Intraepithelial gamma delta T-cell-receptor lymphocytes and genetic susceptibility to coeliac disease

Although the proportion of gamma delta T-cell-receptor (TCR)-bearing intraepithelial lymphocytes is increased in the jejunum of patients with active coeliac disease, an abnormality thought to be specific among those with gluten-sensitive enteropathy, the factors influencing gamma delta TCR expression remain uncertain. We examined the relation between genetic factors associated with coeliac disease and intraepithelial gamma delta T lymphocyte distribution in both coeliac patients and their healthy first-degree relatives. 41% (45/109) of healthy relatives had an increased density of gamma delta T cells in their mucosa and 66% had an increased density of alpha beta T cells. By contrast with alpha beta T cells, the density of gamma delta cells was significantly associated with genetic markers for coeliac disease susceptibility (DR3, DQA, and DQB). We also found a dose effect of DQA and DQB genes on the number of intraepithelial gamma delta T cells. An increased density of gamma delta T cells in normal jejunal mucosa of a healthy individual with appropriate genetic determinants might be necessary for the development of the typical lesions of coeliac disease. Routine jejunal histological studies should include gamma delta T-cell counts, thus allowing early detection of coeliac disease latency.

Evaluation of nasal resistance data in active anterior rhinomanometry with special reference to clinical usefulness and test-retest analysis

A systematic evaluation of the most common parameters used in active anterior rhinomanometry was made with artificial tube and cadaver models and patient recordings. The clinical suitability of the parameters was judged on their calculability, reproducibility and power to separate the recordings into meaningful degrees of patency. It was shown that resistance at 150 Pa was not calculable in 30% of the measurements because such a high pressure gradient was not achieved during quiet breathing. The power to separate the grades of obstruction was good with all the models but in the test-retest analysis, it was shown that the power to detect +/- 20% variation in repeated measurement in the same person with a decongested nose was not sufficient with the resistance at 150 ml/s and at radius 100. The coefficient of resistance W = P/V2 at peak flow and resistance at radius 200 showed good capability to separate the grades of obstruction, they are measurable in all recordings, their reproducibility is good and thus, they are recommended for clinical practice.

Cholesterol-rich diet induced changes in plasma lipids in relation to apolipoprotein E phenotype in healthy students

The hypothesis that apolipoprotein E (apoE) polymorphism modulates an individual's response to cholesterol-rich diet was tested in 36 healthy normolipidaemic students with apoE phenotypes E3/2 (n = 9), E3/3 (n = 11), E4/3 (n = 13) and E4/4 (n = 3). The subjects were instructed to eat their usual diets, omitting eggs, for three weeks (baseline). This was followed by a diet high in cholesterol (750 mg/day, from egg yolks) for three weeks (intervention) after which they returned to their normal diet (without eggs for three weeks). Concentrations of plasma lipids and apolipoprotein B, and the composition of total fatty acids were monitored. At baseline, there were no statistically significant differences in lipid concentrations between the phenotype groups. The cholesterol-rich diet induced significant increases in total cholesterol, LDL cholesterol, and apoB in all apoE groups (P less than 0.001). The magnitudes of these increases were similar in groups E3/2, E3/3, and E4/3, in which total cholesterol concentration rose by 13%, 18%, and 12%, respectively. Stronger responses were observed in the small group of E4/4 subjects, in whom the increases in total cholesterol, LDL cholesterol, and apoB were 2.3-fold (P = 0.054), 2.25-fold (P = 0.02) and 2.3-fold (P = 0.004), respectively, compared with all the other phenotypes studied.

A new Finnish computerized rhinomanometer

We introduce a new sophisticated Finnish rhinomanometer in which the need for routine work has been minimized. Technical information about the instrument is given, recording procedure is described and a normal material and reproducibility test is analyzed.

