Temporal trends of HLA genotype frequencies of type 1 diabetes patients in Sweden from 1986 to 2005 suggest altered risk.

The aim of this study was to compare the frequency of human leukocyte antigen (HLA) genotypes in 1-18-year-old patients with type 1 diabetes newly diagnosed in 1986-1987 (n = 430), 1996-2000 (n = 342) and in 2003-2005 (n = 171). We tested the hypothesis that the HLA DQ genotype distribution changes over time. Swedish type 1 diabetes patients and controls were typed for HLA using polymerase chain reaction amplification and allele specific probes for DQ A1* and B1* alleles. The most common type 1 diabetes HLA DQA1*-B1*genotype 0501-0201/0301-0302 was 36% (153/430) in 1986-1987 and 37% (127/342) in 1996-2000, but decreased to 19% (33/171) in 2003-2005 (P \ 0.0001). The 0501-0201/0501-0201 genotype increased from 1% in 1986-1987 to 7% in 1996-2000 (P = 0.0047) and to 5% in 2003-2005 (P > 0.05). This study in 1-18-year-old Swedish type 1 diabetes patients supports the notion that there is a temporal change in HLA risk.

IA-2 autoantibodies in incident type I diabetes patients are associated with a polyadenylation signal polymorphism in GIMAP5.

In a large case-control study of Swedish incident type I diabetes patients and controls, 0-34 years of age, we tested the hypothesis that the GIMAP5 gene, a key genetic factor for lymphopenia in spontaneous BioBreeding rat diabetes, is associated with type I diabetes; with islet autoantibodies in incident type I diabetes patients or with age at clinical onset in incident type I diabetes patients. Initial scans of allelic association were followed by more detailed logistic regression modeling that adjusted for known type I diabetes risk factors and potential confounding variables. The single nucleotide polymorphism (SNP) rs6598, located in a polyadenylation signal of GIMAP5, was associated with the presence of significant levels of IA-2 autoantibodies in the type I diabetes patients. Patients with the minor allele A of rs6598 had an increased prevalence of IA-2 autoantibody levels compared to patients without the minor allele (OR=2.2; Bonferroni-corrected P=0.003), after adjusting for age at clinical onset (P=8.0 x 10(-13)) and the numbers of HLA-DQ A1*0501-B1*0201 haplotypes (P=2.4 x 10(-5)) and DQ A1*0301-B1*0302 haplotypes (P=0.002). GIMAP5 polymorphism was not associated with type I diabetes or with GAD65 or insulin autoantibodies, ICA, or age at clinical onset in patients. These data suggest that the GIMAP5 gene is associated with islet autoimmunity in type I diabetes and add to recent findings implicating the same SNP in another autoimmune disease.

SUMO4 M55V polymorphism affects susceptibility to type I diabetes in HLA DR3- and DR4-positive Swedish patients.

SUMO4 M55V, located in IDDM5, has been a focus for debate because of its association to type I diabetes (TIDM) in Asians but not in Caucasians. The current study aims to test the significance of M55V association to TIDM in a large cohort of Swedish Caucasians, and to test whether M55V is associated in those carrying human leukocyte antigen (HLA) class II molecules. A total of 673 TIDM patients and 535 age- and sex-matched healthy controls were included in the study. PCR-RFLP was performed to identify the genotype and allele variations. Our data suggest that SUMO4 M55V is not associated with susceptibility to TIDM by itself. When we stratified our patients and controls based on heterozygosity for HLA-DR3/DR4 and SUMO4 genotypes, we found that presence of SUMO4 GG increased further the relative risk conferred by HLA-DR3/DR4 to TIDM, whereas SUMO4 AA decreased the risk. From the current study, we conclude that SUMO4 M55V is associated with TIDM in association with high-risk HLA-DR3 and DR4, but not by itself.

Comparison of diagnostic methods for selection of patients for antireflux operations.

In cases of reflux disease the therapeutic indications are of special significance. The number of patients in need of operation is limited, thus the patients must be chosen carefully. Different diagnostic methods have been compared to standard acid reflux test in a series of 22 consecutive cases. Radiology was the least reliable method for detecting reflux or reflux complications, whereas endoscopy confirmed the diagnosis in 18 of 22 cases. Three-point stepwise manometry did not give reliable data of the lower esophageal sphincter pressure but yielded valuable information about the location of lower esophageal sphincter zone and of esophageal motility. In contrasts to earlier reports, no considerable overlap regarding lower esophageal sphincter pressure values in healthy and diseased individuals were noted.

Permanent indwelling tubes in benign oesophageal stricture.

Permanent intubation of benign oesophageal stricture seems to be rather frequently used, but there are few reports on indications and results. The limited experience from 9 intubations in 7 patients presented, is not encouraging. Massive gastro-intestinal bleeding, peptic reflux and tube migration were seen, and 4 of the tubes had to be sacrificed within 6 weeks. Two patients only had full and lasting benefit of the treatment without serious tube complication. Indwelling tubes should be considered in benign strictures only as an alternative to gastrostomy, particularly in those patients feeling strong aversion to permanent stomy.

The incidence of sliding hiatal hernias in patients with gastroesophageal reflux requiring operation.

