Outbreak of Salmonella Thompson infection in a Swedish dairy herd.

Salmonella Typhimurium was isolated from a faecal sample from a cow in a Swedish dairy herd after calving. When investigations were undertaken in the herd, Salmonella Thompson was isolated from heifers on a separate pasture, and when these heifers were brought into the herd S Thompson spread rapidly. Control strategies managed to rid the herd of the S Typhimurium infection and the prevalence of S Thompson was at first substantially reduced. There was a rapid increase in its prevalence when the animals were let out to pasture and this development eventually led to the depopulation of the entire herd.

A large Escherichia coli O157 outbreak in Sweden associated with locally produced lettuce.

In 2005 a large outbreak of verotoxin-producing Escherichia coli (VTEC) occurred in Sweden. Cases were interviewed and cohort and case-control studies were conducted. Microbiological investigations were performed using polymerase chain reaction (PCR) to detect the Shiga-like toxin (Stx) genes followed by cultivation and pulsed-field gel electrophoresis. A total of 135 cases were recorded, including 11 cases of hemolytic uremic syndrome. The epidemiological investigations implicated lettuce as the most likely source of the outbreak, with an OR of 13.0 (CI 2.94-57.5) in the case-control study. The lettuce was irrigated by water from a small stream, and water samples were positive for Stx 2 by PCR. The identical VTEC O157 Stx 2 positive strain was isolated from the cases and in cattle at a farm upstream from the irrigation point. An active surveillance and reporting system was crucial and cooperation between all involved parties was essential for quickly identifying the cause of this outbreak. Handling of fresh greens from farm to table must be improved to minimize the risk of contamination.

[Placebo-controlled study of melbrosia in treatment of climacteric symptoms]. / Plazebokontrollierte Untersuchung von Melbrosia zur Behandlung klimakterischer Beschwerden.

In a placebo controlled randomized trial we evaluated the efficacy of melbrosia in women who suffered from severe menopausal symptoms. We could show that there was hardly no difference in the change of biochemical parameters, but we found out that the decrease of menopausal symptoms (headache, urinary incontinence, dry vagina, decreasing vitality) was significant in women who did undergo melbrosia medication compared to those who just took placebo. Due to our investigations we reasoned that melbrosia is especially appropriate to women who do not want and who do not need hormone replacement therapy, but who do suffer from menopausal symptoms.

Acute anterior uveitis, arthritides and enteric antigens.

One hundred and fourteen patients with acute anterior uveitis were studied for the presence of the HLA-B27 tissue type, the prevalence of spondylitis and arthritis and the occurrence of gastro-intestinal and urogenital infections or diarrhoeal illness in the history. Eighty-seven (76%) were B27+ and 27 (24%) B27-. Forty-two (48%) of the B27+ group had ankylosing spondylitis (AS); 13 (30%) of them were females. Sacroilitis (SI) with no spinal involvement was present in 21 patients (24%), 13 (61%) males and 8 (38%) females. Peripheral arthritis occurred in 6 patients. Thus, 68 (78%) of the HLA-B27+ positive patients had inflammatory spinal and/or joint disease, compared with 1 (4%) of the HLA-B27- group (p less than 0.001). The AS diagnosis was unknown previous to our examination in 31% of the males and 54% of the females, and SI was undiscovered in 61% of the males and 62% of the females. The occurrence of acute enteric infections was significantly increased in the B27+ AAU group, compared with the B27- patients and the patients reported exacerbation of AAU in connection with episodes of diarrhoea. An increased occurrence of urogenital infections was shown only in co-comparison with the males of the B-27+ AAU group. Thirty-three out of 47 AAU patients assayed by enzyme immuno-assay (EIA) for the quantification of IgM, IgA and IgG antibodies against Klebsiella pneumoniae, E coli, and Proteus mirabilis had significantly raised antibody titres against one or more of the antibodies studied, as compared to 62 healthy controls.(ABSTRACT TRUNCATED AT 250 WORDS)

Arthropathy associated with palmoplantar pustulosis.

