Infection of infants with human herpesvirus type 6 may be associated with reduced allergic sensitization and T‐helper type 2 development

Background Epidemiological studies point to an inverse relationship between microbial exposure and the prevalence of allergic diseases. The underlying mechanism for this observation remains largely unknown, as well as the nature of the microbes involved. Objective To investigate the effects of early infection with human herpesviruses (HHVs) on IgE formation and T‐helper type 2 (Th2) development in infants. Methods Serum was collected from children aged 18 months and assessed for IgE to common allergens and IgG to five common herpesviruses. Cord blood plasmacytoid dendritic cells (pDC) were exposed to HHV type 6 in vitro and mixed with allogeneic cord blood CD4⁺ T cells. Cytokine levels were determined by ELISA and by flow cytometry. Results We found that children seropositive at 18 months of age to HHV type 6 were significantly less often IgE sensitized than seronegative children [odds ratio (OR): 0.08, 95% confidence interval (CI): 0.009–0.68]. HHV type 6 also decreased the production of the Th2‐associated cytokines IL‐5 and IL‐13 by CD4⁺ T cells when co‐cultured with allogeneic cord blood pDC. This was associated with an increased production of IFN‐α by pDC exposed to HHV type 6. Conclusion These data indicate that an early childhood infection with HHV type 6 could down‐regulate Th2 responses and reduce IgE formation to common allergens in a young child.     

Long‐term follow‐up of tailored behavioural treatment and exercise based physical therapy in persistent musculoskeletal pain: A randomized controlled trial in primary care

This study examined long‐term effects of a tailored behavioural treatment protocol (TBT), as compared with an exercise based physical therapy protocol (EBT). One‐hundred and twenty‐two patients who, due to persistent musculoskeletal pain, consulted physical therapists in primary care were originally randomized to either of the two conditions. Follow‐up assessments two‐year post‐treatment were completed by 65 participants. According to per‐protocol analyses, short‐term effects were maintained in both groups for the primary outcome, pain‐related disability. The TT‐group reported lower disability levels compared with the EBT‐group. Intention‐to‐treat analyses (ITT) conveyed similar results. Secondary outcomes of pain intensity, pain control, and functional self‐efficacy were maintained over the 2‐year post‐treatment, but previous group differences were levelled out according to the most conservative method of ITT. Fear of movement/(re)injury increased in the EBT‐group, and EBT participants reported higher fear of movement/(re)injury two years post‐treatment compared to TT. The study supports tailoring of treatments in concordance with patients’ needs and preferences of activity goals and functional behavioural analyses including predictors of pain‐related disability, for successful immediate outcomes and their maintenance in the long run. Exercise‐based treatments resulted in somewhat smaller immediate treatment effects but had similar maintenance of effects over the 2‐year follow‐up period.     

Diagnostic considerations of tongue-base malignancies

Summary Forty-two patients with malignancies localized to the base of the tongue were treated at Sahlgrenska Hospital between 1971 and 1980. These patients were re-analyzed with respect to symptomatology and clinical outcome. Pain in the mouth, throat, and ears as well as swallowing difficulties were the most frequent overt symptoms of disease. In general, patients experienced symptoms for at least 3 months before a positive tumor diagnosis was made. In all, 75% of the patients were found to have large tumors which extended beyond the base of the tongue. Most of the patients were treated with irradiation. The overall 3-year survival rate was 28%, while individual patient survival was related to the size of the primary tumor and to the occurrence of lymph node metastases. Careful attention to symptomatology may reduce delays in establishing an accurate diagnosis and consequently improve the prognosis for patients with these cancers.     