The incidence of sliding hiatal hernias in 44 patients operated upon for gastroesophageal reflux has been analysed. Preoperative X-ray and endoscopy were carried out in all patients. Esophageal manometry was made in 26 patients and preoperative pH-measurements were made in 22 patients. Sliding hiatal hernia was found by X-ray examination in 24 patients. The incidence of hiatal hernia was increasing with age, while the reflux disease in the non-hiatal hernia patients was equally distributed in different age groups. The low incidence of hiatal hernias, especially in young patients with reflux, implies that the indications for surgery ought to be based on the demonstration of reflux itself, and not on the radiological demonstration of hiatal hernia. The low incidence of radiologic reflux means that X-ray alone never can exclude even severe reflux disease.

An alternative fundoplicative maneuver for gastroesophageal reflux.

Twenty-two patients with gastroesophageal reflux undergoing an original antireflux operative procedure are presented. The mean time between operation and follow-up was 19 months. The technique consists of a semifundoplicative maneuver with firm intraabdominal fixation of the esophagus by suturing the fundoplication to the diaphragm. There was no mortality. The patients were free of reflux symptoms and complications, and the standard reflux test was negative in all cases. All patients had postoperative lower esophageal sphincter pressure within the normal range. The phenomenon of gas-bloat as not observed, nor was inability to vomit or belch. These results confirm the observations made earlier in a series of 110 patients operated on with the same method. A long-term prospective randomized study is in progress, with the aim of comparing the technique described herein and the Nissen fundoplication.

Meningitis in a newborn infant caused by Mycoplasma hominis.

When 10 days old an infant born after 34-35 weeks of gestation developed meningitis with pleocytosis and a low glucose concentration in the cerebrospinal fluid. Mycoplasma hominis was recovered from the cerebrospinal fluid and treatment with doxycycline was given. The strain was later found to be resistant to tetracycline. After institution of lincomycin, cultures for mycoplasmas were negative. The infant, who during the course of the meningitis had developed a transient increase in intracranial pressure, was healthy and normally developed at the age of one year.--This is the first report on an infection caused by a tetracycline-resistant strain of Mycoplasma hominis.

Observations during treatment of acute necrotizing pancreatitis with surgical ablation.

Seven patients with acute necrotizing pancreatitis were treated by surgical ablation. Immediate improvement was seen in six patients. Two patients died during the course of postoperative complications requiring reoperations. At operation, strikingly conforming lesions were found in the shape of a sharply limited necrotic portion of the gland. The body and tail of the pancreas constituted this necrotic portion in all patients. In a certain group of patients, the vascular anatomy infers a total infarction of the body and tail of the pancreas if a thrombosis of the transverse pancreatic artery occurs. In view of these observations, more interest should be directed toward the possibility of a vascular occlusion as a cause of pancreatic necrosis.

Single-layer anastomosis of the colon. A review of 165 cases.

One hundred sixty-five patients undergoing elective colorectal or colonic anastomoses with a one-layer technic are presented. One death from suture line dehiscence was noted, and the overall mortality was 2.4 per cent. The usual technic for esophagogastrointestinal suturing in French surgical centers is described and the importance of suture technic in the etiology of anastomotic leaks is discussed.

A clinical evaluation of a test for antibody-coated bacteria in the urine.

A test for antidoby-coated bacteria in the urine for the diagnosis of the anatomical level of urinary tract infection was evaluated in an unselected series of patients with urinary tract infection as a complication of other diseases of the uro-genital tract. Of 19 patients with cancer of the bladder, prostata and the kidney who had clinical signs of lower tract infection, 14 had antibody-coated bacteria in the urine. Among adult patients without cancer of the urinary tract but a clearcut history of upper tract infection, 17 had antibody-coated bacteria, while 8 had not. Six patients also without history of cancer, with clearcut lower tract infection, had antibody-coated bacteria; 38 had not. The results indicate that cancer of the urinary tract seems to influence the correct establishing of level of infection by this method. In patients with diseases of the urinary tract in additional to infection, antibody coating by bacteria in the urine must be interpreted with caution.

Antibody-coated bacteria in the urine of children with urinary tract infections.

The test for antibody-coated bacteria in urine for the diagnosis of the anatomical level of urinary tract infections was evaluated in children with UTI. The ability of the test to differentiate between an upper and lower infection is influenced by the antiglobulin preparation used, since too sensitive an antiglobulin probably detects nonspecifically bound antibodies. Staphylococcal protein A seems to be well suited for use as an antiglobulin in this test. Using staphylococcal protein A all children with X-ray findings suggesting renal damage had antibody-coated bacteria in the urine, however, nine infants and 5 children and clinical symptoms of pyelonephritis had a negative test. Of 28 children with clinical symptoms of cystitis only one had a positive test. Of 50 children with asymptomatic bacteriuria 9 had antibody-coated bacteria in the urine; 41 had not. The findings indicate that the method might be useful in establishing the anatomical level of urinary tract infection and might also be useful for screening children with asymptomatic bacteriuria who risk developing kidney infections.

Results of partial thyroidectomy for thyrotoxicosis.

In a retrospective study, two series of surgically treated patients with thyrotoxicosis were compared. The series differed with respect to preoperative treatment and operative techniquue. In one series a combined preoperative treatment with an antithyroid drug and 1-thyroxine was given and the recurrent nerves and parathyroid glands were routinely identified. In the other series no such operative routine was followed and iodine was given preoperatively. The complication rate was low in both series. There was no postoperative mortality. The existing differences, although subtle, in the frequency of recurrent nerve paralysis, postoperative hypoparathyroidism or hypothyroidism, as well as recurrent toxicosis, favoured the surgical approach with the combined preoperative treatment and a meticulous technique with identification of recurrent nerves and parathyroid glands.