Long-term immunity to measles, mumps, and rubella after allogeneic bone marrow transplantation

A total of 124 patients who had survived at least 2 years after allogeneic bone marrow transplantation (BMT) were studied. Serum was collected at least once yearly. IgG antibodies were determined by enzyme-linked immunosorbent assay for measles and mumps. Rubella antibodies were analyzed by radial hemolysis. Antibody levels were interpreted as representing immunity, seronegativity, or seropositivity, but with uncertain immunity. The median follow-up of the patients was 6.5 years (range, 2 to 13.5 years). The calculated probabilities of being immune to measles at 3, 5, and 7 years from BMT were 47%, 27%, and 20%, respectively. The corresponding probabilities for mumps were 37%, 12%, and 6%, respectively; and for rubella, 47%, 33%, and 28%, respectively. The probabilities for being seronegative for measles, mumps, and rubella at 5 years after BMT were 60%, 73%, and 52%, respectively. When compared with those patients who had experienced previous natural measles disease (P < .05), the only factor that was important for immunity to measles after BMT was whether the patient had been immunized before BMT. There was no influence of donor seropositivity on the probability of becoming seronegative to mumps during follow-up. We conclude that most allogeneic patients will become seronegative to measles, mumps, and rubella during follow-up. Therefore, long-term B-cell memory function is not maintained, regardless of the immune status of the donor.

Immunity to experimental Salmonella typhimurium infections in rats. Transfer of immunity with primed CD4+CD25high and CD4+CD25low T lymphocytes

The protective effect of primed CD4+ T lymphocytes against a lethal dose of 10(8) viable Salmonella typhimurium was studied in Lewis rats. Primed CD4+ T lymphocytes were obtained by inoculating Lewis rats with a non-lethal dose of 10(6) viable S. typhimurium. Four weeks after the infection, spleen CD4+ T lymphocytes were separated using magnetic microspheres coated with an antibody against the CD4 molecule (W3/25). Subsequent sorting into activated and non-activated subpopulations using the p55 alpha-chain of the interleukin-2 receptor (CD25) as an activation marker was performed by a fluorescence-activated cell sorter. Untreated Lewis rats were injected with 10(4) different primed CD4+ T-cell populations 24 h prior to the lethal dose of 10(8) viable S. typhimurium. Blood samples were drawn from the orbital plexus 1, 2, 3, and 4 weeks after the infection, and analysed for specific IgM and IgG antibodies. Cell sorting revealed that 2/3 of the primed CD4+ T lymphocytes expressed high levels of CD25. Cell transfer revealed that both CD25high and CD25low expression populations could induce immunity against a lethal dose of S. typhimurium, whilst antibody analysis revealed that antibody levels were not correlated with protection against S. typhimurium infections, although it showed that a higher and more persistent level of specific IgG antibodies was produced in animals receiving the CD4+CD25high fraction. It is concluded that 10(4) primed CD4+ T lymphocytes can induce immunity in animals challenged with a lethal dose of S. typhimurium and that antibodies do not seem to be correlated with the immunity induced. The CD4+CD25high fraction was, however, associated with a higher and more persistent level of specific IgG antibodies.

Transcranial Doppler sonography, angiography and SPECT measurements in traumatic carotid artery dissection

In two young patients with traumatic internal carotid artery dissection, early transcranial Doppler sonography (TCD) primarily indicated the lesion. A subsequent carotid angiogram confirmed the diagnosis. The course of the disease was followed by daily TCD recordings and repeated SPECT measurements. Beside CT and angiography, TCD and SPECT are helpful guidelines for different therapeutic approaches aiming to reduce cerebral ischaemia and infarction.

HIV infection among seafarers in Denmark

The purpose of this study was to estimate the minimal magnitude of the HIV problem among seafarers in Denmark. The material is based on case records from the 6 medical departments in Denmark that undertake treatment of HIV patients. Retrospectively, all case records of HIV infection among seafarers--and of their sexual contacts--have been identified. 33 seafarers with HIV infection or AIDS were identified; 17 had no other known risk factor than heterosexual contacts in high-endemic areas. These results show that HIV infections have entered into the heterosexual group of seafarers. HIV-infected seafarers are a risk group for carrying HIV infection into the heterosexual population in non-endemic areas. In 5 known cases, this has actually taken place in Denmark. The majority of the heterosexually infected seafarers were probably infected early in the AIDS era. We do not know if Danish seafarers are still acquiring HIV abroad.

