Prognostic value of deep learning-derived body composition in advanced pancreatic cancer-a retrospective multicenter study.

BACKGROUND: Despite the prognostic relevance of cachexia in pancreatic cancer, individual body composition has not been routinely integrated into treatment planning. In this multicenter study, we investigated the prognostic value of sarcopenia and myosteatosis automatically extracted from routine computed tomography (CT) scans of patients with advanced pancreatic ductal adenocarcinoma (PDAC). PATIENTS AND METHODS: We retrospectively analyzed clinical imaging data of 601 patients from three German cancer centers. We applied a deep learning approach to assess sarcopenia by the abdominal muscle-to-bone ratio (MBR) and myosteatosis by the ratio of abdominal inter- and intramuscular fat to muscle volume. In the pooled cohort, univariable and multivariable analyses were carried out to analyze the association between body composition markers and overall survival (OS). We analyzed the relationship between body composition markers and laboratory values during the first year of therapy in a subgroup using linear regression analysis adjusted for age, sex, and American Joint Committee on Cancer (AJCC) stage. RESULTS: Deep learning-derived MBR [hazard ratio (HR) 0.60, 95% confidence interval (CI) 0.47-0.77, P < 0.005] and myosteatosis (HR 3.73, 95% CI 1.66-8.39, P < 0.005) were significantly associated with OS in univariable analysis. In multivariable analysis, MBR (P = 0.019) and myosteatosis (P = 0.02) were associated with OS independent of age, sex, and AJCC stage. In a subgroup, MBR and myosteatosis were associated with albumin and C-reactive protein levels after initiation of therapy. Additionally, MBR was also associated with hemoglobin and total protein levels. CONCLUSIONS: Our work demonstrates that deep learning can be applied across cancer centers to automatically assess sarcopenia and myosteatosis from routine CT scans. We highlight the prognostic role of our proposed markers and show a strong relationship with protein levels, inflammation, and anemia. In clinical practice, automated body composition analysis holds the potential to further personalize cancer treatment.

Benefit-cost analysis of coordinated strategies for control of rabies in Africa.

Previous research suggests that dog mass vaccination campaigns can eliminate rabies locally, resulting in large human and animal life gains. Despite these demonstrated benefits, dog vaccination programs remain scarce on the African continent. We conducted a benefit-cost analysis to demonstrate that engaging into vaccination campaigns is the dominant strategy for most countries even in the absence of coordinated action between them. And quantify how coordinated policy measures across countries in Africa could impact rabies incidence and associated costs. We show that coordinated dog mass vaccination between countries and PEP would lead to the elimination of dog rabies in Africa with total welfare gains of USD 9.5 billion (95% CI: 8.1 - 11.4 billion) between 2024 and 2054 (30 years). Coordinated disease control between African countries can lead to more socially and ecologically equitable outcomes by reducing the number of lost human lives to almost zero and possibly eliminating rabies.

Intra-individual comparison of CAIPIRINHA VIBE technique with conventional VIBE sequences in contrast-enhanced MRI of focal liver lesions.

PURPOSE: To evaluate the impact of controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA) volume interpolated breath-hold examination (VIBE) magnetic resonance imaging (MRI) technique on image quality, reader confidence, and inter-observer agreement for the assessment of focal liver lesions in comparison with the standard VIBE approach. MATERIAL AND METHODS: In this IRB-approved intra-individual comparison study, abdominal arterial and portal-venous contrast-enhanced MRI studies were retrospectively analyzed in 38 patients with malignant liver lesions. Each patient underwent both CAIPIRINHA and conventional VIBE 3T MRI within 3 months, showing stable disease. Images were evaluated using 5-point rating scales by two blinded radiologists with more than 20 and 5 years of experience in MRI, respectively. Readers scored dignity of liver lesions and assessed which liver segments were affected by malignancy (ranging from 1=definitely benign/not affected to 5=definitely malignant/affected by malignancy). Readers also rated overall image quality, sharpness of intrahepatic veins, and diagnostic confidence (ranging from 1=poor to 5=excellent). RESULTS: Reviewers achieved a higher inter-observer reliability using CAIPIRINHA when they reported which liver segments were affected by malignancy compared to traditional VIBE series (κ=0.62 and 0.54, respectively, p<0.05). Similarly, CAIPIRINHA showed a slightly higher inter-rater agreement for the dignity of focal liver lesions versus the standard VIBE images (κ=0.50 and 0.49, respectively, p<0.05). CAIPIRINHA series also scored higher in comparison to standard VIBE sequences (mean scores: image quality, 4.2 and 3.5; sharpness of intrahepatic vessels, 3.8 and 3.2, respectively, p<0.05) for both reviewers and allowed for higher subjective diagnostic confidence (ratings, 3.8 and 3.2, respectively, p<0.05). CONCLUSION: Compared to the standard VIBE approach, CAIPIRINHA VIBE technique provides improved image quality and sharpness of intrahepatic veins, as well as higher diagnostic confidence. Additionally, this technique allows for higher inter-observer agreement when reporting focal liver lesions for both dignity and allocation.

