Previous exposure to measles, mumps, and rubella--but not vaccination during adolescence--correlates to the prevalence of pancreatic and thyroid autoantibodies

OBJECTIVE

This study was designed to determine whether a relationship exists between previous exposure to measles, mumps, and rubella (MMR) by natural infection or vaccination or by new immunization with MMR vaccine, and either the presence or levels of autoantibodies against thyroid cell and pancreatic beta-cell antigens.

METHODS

Antibodies against MMR and autoantibodies against thyroglobulin, thyroid peroxidase, pancreas islet cells (ICA), islet cell surface, glutamic acid decarboxylase 65k autoantibodies, and insulin were studied before, and 3 months after, vaccination with combined MMR vaccine in 386 school children between 11 and 13 years of age.

RESULTS

The vaccination changed neither the prevalence nor the level of autoantibodies. Children with rubella antibodies before vaccination had higher levels of ICA than did the rubella seronegative children. In contrast, thyroid autoantibody levels and prevalence were lower in children with antibodies against measles, mumps, or both before vaccination than in children without those antibodies.

CONCLUSIONS

Previous natural infection or vaccination against measles, mumps, or both seemed to have an inhibitory effect on the development of thyroid autoantibodies. In contrast, children with previous exposure to rubella had higher levels of ICA. No evidence was found that MMR vaccination during adolescence may trigger autoimmunity.

The microbiota of periodontal pockets with different depths in therapy-resistant periodontitis

This study presents the composition of the cultivable microbiota colonising periodontal pockets of different depths among 2 patient-groups classified as non-responsive (NR-group; 11 participants) or responsive (R-group; 10 participants) to periodontal treatment. Microbiological samples from three types of pocket (< 4 mm deep A-samples; 4-5 mm B-samples; > 5 mm C-samples) were analysed by cultural methods for putative periodontitis pathogens, microbial groups constituting > or = 5% of the total cultivable flora and opportunistic pathogens. Actinomyces naeslundii, A. israelii, Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia, Peptostreptococcus micros, anaerobic streptococci and facultative anaerobic streptococci were most prevalent. Actinobacillus actinomycetemcomitans, Staphylococcus aureus, enteric rods and yeasts were less prevalent. The periodontitis pathogens Bacteroides forsythus, Fusobacterium spp, Porphyromonas gingivalis, Prevotella intermedia and Peptostreptococcus micros constituted together (on average) < or = 23% of the viable counts in the A- and B-samples of both patient groups and in the C-samples of the R-group. In the C-samples of the NR-group their mean counts were 45%. Correlations were found between smoking habits and the five pathogens in the C-samples and in pooled pocket depth samples. The results show that groups of periodontopathogens should be considered a causal factor in therapy-resistant periodontitis. Further, smoking and deep pockets can enhance a shift in the balance of the subgingival microflora predisposing a site to disease and a susceptible host may be the pre-requisite to therapy-resistant periodontitis.

Islet autoantibodies in cord blood from children who developed type I (insulin-dependent) diabetes mellitus before 15 years of age

Islet autoantibodies are early markers for Type I (insulin-dependent) diabetes mellitus. The aim of this study was to establish whether islet autoantibodies were present at birth in children who developed Type I diabetes before 15 years of age. Cord blood sera from 81 children who developed Type I diabetes between 10 months and 14.9 years of age were tested for glutamic acid decarboxylase autoantibodies (GAD65Ab), islet cell antigen 512 autoantibodies (ICA512Ab), insulin autoantibodies (IAA) all by quantitative radioligand binding assays and islet cell autoantibodies (ICA) by indirect immunofluorescence. Cord blood sera from 320 randomly selected matched children were controls. The children who developed Type I diabetes had an increased frequency of cord blood islet autoantibodies compared with control subjects: Glutamic acid decarboxylase autoantibodies were detected in 6% (5/81) patients and 2% (5/320) control subjects (p = 0.03); islet cell antigen 512 autoantibodies in 5% (4/73) patients and 1% (4/288) control subjects (p = 0.06); insulin autoantibodies (IAA) in 0% (0/79) patients and 0.3% (1/320) control subjects (p = 0.36); and islet cell autoantibodies in 10% (8/81) patients compared with 0.6% (2/320) control subjects (p = 0.0001). Taken together, 17% (14/81) patients had one or more islet autoantibody compared with 4% (12/320) control subjects (p = 0.0001). Whereas none of the control children had more than one antibody, 4% (3/81) children who later developed Type I diabetes were double positive (p = 0.002). Although glutamic acid decarboxylase autoantibodies' concentrations in cord-blood correlated to those in the mothers' blood at the time of delivery, no corresponding correlation was found for the other two types of autoantibodies. The increased frequency of cord blood islet autoantibodies suggests that the Type I diabetes process could already be initiated in utero.