[The behavior of arterial and mixed venous oxygen and carbon dioxide partial pressure and the pH value during and following intubation apnoea. Studies on the occurrence of the Christiansen-Douglas-Haldane effect]

The Christiansen-Douglas-Haldane effect describes the reduced CO2 binding capacity of oxygenated compared to deoxygenated haemoglobin. Under the condition of a "closed system", for example hyperoxic apnoea after adequate preoxygenation (continuous O2 uptake with lack of CO2 delivery), specific effects on the arterial and mixed venous blood gas status, due to the Haldane effect, are seen: within 30 s after onset of apnoea, "paradoxical pCO2" (paCO2 exceeds pvCO2) and "pH reversal" (pHa falls under pHv) can be observed. It was the aim of this study to demonstrate how fast arterial and mixed venous pCO2 and pH normalize when a change from apnoea ("closed system") to controlled ventilation ("open system") takes place. METHODS. 12 patients (ASA II-IV, NYHA II-III) scheduled for coronary artery bypass grafting were studied. Premedication consisted of flunitrazepam 2.0 mg p.o. given the evening before operation and another 2.0 mg p.o. given 90-120 min before induction of anaesthesia. Routine preparation for induction consisted of venous and arterial cannulas, pulmonary artery catheter and continuous pulse oximetry. Following standardized preoxygenation, induction of anaesthesia was performed with fentanyl, pancuronium and etomidate. After cessation of spontaneous respiration, controlled ventilation was continued with 100% O2 until intubation. Intubation and insertion of stomach tube and oesophageal temperature probe were undertaken after exactly 2 min. After reconnection to the semi-closed circle breathing system, controlled ventilation was continued with 100% O2. Eighteen arterial (a) and 18 mixed-venous (v) blood samples were drawn simultaneously in a sequential manner immediately before and during the last 20 s of apnoea, as well as within 4 min after onset of controlled ventilation (Table 1). The pO2 (mmHg), pCO2 (mmHg) and pH were determined using a Stat Profile 5 blood gas analyser. RESULTS. During apnoea and within the first 35 s of controlled ventilation the paO2 showed a total decrease of 131.5 mmHg that was followed by an almost linear increase of 29.7 mmHg/min (Fig. 1a). In the course of apnoea and controlled ventilation the pvO2 remained relatively stable, with values ranging from 42 to 43 mmHg (Fig. 1b). During apnoea the paCO2 showed an increase of 12.5 mmHg that was followed by a biphasic decrease (first 13.8 mmHg/min and then 0.75 mmHg/min) beginning 15 s after the onset of controlled ventilation (Fig. 2a). With an increase of 4.2 mmHg, the pvCO2 showed about a third of the increase of the paCO2 during apnoea, reaching a maximum 45 s after the onset of controlled ventilation and then being followed by a linear decrease of 0.86 mmHg/min (Fig.2b). Comparing the course of paCO2 and pvCO2 during apnoea as well as during the period of controlled ventilation, pHa and pHv changed in a reciprocal manner (Fig. 3a/b). The so-called normalization of pCO2 (paCO2 falls under pvCO2) and pH (pHa exceeds pHv) began 18.2 s and 23.2 s respectively after the onset of controlled ventilation (Fig. 4a, b). CONCLUSION. Considering the expected decrease of paO2 during hyperoxic apnoea, insufficient pulmonary N2 elimination prior to the onset of apnoea, as well as direct N2 delivery into the alveoli, due to the so-called a ventilatory mass flow, will limit unrestricted pulmonary O2 uptake. The continuing decrease of the paCO2 after the onset of controlled ventilation can be regarded as indirect proof of a ventilatory mass flow. The course of pCO2 and pH after the onset of controlled ventilation shows that normalization in arterial and mixed-venous blood gas status takes place in about 18.2 s after the cessation of apnoea.

