THYROID DISEASE AND OTHER AUTOIMMUNE PHENOMENA IN A FAMILY STUDY OF PRIMARY SJOGREN'S SYNDROME

Autoimmune diseases and autoantibodies have been documentedin 42 index cases with definite primary Sjögren's syndrome(1° SS), 207 relatives and 39 spouses. The results werecompared with control data from a local population survey. Thyroiddisease, 1° SS and their associated autoantibodies werethe commonest autoimmune abnormalities observed and found predominantlyin older female relatives. The HLA-DR3 phenotype associatedwith 1° SS, antinuclear factor, hypothyroidism, and thyroidmicrosomal antibody. Rheumatoid arthritis and systemic lupuserythematosus were not found in excess in the families. PrimarySjögren's syndrome is frequently associated with thyroiddisease and we suggest that there is a common genetic predispositionbetween these diseases which differs from 2° SS associatedwith rheumatoid arthritis and systemic lupus erythematosus.This includes MHC and non-MHC genes. KEY WORDS: Thyroid disease, Genetics, HLA-DR3, Sjögren's syndrome     

ERYTHROCYTE SEDIMENTATION RATE, PLASMA AND SERUM VISCOSITY AS MEASURES OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS

The activity of rheumatoid arthritis was assessed in 96 unselectedout-patients by performing a number of clinical measurementsand comparing them to ESR, plasma and serum viscosity. It wasfound that ESR correlated with clinical parameters better thandid both plasma and serum viscosity. These tests were repeated3 months later in 87 of the same patients and again change inESR correlated with change in disease activity better than didchange in plasma viscosity. Plasma viscosity was a consistentlymore reliable measure of disease activity than was serum viscosity. KEY WORDS: Rheumatoid arthritis, ESR, Plasma viscosity     

HEART – the Hounslow Early Active Recovery Team: implementing an inclusive strength-based model of care for people with early psychosis

In recent years in the UK, the National Health Service has made policy commitments to delivering mental health services based on recovery principles. In general though, the UK mental health service providers are in the early stages of implementing recovery principles and approaches in front-line services. This paper describes the work of the Hounslow Early Active Recovery Team (HEART), which has made substantial progress in placing recovery principles and approaches at the heart of the work of an early intervention for psychosis team working in an ethnically diverse area of West London. As evidence of the success of the HEART, in its first year and half, the team has achieved high levels of customer satisfaction with its work and a recent audit has revealed that 57% of respondents were in employment or education contrasting with the extremely high unemployment rates reported in several UK studies of people with serious mental health problems.     

CELLULAR IMMUNITY AND CHLAMYDIA GENITAL INFECTION: INDUCTION,RECRUITMENT, AND EFFECTOR MECHANISMS

Chlamydia trachomatis is one of the major causes of bacterial sexually transmitted disease worldwide. The initial infection of endocervical epithelium in females is asymptomatic and commonly ascends to fallopian tubes when left untreated. Immunity to Chlamydia develops after infection and appears to provide short-term protection. Consequently, a significant rate of reinfection occurs among sexually active individuals, which can result in reproductive disability. T helper type 1 responses are implicated in providing protective immunity but may also contribute to tubal infertility. The purpose of this chapter is to review the factors that regulate the induction and recruitment of protective cellular immune responses within the local genital mucosa. An understanding of these events is important for the design of a protective vaccine and control of immunopathologic reactions.     

Primary omental torsion in children

Objective : A retrospective review was conducted to establish the prevalence and clinical features of omental torsion or infarction as a cause of acute abdominal pain in childhood.
Methodology : The case records were analysed for all patients admitted with primary omental pathology to the Department of General Surgery, Royal Children's Hospital, Melbourne, between January 1975 and July 1994.
Results : From 1975 to 1994 (20 years) 13 children were admitted to our General Surgical Department with primary omental disease. There were nine males and four females under 16 years of age. The presenting complaint was abdominal pain with vomiting or diarrhoea. Four children had major medical conditions. Pre-operative diagnosis in all cases was acute appendicitis. Appendicectomy and omentectomy were performed without complication in all cases. Histology of the omentum demonstrated torsion, infarction or haemorrhage.
Conclusions : All children presented with features of acute appendicitis, a majority were male, and two out of the 13 patients were obese. The absence of any children under 4 years was consistent with the relative paucity of omental fat in younger children. We found no clear mechanism for primary omental torsion, although rotation around the right epiploic artery was observed.     

Comparison of salbutamol powder with terbutaline aerosol administered with a tube spacer in asthmatic children

ABSTRACT. The bronchodilator effect of 400 μ of salbutamol powder (2 capsules) administered by a rota-haler was compared with that of 500 μg of terbutaline (2 mete red doses) administered as an aerosol via a tube-spacer in a group of ten stable asthmatic children (mean age 12 years). The salbutamol powder produced significantly greater bronchodilatation compared with the terbutaline. Forty-five minutes after the administration of each preparation, nebulised salbutamol was given to determine if further bronchodilatation was possible. Additional bronchodilatation was seen in both groups, the greater additional change being after terbutaline. It is concluded that 400 μg of salbutamol powder was more effective than 500 μg of terbutaline via tube-spacer but following both preparations, nebulised salbutamol produced significant additional bronchodilatation.     

Selective improvement in cognitive test scores of extremely low birthweight infants aged between 2 and 5 years

Abstract The cognitive development at 2 and 5 years of a cohort of extremely low birthweight (ELBW) children (birthweight 500-999 g) was compared with that of cohorts of larger very low birthweight (VLBW) children (birthweight 1000-1500 g) and normal birthweight (NBW) children (birthweight > 2500 g) to determine whether the improvements in cognitive function of ELBW infants between 2 and 5 years are apparent or real.
At 2 years of age, ELBW children had a mean Mental Developmental Index (MDI) on the Bayley Scales of 90.4, significantly lower than the means of 100.3 for the larger VLBW children ( P = 0.006), and 107.8 for the NBW children ( P = 0.0002). However by 5 years the mean scores on the Wechsler Preschool and Primary Scales of Intelligence (WPPSI) full-scale for the ELBW and larger VLBW children were virtually identical (105.9 and 106.0 respectively)—but still lower than the mean WPPSI full-scale of 114.6 for the NBW children. After standardizing the MDI and WPPSI scores relative to the NBW children, the ELBW children improved between 2 and 5 years (paired t -test, t = 3.2, P = 0.004) whereas the larger VLBW infants did not.
We postulate that ELBW children require more time than larger VLBW children after birth to compensate for perinatal and other stresses, and that developmental delay at 2 years may not always persist to 5 years.     

Prostaglandin D2 release by endometrium and myometrium

Summary. Prostaglandin D₂ (PGD₂) release was studied using a super-fusion technique in endometrium and myometrium obtained at hysterectomy from 36 women with measured menstrual blood loss (range 4–840 ml). PGD₂ was produced by both tissues with greater rates from endometrium. Cyclical changes in release were found only in the endometrium with increased rates during menstruation and the midluteal phase. In the myometrium the highest release rates were present during menstruation at the start of the superfusion. No significant correlation was found between menstrual blood loss and endometrial or myometrial PGD₂ release.