Cardiac CT for myocardial ischaemia detection and characterization--comparative analysis.

The assessment of patients presenting with symptoms of myocardial ischaemia remains one of the most common and challenging clinical scenarios faced by physicians. Current imaging modalities are capable of three-dimensional, functional and anatomical views of the heart and as such offer a unique contribution to understanding and managing the pathology involved. Evidence has accumulated that visual anatomical coronary evaluation does not adequately predict haemodynamic relevance and should be complemented by physiological evaluation, highlighting the importance of functional assessment. Technical advances in CT technology over the past decade have progressively moved cardiac CT imaging into the clinical workflow. In addition to anatomical evaluation, cardiac CT is capable of providing myocardial perfusion parameters. A variety of CT techniques can be used to assess the myocardial perfusion. The single energy first-pass CT and dual energy first-pass CT allow static assessment of myocardial blood pool. Dynamic cardiac CT imaging allows quantification of myocardial perfusion through time-resolved attenuation data. CT-based myocardial perfusion imaging (MPI) is showing promising diagnostic accuracy compared with the current reference modalities. The aim of this review is to present currently available myocardial perfusion techniques with a focus on CT imaging in light of recent clinical investigations. This article provides a comprehensive overview of currently available CT approaches of static and dynamic MPI and presents the results of corresponding clinical trials.

S-nitroso albumin enhances bone formation in a rabbit calvaria model.

Nitric oxide (NO) is a mediator involved in bone regeneration. We therefore examined the effect of the novel NO donor, S-nitroso human serum albumin (S-NO-HSA) on bone formation in a rabbit calvaria augmentation model. Circular grooves (8 mm diameter, two per animal) were created by a trephine drill in the cortical bone of 40 rabbits and titanium caps were placed on the rabbit calvaria bone filled with a collagen sponge soaked with either 100 µL S-NO-HSA (5%, 20%) or human albumin (5%, 20%). After 4 weeks the titanium hemispheres were subjected to histological and histomorphometric analysis. Bone formation and the volume of the residual collagen sponge were evaluated. S-NO-HSA treatment groups had a significantly higher volume of newly formed bone underneath the titanium hemispheres compared to the albumin control groups (5%: 15.5 ± 4.0% versus 10.6 ± 2.9%; P < 0.05; 20%: 14.0 ± 4.6% versus 6.0 ± 3.8%; P < 0.01). The volume of residual collagen sponge was also significantly lower in the S-NO-HSA groups compared to the control groups (5%: 0.4 ± 0.5% versus 2.6 ± 2.4%; P < 0.05 and 20%: 1.5 ± 2.7% versus 13.0 ± 18.7%; P < 0.01). This study demonstrates for the first time that S-NO-HSA promotes bone formation by slow NO release. Additionally, S-NO-HSA increases collagen sponge degradation.

Anatomical variation of the extracranial course of the optic nerve in the floor of the sphenoid sinus: first reported case.

