An epidemic of cirrhosis in Danish women revisited

Between 1944 and 1947 the mortality statistics for the Danish population show an epidemic increase of liver diseases: subacute necrosis and cirrhosis. The epidemic only affected female mortality rates. Mortality due to cirrhosis remained at a higher rate for women than men until 1970 as a result of an excess mortality in the cohort of women who in 1945 were over the age of 45. Up to 1981 this group showed an excess of 4,000 fatalities. A reevaluation of medico-statistical data shows that the disease cannot be explained by the epidemic hepatitis occurring in 1942-1944 or by increased consumption of alcohol. Possible causes could be pharmaceutical products or additives, perhaps hormone preparations.     

FEASIBILITY OF CONDUCTING CARDIOVASCULAR OUTCOME RESEARCH IN AUSTRALIAN GENERAL PRACTICE: RESULTS FROM THE ANBP2 PILOT STUDY

1. The present study aimed to determine the feasibility of conducting a 5 year cardiovascular outcome trial of the treatment of 6000 elderly hypertensive patients in Australian general practices. 2. General practitioners (GPs) were invited to participate by mail and personal follow-up. Patient records were reviewed to identify subjects for a blood pressure (BP) screening programme. Blood pressure was measured on three occasions and eligible subjects were included if the average BP was 160 mmHg systolic or 90 mmHg diastolic if systolic BP was 140 mmHg. 3. Seven hundred and forty-one GPs were approached and 89 were enrolled in the study (12% of mail invites and 75% of those receiving a personal contact). In 16 practices where screening was completed, 82 000 records were reviewed to identify 4% patients eligible for screening. Twenty-two per cent of eligible subjects attended screening. Of 1938 subjects screened, 180 (9%) had BP 5=160/90 mmHg. Forty-seven percent of subjects (n = 916) were receiving antihypertensive therapy and 184 (20%) were withdrawn from therapy. One hundred and sixteen (63%) of these subjects had BP return to study entry levels within 6 weeks. Fifty-seven newly diagnosed and 81 previously treated subjects were randomized (7% of the screened population). 4. Based on the high participation rate of GPs, the response rate of patients to attend a BP screening programme and the 7% randomization to screening ratio for entry into the study, the ANBP2 pilot study has demonstrated that it is feasible to recruit subjects from Australian general practices to a cardiovascular outcome trial.     

Identification of human T-cell epitopes on the S4 subunit of pertussis toxin.

Ten adult humans were vaccinated with the Japanese acellular pertussis vaccine JNIH-3, containing detoxified pertussis toxin (PT), formaldehyde, and filamentous hemagglutinin. The vaccination induced a specific antibody response to PT and filamentous hemagglutinin, and a Western blot (immunoblot) analysis of the antibody response to PT revealed antibodies to PT subunits S1, S2, S3, S4 and S5. The response of peripheral lymphocytes to PT was assessed in an in vitro proliferation assay. A proliferative response to detoxified PT and PT dimers S2-S4 and S3-S4 was found, and it was further demonstrated that the proliferative response to detoxified PT and dimer S2-S4 was mediated by T cells of the CD4+ phenotype. The specificity of the proliferative response to subunit S4 was analyzed with a range of synthetic peptides synthesized on the basis of the primary sequence of subunit S4. The proliferative response to the peptides revealed two major and one minor T-cell epitope located in the NH2-terminal end of subunit S4.     

SKIN FERMENTS

That a definite change in the reactivity of the skin takes place during the transition from infancy to childhood has been repeatedly noted. Rolly (5), working with a variety of bacterial toxins, found that infants did not react, but that reactions occurred with advancing age. Similarly Tenner (6), using Witte''s peptone, colon bacilli, and tuberculin observed that at about the period that the skin of children became increasingly sensitive to tuberculin, a corresponding reactivity was manifest toward the other antigens. It seems possible to us that this phenomenon is related to the alteration in the ferments of the skin that takes place during the transition period. Thus while the protease of the adult type of skin causes a definite autolysis, that of the fetal skin does not, the synthetic potential evidently predominating. Of greater significance seems to be the fact that the skin of the young animal contains peptidase to a considerable amount, while the adult skin seems to be without this ferment activity. If we assume that the disintegration of the native protein of the antigen is essential in eliciting certain skin tests, it would seem probable that the splitting would be less apt to take place in the young skin in which the lytic effects of the ferments are relatively suppressed. On the other hand, the young skin, containing peptidase, would be able to digest rapidly any antigen consisting of partially hydrolyzed proteins—as tuberculin—and in this way detoxicate and remove the noxious material. From these considerations the undoubted alteration of the skin reactivity taking place after infancy seems definitely correlated with changes in the proteolytic ferments. In how far they enter into and alter the specific reactions cannot be determined from the limited data so far available. Of the other ferments, the lipases, as pointed out by Porter, are possibly of importance in the resistance of the skin to tuberculous infection. It will be observed from the table that the activity of these skin ferments is less manifest in their action as esterases, on ethyl butyrate, than on the neutral fats used, oleic oil and butter fat, in this way differing from the activity of the serum. The relative resistance of the skin to tuberculous infection can, however, hardly be due to the activity of the lipase alone, for it must be kept in mind that the lepra bacillus, also rich in lipoids, is enabled to proliferate well within the epithelial tissues.     

Minimally Invasive Coracoclavicular Ligament Augmentation With a Flip Button/Polydioxanone Repair for Treatment of Total Acromioclavicular Joint Dislocation

Treatment of complete acromioclavicular joint disruption remains controversial and ranges from rehabilitation to extensive surgical reconstruction. However, high-grade injuries (type IV, V, and VI) are typically treated surgically. Most reconstruction techniques addressing these injuries selectively focus on coracoclavicular ligament augmentation because it has been shown to be the primary stabilizer of the acromioclavicular joint. The conventional coracoclavicular polydioxanone (PDS) loop, which is widely performed, has been detected to have some pivotal disadvantages, including anterior subluxation of the clavicle, extensive preparation of the coracoid, and bony avulsion of the clavicle as a result of rotational clavicle movement. Therefore we present an augmentation technique that reduces these complications by replicating the orientation of the native coracoclavicular ligament complex and providing a minimally invasive subcoracoid and clavicular fixation of a double PDS loop by use of 2 flip buttons, typically used for extracortical anterior cruciate ligament graft fixation. The key step of the procedure includes the anatomic, secure, and stable placement of the double PDS cerclage under the coracoid base transferring a flip button through a coracoid bone tunnel. Our clinical experience shows that the presented technique is easy to perform and has a comparable invasiveness to recently presented arthroscopic techniques.