Brain atrophy on computerized axial tomography scans: interaction of age, diabetes and general morbidity

We evaluated, retrospectively, the occurrence of brain atrophy in all patients (n = 416) with a brain CT scan performed during a 3-month period in 1989 at the Tampere University Central Hospital. Age, diabetes, hypertension, chronic cerebrovascular disorders and an increasing number of medications were associated with brain atrophy in the log-linear models. We suggest that the effect of various systemic medical disorders on the brain requires consideration when evaluating and assessing physiological ageing of the brain.

Macrocytosis as a consequence of alcohol abuse among patients in general practice

Macrocytosis, a common finding in patients without anemia or other hematologic abnormalities, is often ignored. The purpose of this prospective study was to investigate 300 consecutive, adult health-center patients with a mean cell volume (MCV) value greater than or equal to 100 fl. The incidence of macrocytosis was 2.4%. Of the 177 male and 123 female patients, only 14 (4.7%) were anemic; 80.2% of the men (89.3% of those under 60 years) and 34.1% of the women were alcohol abusers, representing the largest diagnostic group. The highest MCV value found in alcoholics without folate or vitamin B12 deficiency was 120 fl. The most useful laboratory test for identifying alcohol abuse among macrocytic patients was the measurement of serum gamma-glutamyltransferase. Of the several morphologic abnormalities in the marrow the only specific finding were vacuoles in the granulocyte or erythrocyte precursors. No underlying cause was found for macrocytosis in 6.8% of the men and 35.8% of the women. Even when it is not associated with anemia, macrocytosis should not be ignored. It may be the only indicator of a disease which often, particularly in young and middle-aged men, is alcohol abuse.

Prognostic value of analysis of DNA in pancreatic adenocarcinoma by flow cytometry

DNA was analysed by flow cytometry in paraffin-embedded tumour specimens from 58 patients who had undergone resection of pancreatic ductal adenocarcinoma, to see if there was any correlation between DNA analysis and survival. Because of the poor quality of the DNA histogram five cases were excluded from the analysis of DNA-ploidy and 10 from the analysis of the synthesis phase fraction. Aneuploidy was detected in 11 (21%) of the 53 tumours. Neither aneuploidy nor synthesis phase fraction correlated significantly with size, stage or differentiation of the tumours. The survival of the patients with DNA-aneuploid tumours (median 9 months) did not differ significantly from that of the patients with diploid tumours (median 14 months). Four patients survived for 5 years or longer, two of whom had aneuploid tumours. Synthesis phase fraction did not correlate with survival. Using univariate survival analyses, location of the tumour in the head of the pancreas (p = 0.02), a tumour diameter of less than 3.8 cm (p = 0.003), tumour stages I and II (p = 0.03), and a well differentiated tumour (p = 0.04) correlated with favourable survival. In a Cox's regression analysis, however, only the diameter of the tumour had independent prognostic value. We conclude that DNA analysis by flow cytometry is not helpful in selecting patients with resectable pancreatic carcinoma who will benefit from resection.

Incidence of falling injuries leading to medical treatment in the elderly

The incidence of falling injuries leading to medical treatment was described by sex, age, marital status, education, amount of daily motion, self-perceived health, mechanism of fall and severity of injury. Material was collected regarding persons aged 65 years or over seeking medical treatment due to a fall during a period of one year. Altogether 3.8% of the elderly population (men: 2.5%; women: 4.4%) sought medical treatment due to a fall at least once during this year. When repeated falls were taken into account, the total incidence rate was 5.5 per 100 persons per year. The cumulative incidence rate (percentage of persons seeking medical treatment due to a fall) of women was higher than that of the men and in both sexes it increased with age. It was also higher for unmarried, widowed or divorced persons than for married ones, and higher in less educated persons than in better educated ones. It was also higher in persons with a low amount of daily motion or poor self-perceived health than in persons with a moderate or high amount of daily motion or good health status. The multivariate analyses based on log-linear models showed two-term interactions. A low amount of daily motion, poor self-perceived health and high age were independently related to the occurrence of a fall leading to medical treatment in both sexes.