OBJECTIVE: We report a unique case of anatomical variation of the extracranial course of the optic nerve running in the floor of the sphenoid sinus. METHOD: Clinical and radiological findings are presented. RESULTS: A 39-year-old woman with Turner syndrome presented with severe headache associated with visual disturbances. Magnetic resonance imaging revealed a mass presumed to be a sella meningioma. Computed tomography of the paranasal sinuses was undertaken to help plan surgical removal via an endoscopic trans-sphenoidal approach; this scan revealed an atypical extracranial course of the optic nerve, running in the floor of the sphenoid sinus.

Fixed-time AI pregnancy rate following insemination with frozen-thawed or fresh-extended semen in progesterone supplemented CO-Synch protocol in beef cows.

The objective of this study was to compare fixed-time AI pregnancy rate in Angus crossbred beef cows inseminated with frozen-thawed or fresh-extended semen. Two ejaculates from each of two Angus bulls were collected by artificial vagina and pooled for each bull. The pooled semen from each bull was divided into two aliquots; Aliquot 1 was extended using Caprogen (LIC, Hamilton, New Zealand) to a concentration of 3 x 10(6)sperm/straw and Aliquot 2 was extended using egg-yolk-glycerol extender to a concentration of 20 x 10(6)sperm/straw. Semen extended with Caprogen was maintained at ambient temperature and semen extended with egg-yolk-glycerol extender was frozen and maintained at -196 degrees C until insemination. In each of two breeding seasons (Fall 2007 and Spring 2008), Angus-crossbeef cows (N=1455) at 12 locations were randomly assigned within location to semen type [Fresh (N=736) vs. Frozen (N=719)] and sire [1 (N=731) vs. 2 (N=724)]. All cows were synchronized with 100 microg of GnRH im and a progesterone Controlled Internal Drug Release insert (CIDR) on Day 0, and on Day 7, 25mg of PGF2(alpha) im and CIDR removal. All cows received 100 microg of GnRH im and were inseminated at a fixed-time on Day 10, 66 h after CIDR removal. Timed-AI pregnancy rates were influenced by season (P<0.05), cows detected in estrus prior to and at AI (P<0.001), and dam age (P<0.01). Pregnancy rates were not affected by semen type (Fresh=51.5% vs. Frozen=50.4%; P=0.66) and there were no significant interactions of semen type by estrus expression, semen type by sire, or semen type by season (P>0.1). In conclusion, commercial beef cows inseminated with fresh-extended semen (3 x 10(6)sperm/straw) yielded comparable pregnancy rates to conventional frozen-thawed semen in a progesterone supplemented, CO-Synch fixed-time AI synchronization protocol and may provide an alternate to frozen semen for more efficient utilization of superior genetics.

Carboplatin pharmacokinetics following a single-dose infusion in sulphur-crested cockatoos (Cacatua galerita).

OBJECTIVE: To determine the pharmacokinetics of carboplatin in sulphur-crested cockatoos, so that its use in clinical studies in birds can be considered. DESIGN: A pharmacokinetic study of carboplatin, following a single intravenous (IV) or intraosseus (IO) infusion over 3 min, was performed in six healthy sulphur-crested cockatoos (Cacatua galerita). PROCEDURE: Birds were anaesthetised and a jugular vein cannulated for blood collection. Carboplatin (5 mg/kg) was infused over 3 min by the IV route in four birds via the contralateral jugular vein, and by the IO route in two birds via the ulna. Serial blood samples were collected for 96 h after initiation of the infusion. Tissue samples from 11 organs were obtained at necropsy, 96 h after carboplatin administration. Total Pt and filterable Pt in plasma and tissue Pt concentrations were assayed by inductively coupled plasma-mass spectrometry. A noncompartmental pharmacokinetic analysis was performed on the plasma data. RESULTS: The mean +/- SD for the Cmax of filterable Pt was 27.3 +/- 4.06 mg/L and in all six birds occurred at the end of the 3 min infusion, thenceforth declining exponentially over the next 6 h to an average concentration of 0.128 +/- 0.065 mg/L. The terminal half-life (T1/2) was 1.0 +/- 0.17 h, the systemic clearance (CI) was 5.50 +/- 1.06 mL/min/kg and the volume of distribution (Vss) was 0.378 +/- 0.073 L/kg. The extrapolated area under the curve (AUC0-x) was 0.903 +/- 0.127 mg/mL x min; the area extrapolated past the last (6 h) data point to infinite time averaged only 1.25% of the total AUC0-x. The kidneys had the greatest accumulation of Pt (7.04 +/- 3.006 microg/g), followed by the liver (3.08 +/- 1.785 microg/g DM). CONCLUSIONS AND CLINICAL RELEVANCE: Carboplatin infusion in sulphur-crested cockatoos produced mild, transient alimentary tract signs and the Pt plasma concentration was similar whether carboplatin was given intravenously or intraosseously. Filterable plasma Pt concentrations for carboplatin persisted longer than for cisplatin, due mostly to the difference in systemic clearance between these drugs in sulphur-crested cockatoos. The distribution of tissue Pt after carboplatin administration was similar to that reported for cisplatin in sulphur-crested cockatoos. Despite anatomical, physiological and biochemical differences among animal species, the pharmacokinetic disposition of filterable Pt in the sulphur-crested cockatoo shares some features with the kinetics reported previously in other animals and human beings.