Glutamate decarboxylase antibodies in non-diabetic pregnancy precedes insulin-dependent diabetes in the mother but not necessarily in the offspring

We studied the risk for diabetes of glutamate decarboxylase (GAD65Ab) and islet cell (ICA) autoantibodies in non-diabetic pregnant mothers and their children. Pregnancy and cord blood sera were collected in 1970-87 from about 35,000 mothers who delivered a child in the city of Malmö, Sweden. A total of 42 mothers were identified in 1988 who, 1-18 years after their pregnancies, had developed either insulin-dependent (n = 22) or non-insulin dependent (n = 20) diabetes mellitus. First, in 123 pregnant mothers selected as controls, 0.8% had GAD65Ab and 0.8% ICA. Second, among the mothers with non-insulin dependent diabetes, 7/20 (35%) had GAD65Ab eight months to 13 years, 10 months before clinical diagnosis. Third, in mothers who later developed insulin-dependent diabetes, 12/22 (55%) had GAD65Ab and 10/22 (45%) had ICA in pregnancies preceding the clinical diagnosis by 13 months to 9 years, 4 months. In 1996, none of the children born to the 42 mothers have developed diabetes. GAD65Ab and ICA in non-diabetic pregnancies may predict insulin-dependent diabetes in the mother but not necessarily in the offspring.

Bolus injection (2-4 min) versus short-term (10-20 min) infusion of 5-fluorouracil in patients with advanced colorectal cancer: a prospective randomised trial. Nordic Gastrointestinal Tumour Adjuvant Therapy Group

The use of bolus 5-fluorouracil (5-FU) as a short-term infusion over 10-30 min is increasing at the cost of a push injection, mainly due to practical advantages. Since even a short prolongation of the administration time results in lower 5-FU peak and area under the curve (AUC) levels, there might be a risk of decreased efficacy. The aim of this study was to compare a rapid intravenous (i.v.) 5-FU injection and a short-term 5-FU infusion with respect to objective responses and toxicity in patients with advanced colorectal cancer. 203 patients with measurable advanced colorectal cancer were randomised to bolus 5-FU either as an injection for 2-4 min or as a short-term infusion lasting 10-20 min. In both groups, the 5-FU dose was 500 mg/m2 and leucovorin 60 mg/m2 was given 40 min after the start of 5-FU. Treatment was given on two successive days every other week until progression. Objective tumour regression was seen in 27/100 (27%) in the injection group and in 13/103 (13%) in the infusion group (P = 0.02). Severe toxicity was rare and did not differ significantly between the groups. Progression-free survival tended to be longer in the injection group (P = 0.07), but overall survival did not differ between the groups. Bolus 5-FU should be administered as a rapid i.v. injection rather than as a short-term infusion, since the former rate of administration results in a higher response rate without being significantly more toxic.

The coexistence of thyroid autoimmunity in children and adolescents with various allergic diseases

The aim of our study was to investigate the coexistence of thyroid autoimmunity and allergic diseases. The prevalence of thyroid autoantibodies was studied in sera from 140 children with different kinds of allergic diseases, 370 11-13-y-old schoolchildren without allergic diseases serving as controls. The prevalence of thyroid peroxidase autoantibodies was found to be higher among the patients than in the control group, 11.4% vs 5.4% (p < 0.05). Ultrasound investigation identified autoimmune thyroiditis in 4.3% (6/140) of the series, which was later confirmed with fine needle aspiration in all six cases, four of which were unknown prior to the study. Our findings may be useful to alert clinicians that thyroid diseases may be superimposed on allergic children.

