Autochthonous hepatitis E in southwest England.

Although autochthonous hepatitis E has been reported in developed countries, its extent and nature in the United Kingdom are unclear. The aim of the present study was to report the natural history, lifestyle risk factors and molecular epidemiology of autochthonous hepatitis E infection in southwest England. Three hundred and thirty-three patients with unexplained hepatitis were tested for markers of hepatitis E virus (HEV) infection over a 7-year period. HEV RNA isolated from the cases was amplified and characterized. Of the 333 patients, 21 had autochthonous hepatitis E. Patients were middle-aged or elderly and males were more commonly affected. Clinical manifestations ranged from asymptomatic infection to severe hepatitis. Of the 21 patients, 20 recovered within 6 weeks. None of the cases had travelled to an area endemic for HEV. None of the patients were vegetarian and all ate pork. Of the 21 cases, 20 occurred in the spring, summer and autumn months. All polymerase-chain-reaction-confirmed cases carried HEV genotype 3, which bore close sequence homology to HEV circulating in UK pigs. In the United Kingdom, autochthonous hepatitis E may be more common than previously recognized. Although the mode of transmission remains to be determined, it may be a zoonosis with pigs as a reservoir. Hepatitis E should be considered a public health issue in the United Kingdom.

Lymph node harvests directly influence the staging of colorectal cancer: evidence from a regional audit.

AIMS: To assess the quality of histopathology reporting and accuracy of Dukes's staging of colorectal cancers in the former South Western Health region and to determine the impact of numbers of lymph nodes examined on stage ascription. METHODS: Histopathology reports of colorectal cancer for 1993-7 were analysed. Completeness was assessed regarding reported numbers of lymph nodes examined, numbers found positive, Dukes's stage, and ICD9 code. Numbers of lymph nodes examined, numbers found positive, and Dukes's stage were recorded. Results from one hospital known to have high standards of reporting were compared with those from elsewhere. RESULTS: In total, 629 reports were examined from the reference hospital and 918 from elsewhere. Fewer than one in 20 (4.3%) reports from the reference hospital were incomplete, compared with a third (36.1%) elsewhere. The average number of nodes examined for each case at the reference hospital was 18.81 and 6.41 elsewhere. The average number of positive nodes for each case was 2.47 at the reference hospital and 1.15 elsewhere. The proportion of Dukes's stage C cases was significantly higher at the reference hospital than elsewhere. Ascertainment of Dukes's stage C cases was related to number of lymph nodes examined, with optimal ascertainment levels when at least 10 and fewer than 15 nodes were examined. CONCLUSIONS: Standards of histopathology reporting, and ascertainment of Dukes's stage C, were significantly higher at the reference hospital. Variations in ascertainment levels of Dukes's stage C disease mainly resulted from variations in the numbers of lymph nodes examined.

Partial sequence analysis of indigenous hepatitis E virus isolated in the United Kingdom.

The first nucleotide sequences of hepatitis E virus (HEV) acquired in the United Kingdom are described. The sequences are novel and are related most closely to HEV isolated from Greece (Greece 2 strain), consistent with their having been derived from an indigenous European virus. HEV was assumed until recently to be rare in the United Kingdom and other industrialised countries and, consequently, hepatitis E may be under-diagnosed in industrialised countries.

Interleukin-1beta production in periradicular lesions in a human immunodeficiency virus/acquired immune deficiency syndrome model compared with a noninfected host.

This study elucidates the role of interleukin-1 (IL-1) in developing periradicular lesions in immunocompetent and immunocompromised (human immunodeficiency virus/acquired immune deficiency syndrome) hosts. Eight cats were immunosuppressed with steroids before infection with feline immunodeficiency virus (FIV). Eight uninoculated cats served as controls. Periradicular lesions were induced around the canine teeth. At 1 and 4 wk periradicular exudate was sampled via the root canals. IL-1beta levels were measured with ELISA. Data were analyzed using the Mann-Whitney U test and the Wilcoxon signed rank test. Statistically significant differences existed in cytokine levels between the FIV and non-FIV groups (p < 0.001). Cytokines were below detectable levels in the FIV group. A significant decrease in IL-1beta levels at 4 wk compared with 1 wk occurred in the non-FIV group (p < 0.05). In conclusion decreased IL-1beta production was obtained in the FIV group. In the non-FIV group decreases in IL-1beta levels were encountered at the chronic stage of the periradicular lesion compared with the acute stage.

Feline immunodeficiency virus model to study human immunodeficiency virus/acquired immune deficiency syndrome conditions.

This study was designed to induce rapid progression of the feline immunodeficiency virus (FIV) infection in cats. Predictably inducing the FIV disease state in the cat would yield an excellent tool to study endodontic disease processes under immunosuppressed conditions. Eight cats were immunosuppressed with steroids before infection with FIV. Another eight cats, age- and sex-matched littermates, served as uninoculated seronegative controls. Complete blood counts were taken for 10 mo in the FIV group, and 10 wk in the control group, including lymphocyte subsets. ELISAs were used to detect FIV infection. Statistical analysis was performed with generalized estimating equation models. All cats were positive at one point in time. The FIV group had significantly lower peripheral blood CD4+ counts compared with the control group. Therefore the FIV model presented gives the desired outcome and simulates what occurs in human immunodeficiency virus infection.

