Adverse reactions in healthy and immunocompromised children under six years of age vaccinated with the Danish BCG vaccine, strain Copenhagen 1331: implications for the vaccination policy in Sweden

A retrospective analysis of the adverse reactions reported between 1979 and 1991, in the 139000 children under six years of age vaccinated in Sweden with the Danish BCG vaccine, strain Copenhagen 1331, showed an incidence of I.9 per 1000 vaccinated children. Regional lymphoglandular swellings and/or abscesses were most commonly reported in 1.4 per 1000. Serious, disseminated, BCG infections developed in four infants vaccinated neonatally. Three of the infants suffered from severe, combined, immunodeficiency syndrome, undiagnosed at the time of vaccination. The incidence of severe, combined, immunodeficiency syndrome was higher in the BCG-vaccinated population (4 per 100000 infants vaccinated within a year of their births), compared with all newborns in Sweden (1 per 100 000). The mean age at the onset of symptoms was 2.4 months for the seven non-BCG-vaccinated infants versus 1.3 months for the four BCG-vaccinated ones, while the immunodeficiency syndrome was diagnosed at an average age of 7.6 months in those who were not vaccinatedversus 5.3 months in those BCG-vaccinated. It is recommended that the selective BCG vaccination of infants at high risk of exposure to tuberculosis should be postponed to six months of age to reduce the risk of inoculating infants suffering from immunodeficiency syndromes.     

Amyloid: morphology and toxicity.

We have expressed transthyretin (TTR) mutants which have significantly destabilised tetramers that aggregate into amyloid fibrils via a series of intermediates. We used atomic force microscopy to follow the morphology of aggregates during fibril formation. Initially, amorphous aggregates are formed that subsequently mature into fibrillar structures. This observation is interpreted as an optimisation of beta-strand registers. The rate of aggregation and maturation is highly temperature-dependent suggesting that entropic forces significantly contribute to stability. In addition, we identified a correlation between the presence of early formed aggregates of TTR and cytotoxicity. The toxic response was mediated via an apoptotic mechanism. The fact that early formed amorphous aggregates, but not more mature fibrils, exert a toxic response suggests that the rate of fibril formation may be a critical parameter. We propose that a slow rate of aggregation facilitates an increased concentration of a toxic intermediate.     

Predictors of Survival following Cardiac Arrest in Patients Undergoing Noncardiac Surgery: A Study of 518,294 Patients at a Tertiary Referral Center

Background: The authors determined the incidence of cardiac arrest and predictors of survival following perioperative cardiac arrest in a large population of patients at a tertiary referral center.

Methods: Medical records of patients who experienced cardiac arrest in the perioperative period surrounding noncardiac surgery between January 1, 1990, and December 31, 2000, were reviewed. Logistic regression identified characteristics associated with immediate (>= 1 h) and hospital survival, with P <= 0.01 considered statistically significant.

Results: Cardiac arrest occurred in 223 of 518,294 anesthetics (4.3 per 10,000) during the study period. Frequency of arrest for patients receiving general anesthesia decreased over time (7.8 per 10,000 during 1990-1992; 3.2 per 10,000 during 1998-2000). The frequency of arrest during regional anesthesia (1.5 per 10,000) and monitored anesthesia care (0.7 per 10,000) remained consistent. Immediate survival after arrest was 46.6%, and hospital survival was 34.5%. Twenty-four patients (0.5 per 10,000) had cardiac arrest related primarily to anesthesia. From multivariate analysis, patients who experienced arrest due to bleeding were less likely to survive hospitalization (P = 0.001). Survival was also lower for patients who experienced arrest during nonstandard working hours (P = 0.006) and for patients who had protracted hypotension before arrest (P < 0.001).     

The biosynthetic origins of rebeccamycin

Experimental evidence is presented to demonstrate that the antitumor-antibiotic rebeccamycin is biosynthesized by Saccharothrix aerocolonigenes from one unit of glucose, one of methionine, and two of tryptophan. Evidence is presented that suggests that the alpha-amino group of neither tryptophan unit provides the nitrogen of the phthalimide system.     

Cryosurgery for cervical intraepithelial neoplasia: 10-year follow-up

Cryotherapy was performed for the treatment of CIN in 261 patients, who were followed for 5 to 10 years after treatment. The overall cure rate was 83.5%. Increasing grade of CIN and enocervical involvement significantly reduced the cure rate. In pure exocervical lesions, a 91% cure rate in patients with CIN II lesions and a 77.8% cure rate in CIN III patients were observed. In patients with endocervical involvement, the influence of grade of lesion was of no significance. Life-table calculations demonstrated an overall risk of persisting CIN during the first year of observation of 8.8%, compared to a risk of 0.8% during Years 6 to 10. Log-rank test showed a risk of recurrence in patients with CIN III lesions significantly higher than that in patients with CIN II lesions and also a higher risk in patients with endocervical involvement. There was no significant influence of age on cure rates. Endocervical involvement should be considered a contraindication to cryotherapy, and a careful follow-up schedule is mandatory if cryotherapy is to keep its position as a recommendable therapy in patients with CIN.     

POSTOPERATIVE FATIGUE AFTER LAPAROSCOPIC SURGERY

Postoperative fatigue (POF) appears to be less following laparoscopic surgery but this has not been proven previously. This study compared a group of patients who had undergone open cholecystectomy with a group undergoing laparoscopic cholecystectomy. Postoperative fatigue was found to be decreased in duration in the patients having laparoscopic surgery, returning to pre-operative fatigue levels by 14 days, compared to 28 days for open surgery. Postoperative pain in the first 24h and the early metabolic response to surgery were similar for both groups. The authors conclude that laparoscopic surgery is associated with decreased POF and that this is unlikely to be accounted for by a decrease in the early metabolic response to surgery.