Spectrum of abdominal and pelvic infections caused by pneumococci in previously healthy adult women.

Eleven cases of pneumococcal infection of abdominal and pelvic origin that occurred in previously healthy adults are described. All cases occurred in women who were admitted to a county hospital in Norway with acute abdominal symptoms such as pain, nausea, vomiting and diarrhea. Explorative laparotomy was performed in eight patients. Three patients had diffuse peritonitis and seven cases were classified as pelvic inflammatory disease; five of these seven patients had pelvic peritonitis. All patients but one were treated with antibiotics, and all survived without long-term sequelae. Although abdominal and genital infections caused by pneumococci are rare, their potential occurrence should not be neglected.

Effect of interferon-alpha induction therapy on genotype 2b/3a and low viral load hepatitis C virus infection. A randomized multicentre study.

BACKGROUND: Interferon monotherapy for chronic hepatitis C virus (HCV) infection leads to sustained viral eradication in a minority of patients. However, in selected groups of patients, sustained virological response is observed in as many as 50% of patients. High initial interferon dose (induction therapy) has been reported to increase the initial response rate. We have studied the effect of interferon induction therapy in patients infected with HCV genotype 2b/3a, low viral load and no cirrhosis. METHODS: A total of 71 treatment-naive HCV RNA-positive patients with biopsy-confirmed chronic hepatitis, with genotype 2b or 3a, viral load < or = 3 million copies per ml and no cirrhosis were randomized to receive either standard interferon therapy (3 MIU interferon-alpha-2a thrice weekly) for 26 weeks or 6 MIU interferon-alpha-2a daily for 4 weeks (induction group) followed by the standard dose (3 MIU thrice weekly) for 22 weeks. Those with persistent HCV RNA at 4 weeks stopped treatment. Patients were monitored for HCV RNA during and following treatment, and data were interpreted according to intention-to-treat analysis. RESULTS: Viral clearance occurred more rapidly (after 4 weeks) in the induction group (33/36 = 92%) compared to the standard interferon group (21/35 = 60%) (P = 0.01). Among the initial responders, 23/33 (induction group) compared to 16/21 (standard group) were persistently HCV RNA-negative at the end of treatment. At 52 weeks (6 months' follow-up), 22/36 (61%) (induction group) compared to 10/35 (29%) (standard group) were HCV RNA-negative. Among initial responders, 22/33 (induction group) and 10/21 (standard group) achieved a sustained virological response. Among end-of-treatment responders, 22/24 (induction group) and 10/16 (standard group) were HCV RNA-negative at 6 months' follow-up (P = 0.013). CONCLUSIONS: In patients infected with HCV genotype 2b/3a, low viral load and without cirrhosis, IFN induction therapy increases the initial viral clearance and reduces the risk of relapse in end-of-treatment responders. A sustained virological response was achieved in 61% of the patients receiving IFN induction therapy.

[Infections and use of antibiotics in nursing homes]. / Infeksjoner og antibiotikabehandling ved sykehjem.

