Patients with coeliac disease have a characteristic gliadin antibody pattern

By use of an immunoblotting technique we have investigated the specificity of circulating IgG antibodies with respect to reactions with the alpha-, beta-, gamma- and omega-fractions of gliadin in patients with coeliac disease and in patients with diarrhoea of other causes. Untreated coeliac patients show a characteristic reactivity against polypeptides in the gamma-fraction, with an Mr of 35 and 45 kilodaltons, but only minor reactivity against the other fractions. One coeliac patient exclusively had antibodies to a 80 kilodalton component. Such a reaction pattern was not observed in other groups of patients with diarrhoea, as they had only weak reactions against the gamma-fraction but a stronger reaction against the other fractions. This might indicate that enterocytes of coeliac patients specifically take up distinct polypeptides of gamma-gliadin and by transcellular transport present them to immunocompetent cells. The results also suggest that there are distinct components of gliadin that provoke symptoms in different coeliac patients, indicating a heterogenecity of the disease. The study might lead to new diagnostic methods and to elucidation of the pathogenetic mechanisms behind coeliac disease.     

Factors influencing the ward atmosphere

On 35 short-term wards the connection between ward atmosphere as perceived by patients and various setting and treatment characteristics was explored by the use of a hierarchical multiple regression analysis. The most important variables proved to be: mean age of patients, percentage of psychotic patients, number of patients, staff turnover rate, and interaction score. A higher mean age of patients was associated with changes in the ward atmosphere preferred by older patients. An increased percentage of psychotic patients and an increased number of patients were associated with changes which were probably anti-therapeutic for psychotic patients. Increased staff turnover was paralleled by changes which were probably unfavourable for both psychotic and nonpsychotic patients. An increased emphasis on interaction was paralleled by changes which were probably beneficial for nonpsychotic patients, but partly unfavourable for psychotic patients.     

Concentrations of thyroxine, 3,5,3'-triiodothyronine, 3,3',5'-triiodothyronine, 3,3'-diiodothyronine, and 3',5'-diiodothyronine in human red blood cells

A simple and rapid method for the estimation of cellular concentration of thyroxine (T4), 3,5,3'-triiodothyronine (T3), 3,3',5'-triiodothyronine (rT3), 3,3'-diiodothyronine (3,3'-T2), and 3',5'-diiodothyronine (3',5'-T2) as well as their distribution between cytosol and membranes in human red blood cells (RBC) is presented. Concentrations of iodothyronines in RBC (RBC-T) were calculated by multiplying the total serum concentrations by the ratio of radioactivity in equal volumes of packed RBCs and serum, pre-incubated with 125I-labelled iodothyronines of high specific activity. Plasma and RBC were separated by centrifugation in capillary glass tubes. The separation of membranes and cystosol was performed by hypotone lysis and centrifugation. The median RBC-T of T4, T3, rT3, 3,3'-T2, and 3',5'-T2 from 17 euthyroid subjects were 360 pmol/l, 156 pmol/l, 2.77 pmol/l, 6.81 pmol/l, and 2.17 pmol/l, respectively. The cytosol/cytosol + membrane ration were 66%, 40%, 84%, 77%, and 97%, respectively. The differences in RBC-T were not similar to the differences in free serum concentrations. The ratio of RBC-T to free serum concentration differed considerably between T4 (16.6), T3 (24.4), and 3,3'-T2 (15.5) as compared to rT3 (5.8) and 3',5'-T2 (2.6). Data on three patients with thyroid diseases suggested that RBC-T values were increased in hyperthyroidism and decreased in hypothyroidism, whereas the cytosol/cytosol + membrane-ratio was unaltered.     

Penicillin G versus cefuroxime for prophylaxis in lower limb amputation

Out of 457 patients amputated below or above the knee, we randomized 288 to receive penicillin G and 229 cefuroxime as prophylaxis against infection. We also stratified the patients into two groups: Group A (313 patients) who did not receive antibiotic treatment within 48 hours prior to the operation and Group B (88 patients) who did. There were 56 dropouts according to protocol regulations. The patients were evaluated for efficacy on the 21st postoperative day. In Group A, 20 of 158 (13 per cent) penicillin G-treated and 27 of 155 (17 per cent) cefuroxime-treated had wound sepsis; 5 (3 per cent) penicillin G-treated and 4 (3 per cent) cefuroxime-treated patients had been reamputated by Day 21 (P greater than 0.05). We concluded that prophylactic penicillin G prevents infection as effectively as cefuroxime after lower limb amputation.     