[Anesthesia and intensive therapy for a patient with mitochondrial myopathy]

Since 1983 we have been involved in the diagnostic work-up and emergency treatment of a female patient now 48 years old who has a mitochondrial myopathy resembling Luft's disease. The syndrome was first described in 1959, and in more detail in 1962, by Luft and et al., who reported a picture of hypermetabolism with high temperature, extreme sweating, tachycardia, dyspnoea at rest, polydipsia, polyphagia and irritability but normal thyroid function. In 1971 and 1976 Haydar and Di Mauro presented a second case and proposed treatment with chloramphenicol. Our patient has the third case of the syndrome reported so far: her case was initially published in 1987. CASE REPORT. Since her 17th year of life the patient had suffered from episodes of fever, tachycardia and sweating. At the age of 32 these attacks worsened, leading to unconsciousness and apnoea. The patient then had to be intubated, ventilated and sometimes resuscitated. The diagnosis of MH susceptibility and Luft's disease was made on biochemical grounds after the first muscle biopsy in 1983. Therapy with chloramphenicol failed. Therapy with beta blockers, vitamin C and K or E, coenzyme Q10 and a high-caloric diet was started in 1985. The patient was registered with an emergency service, which flew her to our ICU whenever she had a severe crisis. For milder episodes she was supplied with an oxygen breathing mask at home. Myalgia increased with the episodes starting in 1988, and the patient needed dantrolene infusions and analgesics at home. To facilitate venepuncture a Port-A-Cath system was implanted in 1987, which had to be removed four times due to infection and sepsis. A muscle biopsy was taken in Rotterdam, which revealed differences in mitochondrial function from the biochemical findings recorded in 1983 and not in keeping with Luft's disease. Unfortunately, the patient was not able to undergo further metabolic investigations or therapeutic trials. ANAESTHESIA. The patient received three local and six general anaesthetics in our clinic. The muscle biopsies, two in 1983 and one in 1985, were performed under local infiltration with procaine and were uneventful. The general anaesthetics were carried out without MH trigger substances following pretreatment with dantrolene for the following surgical procedures: the repair of an extensive arterio-venous fistula between the brachiocephalicus trunk and the right jugular and subclavian vein, revision of the sternum cerclage, implantations and explanations of infectious Port-A-Cath systems. We used etomidate, propofol and fentanyl or alfentanil with nitrous oxide and oxygen for induction and maintenance of anaesthesia. Muscle relaxation was induced with vecuronium or atracurium. All cardiovascular, respiratory, metabolic and temperature measurements stayed in normal ranges. After the extensive vascular repair (av fistula) the patient had to be mechanically ventilated for some hours until normal body temperature was restored. At the end of all other periods of anaesthesia she was extubated in the operating theatre. In five cases the postoperative period was uneventful. Only once she developed a crisis with hyperthermia, tachycardia, sweating and dyspnoea. INTENSIVE CARE. From 1985 to 1992 the patient was treated in our ICU 21 times. On 11 occasions she was already intubated and being ventilated by the emergency service on arrival. Extubation was usually possible within 2-20 h. During the crisis, heart rate was about 160-190 per minute and temperature above 40 degrees C. Serum values of CK, glucose, BUN, electrolytes, lactate and thyroid hormones were always in the normal ranges. Blood gas controls showed a constant respiratory alkalosis, arterial pCO2 values decreasing to 20 mm Hg or less. In addition to mechanical ventilation, treatment consisted in dantrolene infusions and droperidol injections, supplemented from 1989 onward with piritramide injections because of the increased severity of myalgia. In 1991 we gave propofol by

[The effect of hyperbilirubinemia on the measurement of oxygenated hemoglobin (O2Hb), carboxyhemoglobin (COHb) and methemoglobin (MetHb) using multiwavelength oximeters in mixed venous blood]