BACKGROUND: The number of elderly people is constantly increasing in the western world. Many of these elderly spend their last years in a nursing home. Long-term care residents frequently have infections. However, there is only limited knowledge with regard to the spectrum of infections and the usage of antibiotics in nursing homes, in Norway and also in other European countries. MATERIAL AND METHODS: Prevalence of infections, risk factors related to infections and antibiotic usage were studied in four nursing homes in Baerum county. RESULTS: Of all 262 nursing home residents, 8.4% had an infection; 3.4% received antibiotic treatment. 66% of residents were more than 80 years old, 98% had a private room. Of all residents 3.4% had a urinary tract infections, 1.9% a skin infection, 1.1% a respiratory tract infection, and 1.9% an eye infection. 42% of all residents were treated with psychopharmacological drugs. 3.9% had an urinary catheter, and 11% skin ulcers. INTERPRETATION: Our study did not discover any extraordinary problems with infections or antibiotic overuse in the nursing homes investigated. However, further studies are warranted in order to learn more about this issue in these institutions, which may represent an important but frequently underestimated source of resistant bacteria in a community.

[Not Available]. / Gewebsspezifische Veränderungen bei geschlechtsreifen Sauen nach Aufnahme von Zearalenon-hältigem Futter.

Four groups of 16 cyclic sows were fed with 50, 100, 500 or 1000 µg zearalenone per kg feed for 10 days. Afterwards the genital organs were examined routine histologically and lectinhistochemically. Alterations of the lectin binding pattern of the glandular and surface epithelial cells was seen in all four groups, while the routine histology often showed normal results by the two lower concentrations. Macroscopically detectable organ alterations were seen only in the two groups with the highest concentration steps, but not constantly. Clinical symptoms of hyperestrogenismen were very seldom seen.

Streptococcus pneumoniae heat shock protein 70 does not induce human antibody responses during infection.

Mouse monoclonal antibodies (mAbs) were developed against Streptococcus pneumoniae in search for potential common pneumococcal proteins as vaccine antigens. mAb 230,B-9 (IgG1) reacted by immunoblotting with a 70-kDa protein which was isolated by immunoaffinity chromatography and subsequent preparative electrophoresis. N-terminal amino acid sequencing showed homology to that of heat shock protein 70 (hsp70). The hsp70 epitope reactive with mAb 230,B-9 was found in all the pneumococci examined as well as in other streptococci and enterococci. The epitope was not expressed in several other examined Gram-positive or -negative bacteria. Pneumococcal hsp70 has by other investigators been proposed to be a vaccine candidate. Binding experiments using flow cytometry showed that the epitope was not surface-exposed on live exponential phase grown S. pneumoniae. Human patient sera did not react with affinity-purified pneumococcal hsp70. Therefore the pneumococcal hsp70 does not seem to be of special interest in a vaccine formulation. The human sera contained antibodies to high molecular proteins co-purified with hsp70. Some of these proteins could be the pneumococcal surface protein A.

Platinum pharmacokinetics in sulphur-crested cockatoos (Cacatua galerita) following single-dose cisplatin infusion.

OBJECTIVE: To determine the pharmacokinetics of platinum (Pt) in cockatoos. DESIGN: A pharmacokinetic study of Pt, following a single i.v. infusion of cisplatin, was done in six healthy sulphur-crested cockatoos (Cacatua galerita). PROCEDURE: Birds were hydrated for 1 h before and 2 h after a 1-h cisplatin infusion (1 mg/kg, i.v.). Serial blood samples were collected for 96 h after initiation of the infusion and urine was collected for 2 h during the hydration period after cisplatin administration. Tissue samples from 10 organs were obtained at necropsy, 96 h after cisplatin infusion. Total Pt and filterable Pt in plasma, urinary Pt and tissue Pt concentrations were assayed by inductively coupled plasma-mass spectrometry. A noncompartmental pharmacokinetic analysis was performed on the plasma and urine data. RESULTS: For total Pt and filterable Pt, the respective mean systemic clearances were 0.373 and 0.699 L/kg hourly, the steady state volumes of distribution were 4.19 and 0.356 L/kg, and the mean residence times were 111 and 0.512 h. Total plasma Pt displayed a bi-exponential decay profile with average half-lives of 0.398 and 79.0 h, while filterable Pt had a monoexponential decay with mean half-life of 0.413 h. The renal clearance during the 2-h postinfusion period was 0.167 L/kg hourly. The kidneys had the highest Pt accumulation (4.54 micrograms/g DM). CONCLUSIONS AND CLINICAL RELEVANCE: Cisplatin infusion in cockatoos was well tolerated and Pt plasma concentrations were similar to those measured during treatment of solid tumours in human patients. Despite anatomical, physiological and biochemical differences among animal species, the pharmacokinetic disposition of Pt in the cockatoo shares some features with the kinetics reported previously in rodents, dogs and human beings.