Peri- and postoperative changes in serum levels of four tumor markers and three acute phase reactants in benign and malignant gynecological diseases

Summary Serum levels of squamous cell carcinoma antigen, carcinoembryonic antigen, CA 125, tissue polypeptide antigen, CRP, α₁-antitrypsin and haptoglobin were determined peri- and postoperatively in patients undergoing surgery for benign gynecological disease (n=18) and postoperatively in women operated for cervical carcinoma (n=23). The only significant changes seen after premedication, during anesthesia and during surgery were a decrease in serum concentrations of α₁-antitrypsin and haptoglobin. We found no post-operative changes in the serum levels of squamous cell carcinoma antigen nor in carcinoembryonic antigen values. However, the latter analyte was influenced by smoking habits. Elevated levels of CA 125 and tissue polypeptide antigen were found in the cancer patients, predominantly within the first 1–3 weeks after surgery. These levels decreased to normal values within 4–6 weeks postoperatively. The median intraindividual coefficients of variation for the tumor markers ranged between 15% and 28% in 30 control women not having surgery. In general, it would seem advisable to wait 6 weeks after surgery before monitoring with CA 125 and TPA is started.     

Imaging in chronic achilles tendinopathy: a comparison of ultrasonography,magnetic resonance imaging and surgical findings in 27 histologically verified cases

 Objective. To compare information gained by ultrasonography and magnetic resonance imaging (MRI) in chronic achilles tendinopathy with regard to the nature and severity of the lesion. Design. Imaging of both achilles tendons with ultrasonography and MRI was performed prior to unilateral surgery. Operative findings and histological biopsies together served as a reference. Patients. Twenty-seven patients (22 men, 5 women; mean age 44 years; 21 athletes) suffering from chronic achilles tendinopathy participated in the study. Eighteen patients had unilateral and 9 had bilateral symptoms. Results and conclusions. Surgical findings included 4 partial ruptures, 21 degenerative lesions and 2 macroscopically normal cases. Microscopy revealed tendinosis (degeneration) in all tendon biopsies, including cases with a partial rupture, but only slight changes in the paratendinous tissues (paratenon). Ultrasonography was positive in 21 of 26 and MRI in 26 of 27 cases. Severe intratendinous abnormalities and a sagittal tendon diameter >10 mm suggested a partial rupture. In tendons with a false negative result histopathological changes were mild and a tendency towards a better clinical outcome was noted in the sonographic cases. Assessment of the paratenon was unreliable with both methods. Ultrasonography and MRI give similar information and may have their greatest potential as prognostic instruments.     

Aeromonas hydrophila toxins—intestinal fluid accumulation and mucosal injury in animal models

Strains of Aeromonas hydrophila were earlier shown to produce a heat-labile enterotoxin and two cytolytic toxins, alpha- and beta-haemolysin. These investigations have been extended. When separated from the cytolysins, the enterotoxin elicited fluid accumulation in rabbit intestinal loops. The electrolyte and albumin content of the fluid was similar to that of cholera toxin. The enterotoxin was non-injurious to the mucosa. Purified hemolysins did not give a positive loop test. They produced hemorrhagic enteritis with leakage of small amounts of hemorrhagic fluid. In electrolyte and albumin content this fluid differed from the fluid elicited by the enterotoxin. Prostaglandin inhibitors did not reduce the diarrheal response to Aeromonas enterotoxin. The cAMP inhibitor chlorpromazine reduced the fluid accumulation in rat and mice intestinal loops by 60%. Cholera toxin and Aeromonas enterotoxin may have a common pathway in the elicitation of intestinal fluid accumulation. By passage in intestinal loops, strains of A. hydrophila could regain lost enterotoxicity. Experimental diarrhea could not be induced in rabbits and rats with various enterotoxigenic strains of Aeromonas.     

Selective or routine intraoperative cholangiography: A cost-effectiveness analysis

In a retrospective analysis of 819 patients operated on for gallbladder disease, the costs and mortality rates were compared for 2 different strategies: (a) routine use of intraoperative cholangiography, or (b) selective use of intraoperative cholangiography on patients fulfilling at least 1 of 4 common clinical criteria. Selective use led to lower costs and lower mortality rates. The main reason for this outcome was that the benefits of detecting more stones in the bile duct by the routine use of cholangiography were counterbalanced by an increase in costs and risks because false-positive operative cholangiograms led to a greater number of unnecessary choledochotomies.