Peripheral inflammatory vascular disease in Sjögren's syndrome. Association with nervous system complications

Two histopathologic types of inflammatory vascular disease (IVD) occur in Sjögren's syndrome (SS): mononuclear IVD (MIVD) and neutrophilic IVD (NIVD). We describe 50 SS patients with IVD (30 with NIVD and 20 with MIVD). Thirty-three (66%) of the SS patients with biopsy-documented IVD had nervous system disease unattributable to other causes. Nineteen patients (58%) had involvement of both the central and peripheral nervous systems, while 9 had peripheral and 5 had central nervous system dysfunction alone. Patients with both histopathologic types of IVD were at risk for the development of nervous system abnormalities (57% of NIVD patients and 80% of MIVD patients). Indirect evidence is presented which suggests that IVD may play a role in the immunopathogenesis of nervous system disease, at least in a subset of SS patients.

Breast disease in young West Indian women: an analysis of 1051 consecutive cases

Our analysis of 1051 breast biopsies in West Indian women under the age of 30 y revealed that 99% of the breast lumps were benign. Fibroadenoma was the commonest (67%) lesion and there was a steady increase in the frequency of fibrocystic disease with age. Carcinoma in this group is therefore rare. Thus most patients can be reassured with certainty of their benign disease and have biopsy at a convenient time.

High-density lipoprotein cholesterol and angiographic coronary artery disease in black patients

The clinical epidemiology of coronary artery disease (CAD) among black patients has not been well described, particularly in relation to the impact of the major risk factors. Lipoprotein profiles and other risk factors were measured in 114 black patients undergoing cardiac catheterization for probable CAD. Patients (coronary narrowing of 50% or greater; n = 63) were compared to those without significant stenoses (n = 51). Total cholesterol and low-density lipoprotein cholesterol (LDLC) were both significantly associated with the presence of CAD in men and women; however, high-density lipoprotein cholesterol (HDLC) had discriminatory value only for women. The ratio of total cholesterol to HDLC (TC:HDL) separated patients from control subjects in both sexes, most efficiently among women, and was the only lipid variable associated with CAD in the age group over 55 years. Hypertension and angina were frequent in both groups and did not identify those with disease. In summary, LDLC was the best predictor among the lipids for men (likelihood ratio = 9.4) and TC:HDL was the best indicator of disease among women (likelihood ratio = 15.7). Low HDLC levels may, in part, account for the increased incidence of CAD among black women. Further population studies of factors leading to reduced HDLC, namely, obesity and diabetes, are needed.

Estrogen-mediated cytoplasmic and nuclear distribution of rat cardiovascular estrogen receptors

We used either the synthetic estrogen R2858 (moxestrol) or estradiol-17 beta to characterize estrogen receptors in cytoplasmic (R2858) and nuclear (estradiol-17 beta) preparations from rat aorta and myocardium. Relative steroid specificity studies showed that only estrogens were effective inhibitors of R2858 or estradiol-17 beta binding to aortic and myocardial estrogen receptors, whereas androgens, progestins, and cortisol were ineffective inhibitors. Low ionic strength sucrose density gradient analyses showed that myocardial estrogen receptors that localized in the cytoplasmic fraction migrated as macromolecules with sedimentation coefficients of 8S to 9S. In contrast, two binding components of sedimentation coefficients 8S to 9S and 10S to 11S were characteristic of the estrogen receptors localized in aortic cytoplasmic preparations. High ionic strength sucrose density gradient analysis showed that aortic and myocardial estrogen receptors localized in the nuclear fraction migrated as macromolecules with sedimentation coefficients of 4S to 6S. Saturation analyses showed that aortic and myocardial cytoplasmic preparations from intact young mature male rats contained 50.6 +/- 12.9 (mean +/- SD) and 51.0 +/- 14.1 fmol receptor/mg DNA, respectively. The respective R2858 dissociation constants were 0.42 and 0.15 nM. Estrogen receptors could not be demonstrated in nuclear preparations from cardiovasculature of intact males. Estradiol-17 beta injection of intact young mature male rats caused "depletion" of aortic and myocardial cytoplasmic fraction estrogen receptors and resulted in the appearance of 51.9 +/- 21.0 and 36.9 +/- 9.5 fmol receptor/mg DNA in the corresponding nuclear fractions. The respective estradiol-17 beta dissociation constants were 1.56 and 0.71 nM. Increased estrogen receptor content of cardiovascular nuclear fractions of estradiol-17 beta injected male rats correlated well with the concomitant decreased cytoplasmic fraction receptor content. The ability of estradiol-17 beta to affect localization of cardiovascular estrogen receptors between cytoplasmic and nuclear fractions suggests these estrogen receptors are physiologically functional and indicates that estrogen may directly regulate cardiovascular cell function.

