Risk of gallstone disease is associated with serum level of alpha-1-acid glycoprotein.

We explored the association between serum level of alpha-1-acid glycoprotein (AGP, an acute phase protein) and the risk of gallstones. AGP was determined in stored serum samples from a case-control study (cases: 113 patients who underwent cholecystectomy for gallstone disease; controls: 184 surgery patients screened by ultrasound, showing no gallstones). Serum AGP correlated negatively with HDL-cholesterol and positively with triglycerides. Presence of gallstones was positively associated with serum AGP, more strongly so for cholesterol gallstones than for pigment gallstones, but not differently between solitary and multiple cholesterol stones. Asymptomatic gallstones (13 surgery patients with gallstones found by screening) were also associated with serum AGP levels. A causal role of elevation of serum AGP (or underlying immune activation) in gallstone formation is discussed.

The efficacy of influenza vaccination in elderly individuals. A randomized double-blind placebo-controlled trial.

OBJECTIVE: To determine the efficacy of influenza vaccination in elderly people. DESIGN: Randomized double-blind placebo-controlled trial. SETTING: Fifteen family practices in the Netherlands during influenza season 1991-1992. PARTICIPANTS: A total of 1838 subjects aged 60 years or older, not known as belonging to those high-risk groups in which vaccination was previously given. INTERVENTION: Purified split-virion vaccine containing A/Singapore/6/86(H1N1), A/Beijing/353/89(H3N2), B/Beijing/1/87, and B/Panama/45/90 (n = 927) or intramuscular placebo containing physiological saline solution (n = 911). MAIN OUTCOME MEASURES: Patients presenting with influenzalike illness up to 5 months after vaccination; self-reported influenza in postal questionnaires 10 weeks and 5 months after vaccination; serological influenza (fourfold increase of antibody titer between 3 weeks and 5 months after vaccination). RESULTS: The incidence of serological influenza was 4% in the vaccine group and 9% in the placebo group (relative risk [RR], 0.50; 95% confidence interval [CI], 0.35 to 0.61). The incidences of clinical influenza were 2% and 3%, respectively (RR, 0.53; 95% CI, 0.39 to 0.73). The effect was strongest for the combination of serological and clinical influenza (RR, 0.42; 95% CI, 0.23 to 0.74). The effect was less pronounced for self-reported influenza. CONCLUSION: In the elderly, influenza vaccination may halve the incidence of serological and clinical influenza (in periods of antigenic drift).

Routine testing for Chlamydia trachomatis on Curaçao, Netherlands Antilles.

OBJECTIVE: Although genital Chlamydia trachomatis infection is most often asymptomatic, early treatment may prevent serious complications. For screening or routine testing to be cost effective, the prevalence of the infection must not be too low. STUDY DESIGN: On Curaçao, Netherlands Antilles, the prevalence of chlamydial infection in 205 asymptomatic women of reproductive age, who were seen by a general practitioner or gynecologist for a gynecologic examination was measured. RESULTS: The overall prevalence was found to be 5.4% (95% confidence interval 2.7% to 9.4%) with the enzyme-linked immunosorbent assay method. Of all possible predictors of a chlamydial infection, only young age (< 25 years, prevalence 10.3%) seemed to be indicative of such an infection. CONCLUSION: Routine testing for Chlamydia trachomatis in sexually active women on Curaçao and on other Caribbean islands is indicated for women < 25 years old.

Fair, and still a sun lover: risk of gallstone formation.

STUDY OBJECTIVE: The aim was to evaluate the hypothesis that sunlight exposure leads to the development of gallstones in people with a sun sensitive skin. DESIGN AND SETTING: This was a case-control study among 206 white patients referred for an ultrasound examination of the gallbladder. Sunlight exposure and skin sensitivity were retrospectively assessed by a structured questionnaire. The questionnaire was taken before the outcome of the ultrasound examination was known, so that the patients and the interviewers were blind to the outcome. The main outcome measure was gallstones in the gallbladder detected by ultrasound. MAIN RESULTS: 87 patients had gallstones (cases), 119 had none (controls). In subjects with a skin sensitive for sun (Fitzpatrick skin type I) a positive attitude to sunbathing was associated with a higher risk of gallstones than a negative attitude. In subjects with an insensitive skin (skin type IV) no association was found. CONCLUSIONS: This study confirms a hypothesis which was based upon metabolic research. However it is too early to upgrade the first "F" in the traditional adage that gallstone patients are "fair, fat, female, fertile and forty". Since both epidemiological and pathobiological evidence is scarce, the role of sun and/or (ultraviolet) light exposure and skin sensitivity in the aetiology of gallstones should be confirmed by further research.

