Recognition of heat shock protein 60 epitopes in children with type 1 diabetes.

BACKGROUND: Treatment with a specific HSP60 epitope in new onset of type 1 diabetes (T1D) patients has been shown to preserve endogenous insulin production. Previously, recognition of pan HLA-DR-binding HSP60 epitopes in various autoimmune diseases was found; this study investigated recognition of these epitopes in newly diagnosed T1D patients and correlated findings to the occurrence of a partial remission. METHODS: Peripheral blood mononuclear cells of 18 children with T1D were prospectively collected at disease onset and a few months after diagnosis. Epitope-specific T-cell proliferation and cytokine production (intracellular and in culture supernatants) were measured. Results were compared with 31 longstanding T1D patients and ten healthy controls. RESULTS: Although HSP60 epitope-specific T-cell proliferative responses were detected, overall proliferative responses were low. At onset, epitope-specific intracellular IFN-γ production was higher in T1D patients compared with healthy controls (p < 0.05). At follow-up, both IL-10 and IFN-γ production were higher in those without a partial remission than in those with a partial remission (both p < 0.05). Also, IL-10 and IFN-γ production were higher compared with onset for patients without a PR (both p < 0.01). In supernatants of HSP60 epitope-specific T-cell cultures, no substantial differences in cytokine production were found between T1D patients with and without a partial remission, either at onset or a few months after onset. As patient numbers were small, results should be interpreted with caution. CONCLUSIONS: Pan-DR-binding HSP60 peptides induced low peptide-specific proliferative responses and peptide-specific production of some, mainly intracellular, cytokines in T1D patients. Recognition did not differ significantly between patient groups and various time points.

Reliability of interpretation of CT examination of the larynx in patients with glottic laryngeal carcinoma.

INTRODUCTION: Reports in literature suggest that tumor volume, cartilage invasion, and cartilage sclerosis are independent prognostic factors for tumor control in radiotherapy as primary treatment of laryngeal carcinomas. OBJECTIVE: Assessment of the interobserver variability and prognostic value in the measurement of tumor volume, cartilage invasion, and sclerosis. MATERIALS AND METHODS: Retrospective analysis of 55 CT scans by three independent observers. Volume measurements and determination of cartilage invasion, cartilage sclerosis, and tumor localization were calculated. Correlation between the prognostic factors and radiotherapy was calculated for each observer. RESULTS: Values for interobserver agreement varied substantially; cartilage invasion (kappa value: -0.02 to 0.66), cartilage sclerosis (kappa value: 0.13 to 0.57), tumor localization of subsites (kappa value: 0.03 to 0.60), and tumor volume (correlation: 0.34 to 0.73). The found interobserver variation makes it impossible to establish accurate prognostic factors. CONCLUSION: Determination of tumor volume, cartilage invasion, and cartilage sclerosis on the basis of CT imaging shows considerable interobserver variation; clinical significance appears to be limited. EBM RATING: B-3a.

Treatment of hypopharyngeal carcinoma: analysis of nationwide study in the Netherlands over a 10-year period.

OBJECTIVE: To analyse different treatment strategies and treatment results of hypopharyngeal carcinoma in the Netherlands. DESIGN: Retrospective study. SETTING: Eight head and neck centres in the Netherlands. PARTICIPANTS: A total of 893 patients were treated between 1985 and 1994. Patients were mostly treated with radiotherapy alone, combined surgery and radiotherapy and surgery alone. RESULTS: The 5-year survival for the whole group was 26%. The 5-year survival for patients treated with curative intention was 32% and treated with palliative intention was 5%. The 5-year disease-free survival after radiotherapy alone was 37%, after surgery alone 41% and after combined therapy 47%. The role of chemotherapy could not be investigated because of a small number of patients treated with chemotherapy in this period. CONCLUSION: Combined therapy with surgery and radiotherapy has a better survival for patients with a hypopharyngeal carcinoma in comparison with radiotherapy alone. The N-stage is more important for the prognosis than the T-stage.

[Trigeminal trophic syndrome: 2 patients with a non-healing ulcer on the ala nasi]. / Het trofisch syndroom van de N. trigeminus: 2 patiënten met een niet-genezend ulcus op de ala nasi.

Two female patients, aged 74 and 91 years respectively, had a skin ulcer on a nostril and ipsilateral sensory paralysis in the area covered by the N. trigeminus. This is known as trigeminal trophic syndrome. It may be caused by (iatrogenic) damage to the trigeminal nerve by chronic manipulation of the senseless skin. Only in case of doubt, histological examination of a tissue sample is advised to exclude malignancy. The main treatment consists of instructing the patient not to manipulate the skin. In some patients surgical reconstruction is necessary.

Metastasizing pleomorphic adenoma: a report of three cases.