Menarcheal age and habitual miscarriage: evidence for an association

Among women who habitually miscarried (two or more miscarriages) we observed a modest association for increased risk of miscarriage of first pregnancies in those with younger (especially less than or equal to 11 years) and older (greater than or equal to 16 years) menarcheal age (quadratic G2 = 3.49, P = 0.062). No associations of menarcheal age with first pregnancy miscarriage were observed when analysed by age at first pregnancy, or with pregnancy number among women with only one miscarriage. Unusually early or late menarcheal age appears to increase the risk of miscarriage of the first pregnancy but only among women who will go on to habitually miscarry.

Risks of preterm delivery and small-for-gestational age infants following abortion: a population study

We examined hospital discharge records in 1980-81 for singleton third trimester deliveries in Scotland. We compared 3000 women who had previously experienced induced termination of pregnancy, and 4000 who had experienced spontaneous abortion with primigravidae and with women in their second pregnancy, their first having resulted in a livebirth. Two aspects of low birthweight were examined: delivery before the 37th completed week of gestation, and low birthweight for gestational age. Our comparisons were further controlled for maternal height, age, sex of infant, marital status and social class. Women with previous spontaneous abortions experienced significantly increased risk of preterm delivery but not of low birthweight for gestational age. Women with a history of induced abortion also experienced increased risk of preterm delivery, but for women aged 18-24 years, risk of low birthweight for gestational age was significantly reduced compared with primigravidae.

Health implications of a 5 mm Hg increase in blood pressure

The health implications of a mean increase in blood pressure on the order of 5 mm Hg among young persons are explored primarily from a public health point of view. After an overview of the epidemiologic behavior of human blood pressure is provided, the phenomenon of "tracking" of blood pressure is examined as is the possible relationship between the rate of blood pressure change over time and the initial value. In the last part of the paper, the community benefits of lowering the average blood pressure 5 mm Hg (in terms of number of heart attacks prevented) are estimated under several simplifying assumptions.

IgG (Gm) allotypes and multiple sclerosis in a French population: phenotype distribution and quantitative abnormalities in CSF with respect to sex, disease severity, and presence of intrathecal antibodies

The association of a given Gm allotype or phenotype with MS susceptibility, as previously described in some Caucasian populations, was not observed in a large French MS group, whether or not considering the possible influence of sex or disease severity. This result could be related to variations in geographical distribution of Gm alleles and MS susceptibility gene(s) or suggests the simultaneous involvement of Gm and other genetic system(s). In contrast, the corresponding CSFs exhibited already known MS-associated abnormalities of IgG1 (G1m) allotype contents, which therefore did not merely result from a Gm-associated MS susceptibility. These quantitative abnormalities were not sex dependent, but may fluctuate with MS severity. The G1m allotype levels in each CSF were not correlated with titers of various intrathecal antibodies but with the number of antibody specificities detected, a picture arguing for a polyclonal, non-antigen-specific activation of G1m allotype-producing B cells present in MS brain.

Influenza B virus model of Reye's syndrome in mice: the effect of aspirin

Aspirin is a possible cofactor with influenza B virus in Reye's syndrome. In an attempt to determine whether single or multiple doses of acetylsalicylic acid (ASA) alter mortality in an influenza B virus mouse model of Reye's syndrome, either ASA (300 to 667 mg/kg) or saline was given intraperitoneally to 3-week-old Balb/c mice. Two hours later, one median lethal dose (LD50) of influenza B/Lee virus was given intravenously. Mortality was not significantly increased by the single ASA dose. Blood ASA levels rose as high as 68 mg/dl. The average ASA blood levels in mice 12 hours after receiving the virus plus 667 mg/kg ASA was 22.6 mg/dl, which was significantly higher than the 3.4 mg/dl for mice who received saline plus ASA. No significant increase in mortality occurred in mice given 67 mg/kg ASA twice daily for 7 days and one LD50 dose of virus on day 4. We conclude that a single dose of ASA at up to half the median lethal dose or multiple doses of ASA do not significantly increase mortality in this influenza virus model of Reye's syndrome. However, influenza B virus infection appears to interfere with ASA metabolism.