The effect of FIV infection on CD4+ and CD8+ counts in periradicular lesions.

AIM: The purpose of this study was to elucidate whether a decrease/increase in T-cell populations is present in the development of periradicular disease in the immunocompromised feline model. METHODOLOGY: Eight cats were immunosuppressed with steroids prior to infection with feline immunodeficiency virus (FIV). Another eight cats, age and sex matched littermates, were monitored and tested at equivalent periods of time and served as uninoculated, seronegative controls. Periradicular lesions were induced using local bacterial inoculations into the pulp of the canine teeth and assessed after one- and four-week periods, corresponding to the acute and chronic stages of the periradicular disease. Block sections were obtained and specimens were prepared for H & E and immunohistochemical staining for CD4+ and CD8+ receptors. Cells were quantified using a computer imaging system and data analysed using generalized estimating equation (GEE) regression models. RESULTS: Significantly lower CD4+ counts and CD4+/ CD8+ ratios were observed at all time periods in the periradicular region of the FIV group (P = 0.0006). No significant difference in CD8+ counts was observed between the two groups. In both groups there was a significant difference in the CD4+ counts between one week and baseline, and 1 week and 4 weeks. There was no significant difference between baseline and 4 weeks for either group. CONCLUSION: FIV infection reflected decreased CD4+ counts at the periradicular level, however, inflammation and progression of the lesion, appeared to be comparable to the non-immunocompromised controls.

Colorectal cancer registration: the central importance of pathology.

BACKGROUND: Changes in cancer care have increased the importance of cancer registries in monitoring trends and outcomes. Registries are increasingly using computerised systems, such as patient administration and histopathology, as data sources. Omissions by registries can cause interpretation errors, but use of multiple data sources can overcome this. METHODS: Registrations of new colorectal cancers in Cornwall were compared with cases identified from primary sources over one year. RESULTS: Two hundred and thirty cases were identified locally, 93% in documentary records, 89.6% via histopathology, and 81.3% in the clinical data capture module of the patient administration system. Two hundred and forty four cases were known to the regional registry, but after eliminating wrongly assigned and unconfirmed cases only 201 remained. Twenty nine cases identified locally, particularly cases of advanced disease, were unknown to the registry. CONCLUSIONS: District registers based on histopathology augmented from other sources would provide more accurate and less biased information than existing regionally based methods.

A review of osseous resective surgery.

The treatment of periodontal diseases associated with attachment loss has involved a variety of approaches. While the goal of periodontal surgical treatments is to access the root surfaces for proper debridement, the decision to remove or reshape the supporting bone has been controversial. This paper will address the controversy as well as discuss surgical pocket therapy directed toward pocket reduction through recontouring the underlying bone.

Crown lengthening surgery: a restorative-driven periodontal procedure.

Improper management of the periodontal tissues during restorative procedures is a common, but often overlooked, cause of failure. When a restoration is placed, the preservation of an intact, healthy periodontium is necessary to maintain the tooth or teeth being restored. Predictable long-term restorative success requires a combination of restorative principles with the correct management of the periodontal tissues.

Occlusion and the periodontium: a review and rationale for treatment.

The effect of occlusion on periodontal disease has long been controversial. There are a few studies showing the benefit of occlusal therapy in the treatment of periodontal disease. This paper discusses these studies in an effort to give guidelines for treatment of occlusal trauma and its relationship to periodontal therapy.

Initial therapy for the periodontally diseased patient.

The crucial first steps in periodontal therapy often are neglected. In initial therapy must include oral hygiene instruction; scaling and root planing; caries control, endodontic therapy, occlusal adjustments, reduction or elimination of tooth mobility, provisionalization, extraction and/or specialty consultation as warranted; and re-evaluation.

Periodontal procedures to enhance restorative dentistry.

Alteration of soft tissue contours can enhance the esthetic result of a restoration. Current techniques, such as ridge augmentation and preservation, gingival augmentation and sculpturing, crown lengthening and root coverage, are reviewed.

A method for studying the actions of drugs on motility of vascularly perfused segments of human colon.

The isolated, vascularly perfused human colon is a novel method for investigating drug action on this organ. Measurement of the integrated motility of the muscle layers and the facility for administering drugs via the blood supply represent advances over muscle strip studies. Viability of the specimens was improved by addition of Dextran 70 to the perfusion fluid to minimise oedema. Changes in motility were recorded with small, water-filled intraluminal balloons. Measurements were made for 10 min periods immediately before and after drug administration using a linear displacement method. Both neostigmine (1.0-3.0 micrograms/ml) and bethanechol (1.0-5 micrograms/ml) significantly increased motility of the segments, while morphine (10-50 micrograms/ml) did not.