescreening interval.

Screening for cancer of the uterine cervix in Greenland

During 1986-1991 diagnostic Pap smear examinations were performed in 10,998 Greenlandic women, corresponding to 60 per cent of all women over 14 years of age. Of these, more than half had at least two smears taken. Three-year screening coverage of women over 14 was 40 per cent. Screening intensity was highest in the 25-39 age group, where more than half the population was covered. Compared to the previous 10-year period, rates for all precursor lesions were considerably lower, most pronounced for carcinoma in situ. Such findings probably reflect previous screening experience rather than reduced background risk. However, cytological screening activity failed to reduce the incidence of invasive cancer-one of the world's highest. Most cancer patients had slipped through the system because of failure to be screened at all (57%) or failure of adequate follow-up (23%). Infrequent screening and possible false-negative results seem to account for most of the remaining cases. Cancer patients with a history of failed follow-up reflected an inadequate follow-up management over the last 15 years of women with abnormal smear results. The findings of this study were similar to results for 1976-1985. A nationwide, centrally organized mass screening programme is recommended.

Human papillomavirus, herpes simplex virus and other potential risk factors for cervical cancer in a high-risk area (Greenland) and a low-risk area (Denmark)--a second look

The prevalence of human papillomavirus (HPV) infection and other risk factors were studied in a high risk area for cervical cancer (Greenland) and in a low risk area (Denmark). From Nuuk (Greenland) and Nykøbing Falster (Denmark), random samples of 150 women aged 20-39 years were drawn. A total of 129 and 126 women were included in Greenland and Denmark, respectively. The proportion of HPV infected women assessed by ViraPap was similar in Denmark and Greenland (4.8 vs 3.9%). When type specific polymerase chain reaction (PCR) was used, the total HPV detection rate was 38.9% in the Danish population and 43.4% in the Greenlandic. A similar interrelationship between Greenland and Denmark applied to the HPV types 11, 16, 18 and 33. No relationship was observed between HPV detection and number of partners for any of the diagnostic methods. Significantly more Greenlandic than Danish women had antibodies to HSV 2, 76.0% and 26.2%, respectively. The prevalence of self-reported histories of selected venereal diseases was also highest among Greenlanders, except for genital warts where the prevalence was similar in the two areas. Greenlandic women had significantly more sexual partners, earlier age at first intercourse, more current smokers and less use of barrier contraceptives compared to the Danish women. This study confirms the results of our previous population-based cross-sectional comparison study in these areas, corroborating the conclusion that the prevalence of detectable HPV infection does not seem to be a determinant of cervical cancer incidence. However, by using DNA hybridisation techniques, temporal virus shedding is only measured at one point in time. Detectable virus shedding may not correlate with the risk of cervical cancer. In fact, HPV DNA detection may have different implications in different populations. In Denmark, HPV DNA detection may reflect transient, recently acquired infection, whereas in Greenland, it is more indicative of chronic persistent infection.

Severe low-back pain. I: Clinical assessment of two weeks conservative therapy

A standard clinical examination was performed by two independent investigators, before and after two weeks of conservative therapy, on 33 patients with severe low-back pain. Kappa coefficients indicated a higher reproducibility of neurological tests than of e.g. muscular tenderness or scoliosis. All patients were diagnosed by CT-scan and a disc herniation was found in 20. The clinical diagnosis was more in agreement with the CT-diagnosis after than before treatment. By discriminant analyses six variables were found to classify the clinical diagnosis correctly in 32 of the 33 patients: sensory loss, ankle jerk, soreness of back extensors, lumbosacral soreness, radiating pain and back extension test. Similarly, the CT-diagnosis was classified in 25 of 33 patients by the variables: sensory loss and limping.

Severe low-back pain. II: Changes in CT scans in the acute phase and after long-term observation

No significant changes were noted in the CT-scan before and after 14 days of conservative therapy for low-back pain. Twenty of 33 patients had a disc herniation diagnosed on CT, and of these 18 patients were re-scanned after two weeks. Twelve patients were subsequently treated surgically, and of the remaining 8 patients 6 were re-scanned after 18 months. At this time the disc herniation had diminished significantly and was located in a more median position. In the 8 conservatively treated patients, the pain score at follow-up was related to the original size of the herniation (r = 0.72, p < 0.05).

[Can progression of myopia be prevented? A literature review]

There is no simple explanation as to when or how myopia commences, nor is there any simple method of preventing the progression of myopia. Non-surgical methods have been attempted: sight training, exercise, drugs to induce cycloplegia and to reduce intraocular pressure, as well as contact lenses and bifocal glasses; none of these have been able to prevent progression. Promising results have been disappointing when these treatments are repeated on larger groups of patients without investigator bias. Surgical procedures for the prevention of progression are not carried out in Denmark at present. New methods of reinforcing the scleral wall also in low grade myopia have been reported from Moscow. Compounds are being injected and transplants are being inserted behind the eye. It is exciting to see whether these results can be reproduced, if trial of this type of treatment is permitted in Denmark.

A new simplified dietary history method for measuring intake of energy and macronutrients

In this dietary history method, which preserves the characteristic features of the full dietary history, the principle of simplification is to group several food items into common codes. This enables us to complete both an interview and all nutrient calculations within 35-45 min. In this study we investigated whether the method could replace a 4-day food record for assessing individual intakes of energy and macronutrients. Dietary data were collected from 75 individuals (57 males and 18 females). Protein intake was validated by comparison with 24 h urinary nitrogen excretion (33 subjects), and energy intake was compared to weight maintenance energy intake from a later controlled diet study (19 subjects). When average intakes according to the two methods were compared, dietary history intakes were slightly higher than food record results (0-13%) except for alcohol. Comparison with urinary nitrogen excretion and energy intake data indicate that this is due to an overestimation by the dietary history method, rather than an underestimation by the food record. For individuals most of the correlations between the two methods were in the range 0.5-0.7, but alcohol correlation was down to 0.2. About 75% (53-93%) of the individuals at the extremes of the intake distribution were classified similarly by both methods. Although the ability of the dietary history to predict the individual food record results was unreliable the two methods agreed better when classifying individuals relative to certain cut-off points (sensitivity and specificity values of 0.7-0.9, relative to the food records).(ABSTRACT TRUNCATED AT 250 WORDS)

[Leprosy--still a possibility in Denmark]

A case of borderline tuberculoid leprosy in a 27 year old woman from the Philippines is presented. The diagnosis was made after repeated biopsies. Only a single mycobacterium was present and the histology of the initial biopsies was inconclusive. This case emphasizes that leprosy is still imported to Denmark, and that the diagnosis is often difficult and delayed for years.

[Pigmented villonodular synovitis of the shoulder joint in childhood]

A case of a 5-year-old boy with a pigmented villonodular synovitis of the shoulder is described in this article for the first time. The clinical features, preoperative diagnostic imaging including MRI and treatment were explained and compared with the literature.