Treating gonococcal infections resistant to penicillin in Bangkok: comparison of cefuroxime and spectinomycin

Gonococcal organisms have become resistant to antimicrobials throughout the world. Such resistance is common in Thailand, where 40% of gonococci produce penicillinase (PPNG strains) and over half the remainder have MICs of penicillin greater than or equal to 1 mg/l. To evaluate the effectiveness of cefuroxime against such resistant organisms, a controlled clinical trial comparing spectinomycin and cefuroxime was conducted at Bangrak Hospital, Bangkok, in 1982-3. Of 472 patients who were randomly assigned to treatment, 365 (77%) yielded positive cultures before treatment and returned for follow up evaluation three to 13 days after treatment. Of the 365 patients, 359 (98%) were cured, and no difference between the two treatment regimens was found either by the sex of the patient or by the presence of PPNG strains. The MIC of cefuroxime against all organisms was less than or equal to 1 mg/l. In vitro susceptibilities of gonococci in Bangkok have not changed appreciably during the past two years. Regimens of cefuroxime and spectinomycin are highly effective even for the relatively resistant gonococci in Bangkok. The pharmacokinetics, in vitro susceptibilities, and effectiveness of cefuroxime encourage evaluation of lower doses of the drug.

Rubella in teenagers: epidemiology and prophylaxis in Siena, Italy

Six hundred and fifty-three teenagers (aged 11-13 year) living in Siena and its surroundings (Tuscany, Italy) were the sample for serological screening intended to ascertain immunity to rubella. It was found that 324 of the teenagers (49.62%) lacked antibodies and, hence, were unprotected against the infection. Out of the 324 girls, 196 (around 3/5) were vaccinated using live vaccine. Post-vaccinal complications, with clinical signs of rubella infection, were recorded in almost one third of the vaccinees. Virus isolation from the blood was, in every case, not possible after either 10 or 30 days from vaccination. The serological findings, expressed in hemagglutination inhibition antibodies, could be summarized in the following way: (i) antibodies at low titre were found in only eight out of 184 girls (4.35%) ten days after vaccination; (ii) serological conversion was recorded in 187 out of 188 girls (99.47%) 30 days after vaccination; (iii) the titres were moderately high but much lower than those recorded for the natural infection. The results are discussed in the context of their implications for the strategies of rubella vaccination as far as the safety and the effectiveness of the vaccine are concerned, with emphasis on the duration of the protective immunity.

Depressed chemiluminescence response by influenza virus is enhanced after conjugation of viral subunits to muramyl dipeptide

The effect on respiratory burst of murine spleen cells after in vitro exposure to influenza virus, subunits, or subunits conjugated to muramyl dipeptide (MDP) was studied by luminol-dependent chemiluminescence (CL) in response to stimulation by zymosan. CL induced by infectious influenza A virus was depressed but could be elevated to normal levels when MDP was added together with a low, but not with a high, dose of the virus. Profound depression of CL was induced by high doses of influenza A/Brazil, A/Bangkok, and B/Singapore subunits. The same amounts of viral subunits conjugated to MDP restored or even enhanced the CL responses of spleen cells from BALB/c and C57BL/6 mice. Splenic cells from BALB/c mice generated higher levels of CL than did cells from C57BL/6 mice.

Community-acquired pneumonia requiring hospitalization. Is it different in the elderly?

The authors studied 138 patients, 57 of whom were younger than 65 years of age and 81 who were 65 years of age and older, with community-acquired pneumonia to determine whether or not such pneumonia is different in the elderly and to define how such patients are investigated and treated. Pneumonia in the elderly was characterized by a higher mortality, 30 v 10%; more likely to be of unknown etiology, 54 v 30%; and more likely to show radiographic progression after the patient had been admitted to the hospital, 48 v 11%. In addition, elderly patients were more likely to be afebrile when admitted, 57 v 26%. Twenty-seven etiologic categories were present in 77 patients in whom a cause for the pneumonia was established. Streptococcus pneumoniae accounted for 9.4% of the pneumonia overall and for 27% of the pneumonia among patients who had sputum cultures performed before antibiotic therapy. The diagnostic yield was 11.6% for blood cultures, 38.2% for sputum cultures, 2.3% for throat washing, and 22.1% for serological studies. Twenty-seven percent of patients were receiving antibiotics of the time of admission to the hospital. Most (79%) received more than one antibiotic after admission. This study indicates that community-acquired pneumonia is a serious illness and that an algorithm approach to diagnosis and treatment of such pneumonia is necessary.