Radiation doses to staff involved in sentinel node operations for breast cancer

BACKGROUND: The use of radioactive compounds for sentinel node biopsy is now a generally accepted part of the surgical treatment of breast cancer and melanoma, with the risk of radiation exposure to the operating team. The aim of this investigation was to study the levels of this exposure in relation to the permissible radiation dose limits. METHODS: The radiation exposure to the hands and bodies of the operating surgeons (the 'risk persons') was measured by thermoluminescent dosimeters in 79 operations and to the pathologists handling the specimens in 17 cases. Radioactivity and dose rate measurement from tumours and breast specimens were also performed. RESULTS: During an operation the mean skin dose (+/-SD) to the thermoluminescent dosimeters placed at the hand and the abdominal wall were 0.04 +/- 0.04 mSv (79 operations) and 0.01 +/- 0.02 mSv (67 operations) respectively. For the pathologist, the mean hand dose per operation was below the detection limit (17 operations). Correlation between the measured dose rate and the radioactive content of the tumours was 0.998. CONCLUSIONS: The radiation exposure to the staff involved in sentinel node (SN) biopsy for breast cancer using radioactive labelled tracers will be considerably below the permissible limits, even with high numbers of SN biopsy procedures. Pregnant staff members should participate in <100 SN operations.     

How do line managers experience and handle the return to work of employees on sick leave due to work-related stress? A one-year follow-up study

Purpose: To examine how line managers experience and manage the return to work process of employees on sick leave due to work-related stress and to identify supportive and inhibiting factors.

Materials and methods: Semi-structured interviews with 15?line managers who have had employees on sick leave due to work-related stress. The grounded theory approach was employed.

Results: Even though managers may accept the overall concept of work-related stress, they focus on personality and individual circumstances when an employee is sick-listed due to work-related stress. The lack of a common understanding of stress creates room for this focus. Line managers experience cross-pressure, discrepancies between strategic and human-relationship perspectives and a lack of organizational support in the return to work process.

Conclusion: Organizations should aim to provide support for line managers. Research-based knowledge and guidelines on work-related stress and return to work process are essential, as is the involvement of coworkers. A commonly accepted definition of stress and a systematic risk assessment is also important. Cross-pressure on line managers should be minimized and room for adequate preventive actions should be provided as such an approach could support both the return to work process and the implementation of important interventions in the work environment.

• Implication for rehabilitation

• Organizations should aim to provide support for line managers handling the return to work process.

• Cross-pressure on line managers should be minimized and adequate preventive actions should be provided in relation to the return to work process.

• Research-based knowledge and guidelines on work-related stress and return to work are essential.

• A common and formal definition of stress should be emphasized in the workplace.

     

C-Reactive Protein Levels at Diagnosis of Acute Graft-versus-Host Disease Predict Steroid-Refractory Disease,Treatment-Related Mortality,and Overall Survival after Allogeneic Hematopoietic Stem Cell Transplantation

Acute graft-versus-host disease (aGVHD) remains a cause of excessive morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). Primary treatment consists of high-dose corticosteroids, but a small group of patients develop steroid-refractory disease, and their prognosis is especially poor. There is experimental evidence that coexisting inflammation aggravates aGVHD. Because C-reactive protein (CRP) is a systemic inflammatory marker, we aimed to investigate whether plasma CRP concentrations at the diagnosis of aGVHD can predict the risk of failing first-line therapy and developing steroid-refractory disease. We retrospectively studied 461 patients who underwent HSCT between 2010 and 2015. aGVHD grade II-IV was diagnosed in 148 patients (32%). CRP level and total white blood cell, lymphocyte, and neutrophil counts were available for all patients at the time of aGVHD diagnosis. According to local protocol, patients with failed response to high-dose steroid therapy (2?mg/kg) were treated with the TNF-α inhibitor infliximab and categorized as having steroid-refractory disease. Of 148 patients with grade II-IV aGVHD, 28 (19%) developed steroid-refractory disease. In these patients, plasma CRP concentration at diagnosis ranged between <1 and 253?mg/L. CRP levels were significantly higher in patients who developed steroid-refractory disease compared with those who responded to high-dose corticosteroid therapy (odds ratio, 1.50; 95% confidence interval, 1.18-1.93; P?=?.001). This translated into significantly increased transplantation-related mortality and decreased overall survival in the patients with high CRP levels. Total white blood cell, lymphocyte, and neutrophil counts were not associated with steroid resistance in the patients with aGVHD. These results suggest that CRP level at diagnosis is a valid predictor of the development of steroid-refractory disease in patients who develop grade II-IV aGVHD after HSCT.