Prevalence of IgA-antigliadin antibodies and IgA-antiendomysium antibodies related to celiac disease in children with Down syndrome

OBJECTIVE

This study was undertaken to investigate the prevalence of celiac disease in children and adolescents with Down syndrome.

MATERIAL AND METHODS

Forty-three children and adolescents with Down syndrome were screened for IgA-antigliadin antibodies (AGA) and IgA-antiendomysium antibodies (EMA). Patients found to be either AGA- or EMA-positive were investigated further with intestinal biopsy.

RESULTS

None of the 43 patients had known celiac disease at entry into the study; 37% (16/43) were found to have AGA levels above normal, and 16% (7/43) to be EMA-positive. Of the 15 patients who underwent biopsy, 8 manifested villous atrophy. Villous atrophy was present in all 7 of the EMA-positive patients, whereas the villi were normal in 7 of the 13 AGA-positive patients who underwent biopsy.

CONCLUSIONS

EMA is a good immunologic marker for use in screening for celiac disease, and screening is justified in patients with Down syndrome.

Intravenous nitroglycerin for rapid uterine relaxation

BACKGROUND

To investigate the effect of nitroglycerin in vitro and in vivo on human uterine contractile activity.

METHODS

In vitro myometrial strips were obtained from six pregnant women at term who underwent elective cesarean section. The biopsies were mounted in tissue baths. After spontaneous or oxytocin-induced activity had been accomplished, nitroglycerin in various concentrations was added to the baths and the effects were continuously registered. In vivo, in an open study nitroglycerin was administered as a bolus injection of 100-200 micrograms intravenously to 32 women at cesarean section when uterine relaxation was urgently needed; to 22 other women after vaginal delivery for facilitation of manual removal of retained placentas, and to one patient at vaginal delivery of premature twins.

RESULTS

In vitro nitroglycerin induced a dose-dependent inhibition of spontaneous as well as oxytocin-induced myometrial contractile activity. Complete muscular relaxation was obtained at a concentration of 25-50 micrograms/ml. In vivo all patients had rapid effective uterine relaxation after intravenous injection of 100-200 micrograms nitroglycerin.

CONCLUSION

Nitroglycerin administered intravenously seems to be a rapid and effective uterine muscle relaxant agent without overt adverse effects on mother or fetus.

High prevalence of thyroid autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children

The prevalence of thyroglobulin autoantibodies and that of thyroid peroxidase autoantibodies were studied in serum samples from 52 children with insulin-dependent diabetes mellitus, sampled at diagnosis and before the start of insulin treatment, with 386 non-diabetic schoolchildren (11 to 13 years of age) serving as control subjects. Using exactly the same sensitive solid-phase immunosorbent radioassay for both thyroid autoantibodies, with comparable sensitivity, we found the prevalences of both autoantibodies to be higher in the insulin-dependent diabetes mellitus group than in the control group, the difference being most pronounced for thyroid peroxidase autoantibodies. Thyroglobulin autoantibodies were positive in 33% of the diabetics versus 14% in the control group (p = 0.002), and thyroid peroxidase autoantibodies were positive in 38% versus 6% (p = 0.0001). The high prevalence of thyroid autoantibodies already at diagnosis stresses the importance of early screening for thyroid disease in patients with insulin-dependent diabetes mellitus.

[Potentially avoidable perinatal deaths in Denmark and Sweden 1991]

In 1991 the perinatal mortality rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care. Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min. Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) were significantly higher in Denmark than in Sweden. The study raised the following questions: why is the rate of perinatal death of malformed infants higher in Denmark than in Sweden and could intrapartum care in Denmark be improved?

Twenty years' colonoscopic surveillance of patients with ulcerative colitis. Detection of dysplastic and malignant transformation

BACKGROUND

Endoscopic cancer surveillance in patients with ulcerative colitis has been performed for almost 3 decades. There is still no consensus on its clinical value.