Race-related differences in breast cancer patients. Results of the 1982 national survey of breast cancer by the American College of Surgeons

Data from the 1982 breast cancer survey of the American College of Surgeons were used to evaluate factors related to clinical, epidemiologic, and survival differences between black and white patients. Breast cancer in blacks was not discovered as early as in whites. Distribution of pathologic types of tumors were similar for both races with the exception of medullary carcinoma, which was more frequent in blacks than in whites. Estrogen receptor-positive tumors were found significantly less frequently in blacks compared with whites. Survival was better for whites compared with blacks within each axillary nodes group 0, 1 to 3, and 4+. Black women with negative or positive estrogen receptors had lower survival rates than white women of the same receptor status. A regression analysis using Cox's proportional hazards model showed race, clinical stage or axillary nodal status, age at diagnosis, and estrogen receptor status as significant predictors of survival. Significant differences between black and white patients were also observed with respect to the report of family history of breast cancer, age at first pregnancy, number of pregnancies, and age at cessation of menses.

Large-scale survey of hepatitis B virus infection in families

To investigate HBV transmission in families on three islands in Okinawa, Japan, prevalence of HBV markers in two groups of inhabitants was determined. One group consisted of members of families in which there was at least one HBsAg carrier (carrier families); the other group consisted of members of families in which there were no HBsAg carriers (non-carrier families). A total of 3,261 serum samples were collected from subjects on Iriomote Island, Hateruma Island, and Yonaguni Island. These samples were tested for HBsAg by reversed passive hemagglutination (RPHA) and for antibody to hepatitis B core antigen (anti-HBc) by radioimmunoassay. Overall prevalences of HBsAg and anti-HBc were 8.2 and 65.8 per cent respectively. The prevalence of anti-HBC among members of carrier families (80.8%) was significantly higher than that among members of non-carrier families (61.6%) (P less than 0.001). The prevalence of anti-HBc among members of carrier families was higher in all age groups, and was particularly so in children. Within carrier families, the prevalence of anti-HBc was significantly higher in families in which there was at least one HBsAg carrier with HBeAg (94.5%) than in families with no HBeAg-positive carriers (76.1%). This difference was especially marked in young children. These data suggest that in families with HBsAg carrier(s), the risk of transmitting HBV to members, particularly to young children, is higher than in families without carriers, and that the risk is further increased in families with HBeAg-positive carrier(s).

Risk factors for gestational trophoblastic neoplasia

A case-control study to determine the gynecologic and reproductive risk factors for gestational trophoblastic neoplasia was conducted in the Baltimore Metropolitan Area. All cases (N = 190) that were pathologically diagnosed from 1975 to 1982 as hydatidiform mole, invasive mole, or choriocarcinoma were ascertained. Slides were independently reviewed by two pathologists. Cases were matched by age, race, and last menstrual period to controls who were delivered of normal pregnancies at term. In the analysis of medical record and interview data, factors found to be positively associated with gestational trophoblastic neoplasia included professional occupations (odds ratio = 2.56, p less than 0.0001), prior spontaneous abortions (odds ratio = 2.32, p = 0.02), and the mean number of months from the last pregnancy to the index pregnancy (cases = 35.9, controls = 28.2; p = 0.03). Factors found not to be associated with disease included contraceptive history, irradiation, ABO blood group, and smoking factors of the male partner. The findings suggest that gestational trophoblastic neoplasia may be part of a continuum of early (first-trimester) reproductive abnormalities.

Women and health in Europe: the scope and limits of epidemiology

Epidemiology is one tool for assessing women's health, at least in terms of the main diseases which cause morbidity and mortality. When employed for international comparisons across Europe, its value, even at this level, is diminished by the shortage of reliable data. Examples are chosen from the fields of cancer and cardiovascular disease. The latter part of the article draws attention to the inadequacies and limits of clinical epidemiology when applied to women's broader experience in respect to health.

