Pregnancy and delivery in patients with urinary diversion through the continent ileal reservoir

The social and psychologic sequelae after external urinary diversion are known to be fewer in patients with urinary diversion through the continent ileal reservoir (Kock pouch) compared with those with diversion through the incontinent ileal conduit. Therefore, in young female patients treated surgically with urinary diversion through the continent ileal reservoir, a number of pregnancies can be expected. We report herein the results of four pregnancies in three women with this type of reservoir. All deliveries were vaginal. One patient showed urinary obstruction at the end of the pregnancy and delivery was induced. This particular infant was treated with phototherapy because of hyperbilirubinemia; the other three infants were mature. No damage to renal function was noted and revisional surgical treatment of the reservoir was not necessary in any. Consequently, pregnancy is not contraindicated after urinary diversion through the continent ileal reservoir (Koch pouch).     

Prostate Cancer in Northern Sweden: Incidence, survival and mortality in relation to tumour grade

In order to study changes in incidence, survival and mortality of prostate cancer in relation to morphological grade, we analysed all incident cases of prostate cancer in Northern Sweden during three 2-year periods (1974-1975, 1980-1981 and 1986-1987). The age-adjusted incidence increased by 35% from 1974-1975 to 1986-1987, but there was only a minor increase in the mortality rates. The increase in incidence was mainly due to well-differentiated (Gl) and moderately differentiated (G2) tumours, whereas the incidence of poorly differentiated (G3) tumours remained stable. The 5-year relative survival rate increased significantly from 1974-1975 to 1986-1987. The relative survival rate for each tumour grade was, however, almost stable over the studied time period. After adjustment for tumour grade the differences in relative survival rate diminished. We believe that the most likely explanation for these changes in incidence, survival and mortality is enhanced detection of tumours with more favourable histology as a result of a more frequent use of the diagnostic tools available.     

Activity of cyclosporins as resistance modifiers in primary cultures of human haematological and solid tumours.

The semiautomated fluorimetric microculture cytotoxicity assay (FMCA) was used for evaluation of the ability of cyclosporin A (CsA) and its novel non-immunosuppressive derivative SDZ PSC 833 (PSC) to modify the response to doxorubicin or vincristine in vitro in different haematological and solid human tumour types. Primary cultures of 322 tumour samples were analysed. Both cyclosporins showed resistance-modifying activity in all haematological tumours tested, and in solid tumours activity was observed in ovarian carcinoma and childhood tumours. Little or no effect was found in the remaining tumour types, including breast, renal and adrenal cortical carcinomas and adult sarcomas. In most of the responsive cases the interaction between the modifier and the cytotoxic drug was synergistic. There was a tendency to higher activity in samples from previously treated patients, and an inverse relationship between degree of cytotoxic drug resistance and resistance-modifying activity was noted. No difference in potency between CsA and PSC could be discerned. The results indicate differential in vitro resistance-modifying activity of the cyclosporins depending on tumour type. The results also suggest that treatment with resistance modifiers should be considered also for primary therapy of drug-sensitive tumours. Drug resistance assays such as the FMCA may become useful in preclinical evaluation of resistance modifiers.     

Magnetic resonance in Bell's palsy

The brain and the brain stem were investigated by magnetic resonance (MR) in 19 patients with complete acute peripheral facial palsy, diagnosed as Bell's palsy. Five patients with a median age of 57 years had changes on T2 weighted MR: One patient showed transient signal changes with increased signal intensity in the ipsilateral brain stem. Another patient had persisting abnormal signals both in the brain and the brain stem. Two patients presented regions of high signal intensity in the subcortical cerebral white matter and still another patient had increased signal intensity in the periventricular white matter. MR abnormalities anatomically related to the facial nerve or its nucleus were not demonstrated. The significance of the MR findings is not quite certain but the MR pattern in conjunction with the patient's high median age most likely indicate vascular disease.     