Oximetric measurements are influenced by several mechanisms. Severe jaundice is one of these mechanisms with some clinical interest. In the literature it is pointed out that a high bilirubin concentration may falsify oximetric measurements and is often accompanied by elevated COHb levels. The reason for this phenomenon is thought to be an interference in the absorption spectra of haemoglobin derivatives and bilirubin [2, 3, 4, 10]. In our investigation we attempted to answer the following questions: 1. How do multiwavelength oximeters measure haemoglobin derivatives in different bilirubin concentrations? 2. Do different multiwavelength oximeters give different concentrations of haemoglobin derivatives? METHODS. In 13 patients who developed postoperative jaundice on the intensive care unit, O2Hb, COHb and MetHb were measured in mixed venous blood with two multiwavelength oximeters (OSM3, Radiometer; CO 2500, Ciba-Corning). Bilirubin concentration was measured by the DPD (dichlorphenyldiazonium) method in the central laboratory of our hospital. RESULTS. With increasing bilirubin concentrations, both oximeters measured increasing O2Hb values; the OSM3 consistently showed higher O2Hb concentrations than the CO 2500, with a maximal difference of 2.8% (Fig. 3). Regarding COHb, we saw clear increases in the values with increasing bilirubin concentrations (Fig. 4). The CO 2500 showed higher COHb values than the OSM3 (average 1.54 +/- 0.3%). The findings regarding MetHb differed. The CO 2500 showed increasing MetHb values as the bilirubin concentration increased (Fig. 5). All measurements exceeded normal values above a bilirubin concentration of 17 mg/dl. The OSM3, however, measured constant MetHb values which did not depend on jaundice. CONCLUSIONS. 1. The in vitro measurement of haemoglobin derivates by multiwavelength oximeters is influenced by hyperbilirubinaemia. This is caused by an interference between the light absorption spectra of the haemoglobin derivates and of bilirubin and by the increasing development of endogenous CO in the haem metabolism during severe jaundice (Fig. 7). 2. With increasing bilirubin levels, a lower O2Hb is measured with the CO 2500 than with the OSM3. 3. We also see increasing COHb values with rising bilirubin concentrations. 4. With increasing bilirubin levels the MetHb concentration measured with the CO 2500 rises, while the OSM3 gives constant MetHb values. 5. In severe jaundice the O2Hb values measured with multiwavelength oximeters are not identical with the real blood concentration of this haemoglobin derivative. In this situation multiwavelength oximeters cannot be used as a reference method for in vivo oximetric systems such as pulse oximeters or fibreoptic pulmonary artery catheters.

Causes of morbidity and mortality, with special reference to surgical complications, after early aneurysm operation: a prospective, one-year study from neurosurgical units in Sweden

In the present prospective study, 6.93 of Sweden's 8.59 million inhabitants (81%) were covered by the five participating centres. All patients with verified aneurysmal SAH admitted between June 1, 1989 and May 31, 1990, were enrolled. Basically, all participating centres have the same management protocol for SAH victims, including ultra-early referral to a neurosurgical unit, followed by pan-angiography and surgery as early as logistically possible. In this presentation, 145 patients who preoperatively were in Hunt & Hess Grades I-III and who underwent surgery for a supratentorial aneurysm within 72 h after the bleed, are evaluated. Eighty-one % (117 patients) made a good recovery. The morbidity was 12% (17 patients) and the mortality 7% (11 patients). The most common cause of unfavorable outcome was surgical complications, which accounted for 8% of the total series (12 patients). A subanalysis of these cases did reveal a positive correlation to higher age and more severe SAH on CAT scan.

Electroneurography index: a standardized neurophysiological method to assess peripheral nerve function in patients with polyneuropathy

An index based on 12 electrophysiological parameters (conduction velocities, F-latencies, and amplitudes) was constructed to obtain an overall estimation of peripheral nerve conduction. The index was expressed as the mean deviation (in SD) compared to controls standardized for age or height. The stability of the index was tested by repeated examinations during intervals of several months in healthy subjects. The use of a compound index enabled detection of slight impairments of nerve conduction. The relatively low interrecording variability of the index makes it suitable to follow the progression of a polyneuropathy.