Sunlight exposure as risk factor for intraocular malignant melanoma

In a case-control study, we compared 444 patients with intraocular malignant melanoma with matched controls to evaluate the role of exposure to ultraviolet radiation and other risk factors in the pathogenesis of this tumor. Persons born in the southern United States had a relative risk of 2.7 (95 per cent confidence interval, 1.3 to 5.9) as compared with those born in the North. Subjects with brown eyes were protected as compared with those with blue eyes (relative risk, 0.6; 95 per cent confidence interval, 0.4 to 0.8), but complexion and hair color were not important risk factors. Patients with intraocular malignant melanoma were also more likely to have spent time outdoors in their gardens, to have sunbathed, and to have used sunlamps. Rarely wearing hats, visors, or sunglasses while in the sun was a risk factor for the disease (relative risk, 1.9; 95 per cent confidence interval, 1.6 to 2.2). These data suggest that sunlight exposure is an important risk factor for intraocular melanoma.

HLA-DRw6 as a risk factor for active cytomegalovirus but not for herpes simplex virus infection after renal allograft transplantation

To study genetically determined susceptibility to cytomegalovirus and herpes simplex virus infections in patients given renal transplants a prospective study was performed of 68 consecutive patients receiving their first cadaveric kidney allograft. The recipients positive for HLA-DRw6 showed a significantly increased incidence of active cytomegalovirus infection as early as the 10th week after transplantation (p less than 0.05). No relation with other human leucocyte antigens was found, nor did a correlation exist between HLA typing and the incidence of herpes simplex virus infections. Furthermore, recipients positive for HLA-DRw6 with secondary cytomegalovirus infections excreted infectious virus more often (p less than 0.01) and showed more clinical symptoms (p less than 0.01) than a comparable group of recipients negative for HLA-DRw6. These observations may have practical implications for the treatment of patients who have had renal transplant operations.

Inability of Japanese rubella vaccines to induce antibody response in rabbits is due to growth restriction at 39 degrees C

We have compared the kinetic growth patterns of To-336, MEQ11, KRT, and SK2 rubella vaccine strains licensed in Japan at 37 degrees and 39 degrees C with those of progenitor wild strains of rubella virus. The growth of vaccine strains was depressed at 39 degrees C to a level about 3 log10 lower than that at 37 degrees C. The difference in virus titer attained by wild strains at 37 degrees and 39 degrees C was less than tenfold. The growth potential at 39 degrees C paralleled the immunogenic marker of rubella virus, i.e. the capability of virus to induce antibody response upon subcutaneous injection in rabbits for all wild and vaccine strains examined, including one strain at an intermediate level of attenuation. Several clones were isolated from the progeny produced by a vaccine strain during the growth at 39 degrees C. Among them were partial revertants in immunogenic marker as well as in the growth potential at 39 degrees C. It was concluded that the immunogenic marker of rubella virus in rabbits represented its capability to replicate at the body temperature of the animal.

The use of epidemiology, scientific data, and regulatory authority to determine risk factors in cancer of some organs of the digestive system. 2. Esophageal cancer

The epidemiologic aspects of esophageal cancer are well known. The extreme geographical variations in incidence of the disease, the variability in the sex ratio, and the secular trends have been described frequently. The etiology of cancer of the esophagus is known to be complex and composed of multiple factors, those caused by the environment being of greatest importance. The disease preferentially attacks groups with a low socioeconomic status or those hindered by poverty. The esophageal cancer belt has been frequently studied to provide clues to the etiology of esophageal cancer but no definite culprit has yet been found. The majority of the factors so far implicated in cancer of the esophagus appear to act directly on the esophagus rather than systemically. This is an unusual situation in that it enables the disease to be prevented by primary means. There appears to be an enormous disparity in the etiology of the disease among various countries. This disparity may be more apparent than real if the epidemiologic data are interpreted to mean that there is a two-stage process involved, with multiple etiologies for each stage. If we assume that nutritional deficiencies, even subtle ones, predispose the esophagus to influence by carcinogenic substances, the geographic differences fade. Nutritional deficiencies can develop by chronic alcohol use as well as by poverty and lack of an adequate food supply, but diet does not explain the whole picture. External carcinogens are necessary to effect the end result. The culprit may be tobacco in one culture and fungal elements in another. The South African studies which showed an association with tobacco and not alcohol could be explained if we assume that the population's nutritional deficiencies already predisposed the esophagus for the effect of an external carcinogen, thereby making alcohol usage superfluous. It would be helpful if the relationship between esophagitis and nutritional status were elucidated and if it were determined that the condition could be improved or eliminated by dietary factors. The association between nutrition and esophagitis may suggest methods of primary prevention of esophageal cancer and provide a chance of lowering the incidence of this deadly disease.