[Hand hygiene--is hand disinfection the best solution?]. / Håndhygiene--er hånddesinfeksjon den beste løsning?

Nosocomial infections have been recognized as a critical problem in modern medicine and are associated with the quality of health care provided in hospitals. On average, 7-10% of hospitalized patients acquire an infection after hospital admission. A substantial proportion of these result from cross-contamination. Transmission of microorganisms by the hands of health care workers is the main cause for spreading. Prevention of bacterial contamination and infection to the patients requires good hand washing or disinfection, and a series of guidelines have been proposed. However, health care workers show poor compliance with such rules. At a time when costs for patient care are increasing and hospitals are threatened by bacterial resistance, prevention of nosocomial infections is an important issue. Thus, many international publications at present discuss the general problems of hand hygiene, still is the most cost effective method in prevention of nosocomial infections. Factors that contribute to poor compliance in hand hygiene have been targeted, and practical solutions in order to improve hand cleansing practices have been suggested. Increased use of the quicker methods of hand disinfection instead of hand washing is one of them.

Soft tissue correction of a single-tooth pontic space: a comparative quantitative volume assessment.

STATEMENT OF PROBLEM: Various augmentation procedures are recommended for the correction of localized alveolar ridge defects. However, no study has quantitatively evaluated the results of these procedures to date. PURPOSE: This study compared 2 soft tissue augmentation surgeries commonly used to alter contours of single-tooth pontic space by quantifying 3-dimensional volume changes with the optical projection Moiré method at 1 and 3.5 months after surgery. MATERIAL AND METHODS: Twenty-four patients required surgery. Each patient had a localized alveolar ridge defect, corresponding to a mesial-distal width of 1 single tooth. The defect of 12 patients was corrected with a subepithelial connective tissue graft; the remaining 12 patients were treated by receiving a free full-thickness gingival graft, which included epithelium and connective tissue with fatty tissue. Six unoperated defects of 6 patients formed the control group. For each defect, an impression was made before treatment, at 1 and 3.5 months after surgery to measure the volume changes on the dental casts with a validated projection Moiré system. Volume change was assessed relative to the preoperative dimension at the buccal and crestal aspects of the single-tooth pontic space. RESULTS: At 3.5 months postsurgery, mean volumetric gain for the connective tissue group with 159 mm(3) (SD +/- 80) was significantly greater (P =.027) than for free full-thickness gingival graft group with 104 mm(3) (SD +/- 31). CONCLUSION: The applied projection Moiré method proved its applicability in assessing 3-dimensional volume changes of pontic spaces with a single-tooth width. Volumetric assessment after 1 and 3.5 months revealed significantly greater volume gain with the subepithelial connective tissue graft in comparison to the free full-thickness gingival graft.

An occupational cohort mortality study of women in the German rubber industry: 1976 to 1991.

Few previous studies of workers in the rubber industry have focused on women. We examined patterns of mortality among 2871 women employed in one of five German rubber plants for at least 1 year on or after January 1, 1976, and observed through December 31, 1991. All-causes mortality was near that expected (standardized mortality ratio [lsqbSMR], 101; 95% confidence interval [CI], 87 to 118), but cancer mortality was decreased (SMR, 90; 95% CI, 70 to 115). Nevertheless, excesses were observed for mortality from stomach cancer (SMR, 156; 95% CI, 63 to 322), lung cancer (SMR, 140; 95% CI, 56 to 289), and lymphatic system cancers (SMR, 175; 95% CI, 48 to 448). Stronger associations were observed among sub-cohorts defined by time period hired. Despite limited numbers of deaths, modest excesses of mortality due to specific cancers were observed and are consistent with previous studies.