Effects of calcium supplementation and deoxycorticosterone on plasma atrial natriuretic peptide and electrolyte excretion in spontaneously hypertensive rats

The effects of calcium and the mineralocorticoid deoxycorticosterone (DOC) on blood pressure were studied in four groups of spontaneously hypertensive rats (SHR): (1) control; (2) calcium; (3) deoxycorticosterone and; (4) deoxycorticosterone + calcium. Calcium was given as 1.5% calcium chloride in drinking fluid and deoxycorticosterone by weekly subcutaneous injections (25 mg kg-1). During the nine weeks of treatment the increase in systolic blood pressure was enhanced in the deoxycorticosterone and attenuated in the calcium group, whereas the deoxycorticosterone + calcium group did not deviate from control. Total plasma calcium was elevated in the calcium group. Plasma concentrations of sodium and atrial natriuretic peptide (ANP) were increased by deoxycorticosterone while neither of the calcium-treated groups differed from control in these respects. Urinary excretions of calcium and sodium were increased in both groups receiving calcium, and also the deoxycorticosterone group excreted more calcium into urine than the control. Adrenergic nerve density in a section of the mesenteric artery and the urinary excretion of noradrenaline and adrenaline were similar in all study groups. The results indicate that calcium supplementation can attenuate the development of hypertension and prevent the deoxycorticosterone-induced blood pressure rise in SHR, possibly by influencing sodium metabolism as seen in increased natriuresis, and by preventing the actions of deoxycorticosterone on sodium balance.

Social and environmental factors and major depression in old age

This community-based epidemiological survey is concerned with relationships between social and environmental factors and major depression in a Finnish population aged 60 years and over. The occurrence of major depression was related to advanced age, widowhood or divorce, low number of hobbies, frequently being alone, poor social participation, and many long-standing and current social-stress factors. According to the questionnaire data, subjects suffering from major depression had more frequently experienced serious illnesses and deaths among their close relatives during the five years before the beginning of this survey than had the non-depressed subjects. The log-linear model constructed for major-depressive persons revealed six interactions. The first was characterized by a low number of hobbies, high incidence of long-standing social-stress factors, and widowed or divorced status; the second by poor social participation and high incidence of long-standing and current social-stress factors, or combination of moderate level of social participation, high incidence of long-standing social-stress factors, and low incidence of current social-stress factors; the third by a low number of hobbies and high incidence of current social-stress factors; the fourth by a high incidence of current social-stress factors and widowed or divorced status; the fifth by a low number of hobbies and low level of social participation; and the sixth by a moderate level of social participation and widowhood or divorce.

Predictors of high functional capacity and mortality in elderly Finnish men

Factors predicting high functional capacity in old age and 25-year mortality were studied in 1711 men aged 40 to 59 years. The study population was that of the East-West Study, i.e. the Finnish part of the Seven Countries Study. After the 25-year follow-up (in 1984) 766 men were still alive. Nonsmoking and good pulmonary function in earlier middle-age and the absence of coronary heart disease, cerebrovascular disease or emphysema in later middle-age predicted high functional capacity in old age. High systolic blood pressure, low forced vital capacity, smoking, and the presence of coronary heart disease predicted mortality in the next 10 to 25 years. Although mortality rates were higher in eastern Finland, the predictors were similar in both the eastern and the southwestern parts of the country.

Effects of calcium and deoxycorticosterone on blood pressure, plasma renin activity and vascular reactivity in spontaneously hypertensive rats