Three cases of metastasizing pleomorphic adenoma are described. All three had a history of incomplete surgery of the primary tumour and several surgical procedures for local recurrences before systemic metastases became apparent. The histology of the primary tumour, recurrences and metastases were typical of pleomorphic adenoma. In view of the lack of information in the literature, it is concluded that inadequate surgical procedures, such as incomplete surgery or enucleation, leading to multiple recurrences, appear to be a prerequisite for the development of systemic disease.

Osteoid and bone formation in a nasal mucosal melanoma and its metastasis.

AIMS: To present a literature review and a case history concerning bone and osteoid formation by a metastasizing (mucosal) melanoma. CASE DETAILS: Osteocartilaginous differentiation and production of osteocartilaginous structures in malignant melanoma have been described only in 12 previous cases (osteoid in 11. bone in four), all of which involved dermal melanomas. Five of these melanomas were recurrent and one was associated with neurofibromatosis. The case report concerns a 75-year-old man with a nasal mucosal melanoma which was treated surgically. One year later, the patient developed a local recurrence and a cervical lymph node metastasis. Both the recurrent tumour and the metastasis showed clear evidence of bone and osteoid formation. CONCLUSIONS: This case is the first report in the literature, clearly demonstrating bone and osteoid formation by a mucosal melanoma, not only at the primary site, but even more convincingly in a cervical lymph node metastasis.

Nutrition in agricultural development: land settlement in Coast Province, Kenya.

PIP: Coast Province is the third area of population concentration in Kenya with more than 1.8 million people at the time of the census in 1989. The region is economically underdeveloped relative to central and western Kenya. In response to a great demand for land, the government of Kenya has since 1963 parcelled out tracts of land in Coast Province among smallholder tenants. This paper reviews the settlement of land in the province during 1960-70 and the effects upon later household income, food production, and nutrition. Findings are based upon information gathered from 300 tenant households surveyed between August 1985 and September 1986 in the Ukunda, Mtwapa, and Roka-East schemes respectively established in 1962, 1968, and 1969, and 150 households in rural comparison locations visited during the same period. In all aspects studied, including living conditions, household resources and income, food self-sufficiency and consumption, and nutritional status of children, the settlement tenants were better off than the rural population. Further analysis determined that the relatively better nutritional status of tenant households is only partly due to increases in food production and agricultural income. Income from employment was also higher than that of the rural comparison population. Households with large farms generally realized larger incomes, but they also had much larger families and food consumption, and the nutritional status of young children was lower among those households.^ieng

Free vascularized jejunum interposition for pharyngoesophageal reconstruction after total laryngopharyngectomy.

The records of 28 patients who underwent free jejunal graft reconstruction after resection for cancer involving the pharynx were analysed. Seven patients had a T3 carcinoma, 15 patients T4 and six patients recurrence after laryngectomy. Ten patients had received radiotherapy in the past. Post-operatively, 15 patients (54%) had complications and two patients (7%) died. No significant difference was observed in the complication rate between the group that received radiotherapy in the past and those who did not. Nineteen patients received post-operative radiotherapy. Nine patients had no radiotherapy on the basis of complete resection or because of serious complications. For the whole group the 2-year recurrence free period and survival were 42% and 51% respectively. The post-operative radiotherapy group had a significantly better survival (73%) and recurrence free period (63%) than the group without post-operative radiotherapy (0%). Thus, post-operative radiotherapy seems indicated irrespective of resection margins.

The significance of socio-economic characteristics for adult seasonal body-weight fluctuations: a study in north-western Benin.

Large variations in seasonal body-weight fluctuations have been described for individuals from different households living and working under comparable circumstances. In the present study the relationship between socio-economic household characteristics and seasonal body-weight fluctuations of individual members of rural Beninese households were studied. No significant correlation was found for body-weight fluctuation between the two study years, nor for body-weight fluctuation of men and women belonging to the same household. When comparing dichotomized socio-economic classes for relative body-weight fluctuation of men and women in both study years, no consistent trends were observed for both years nor for both sexes. The distribution of subjects with a consistent high weight fluctuation over the two study years did not differ between socio-economic groups. In conclusion it may be stated that there were no indications that socio-economic characteristics play a determining role in the magnitude of body-weight fluctuation of this study population, despite the large variations observed in the latter. Therefore it is most likely that other factors decide the weight fluctuations of individuals, health and sanitation being the most likely candidates.

The ambivalent role of glutathione in the protection of DNA against singlet oxygen.

Glutathione (GSH) was examined with respect to its ability to protect DNA against 1O2 damage. We have found that GSH protected, at least partly, the DNA against inactivation by 1O2. Up to 10 mM the protection increased as a function of GSH concentration. Above 10 mM the protection remained constant and less than expected on the basis of scavenging/quenching of 1O2, in contrast to the protection offered by sodium-azide. Especially at the higher concentrations of GSH the protection against the biological inactivation is accompanied by an increase in single-strand breaks and also probably lethal base damage. However, all together the data suggest that at least in the physiologically important range (0.1-10 mM) GSH is able to protect efficiently against 1O2-induced inactivating DNA damage.

