DNA analysis of HLA-DR, DQ and DP genes in pauciarticular juvenile rheumatoid arthritis.

HLA-DR, DQ, and DP alleles were determined by restriction fragment length polymorphism (RFLP) and oligonucleotide hybridization analysis in 50 Caucasian children with pauciarticular juvenile rheumatoid arthritis (PaJRA) and 82 controls. There was an increased frequency of DR5, DRw8, and DQw4, as well as individual DQ alpha and beta chains, DQA*0401 and DQB1*0402, respectively, in this group of patients. There was an absolute association between DRw8, DQw4, DQA1*0401, and DQB1*0402 in the patient population. HLA-DPw2.1 was also increased in frequency. There was little evidence of linkage disequilibrium found between DPw2.1 and DR5, DRw8, or DQw4. These MHC Class II associations were more characteristic of those patients with young age of onset (less than 5 years), rather than those with onset greater than or equal to 5 years of age. Our data confirmed the previous associations of HLA-DR5, DRw8, and DPw2.1 with PaJRA and suggested a new association for DQ alpha and beta genes in the clinical expression of this disease.     

Ethical dilemmas in today's nuclear medicine and radiology practice.

Throughout history, societies have developed their own codes of ethics, including those pertaining to the practice of medicine. In the United States, physicians have adopted a set of ethics based on religious values and historical teachings. We, as physicians, have been presented several codes of ethics, including the American Medical Association Code of Ethics and the American College of Radiology Code of Ethics. Over time, we have learned to appropriately apply these codes to our daily practice. With the advent of new technologies in imaging, we may lose sight as to the transfer of these principles to reflect current conditions. Recent history has shown a trend of new technology leading to potential misuse of this technology and further leading to stricter governmental regulations. It is the purpose of this review to give guidelines for dealing with new technologies, such as PET imaging, and we describe a radiologist's ethical responsibility in a doctor-patient relationship. A historical review of medical ethics will lead to discussions about various issues affecting radiologists and nuclear physicians. To be sure, not all ethical situations are black and white, and therefore there are many gray areas. The opinions expressed in this article are those of the authors and are based on extension of already established rules of ethical conduct.     

International disaster mental health.

This article distills key issues and controversies in the field of international disaster mental health. It offers perspectives from cross-cultural research and describes current controversies, including the appropriateness of bringing to bear Western structures of mental health and psychiatric diagnosis to non-Western settings. It reports early lessons learned from the field regarding what might best constitute assistance within a foreign culture and where to place emphasis. It recommends becoming involved within the relief establishment.     

Indirect blood pressure measurement in pregnancy: Korotkoff phase 4 versus phase 5.

Controversy exists regarding which Korotkoff phase should be used to estimate diastolic blood pressure during pregnancy, some authorities recommending phase 5 (disappearance of sounds) and others suggesting phase 4 (muffling). Available data indicate that Korotkoff phase 5 more closely approximates true intraarterial diastolic pressure in pregnant women. Nonetheless, it has been suggested that phase 5 is unmeasurable in a significant number of gravid women, making this end point less desirable. However, studies examining this issue indicate that Korotkoff phase 5 is determinable in more than 90% of gravid women and that the incidence of an indeterminable phase 4 is at least as great as that for phase 5. Moreover, there appears to be greater observer variability in the measurement of phase 4 compared with phase 5. We conclude that available evidence supports recommendations for the use of Korotkoff phase 5 as the preferred end point to estimate diastolic blood pressure during pregnancy. In those few patients having very low or indeterminate phase 5 determinations, both phase 4 and phase 5 should be recorded and the former used to guide patient management. An alternative strategy is to record both phases in all gravid women beginning at the first prenatal visit so that baseline phase 4 values are available in the event that phase 5 becomes indeterminate.