Effects of pinacidil on cerebral and mesenteric arteries--influence of the endothelium

The effect of pinacidil on the contractile response to stepwise increases of the extracellular K+ concentration ([K+]o) was investigated in isolated segments of human pial and mesenteric arteries and rabbit basilar and mesenteric arteries. The [K+]o eliciting half maximum contraction (EC50) was lower in human pial (18 mM) and rabbit basilar (27 mM) arteries than in human (33 mM) and rabbit (32 mM) mesenteric arteries, respectively. The alpha-adrenoceptor blocker, prazosin, increased the EC50 value for K+ from 27 to 40 mM and reduced the maximum response in rabbit mesenteric arteries, but had no effect on the K(+)-induced contraction in rabbit basilar arteries, indicating a substantial noradrenergic component of the K+ response in the former arteries. Removal of the endothelium decreased the EC50 value for K+ from 27 to 15 mM in rabbit basilar arteries, whereas the K+ sensitivity was unaffected in rabbit mesenteric arteries. Pinacidil shifted the K+ concentration-response curve to the right in human and rabbit cerebral and mesenteric arteries. In rabbit basilar arteries, but not in mesenteric arteries, the shift was larger in the absence than in the presence of an intact endothelium. When endothelium-denuded rabbit arteries were compared, the inhibitory effect of pinacidil was larger in basilar than in mesenteric arteries. Thus, pinacidil inhibits K(+)-induced contractions in both cerebral and mesenteric arteries, but appears to act preferentially on endothelium-denuded rabbit basilar arteries. Provided that endothelial damage and depolarization-induced vasoconstriction are of pathophysiological importance in cerebrovascular disorders such as stroke and cerebral ischemia secondary to vasospasm after subarachnoid hemorrhage, pinacidil may have a therapeutic potential.

Predictors of alcoholism in young Swedish men

OBJECTIVES

The purpose of the study was to assess risk indicators for admission for alcoholism in young men.

METHODS

Level of alcohol consumption and background variables were analyzed in a survey of 49,464 Swedish conscripts. Admissions to psychiatric care were registered during a 15-year follow-up.

RESULTS

A strong association was found between level of alcohol consumption at conscription and future admission for alcoholism. The strongest risk indicator for admission for alcoholism, however, was "Contacts with police or child care authorities," with an odds ratio of 4.9.

CONCLUSIONS

For conscripts reporting moderate alcohol consumption at conscription there was a clear association between an increasing burden of risk indicators and future alcoholism. Among men who already had a high level of alcohol consumption at conscription, additional risk indicators, with the exception of psychological factors, had relatively little impact on future admission for alcoholism. Poor emotional control and early symptoms of mental disorder, however, were instrumental not only in enhancing the risk for high consumption at conscription, but also in enhancing the risk for high consumers to become abusers or addicted.

Myelography in the late postoperative period in patients subjected to anterior cervical decompression and fusion

During a 13 year period, 286 patients with cervical disc herniation and/or spondylotic spurs, were subjected to anterior decompression and vertebral interbody fusion with autologous bone. Twenty patients were re-admitted in the late postoperative period due to recurrent radicular symptoms and/or signs of myelopathy. In these patients myelography was performed again. In 14 patients spinal cord compression and/or nerve root involvement at a new level was visualized. At the operated level, however, the myelograms demonstrated a smooth anterior wall in the spinal canal. The series confirms the safety, effectiveness and reliability of the Cloward procedure in achieving long term spinal cord and nerve root decompression, and a solid vertebral interbody fusion.

Cytomegalovirus viraemia and specific T-helper cell responses as predictors of disease after allogeneic marrow transplantation

Risk factors for cytomegalovirus viraemia and disease, the relation between viraemia and disease, effect of antiviral treatment, and T-helper cell response to cytomegalovirus antigen were analysed retrospectively among 279 patients who underwent bone marrow transplantation at Huddinge Hospital. Ninety-one of 279 (32.6%) patients developed viraemia. Donor and recipient pre-transplant serologic status and degree of acute graft-versus-host disease were independent risk factors for viraemia. Forty-nine patients (17.6%) developed cytomegalovirus disease and 44 of these patients had viraemia. Seventeen patients (6%) developed cytomegalovirus pneumonia and 14 of these patients had preceding viraemia. Among patients with viraemia, acute graft-versus-host disease and total body irradiation were risk factors for pneumonia. Antiviral treatment initiated within 7 d of development of viraemia was associated with lower risk for development of pneumonia (P < 0.05). Sixty-seven patients with viraemia were repeatedly tested by lymphocyte stimulation with cytomegalovirus antigen. No patient who developed cytomegalovirus pneumonia had measurable specific helper T-cell response at the time of viraemia detection compared to 42% of patients with other concurrent or subsequent cytomegalovirus disease, and 75% of patients without subsequent disease. We conclude that viraemia is a major risk factor for development of cytomegalovirus disease. Furthermore, early antiviral treatment based on detection of viraemia can be effective in preventing cytomegalovirus disease. The length of antiviral treatment might be decided through measurements of the helper T-cell response to cytomegalovirus antigen.

