A CLINICAL EPIDEMIC-LOGICAL STUDY IN LOW BACK PAIN. DESCRIPTION OF TWO CLINICAL SYNDROMES

In 100 patients with mainly chronic low back pain (LBP) signsand symptoms were evaluated prospectively and without preconceivedexpectation of particular findings. Two clinical syndromes weredistinguished, both characterized by 'typical local tenderness'and associated with specific clinical features; these syndromes,described previously in the literature but receiving scant attention,were named the greater trochanteric pain syndrome (trochantericbursitis) and the iliac crest pain syndrome (iliolumbar syndrome),and occurred in 35% and 43% of the patients, respectively. Therecognition of these syndromes may enable us to study aetiology,prognosis, and therapy of LBP in more homogeneous groups ofpatients KEY WORDS: Low back pain, Regional pain syndromes, Greater trochanteric pain syndrome, Trochanteric bursitis, Iliac crest pain syndrome, Iliolumbar ligament syndrome     

Effects of hemicolectomy on bile acid metabolism in relation to colon carcinogenesis in man

Bile acids are probably important in colon carcinogenesis. Regional differences in bile acid metabolism within the colon were studied to illuminate the preferential distal occurrence of colon cancer in Western countries. Faeces (24 h) were collected for bile acid measurement from 25 patients with hemicolectomy (nine left and 16 right) and 17 adenoma patients with an intact colon (control subjects). Duodenal bile and cytolytic and alkaline phosphatase activity of faecal water were also studied. The median percentage of deoxycholic acid (DCA) was lower in the hemicolectomy groups [left 48% (range 38–57%), right 45% (2–62%) vs. control subjects 59% (38–70%), P  < 0.05]. In duodenal bile, the proportion of DCA in left [4% (1–25%)] was lower than in the patients with right hemicolectomy [19% (0–69%)] and control subjects [24% (7–50%)], P  < 0.05. Faecal concentration of protonated DCA was higher in those with right hemicolectomy (0.101 μmol g⁻¹) than in those with left hemicolectomy (0.048 μmol g⁻¹), which coincided with a higher cytolytic [right 49% (3–93%), left 2% (1–37%)] and alkaline phosphatase activity [right 6.7 U mL⁻¹ (1.2–40.1 U mL⁻¹), left (2.0 U mL⁻¹ (1–25.7 U mL⁻¹), both P  < 0.02]. These findings suggest differences in bile acid metabolism between the proximal and distal colon that may contribute to the disparity in cancer risk.     

SYMPTOMATIC OSTEOARTHROSIS OF THE KNEE: A FOLLOW-UP STUDY

In a retrospective study at a single rheumatology centre of72 patients with symptomatic arthrosis of the knee, more than50% of the clinical phenomena improved within six months whilepatients were treated conservatively. This improvement appearedto be irrespective of age and duration of knee complaints exceptfor a group of obese patients with symptoms for more than oneyear. KEY WORDS: Osteoarthrosis, Knee, Prognosis     

High-Dose Survival in the Lymphocytic Choriomeningitis Virus Infection Is Accompanied by Suppressed DTH but Unaffected T-Cell Cytotoxicity

Provided that intracerebral inoculation is applied, an increase in the virus dose from 10(2) to 10(4) LD50 of lymphocytic choriomeningitis virus (LCMV) leads to strikingly reduced mortality. To analyse the background for this autointerference, we measured several virologic and immunologic variables in mice infected with these doses of virus. In the high-dose mice we found generally higher organ virus titres and serum interferon titres than in the low-dose mice. Since we could demonstrate that virus-specific T-cell cytotoxicity in spleen, peripheral blood, and meningeal exudate was similar after intracerebral infection with large and small virus doses, and since the LCMV infection in the brain qualitatively and quantitatively was independent of the size of virus inoculum, the explanation for the survival of the high-dose animals is obviously not lack of possibilities for interaction between cytotoxic T cells and infected sensitive targets in the central nervous system. On the other hand, high doses of virus caused a clear suppression of the LCMV-specific delayed-type hypersensitivity (DTH). In addition, when splenocytes from high-dose animals were transferred either intravenously or locally into the footpad of newly virus-challenged mice, DTH was markedly suppressed as compared with the response after transfer of spleen cells from low-dose mice. We therefore conclude that autointerference in the LCMV infection is due to a selective suppression of Td function. Large amounts of persistent virus late after infection with high doses of virus suggest a central role for Td function also in virus clearance. Finally, our results indicate the existence of two subsets of K,D region-restricted T cells, one mediating cytotoxicity and the other mediating DTH. This possibility is discussed.