Carpal tunnel syndrome: prevalence in the general population.

To study the prevalence of carpal tunnel syndrome (CTS) in the general population and the value of brachialgia paraesthetica nocturna (BPN) in diagnosing CTS, an age and sex stratified random sample of 715 subjects was taken from the population register of Maastricht (The Netherlands) and surrounding villages, between September 1983 and July 1985. The response rate was 70%. Of these, 12 CTS cases had already been diagnosed. Of the remaining subjects, 64 (13 men, 51 women) woke up because of BPN. Among these subjects 1 man and 23 women were found to have CTS. The prevalence rate of undetected CTS was 5.8% [95% confidence interval (CI): 3.5-8.1%] in adult women; 3.4 percent (95% CI: 1.5-5.3%) had already been diagnosed as CTS. The overall prevalence rate for men was 0.6% (95% CI 0.02-3.4%). These figures have to be regarded as minimal estimates. The overall diagnostic value of BPN for CTS was 38%, while for women only this was 45% (95% CI: 31-60%).

[An echographic study of the prevalence of gallstone disease in Maastricht and the surrounding area]. / Een echografish onderzoek naar de prevalentie van galsteenziekte in Maastricht en omstreken.

The prevalence of gallstone disease was studied by ultrasound screening of a hospital population of 424 men and 631 women in Maastricht, admitted for elective surgery unrelated to gallstone disease. In the youngest age group (20-30 yr) no gallstone disease was observed. The prevalence increased with age. In the oldest age category (70-80 yr) 16% of the men and 40% of the women were found to have gallstone disease. The proportion of men with gallstone disease who had undergone cholecystectomy was 39%. In women this was 50%. Data acquired by a list of questions of a sample out of the general population indicated that the prevalence in the general population may be somewhat lower.

The value of secretory component (SC) immunoreactivity in diagnosis and prognosis of colorectal carcinomas.

Immunoreactivity of secretory component (SC) was tested in routinely processed tissue specimens of 314 colorectal cancer patients and correlated with clinicopathologic parameters, such as stage and histologic grade of the tumors as well as survival data of patients. In 22% of the carcinomas almost all tumor cells were SC positive, 36% of the tumors showed SC immunoreactivity in a focal, heterogeneous pattern, whereas in 42% of the carcinomas SC immunoreactivity did not occur. Uniformly SC positive carcinomas demonstrated a tendency to occur more frequently in the low stage and grade carcinomas, whereas uniformly SC negative neoplasms showed the reverse trend. These trends were only statistically significant for stage. Focal SC immunoreactivity (SC heterogeneous tumors) was not correlated with stage nor with grade. Furthermore, inclusion of SC heterogeneous tumors in the analysis of survival data obscured the statistical significance observed in the correlation of SC immunoreactivity status and patient survival in uniformly SC positive or negative tumors. It is concluded that the prognostic value of SC immunoreactivity patterns in colorectal carcinoma tissue appears to be limited due to the occurrence of a substantial proportion of tumors with heterogeneous SC expression and is of less significance than staging. Nevertheless, determination of the SC immunoreactivity status may be of additional value for the identification of a subpopulation of patients with a more favorable prognosis.

Monoclonal antibody (1116 NS 19-9) defined monosialoganglioside (GICA) in colorectal carcinoma in relation to stage, histopathology and DNA flow cytometry.

Immunoreactivity of 1116 NS 19-9 monoclonal antibody defined monosialoganglioside (gastrointestinal cancer-associated antigen, GICA) has been studied in a series of colorectal carcinoma patients of a multicentre prospective controlled trial in order to assess its correlation with parameters such as localization, stage histopathological characteristics and DNA flow cytometry. GICA could be detected in 60% of the carcinomas, but no correlation was observed between its status of immunoreactivity and any of the parameters studied. It is concluded that, though study of the expression of the monosialganglioside may be worth while in relation to fundamental aspects of behaviour of colorectal carcinomas, the significance of its immunohistochemical detection in a diagnostic or prognostic sense is limited.