METHODS

This study evaluates a 20-year prospective study of 143 patients with extensive ulcerative colitis and a disease duration exceeding 10 years. Colonoscopy with double biopsy specimens from nine locations of the colon was performed every 2nd year. Biopsy specimens showing dysplasia were reviewed at the end of the study.

RESULTS

Through the surveillance dysplasia/cancer was detected in 55 patients; 7 of these patients had carcinomas, and 2 were in a possibly curable stage (Dukes A). The predictive value of low-grade dysplasia for either high-grade dysplasia or cancer was 41%.

CONCLUSIONS

Although impaired by limiting factors, colonoscopic surveillance of chronic extensive colitis may identify patients with dysplasia and thereby prevent malignant transformation.

Potentially avoidable perinatal deaths in Denmark and Sweden 1991

BACKGROUND

Since 1950 the perinatal mortality has been significantly higher in Denmark than in Sweden. In 1991 the rate in Denmark was 8.0/1000 deliveries compared to 6.5/1000 in Sweden. An international audit was designed to investigate whether the perinatal death rates in the two countries to some extent could reflect differences in the quality of care, indicated by the numbers of perinatal deaths in categories of potentially avoidable deaths.

MATERIAL AND METHODS

Medical records of 97% of all perinatal deaths in 1991 in the two countries were analyzed. A new classification focusing on potential avoidability from a health services perspective was elaborated at a Nordic-Baltic workshop, using the variables: time of death in relation to admission and delivery, fetal malformation, gestational age, growth-retardation and Apgar score at 5 min.

RESULTS

Rates of perinatal deaths of malformed infants (0.00195 and 0.00145) and intrapartum deaths of non-malformed infants (0.00042 and 0.00019) was significantly higher in Denmark than in Sweden.

CONCLUSION

Application of the Nordic-Baltic Perinatal Death Classification on perinatal deaths in Denmark and Sweden in 1991 raises the questions as to why the rate of perinatal death of malformed infants is higher in Denmark than in Sweden and whether intrapartum care in Denmark could be improved.

Separation of cyclodextrins and their derivatives by thin-layer and preparative column chromatography

Cyclodextrins, their derivatives and products of their partial hydrolysis are clearly separated by chromatography on silica gel by mobile phases containing aqueous ammonia and organic solvent (acetonitrile or 1-propanol). This system allows separation of compounds with different numbers of substituents on cyclodextrin, but does not allow the separation of isomers; the system can be used both for thin-layer chromatography and for preparative column chromatography. The isomers in the fraction thus obtained can be in some cases separated, after peracetylation, by chromatography on silica gel using a mobile phase consisting of methanol and dichloromethane. This chromatographic sequence potentially yields derivatives of cyclodextrins in quantities which enable evaluation of their solubilization and biological properties.

Calcium channel blockade (isradipine) in treatment of hypertension in pregnancy: a randomized placebo-controlled study

OBJECTIVE

Our purpose was to study the effects of isradipine, a dihydropyridine calcium channel blocker, on mother and fetus in the treatment of hypertensive disorders of pregnancy.

STUDY DESIGN

The investigation was performed as a two-group, parallel, double-blind multicenter study of isradipine versus placebo. Fifty-four women were randomized to treatment with isradipine slow-release capsules given orally 5 mg twice a day and 57 to a placebo group.

RESULTS

Isradipine lowered the maternal mean arterial blood pressure effectively in women with nonproteinuric hypertension but did not do so in women with proteinuria at recruitment or appearing during treatment. Blood flow in the umbilical artery and maternal renal and liver function were not influenced by treatment. Isradipine had few side effects and was well tolerated.

CONCLUSION

Calcium channel blockade with isradipine is effective for treatment of nonproteinuric hypertension but not in preeclampsia.

The use of intravenous nitroglycerin for emergency cervico-uterine relaxation

A patient with a twin pregnancy was in preterm labour after 25 gestational weeks when, during vaginal delivery of the second twin, severe spasm of the cervix and fetal bradycardia ensued. Induction of general anesthesia did not relax the cervix. After bolus doses of nitroglycerin 100 + 50 micrograms i.v., prompt cervico-uterine relaxation was obtained allowing manual extraction of the baby. A short review of the literature and a summary of our experience in the administration of nitroglycerin i.v. in obstetrics are presented.

