Contrasting outcomes of donor-specific blood transfusion: effectiveness against cell-mediated but not antibody-mediated rejection.

Background: Giving recipients a prior donor-specific blood transfusion (DST) is effective in prolonging organ allograft survival in some inbred strains but not in others. The present investigation analyzed two such contrasting strains of rats in an attempt to define the basis for this variation.

Methods And Results: The survival of fully mismatched Dark Agouti (RT1a) cardiac allografts was significantly prolonged (from 7 to 44 days, median survival times) in PVG (RT1c) rats given a prior (-14 day) DST, whereas it shortened survival in the high-responder PVG-RT1u strain.

Is delayed nerve conduction associated with increased self-reported disability in individuals with hand symptoms? A population based study.

Objective: To determine whether, in individuals in the general population with hand symptoms, there is a greater level of disability in those with objective evidence of delayed nerve conduction.

Methods: A 19 item disability schedule relevant to hand function was developed for this survey. Subjects included 71 individual respondents to a random population survey who reported pain, tingling, numbness, or loss of sensation in the hands during an interview and who agreed to have nerve conduction studies.

Contributory factors to traffic accident deaths identified at coroner's inquest.

Background: Road traffic accidents (RTAs) are an important public health problem and the collection of local information is central to successful accident initiatives in a district. As the local coroner is responsible for investigating accidental deaths, the coroner's inquest files are a potentially useful source of information in developing a district strategy to reduce accidents.

Methods: A consecutive series of fatal RTAs occurring within the city of Liverpool (1990-1992) were identified and the inquest records of the city coroner reviewed retrospectively to describe the local pattern of fatal RTAs and identify contributory factors.

The case for routine determination of chorionicity and zygosity in multiple pregnancy.

Twin pregnancy has a disproportionate effect on perinatal mortality, being six times higher than for singleton gestations. The major threats to perinatal survival are from two very different pathological processes: spontaneous preterm delivery, and the interlacing clinical complications of monochorionicity. With the realization that perinatal loss/handicap is higher in monochorionic than dichorionic twins, attempts have been made in the last decade to assign chorionicity ultrasonographically, using single or composite parameters, such as number of placental masses, fetal sex, septal thickness and twin peak signs.

Association between measures of spinal mobility and low back pain. An analysis of new attenders in primary care.

Study Design: Comparison of spinal movements in new attenders to primary care with an episode of low back pain with a sample with no recalled history of ever having had low back pain.

Objectives: To examine the association between restriction of spinal movement and the presence of low back pain in primary care.

Summary Of Background Data: The presence of restriction in spinal mobility has frequently been investigated by specialists in the clinical setting.

Assessment of functional ability in patients with scleroderma: a proposed new disability assessment instrument.

Objective: To develop a simple assessment of functional ability in patients with scleroderma and to examine its reliability both as a patient self-administered instrument and when administered by a trained observer.

Methods: An 11 item, 4 grade, functional assessment questionnaire was developed after extensive consultation with patients, physiotherapists (PT), and occupational therapists (OT) with the aim of including all functional areas of relevance. The instrument was self-administered by patients after an interval of 7 days.

A community based stroke register in a high risk area for stroke in north west England.

Study Objective: To develop a community based stroke register to assess the magnitude of the problem of stroke in an entire health district in a high risk area for stroke.

Design: Community based stroke register from general practice data.

Setting: East Lancashire Health Authority with a 1995 population of 534,287.

Allelic markers close to prolactin are associated with HLA-DRB1 susceptibility alleles among women with rheumatoid arthritis and systemic lupus erythematosus.

Objective: To investigate linkage disequilibrium between HLA-DRB1 disease susceptibility alleles and microsatellite markers close to the prolactin gene, among women with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) and normal controls.

Methods: DNA from 89 women with RA, 76 women with SLE, and 94 controls was typed for HLA-DRB1 status and D6S422 and D6S285, 2 highly polymorphic microsatellite markers close to the prolactin gene. RA patients were stratified by DRB1*0401 status, and SLE patients were stratified by *0301 status.

Evidence for interaction of the fusion protein alpha-SNAP with membrane lipid.

alpha-SNAP [soluble N-ethylmaleimide-sensitive fusion protein (NSF)-attachment protein] is required for fusion of transport vesicles with their target membrane. In this study, we have examined the membrane-binding properties of alpha-SNAP. We have found that in several tissues a much larger amount of alpha-SNAP per unit weight of protein is bound to membranes than is free in the cytosol.

Oral contraceptives and rheumatoid arthritis: results from a primary care-based incident case-control study.

Objective: The possibility that oral contraceptives offer a protective effect against the development of rheumatoid arthritis is still contentious. Of the 17 studies investigating this association, 11 have found a protective effect, and 6 have not. These differences are probably attributable to either selection or information biases in a subset of studies, although the exact reason is unknown.

Competencies for Part II of the examination for membership of the Faculty of Public Health Medicine.