Southern travelling habits with special reference to tumour site in Swedish melanoma patients

Southern travelling habits were recorded for 127 melanoma patients from southern parts of Sweden (the 56th latitude), 55 thyroid cancer patients, 100 non-Hodgkin's patients and 794 healthy controls from the same region. Melanoma patients were found to travel significantly more often south of the 45th latitude, as compared with patients with non-Hodgkin's lymphoma or thyroid carcinoma (RR = 2.2 for a difference of + 10 trips), and with the healthy controls (RR = 1.4 for a difference of + 10 trips). Considering men and women separately, the difference was significant only for men. Patients with melanoma had a higher educational level than the tumour controls and the healthy controls (p < 0.001 and p < 0.001 respectively). There was a significant correlation between high travelling frequency and high education. An increased risk related to southern travelling was present for patients with melanoma on the extremities and head and neck, as well as for patients with truncal melanoma. These findings support the concept that acute exposure to sunburn may be a risk factor for malignant melanoma.

Antecedents and covariates of high alcohol consumption in young men

The role of social, behavioral, and psychological characteristics and other risk indicators for high alcohol consumption in young men was analyzed using a survey of 49,464 Swedish conscripts. A strong association between an increasing weight of adverse social and behavioral risk indicators on the one hand and high alcohol consumption on the other was found. Yet many high consumers had no or few risk indicators. In multivariate analysis, substance use and indicators of deviant behavior came out as the strongest risk indicators for high alcohol consumption. Indicators of poor social background generally had relatively low odds ratios. Poor home wellbeing, for instance, had an odds ratio of 0.9. Social group of father was nonsignificant. Very good family economy had a higher odds ratio, 1.7, than average or poor family economy. Psychosomatic symptoms had relatively low odds ratios. Among psychological variables, low emotional control had a significantly elevated odds ratio of 1.8. Increased odds ratios were found for conscripts who were never anxious or never felt insecure. In conclusion, although many high consumers of alcohol had no or few risk indicators, we identified a high-risk group characterized by high levels of alcohol consumption and several indicators of personality disturbances, early deviant behavior, and social maladjustment.

Intravenous drug abuse in young men: risk factors assessed in a longitudinal perspective

The role of family background as well as behavioural and psychological factors as risk factors for intravenous drug abuse was analysed in a longitudinal study of 8168 Swedish men conscripted for military service in 1969-70. Information about risk factors was obtained from a survey of all Swedish conscripts. Records on intravenous drug abuse, during a followup ending in 1986, were obtained from a survey of intravenous drug abusers among persons brought to the Central police arrest in Stockholm. Strong predictors of intravenous drug abuse were contact with the police of juvenile authorities (RR = 22.3 95% CI 15.1-33.0), high alcohol consumption (RR = 9.2 95% CI 6.7-12.7) and psychiatric diagnosis at conscription (RR = 6.0 95% CI 4.5-8.1) and low social class (RR = 3.6 95% CI 2.2-5.9). In multivariate analyses, these factors and indicators of deviant behaviour still carried significantly increased relative risk for intravenous drug abuse, although several of them are interrelated. Low emotional control, nervousness, sleeping problems and other nervous problems were associated with an increased relative risk in univariate but not in multivariate analyses.