Community-wide surveillance of Campylobacter jejuni infection. Evaluation of a laboratory-based method

Surveillance of infections due to Campylobacter jejuni is needed to further define the epidemiology of this disease in the U.S. We assessed one potential method of community-wide surveillance, a laboratory-based reporting network. Six microbiology laboratories that routinely culture fecal specimens for C. jejuni reported all isolates to Seattle-King County Health Department for an 18-month period. Further investigations on 476 cases reported from this broadly based network revealed that C. jejuni enteritis affected primarily children and young adults, occurred sporadically (with a summer-fall predominance), led to hospitalization in 13% of cases, was found negligibly in patients hospitalized or immunocompromised, and produced no fatalities. Comparative statistics showed that C. jejuni was reported more frequently than Salmonella and Shigella combined in individuals served by reporting laboratories. Because one participating laboratory was that of a 280,000-member health maintenance organization, it was possible to calculate age-specific incidence rates for bacterial enteric infections in that population. C. jejuni and Salmonella had high attack rates among 0-4 year-old children: 184 cases/100,000 enrollees per year and 126/100,000 per year, respectively. C. jejuni showed another peak at 20-29 years (108/100,000 per year) that was absent in salmonellosis. This study demonstrates that a laboratory-based reporting system is a feasible approach to community-wide C. jejuni surveillance.

Factors affecting predictability of radial keratotomy

A major criticism of radial keratotomy (RK) has been its lack of predictability, a lack due in large measure to the use of simple correlational statistics assessing the relationship between refractive result and each predictor-variable being evaluated separately. This report utilizes multivariate analysis in an attempt to account for the effects of a number of predictor-variables simultaneously. Variables studied are patient age, optical zone size, number of incisions, mean incision depth, preoperative average keratometry, preoperative average applanation tension, patient sex, and age-sex interrelationship. The area of the optical clear zone selected by the surgeon was found to be the most important factor determining refractive change as a result of RK, explaining one-quarter to one-half of the variability of the procedure. The effects of the other factors and the limitations of the method are discussed. Although this method cannot produce a fully predictive equation, we believe this analysis can serve as a good starting point for beginning RK surgeons and a method by which experienced RK surgeons can improve their techniques.

Nosocomial rubella--consequences of an outbreak and efficacy of a mandatory immunization program

An outbreak of rubella in a large metropolitan hospital is described. Nineteen cases among employees and three secondary cases in family members occurred. Nosocomial cases occurred among the 3,900 employees of an adult medical-surgical unit where a voluntary program of rubella immunization was in effect. No cases occurred among the 1,400 employees of the women's and pediatric units with mandatory policies, despite interfacility and community exposure. Ten pregnant women were among the 377 contacts of the cases. Five were sero-negative to rubella. Two who developed clinical rubella, one asymptomatic sero-conversion and one other, all elected to terminate their pregnancies. The remaining woman, exposed in her third trimester delivered a normal infant. We conclude a policy requiring new employees to be rubella immune is more effective in preventing nosocomial rubella than a voluntary program and is desirable in view of the potential consequences of an outbreak to pregnant employees.

The prevalence of Toxocara species ova in backyards and gardens of Baltimore, Maryland

Toxocara species ova were found in 16 of 146 (11 per cent) soil samples collected from backyards and gardens of private residences within Baltimore City. The recovery rate of parasite ova was similar for households regardless of their grouping by pet ownership characteristics or the presence of visible animal feces. The findings demonstrate the common occurrence of these eggs in locations likely to be important in the transmission of visceral larva migrans.