Background: The assessment of competence is of growing importance in modern educational theory. This paper reports the results of a study to investigate the views of Part II examiners and public health trainees about whether an agreed list of competencies for the practice of public health medicine could be determined.

Methods: A postal questionnaire was sent to Part II examiners and representatives of the Trainee Members Committee of the Faculty of Public Health Medicine.

Case-control study of stroke and the quality of hypertension control in north west England.

Objective: To examine the risk of stroke in relation to quality of hypertension control in routine general practice across an entire health district.

Design: Population based matched case-control study.

Setting: East Lancashire Health District with a participating population of 388,821 aged < or = 80.

Tumor necrosis factor microsatellite haplotypes are different in male and female patients with RA.

We investigated whether tumor necrosis factor (TNF) microsatellite polymorphisms are associated with sex and age at disease onset in rheumatoid arthritis (RA). A case-control study was used to compare the frequencies of TNF microsatellite alleles in 181 Caucasian RA cases and 251 controls. TNF microsatellite genotyping was performed using fluorescent based polymerase chain reaction (PCR) techniques and HLA-DR typing using PCR based sequence specific oligonucleotide probing.

Evaluation of gastric antral motor performance in patients with dysmotility-like dyspepsia using real-time high-resolution ultrasound.

Although manometric antral hypomotility and delayed gastric emptying have been reported separately in patients with dyspepsia, relationships between symptoms, antral contractility and emptying rate have not been sought. The present study therefore aimed to evaluate, simultaneously, gastric antral excursion characteristics and emptying in a sub-group of patients with severe functional dyspepsia using high-resolution real-time ultrasound. The circumference of the relaxed and contracted antrum was measured at 15-min intervals after ingestion of a 360 mL mixed nutrient meal in 36 chronic dyspepsia patients with symptoms of post-prandial bloating and epigastric distension, and in 25 healthy volunteers.

Effect of distension and feeding on phasic changes in human proximal gastric tone.

Background: Proximal stomach by virtue of its property of accommodation acts as a reservoir for the ingested food, but its role in emptying and the factors modulating it remain unexplored.

Aim: To assess the effects of distension and of feeding on proximal gastric tone.

Subjects: 14 healthy volunteers with no current or past history of any gastro-intestinal symptoms.

Neuroendocrine carcinoma of the larynx.

Neuroendocrine carcinomas (NEC) of the larynx are rare. The key to diagnosis is therefore an increased awareness of such lesions amongst otolaryngologists and pathologists. A precise histological diagnosis is crucial, as the management is different for each NEC sub-type.

A prospective study of abdominal computerized tomography and colonoscopy in the diagnosis of colonic disease in an elderly population.

Objective: The aim of this prospective study was to compare the accuracy of abdominal computed tomography (CT) and colonoscopy in diagnosing colonic pathology in an elderly population.

Methods: Patients over the age of 70 for whom an outpatient diagnostic colonoscopy had been requested, were invited to attend for a CT scan of the abdomen following oral colonic preparation. CT was carried out within 1 month of the colonoscopy and all images were evaluated by a single consultant radiologist with no prior knowledge of the colonoscopy result.

A simple algorithm to predict the development of radiological erosions in patients with early rheumatoid arthritis: prospective cohort study.

Objective: To produce a practical algorithm to predict which patients with early rheumatoid arthritis will develop radiological erosions.

Design: Primary care based prospective cohort study.

Setting: All general practices in the Norwich Health Authority, Norfolk.

Are both genetic and reproductive associations with rheumatoid arthritis linked to prolactin?

The risk of rheumatoid arthritis (RA) seems to be associated with reduced fecundity and with breastfeeding; these apparently contradictory risk factors can be explained by their association with high prolactin concentrations. The only consistent genetic association with RA is for genes encoded in the HLA complex, particularly HLA DR4. We have identified some data indicating that the effects of breastfeeding and nulliparity are modified by HLA DR4 status, suggesting an interaction between genetic and reproductive risk factors in the aetiology of RA.

Macrophages during fibrosis following scleral fistulising surgery in a rat model.

Purpose: Glaucoma filtration surgery can fail in a minority of patients as a result of fibrosis in the subconjunctival bleb space and closure of the scleral fistula. In this study, the rat eye has been used as an experimental model for fistulising surgery in order to evaluate the clinical manifestation of bleb failure with the morphological events of the wound healing process.

Methods: A conjunctival bleb was successfully formed in 25 rats and was examined daily using slit lamp microscopy to evaluate postoperative inflammation and the presence of a bleb.

Changing patterns of rheumatology manpower and practice in the UK in the 1990s.

This paper reports the results of two surveys of all UK rheumatologists conducted in 1993 and 1995. Results are presented by regional health authority and by country. During the 2 yr, there has been a rise in the number of consultants, but a fall in the proportion doing rheumatology combined with rehabilitation.