Child nutrition in the pre-harvest season in Kenya.

This study examines the food consumption and nutritional status of pre-school children during the period March-April, at the end of the dry season in the Kano Plain of Nyanza Province. The diet of pre-school children in this region of Kenya consists foremost of maize and milk. Food consumption was generally low with considerable deficits in energy intake and other nutrients among all age groups, although protein intake was generally at recommended levels. The heights of the children did not differ from the available national and regional figures, but the weights of the children were far below earlier figures which must be related to the prevailing lean seasons. The youngest group in the sample, aged 6-12 months, showed the largest deficit in weight status. This group appears to suffer most from the seasonal imbalance. Overall the findings indicate that the seasonal deficits in this part of Kenya are more severe than was assumed until now.

PIP: This study examines the food consumption and nutritional status of preschool children during the period March-April, at the end of the dry season in the Kano Plain of Nyanza Province. Their diet in this region of Kenya consists mostly of maize and milk. Food consumption was generally low with considerable deficits in energy intake and other nutrients among all age groups, although protein intake was generally at the recommended levels. Heights of the children did not differ from the available national and regional figures, but the weights of the children were far below earlier figures; this seems to be related to the prevailing lean seasons. The youngest group in the sample, ages 6-12 months, showed the largest deficit in weight status. This group appears to suffer most from seasonal imbalance. Overall, the findings indicate that the seasonal deficits in this area of Kenya are more severe than was previously assumed.

Impact evaluation of child nutrition programmes.

PIP: A review of current practices and recent developments regarding impact evaluation of nutrition programs for preschool children in developing countries is presented. Nutrition education, food suplementation, and nutrition rehabilitation, the 3 major components of intervention in child nutrition, generally focus on food consumption and are directed at individual cases. Impact evaluations are generally confronted with situations where different programs operate in a variety of cultural settings, where the effects of the interventions are small, and where methodological difficulties usually weaken the evaluations. Definitions of impact evaluation generally include reference to the measurement of program effects by "objective" and "systematic" means. The 1st refers to the use of reliable measuring instruments with standard routines; the 2nd to the comparison of different groups of recipients (and nonrecipients) in such a way that it reveals the impact of the intervention, irrespective of other factors that influence child nutrition. Impact evaluation has 2 major components the indicators selected to reflect program impact, and the design used for the comparison of different groups of recipients. Both the interventions and evaluations have to operate under restricting conditions, and different strategies to accomodate this situation are mentioned. It is argued that the contribution of evaluation is not so much in the nature of being a final arbiter, but rather in the nature of helping to seek the optimal combination of local conditions and type of assistance offered.^ieng

The effects of protein energy malnutrition in early childhood on intellectual and motor abilities in later childhood and adolescence.

Three groups of Ugandan children (20 in each group) and one comparison group of 20 children were examined between 11 and 17 years of age. The first three groups had been admitted to hospital for treatment of protein energy malnutrition between the ages of eight to 15, 16 to 21 and 22 to 27 months, respectively. The comparison group had not been clinically malnourished throughout the whole period up to 27 months of age. All the children came from one tribe and were individually matched for sex, age, education and home environment. It was found that the three malnourished groups fell significantly below the comparison group in anthropometric measurements and in tests of intellectual and motor abilities. No evidence was found for a relationship between the deficit and age at admission. Further analysis among the 60 malnourished children revealed that anthropometry and intellectual and motor abilities are the more affected the greater the degree of 'chronic undernutrition' at admission, but no correlation was found with the severity of the 'acute malnutrition'. The results show a general impairment of intellectual abilities, with reasoning and spatial abilities most affected, memory and rote learning intermediately and language ability least, if at all, affected. These findings are discussed in the context of a comprehensive and critical appraisal of the existing literature.

The long-term effects of protein energy malnutrition in early childhood on bone age, bone cortical thickness and height.

Three groups of Ugandan children, 18 in each group, and one comparison group of 18 children were examined at 11-17 years of age. The three groups had previously been admitted for treatment of protein energy malnutrition between the ages of 8 to 15, 16 to 21 and 22 to 27 months respectively. The comparison group had not been clinically malnourished throughout the period up to 27 months of age. The children came from one tribe and from similar socio-economic background, and were individually matched on age and sex. The bone age was estimated by hand wrist radiography scored for maturity by the Tanner & Whitehouse method. The metacarpal index, a ratio derived from the medullary width and full diameter of the mid-point of the second metacarpal, was used as a measure of bone cortical thickness. The three malnourished groups are significantly shorter in height than the comparison group, but are not different in bone age and metacarpal index. No differences are observed between the three groups of children who had been admitted for protein energy malnutrition at different ages. The findings are discussed as they relate to the existing literature.