Maternal enteroviral infection during pregnancy as a risk factor for childhood IDDM. A population-based case-control study

Using the nationwide childhood-onset diabetes register in Sweden, we were able to trace children who contracted diabetes before the age of 15 years and who were born at a specific hospital in Sweden where maternal sera from delivery had been stored during the years 1969-1989. Sera obtained at delivery from 57 mothers of diabetic children were compared with sera from 203 mothers of control subjects who were delivered at the same hospital during the same time period. The sera were analyzed blindly using a group-specific enzyme-linked immunosorbent assay for enteroviral IgG and IgM antibodies before and after urea wash as an avidity test. On the same plates, IgG antibodies to herpes, mumps, and toxoplasmosis were analyzed. The mean absorbance values of enteroviral IgG antibodies against enteroviral antigens (echo30, coxsackie B5, and echo9) were significantly higher among mothers whose children later developed diabetes (P = 0.002, P = 0.02, and P = 0.04, respectively). When reduction in activity after urea wash, indicating recently formed antibodies, was compared, the differences were even more pronounced (P < 0.001 for all three antigens). No significant differences were found for antibodies against herpes (all types), herpes type 2, mumps, or toxoplasmosis. When IgM activity and/or a significant decrease in avidity index, an indication of recent enterovirus infection, was used as a risk exposure, the odds ratio standardized for year of birth (95% confidence interval) was 3.19 (1.39-7.30). We conclude that the results of this study indicate that enteroviral infection during pregnancy is a risk factor for childhood-onset diabetes in the offspring.(ABSTRACT TRUNCATED AT 250 WORDS)

The reaction between epichlorohydrin and polysaccharides: Part 2, Synthesis of some model substances, with cyclic substituents

Eight derivatives of methyl alpha-D-glucopyranoside, in which the substituents are part of cyclic structures, have been prepared as model substances for possible structural elements formed on reaction of polysaccharides with epichlorohydrin. The substances were converted into the permethylated alditol-1-d acetates and characterised by CIMS and EIMS.

Regioselectivity of alkylation of cyclomaltoheptaose (beta-cyclodextrin) and synthesis of its mono-2-O-methyl, -ethyl, -allyl, and -propyl derivatives

Mono-2-O-methyl-, -2-O-ethyl-, and -2-O-allyl-cyclomaltoheptaose were prepared by alkylations of cyclomaltoheptaose in dilute aqueous alkali, and mono-2-O-propylcyclomaltoheptaose was obtained by hydrogenation of the allyl derivative. All the 2-O-alkyl derivatives were less soluble in water than was cyclomaltoheptaose. All formed inclusion complexes with toluene in aqueous solution, but only the methyl ether was less soluble in the water-toluene system than in water. The solubilities of the other ethers in water were enhanced by the addition of toluene. Partial methylation of cyclomaltoheptase with 13C-enriched dimethyl sulfate in dilute aqueous alkali yielded mixtures of products. The substitution patterns were analyzed by GLC-MS of the alditol acetates, prepared by hydrolysis, reduction, and acetylation, and by 13C NMR after complete permethylation with nonenriched reagent. The results showed that methylation at O-2 is a predominant but not an exclusive reaction; as expected, the regioselectivity decreases with increasing degree of methylation.

Structural studies of the Shigella boydii type 5 O-antigen polysaccharide

The structure of the Shigella boydii type 5 O-antigen polysaccharide has been investigated by sugar and methylation analyses, and specific degradations. It is proposed that it is composed of hexasaccharide repeating units with the following structure. The repeating unit also contains an O-acetyl group, linked to one of the primary positions. [formula: see text]

The reaction between epichlorohydrin and polysaccharides: Part 1. Syntheses of some model substances with non-cyclic substituents

Five derivatives of methyl alpha-D-glucopyranoside, in which the substituents form noncyclic structures, have been prepared as model substances for possible structural elements formed on reaction of polysaccharides with epichlorohydrin. The substances were converted into the permethylated alditol-1-d derivatives and characterised by CIMS and EIMS.