HLA studies in brucellar spondylitis

Among the clinical manifestations of brucellosis, arthritis may occur in over one-third of the patients. Different articular syndromes have been well recognized: some are definitely infectious in nature, whereas others appear to be reactive. The possibility that B27 and B7-CREG antigens could predispose to the occurrence of brucellar spondylitis was investigated in 14 mestizo Peruvian patients. No association was found. Since there is a low frequency of B27 and B7-CREG in the control population, the possibility that a "native" antigen could be the predisposing one remains to be elucidated.

Natural and radiation-induced cataracts in man and mouse, and natural macular degeneration in man: proposed mechanisms

A unified theory of growth and age-dependent disorders is applied to the interpretation of epidemiological data for natural and radiation-induced cataracts and natural macular degeneration in man. Using the same unified theory, mechanisms are also proposed to explain the experimental evidence for natural and radiation-induced lenticular opacities in the lens of the mouse. Epidemiological and experimental data are strikingly consistent with the hypothesis that natural cataract formation is an autoaggressive process but the details of pathogenesis differ greatly between the two species. Radiation dose-response relations reflect these contrasts. Lenticular opacities in the nuclear-bomb survivors at Hiroshima and Nagasaki were probably induced by a 'single-track' mechanism. Radiation-induced generalised opacification in the lens of the mouse results from a 'multi-track' process. The pathogenesis of natural macular degeneration in man happens to have close parallels with that of natural opacification in the mouse. We discuss some implications of these inferences for the phenomenon of radiation-induced lethal disorders in man.

Hypocholesterolemia in cancer patients may be caused by elevated LDL receptor activities in malignant cells

Several epidemiological studies indicate an inverse relation between plasma cholesterol and the occurrence of cancer. Since we in previous studies have found that certain malignant cell types have an elevated LDL receptor activity, the aim of the present study was to further explore the possibility that an elevated LDL consumption by tumor cells causes hypocholesterolemia. The plasma cholesterol concentrations in patients with acute leukemia were inversely correlated with the rate of receptor-mediated degradation of 125I-LDL by the leukemic cells. During chemotherapy, the total plasma and the LDL cholesterol levels increased concomitantly with the reduction in the leukemic cell count in a patient whose leukemic cells exhibited a high rate at receptor-mediated degradation of 125I-LDL. In certain patients with inoperable urinary bladder carcinoma, the plasma cholesterol concentration fell as the disease progressed. Studies in breast cancer patients indicate that the number of LDL receptors in the tumor tissue may have prognostic significance. The results are in agreement with the hypothesis that an elevated LDL receptor activity in malignant cells may lead to hypocholesterolemia.

Migration and death from malignant melanoma

The age-standardized mortality rates for malignant melanoma of the skin in immigrants to New Zealand were compared with those of New Zealand-born non-Maoris. Immigrants from European countries had mortality rates that were generally similar to those prevailing in their countries of origin, although, among immigrants from the British Isles, early age at migration was associated with a mortality rate similar to that of New Zealand-born non-Maoris. In a community survey, British immigrants were not less likely to have had severe sunburn, but had fewer moles, than New Zealand-born non-Maoris. The lower melanoma mortality, and the effect of age at migration, could be mediated by differences in mole frequency.

Reproductive impairments in the united states, 1965–1982

The first national estimates of current fecundity status of women of all marital statuses indicate that, in 1982, about 5.1 million women were unable to have a future birth but would have liked to. About 2.7 million had difficulty bearing children, and the other 2.4 million were surgically sterile for noncontraceptive reasons. Since 1965, infertility was unchanged overall and in most age groups, but increased among wives aged 20–24. This paper explores a number of methodological and substantive questions related to reproductive impairments, such as the frequency of intercourse, the duration of infertility, and the possible causes of trends.

Biotypes and serotypes of thermophilic campylobacters isolated from cattle, sheep and pig offal and other red meats

In this study we examined 730 faecal samples of offal (mainly liver), mince-meat and sausage meat collected from abattoirs and retail butchers' shops for campylobacters. Campylobacter jejuni or C. coli were isolated from 30.6, 10.5 and 6% of sheep, cattle and pig offal samples respectively. Specimens collected from abattoirs were, in general, more often contaminated than material obtained from retail butchers' shops. Only 1.4% of minced meats and sausage meats contained campylobacters. Most isolates (89.5%) were C. jejuni biotype 1 (Skirrow & Benjamin, 1980) of serotypes 1 and 2 (Penner & Hennessy, 1980). This study shows that animal offal is frequently contaminated with C. jejuni of biotypes and serotypes commonly isolated from human beings with campylobacter enteritis.

