Multiple sclerosis and childhood infections

Migration from an area where MS is common to an area where it is rare (and vice versa) affects the risk of MS, provided migration occurs in childhood. A childhood infection might explain this effect. Therefore, the age pattern of infectious diseases in different regions was examined. A higher proportion of children showed positive titers to many viral diseases early in life in areas where MS is rare compared with those where MS is common. Also, mortality rates from a variety of infectious diseases correlated negatively with the MS mortality. Thus, infection early in life may "protect" against MS, and conversely, later infection, when the immune system has partially matured, may increase risk. MS may be an age-dependent, host-immune response to childhood infection.     

Creutzfeldt-Jakob disease

There has been significant advance in our understanding of CJD and similar spongiform encephalopathies in recent years. The range in clinical expression of the disease is better appreciated, and the existence of "atypical" cases of CJD is increasingly recognized. New ideas about the possible modes of natural transmission have been derived from case-control studies in different parts of the world.     

The role of epidemiology in the regulation of oral contraceptives

The U.S. Food and Drug Administration (FDA) has relied to a great degree on epidemiologic studies in the regulation of oral contraceptives (OC). These epidemiologic studies range from individual case reports of adverse reactions to case-control studies and cohort studies. Important findings about adverse reactions to OCs have been communicated through "labeling," which includes information leaflets provided as package inserts for physicians and patients. Also, the FDA communicates its position through publications in medical journals, the FDA Drug Bulletin, public advisory committee meetings, workshops, and symposia. The agency responds to new epidemiologic information; labeling guidelines are under continuing review and revision. Patterns of oral contraceptive use have been affected by the dissemination of this information. There has been a decline in the use of OCs, a shift to formulations with lesser steroidal content, and a greater emphasis on OC use in optimal groups, such as young, nonsmoking women. Considered for future epidemiologic studies that may have an impact on regulatory action are a clarification of the role of various progestins in regard to blood lipid alteration and atherogenesis, a delineation of the possible persistence of cardiovascular risk after termination of OC use, and further clarification in regard to neoplasia, particularly breast and cervical carcinoma.     

Microscopic Wegener's disease: a particular form of Wegener's granulomatosis

We describe a case of Wegener's granulomatosis in which the disease was manifested with crescentic glomerulonephritis, upper airway ulcerations, and microangiopathic hemolytic anemia with consumptive coagulopathy. No granuloma was identified but antibodies to cytoplasmic components of neutrophils were strongly positive with a diffuse pattern. Because microscopic vessels were predominantly involved (capillaritis), and granuloma were absent, were refer to this particular form of the disease as "microscopic Wegener's disease."     

Coronary artery disease and fibrinolysis: from the blood to the vessel wall

This review addresses a continuum of the role of derangements in the fibrinolytic system from the blood to the vessel wall in the pathogenesis of acute coronary events and the underlying vasculopathy. Pharmacologic modification of fibrinolysis has become a primary therapy for acute myocardial infarction caused by thrombotic occlusion of infarct-related coronary arteries. Patients with type 2 diabetes and other insulin resistant states exhibit impaired fibrinolysis in blood, implicated in the pathogenesis of macroangiopathy. An altered balance of activity of proteins involved in the fibrinolytic system within vessel walls (the proteo[fibrino]lytic system) has been recognized as well and appears likely to contribute to the acceleration of macroangiopathy. Accordingly, normalization of the proteo(fibrino)lytic system in blood and in vessel walls is a particularly attractive target for retardation of the progression of macrovascular disease associated with insulin resistant states.