Low frequency of complications in imported falciparum malaria: a review of 222 cases in south-eastern Norway.

We performed a retrospective study of 222 cases of falciparum malaria diagnosed in Oslo and Akerhus counties, Norway, from January 1988 to December 1997. Except for 12 cases, all had acquired the disease in sub-Saharan Africa. Sixty-four (28.8%) cases occurred in assumed non-immune individuals; of these, 41 (64.1%) were compliant to recommended antimalarial chemoprophylaxis. The mean time lag from first symptom to diagnosis (total diagnosis delay) was 4.6 d (median 3 d, range 0-30 d) and the mean time from presentation to diagnosis (doctor's delay) was 1.3 d (median 0 d, range 0-25 d). There were no fatal cases, and only 8 (3.6%) had a complicated course. The following factors were significantly associated with development of complicated disease: higher age, non-immunity combined with chemoprophylaxis non-compliance, prolonged doctor's delay and prolonged total diagnosis delay (p < or = 0.05). Our data suggest that complicated disease in imported falciparum malaria may largely be prevented by high chemoprophylaxis compliance rates in non-immune travellers and a high index of suspicion in physicians evaluating febrile travellers.

Herpes simplex virus type 2 DNA detected in cerebrospinal fluid of 9 patients with Mollaret's meningitis.

We present clinical and virological data on 9 patients, 7 women and 2 men aged 31-56 years, with recurrent aseptic meningitis (Mollaret's meningitis). Polymerase chain reaction detected Herpes simplex virus type 2 DNA in cerebrospinal fluid samples from all patients collected during their latest attacks of meningitis. Six patients had no history of genital herpes. Only 1 patient was offered prophylactic antiviral treatment during the study period (45 months).

Workplace risk factors for cancer in the German rubber industry: Part 1. Mortality from respiratory cancers.

OBJECTIVES: To determine the cancer specific mortality by work area among active and retired male workers in the German rubber industry. METHODS: A cohort of 11,663 male German workers was followed up for mortality from 1 January 1981 to 31 December 1991. Cohort members were classified as active (n = 7536) or retired (n = 4127) as of 1 January 1981 and had been employed for at least one year in one of five study plants producing tyres or technical rubber goods. Work histories were reconstructed with routinely documented "cost centre codes" which were classified into six categories: I preparation of materials; II production of technical rubber goods; III production of tyres; IV storage and dispatch; V maintenance; and VI others. Standardised mortality ratios (SMRs) adjusted for age and calendar year and 95% confidence intervals (95% CIs), stratified by work area (employment in respective work area for at least one year) and time related variables (year of hire, lagged years of employment in work area), were calculated from national reference rates. RESULTS: SMRs for laryngeal cancer were highest in work area I (SMR 253; 95% CI 93 to 551) and were significant among workers who were employed for > 10 years in this work area (SMR 330; 95% CI 107 to 779). Increased mortality rates from lung cancer were identified in work areas I (SMR 162; 95% CI 129 to 202), II (SMR 134; 95% CI 109 to 163), and V (SMR 131; 95% CI 102 to 167). Mortality from pleural cancer was increased in all six work areas, and significant excesses were found in work areas I (SMR 448; 95% CI 122 to 1146), II (SMR 505; 95% CI 202 to 1040), and V (SMR 554; 95% CI 179 to 1290). CONCLUSION: A causal relation between the excess of pleural cancer and exposure to asbestos among rubber workers is plausible and likely. In this study, the pattern of excess of lung cancer parallels the pattern of excess of pleural cancer. This points to asbestos as one risk factor for the excess deaths from lung cancer among rubber workers. The study provides further evidence for an increased mortality from laryngeal cancer among workers in the rubber industry, particularly in work area I.