Causes of death among female chemists

A mortality odds ratio analysis of cause of death among 347 White female members of the American Chemical Society (ACS) revealed a five-fold excess of suicide, notably by cyanide poisoning. Risk was also elevated for all cancers combined and for cancers of the breast, ovary, stomach, pancreas, and lymphatic and hematopoietic system. The excess breast and ovary cancer deaths were limited to unmarried women.

Oral contraceptives and cardiovascular disease: a critique of the epidemiologic studies

Observational study designs used to investigate the relationship of oral contraceptive use to the occurrence of venous thromboembolism, stroke, myocardial infarction, and cardiovascular death include case-control, cohort, and mortality statistics studies. This analysis catalogs the findings of each of these epidemiologic studies, its statistical significance, and its performance with regard to scientific methodologic standards. An association between current oral contraceptive use and incidence of venous thromboembolism without predisposition has been consistently observed in case-control and cohort studies. Associations are less consistent for various types of stroke and for myocardial infarction. Only the Royal College of General Practitioners study found a significantly elevated risk of cardiovascular death with oral contraceptive use. The majority of mortality statistics studies offer little support for a relationship between oral contraceptive use and cardiovascular events. Major systematic problems in the epidemiologic studies include potential for bias in the detection of cardiovascular events and differences in the prognostic susceptibility of compared groups. Bias in the ascertainment of drug exposure is an unresolved issue for most of the case-control studies. Because of possible biases arising from methodologic deficiencies in these epidemiologic studies, questions as to the validity of the observed associations between oral contraceptive use and cardiovascular events should remain.

Factors associated with the blood pressures of children born to women who were hypertensive during pregnancy

At age 7.5 years the supine blood pressures of 216 children born to women who had been hypertensive during pregnancy were recorded. No associations were found between the blood pressures of the children and their mothers. The blood pressures of children whose mothers received methyldopa during pregnancy did not differ from those of children whose mothers had no specific treatment. Four boys whose mothers had taken methyldopa for more than 150 days had significantly lower systolic and diastolic pressures than those in whom the treatment had been of shorter duration. Significant findings from multiple regression analyses were: positive associations between boys' systolic and diastolic pressures and current weight, and diastolic pressure and maternal weight; negative associations between boys' systolic and diastolic pressures and birthweight; and a positive association between girls' systolic pressure and current weight.

Epilepsy and associated handicaps in a 1 year birth cohort in northern Finland

A 1 year birth cohort in the provinces of Oulu and Lapland in the Northern part of Finland consisted of 12058 live-born infants, this being 96% of all children born in 1966 in this area. Information on morbidity up to the age of 14 years was collected prospectively by means of questionnaires, special examinations and from national and regional registers of hospital admissions and social services contacts. The total number of children with epilepsy, defined as the occurrence of at least one afebrile epileptic seizure, was 208, 113 boys and 95 girls. The cumulative incidences for epilepsy up to the age of 14 years was 17.3 per 1000. Primary generalised epilepsy was present in 63% and partial seizures in 37%. At least one additional handicapping condition, such as cerebral palsy, mental retardation, and visual or auditory defect was present in 74 children (35.5%). Mental retardation was the most frequent additional handicap, being present in 28%, whereas 16% of the children had cerebral palsy. A total of 75% of the children were able to attend an ordinary school. The high frequency of epilepsy in this study, as compared to other studies, is explained by the cumulative registration of the cases and a high degree of ascertainment of cases with epilepsy.

Perinatal factors and seizure disorders: an epidemiologic review

In this review, we assess the following six aspects of the epidemiological literature addressing the association between perinatal factors and seizure disorders (mainly of the grand mal type): (1) study design; (2) selection of cases; (3) selection of controls; (4) definition and ascertainment method of seizures; (5) definition and ascertainment method of perinatal factors; (6) sample size and power. Needed are studies of perinatal factors in a homogeneous group of seizure patients, such as those with grand mal seizures. Because of the rarity of the seizure disorder, most follow-up studies of this subject suffer from inadequate sample size. Improvements are suggested for case-control studies, which appear, by necessity, to be the more appropriate design.