The effects of calcium and deoxycorticosterone (DOC) on blood pressure, plasma renin activity (PRA), urinary sodium excretion and aortic responses were studied in spontaneously hypertensive rats (SHR). The animals (age 9 weeks) were divided into four treatment groups: control, calcium, DOC and DOC+calcium (n = 12 and the mean systolic blood pressure 174-177 mmHg in each). Calcium was given as 1.5% CaCl2 in drinking fluid, and DOC trimethylacetate by weekly injections (25 mg/kg s.c.). During the 4-week study systolic blood pressure rose in all groups, but the increase was attenuated by calcium (final levels: control 201 +/- 3, calcium 186 +/- 3, DOC 206 +/- 2, DOC + calcium 203 +/- 2 mmHg, mean +/- SE). PRA was reduced in both groups receiving DOC, but it was not affected by calcium. Calcium supplementation increased urinary excretion of sodium in DOC-treated animals. DOC enhanced the in vitro contractility of helically cut aortic strips to noradrenaline, and decreased the relaxation of the strips to nitroprusside and nifedipine. The results indicate that calcium supplementation attenuates the development of hypertension in SHR, and that this attenuation is not mediated by the renin-angiotensin system. DOC abolished this lowering effect of calcium on blood pressure possibly by its action on vascular smooth muscle, resulting in increased vascular contractility and impaired relaxation.

Social and environmental factors and atypical depression in old age

This community-based epidemiological survey is concerned with relationships between social and environmental factors and atypical depression in a Finnish population aged 60 years or over. The occurrence of atypical depression was related to older age, widowed or divorced marital status, having moved during the previous few years, living in a small dwelling near the local population center, having neighbors living in the same building, living alone, being frequently alone, a low number of hobbies and many long-standing or current social stress factors. In addition, the atypical depressive persons felt that elderly people were not appreciated. The log-linear model constructed for atypical depressive persons revealed five subgroups. The first was characterized by living alone and being widowed or divorced, the second by living alone and having a low number of hobbies and a high incidence of long-standing social stress factors, the third by being frequently alone and being widowed or divorced, the fourth by a low number of hobbies and a low incidence of actual social stress factors, and the fifth by living alone and having a high incidence of long-standing social stress factors and a low incidence of actual social stress factors.

Prevalence of depression in an elderly population in Finland

The prevalence of depression by sex, age and certain sociodemographic variables was investigated in a sample of elderly Finns (60 years or over) living in the semi-industrialized municipality of Ahtäri (n = 1529). The study was carried out in two phases. In the first phase, depressive symptoms were screened with the Zung Self-rating Depression Scale (ZSDS). In the second phase, persons scoring greater than or equal to 40 points in the ZSDS and a random sample of persons scoring less than 40 ZSDS points were examined by a general practitioner. The prevalence of depression was determined on the basis of DSM-III criteria. The estimated prevalence for men was 22.4%, and for women 29.7%. The estimated prevalence for different categories of depression was as follows: dysthymic disorder, men 17.2% and women 22.9%; major depression, men 2.6% and women 4.5%; atypical depression, men 2.2% and women 2.5%; and cyclothymic disorder, men 0.4% and women 0%. No cases of bipolar disorder were found. A high risk of depression was associated with female sex, widowhood and being in long-term institutional care or receiving home nursing and/or home help. The occurrence of depression was not related to age, education or occupation.

Alpha 1-antitrypsin in acute anterior uveitis and rheumatic diseases

To test the pathogenetic role of the phenotype MZ of alpha 1-antitrypsin/alpha 1-protease inhibitor (PI) in acute anterior uveitis (AAU) and in different rheumatic diseases we examined 360 unrelated patients including 93 with AAU alone, 24 patients with AAU and ankylosing spondylitis (AS), 21 patients with AAU and Reiter's disease (RD), 26 patients with AAU, AS, and RD 54 patients with AS alone, 16 patients with RD alone, 115 patients with rheumatoid arthritis (RA) alone, and 11 patients with psoriatic arthritis (PA) alone. Of the 164 AAU patients, 80 had a single attack, and 84 had repeated episodes. There were neither significant differences between different groups of the patients and 120 healthy controls nor between patients with AAU alone and patients with AAU and AS or RD in the frequencies of the PI phenotypes tested. The results indicate that the PI MZ type is not closely associated with AAU, AS, RD, RA and PA and that it does not play any role in determining whether AAU shows a pattern of a single attack or repeated episodes, and whether AAU occurs alone or together with AS or RD.