Overall outcome in aneurysmal subarachnoid hemorrhage. A prospective study from neurosurgical units in Sweden during a 1-year period

The present prospective study, with participation of five of the six neurosurgical centers in Sweden, was conducted to evaluate the overall management results in patients with aneurysmal subarachnoid hemorrhage (SAH). The participating centers covered 6.93 million (81%) of Sweden's 8.59 million inhabitants. All patients with verified aneurysmal SAH admitted between June 1, 1989, and May 31, 1990, were included in this prospective study. A uniform management protocol was adopted involving ultra-early referral, earliest possible surgery, and aggressive anti-ischemic treatment. A total of 325 patients were admitted during the study period, 69% within 24 hours after hemorrhage. On admission, the patients were graded according to the scale of Hunt and Hess: 43 patients (13%) were classified in Grade I, 119 (37%) in Grade II, 53 (16%) in Grade III, 76 (23%) in Grade IV, and 34 (11%) in Grade V. Nimodipine was administered to 269 of the 325 patients: intravenously in 218, orally in 15, and intravenously followed by orally in 36. At follow-up examination 3 to 6 months after SAH, 183 patients (56%) were classified as having made a good neurological recovery, 73 patients (23%) suffered some morbidity, and 69 (21%) were dead. Surgery was performed in 276 (85%) of the patients; emergency surgery with evacuation of an associated intracerebral hematoma was carried out in 30 patients. Early surgery (within 72 hours after SAH) was performed in 170 individuals, intermediate surgery (between Days 4 and 6 post-SAH) in 29 patients, and late surgery (Day 7 or later after SAH) in 47 individuals. Of 145 patients with supratentorial aneurysms who were preoperatively in Hunt and Hess Grades I to III and who were treated within 72 hours, 81% made a good recovery; in 5.5% of patients, the unfavorable outcome was ascribed to delayed ischemia. It is concluded that, among patients with all clinical grades and aneurysmal locations, almost six of 10 SAH victims referred to a neurosurgical unit can be saved and can recover to a normal life.

Treatment of interstitial pneumonitis due to cytomegalovirus with ganciclovir and intravenous immune globulin: experience of European Bone Marrow Transplant Group

Data on 49 allogeneic bone marrow transplant (BMT) recipients who developed interstitial pneumonia due to cytomegalovirus (CMV) were collected retrospectively. All patients were treated with ganciclovir and high doses of intravenous immune globulin, although types of immune globulins and schedules of treatment varied. Seventeen (35%) of 49 patients responded to treatment. Thirty days after the diagnosis of interstitial pneumonia, the survival rate among patients was 31%. CMV was detected in 81% of patients on whom autopsies were performed. The survival rate among patients who received total body irradiation (TBI) was significantly lower (11 [27%] of 41) than that among patients who did not receive TBI (six [75%] of eight; odds ratio = 12.3; P = .009). No other factor, including age, grade of graft-versus-host disease, types and dose of immune globulin used, or dose of ganciclovir, was correlated to survival. These results show that although survival of allogeneic BMT recipients with CMV interstitial pneumonia has improved, more than one-half of the patients still died of pneumonia. Thus, both prophylaxis for and treatment of CMV infection must be improved.

Antecedents of anxiety syndromes in a cohort of 50,465 young men in Sweden. A prospective analysis of self-reported and professionally assessed psychosocial characteristics

The purpose of this study was to find psychiatric, behavioral and social characteristics that predict subsequent anxiety syndromes in men. Questionnaire data were collected in a cohort of all 50,465 men in Sweden who were conscripted for military training. By record linkage with the national psychiatric inpatient register, we identified 68 probands with pure anxiety neurosis occurring in the cohort during a 13-year follow-up period. Baseline characteristics were categorized into 8 variables that were entered into logistic regression models. We found that reported treatment with psychoactive drugs and perceived mental health problems at baseline increased the odds of being admitted for anxiety neurosis by 1.9 and 1.8. Other predictors were family problems (odds ratio = 2.0) and having a family member being treated with psychoactive drugs (odds ratio = 1.7). Univariate relative risks were higher, and a psychiatric diagnosis at conscription conferred a relative risk of anxiety neurosis of 2.2. A similar profile was obtained for subjects admitted for a depressive neurosis, in support of the continuum hypothesis between anxiety and depression. We conclude that the necessity of admission for anxiety neurosis in young men originates in genuine mental symptoms in the family setting.