Socioeconomic costs of rheumatic diseases. Implications for technology assessment

OBJECTIVES: To study the socioeconomic impact of rheumatic illness in Sweden and to discuss the consequences for technology assessment studies. METHODS: A cost-of-illness study based on data from official statistics and treatment studies. RESULTS: The total socioeconomic cost was 52 billion Swedish kronor (SEK) in 1994. The imbalance between direct (10% of total) and indirect costs (90 effectiveness of the healthcare sector, the need for new treatment methods, appropriate information systems, and technology assessment studies as well as the institutional arrangements for rehabilitation and basic medical research. CONCLUSIONS: A discussion of solutions for financial cooperation between county councils and regional social insurance offices should be considered. The new biotechnological pharmaceuticals will increase the cost for drugs in health care about 20 times, but the total socioeconomic cost for society may remain at the same level due to a decrease of inpatient costs and indirect costs for loss of production as well as a decrease of transfer payments from social insurance. It is unavoidable that the new pharmaceuticals require priority discussions and active resource allocation in health care and in other sectors of society.     

Anti-herpes IgG and IgG subclass antibodies in Bell's palsy

To ascertain if there is an association between Bell's palsy and infection by viruses of the herpes group, 78 patients and 59 controls were investigated. The specific antiviral IgG subclass pattern in serum against cytomegalovirus (CMV), herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) was analysed using an enzyme-linked immunosorbent assay (ELISA) combined with monoclonal antibodies directed against the four subclasses of human IgG. Additional ELISA assays of IgG and IgM antibodies were also used. The mean titres of IgG antibodies against HSV-1 were higher in the acute and convalescent stages compared with controls. The frequency of values greater than 0.2 for all subclasses was raised in the patients, but not significantly so. The mean values for the subclasses were alike in patients and controls. The mean titres of IgG antibodies against CMV and VZV were similar throughout the palsy and also in controls. In the patients, the pattern of IgG subclasses was different from the controls, but not statistically so. The patients and controls were not seropositive for IgM against CMV and VZV. Four patients in the acute phase, 4 in the convalescent phase and 3 controls were positive for IgM against HSV-1. While the subclass pattern of IgG antibodies against HSV-1 is not diagnostic of reactivation of the virus, the raised IgG antibodies may suggest reactivation of a disease process and/or a superadded infection.     

Cellular basis of ectopic germinal center formation and autoantibody production in the target organ of patients with Sjögren's syndrome

OBJECTIVE: To investigate functional properties of the germinal center (GC)-like structures observed in salivary glands of patients with Sj?gren's syndrome (SS) and to determine the frequency with which such structures develop. METHODS: Hematoxylin and eosin-stained sections from 165 minor salivary gland biopsy samples were screened for GC-like structures. Expression of markers for GCs (CD3, CD20, Ki-67, CD35, CD31), adhesion molecules (intercellular adhesion molecule 1, lymphocyte function-associated antigen 1, vascular cell adhesion molecule 1, very late activation antigen 4), chemokines (CXCL13, CCL21, CXCL12), and production of autoantibodies (anti-Ro/SSA and anti-La/SSB) was investigated by immunohistochemistry. Apoptosis was investigated by TUNEL staining. RESULTS: GC-like structures were observed in 28 of 165 patients (17%). When GCs were defined as T and B cell aggregates with proliferating cells with a network of follicular dendritic cells and activated endothelial cells, such microenvironments were found in all patients in whom structures with GC-like morphology were observed. The defined microenvironments were not found in patients without apparent GC-like structures. The GCs formed within the target tissue showed functional features with production of autoantibodies (anti-Ro/SSA and anti-La/SSB) and apoptotic events (by TUNEL staining), and the local production of anti-Ro/SSA and anti-La/SSB autoantibodies was significantly increased (P = 0.04) in patients with GC development. CONCLUSION: Lymphoid neogenesis and functional ectopic GC formation take place in salivary glands of a subset of patients with SS. Our data suggest that the ectopic secondary lymphoid follicles contain all elements needed for driving the autoimmune response. Our findings underscore a key role for the target organ in recruitment of inflammatory cells and propagation of the disease process.     

Contacting the host: insights and implications of pathogenic Neisseria cell interactions

Neisseria is a highly adapted human specific pathogen that initiates infection at the mucosal epithelia by using multiple adhesins to interact with host cell receptors. Colonization begins at the apical cell surface with a multi-step adhesion cascade, followed by invasion and persistence within the cell and finally transcytosis at the basolateral surface. The type IV pill are implicated in mediating the initial attachment of both meningococci and gonococci, and this association has been shown to involve contact with the cellular receptor CD46. In this review we describe the initial events in the adhesion, invasion and signaling of pathogenic Neisseria focusing on the initial attachment and signaling induced by the interaction of the type IV pili with CD46.