Anxiety and depression in breast cancer patients at start of adjuvant radiotherapy. Relations to age and type of surgery

Using a self-report questionnaire, the Hospital Anxiety and Depression (HAD) scale, feelings of anxiety and depression were assessed in 133 breast cancer patients referred for adjuvant radiotherapy following surgical treatment. Eighteen patients (14%) had scores indicating morbid anxiety. Significant depression was recorded for only 2 patients (1.5%). Severe anxiety was recorded for 10 out of 54 mastectomized patients (19%) and for 8 out of 79 patients treated with breast conserving surgery (10%). The difference was not significant (p = 0.13). In a subgroup aged 50-59 years, morbid anxiety was significantly more common among mastectomized patients than among patients operated conservatively, 4 out of 9 (44%) vs. 1 out of 23 (4%) (p = 0.01). Such a pattern was not discernable in the patients < 50 years of age or those > or = 60 years old. The results suggest that, at start of adjuvant radiotherapy, emotional distress is characterized by anxiety rather than depression and the risk of morbid anxiety is especially large for mastectomized women in their fifties.

Exposure to organic solvents and risk of haematological malignancies

Epidemiological studies indicating that exposure to organic solvents is a risk factor for haematological malignancies are reviewed. Exposure to benzene is a risk factor for ANLL. A preleukaemic phase with pancytopenia is common and may be associated with a normo- or hypercellular marrow with morphological characteristics suggesting MDS. There are indications that other organic solvents than benzene may be leukaemogenic. Certain chromosome aberrations are characteristic in leukaemic cells from solvent exposed ANLL patients. The average latency time from start of occupational exposure until diagnosis is about 10-11 years. There is epidemiological evidence that exposure to organic solvents may also increase the risk of lymphoproliferative malignancies, i.e. ALL, NHL, HD and myeloma.

Allogeneic bone marrow transplantation in multiple myeloma. European Group for Bone Marrow Transplantation

BACKGROUND AND METHODS

In contrast to autologous bone marrow transplants for hematologic cancers, allogeneic transplants contain no tumor cells that might cause a relapse. We report the results of such allogeneic bone marrow transplantation using HLA-compatible sibling donors in 90 patients with multiple myeloma performed in 26 European centers between 1983 and 1989.

RESULTS

At the time of the most recent follow-up, 79 months after the start of the study, 47 patients were alive and 43 were dead. The rate of complete remission after bone marrow transplantation was 43 percent for all patients and 58 percent for the patients who had engraftment. The actuarial survival at 76 months was 40 percent. The median duration of relapse-free survival among patients who were in complete remission after bone marrow transplantation was 48 months. The stage of the disease at diagnosis and the number of treatment regimens tried before bone marrow transplantation were predictive of the likelihood of complete remission after engraftment. There were trends toward longer survival among patients who were responsive to treatment before bone marrow transplantation, patients with Stage I disease at diagnosis, and patients who had received only first-line treatment before transplantation, as compared with those who were not responsive, those with Stage II or III disease at diagnosis, and those who had received three or more lines of treatment, but the differences in these factors were not statistically significant. Two post-transplantation factors predicted better long-term survival: complete remission after engraftment and grade I graft-versus-host disease, rather than grade II, III, or IV.

CONCLUSIONS

Allogeneic bone marrow transplantation with the use of HLA-matched sibling donors appears to be a promising method of treatment for some patients with multiple myeloma.

Posterior wiring without bony fusion in traumatic distractive flexion injuries of the mid to lower cervical spine. Long-term follow-up in 30 patients

Thirty-four patients with traumatic distractive flexion injuries in the mid to lower cervical spine were treated with posterior wire stabilization without bony fusion from January 1981 through May 1987. Fifteen had cord involvement, and nine had root involvement. Ten were neurologically intact. Thirty patients were followed for a mean of 38 months. Two neurologically intact patients had root deficits postoperatively. One patient was reoperated because of redislocation due to a spinous process fracture. Mean loss of lordosis was 7.5 degrees. Eight patients had a wire break at follow-up, but no case of late instability was observed. Sixteen patients had signs of spontaneous anterior interbody fusion at follow-up, and 11 patients had signs of posterior fusion. Twenty-four patients complained of late--but in most cases--minor pain. These results indicate that simple posterior wiring without bony fusion is a reliable method to obtain good immediate stability in traumatic distractive flexion injuries of the mid to lower cervical spine. The wires provide sufficient stability during the time of soft tissue healing.