A survey of 170 patients with a diagnosis of palmoplantar pustulosis (PPP) has been undertaken. Detailed family histories of our patients were compiled, dermatological and rheumatological examinations were made. Radiography was performed in patients with clinical suspicions of spinal and/or sacroiliacal, sternoclavicular and sternocostal joint involvement. Active chest-wall symptoms were screened by scintigraphy. Twenty-five patients (16 females, 9 males, with an age range of 32-66, mean 51 years) had some rheumatic complaints. Fifteen of them (60%) had anterior chest-wall involvement, 6 (24%) sacroiliitis (3 of whom also had AS) and 11 (44%) peripheral arthropathy. Six other patients suffered from transient and migratory joint pain. The joint disease was mild in all but 6 cases. Laboratory tests showed increased ESR in 6 patients (24%); only 3 of these patients had elevated CRP. A slightly elevated haptoglobin and/or orosomucoid were found in 12 cases (48%). Elevated IgA was present in 4, IgG in 2 and IgM in 1 patient. Fungal and bacteriological cultures of the skin were negative. A family history of psoriasis was present in 4 patients (16%), of psoriatic arthropathy in 1 patients (4%) and of PPP in 2 patients (8%). Six patients (24%) had concomitant psoriasis. No association between PPP H1a-AC antigens was found. A high incidence of HLA-B27 antigen, present in 8 patients (32%), was documented. A similar association with HLA-B27 has been found in patients with psoriatic arthritis (16). The feeble association with HLA-B13,-17,-37 and CW6 found in psoriasis was not present.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary medullary hemorrhage.

Two patients developed primary medullary hemorrhages. Both patients were normotensive. They were both receiving oral anticoagulation but the coagulation studies were not excessively prolonged at the time that the hemorrhage occurred. The diagnosis of primary medullary hemorrhage was established by CT findings. Both patients showed CT resolution of the hemorrhage and this correlated with good clinical outcome.

Low-dose methotrexate treatment of rheumatoid arthritis; long-term observation of efficacy and safety.

Forty-one patients with rheumatoid arthritis (RA) were treated with a weekly low-dose of methotrexate for a mean period of 32 months (range, 5-81 months) and were given a mean total dose of 954 mg (range, 145-2000 mg). Eighty-three percent of the patients improved. Of these 39% (16 patients) had a complete clinical remission and 17% (7 patients) showed marked improvement, 27% (11 patients) showed moderate improvement and 17% (7 patients) were unchanged. Patients responding to methotrexate therapy maintained the improvement as long as the therapy continued, unless severe infections occurred. Seven patients withdrew during the study including two, who died of myocardial infarction. Methotrexate was withdrawn because of adverse drug reactions in two patients, fear of toxicity in two and for administrative reasons in one patient. Adverse reactions developed in 25 patients (61%). In all but two cases these reactions were mild and reversible. Pancytopenia, a major side effect, was present in two patients: in one patient in association with pneumonia and in the other patient associated with an acute infectious enteritis (after three years treatment in the first and six years in the second patient); both recovered when methotrexate was discontinued. Age, sex, duration of treatment did not remarkably influence the outcome of therapy or the occurrence of adverse reactions.

Longitudinal examinations in the course of dietotherapy of mentally retarded obese in-patients.

Mentally retarded obese in-patients were fed by low-energy diet (4.2-4.6 MJ) for 9 months. During this period, an average of 13 +/- 4.5 kg loss of body mass occurred in men and 16 +/- 2.7 kg in women. Anthropometric measurements were performed before starting the dietotherapy and in the ninth month. Changes of body fat could be followed well when calculated according to BMI. Less reliable results were obtained with skinfold thickness measurements, presumably due to body deformities. Results of clinical laboratory tests, which were carried out before starting the dietotherapy and in the fourth and seventh months, suggested that a low-energy-containing diet with balanced nutrient content and adequate protein intake did not impair protein metabolism, favourably affected serum triglyceride and cholesterol levels, but resulted in an unfavourable decrease in the HDL-cholesterol content.

Hepatotoxicity associated with low-dose, long-term methotrexate treatment of rheumatoid arthritis.

Liver biopsies were performed in 17 patients with therapy-refractory rheumatoid arthritis who were treated successfully with 5-15 mg/week methotrexate (mtx). The average duration of exposure to mtx therapy for each patient was 2.8 years (range 1.5-5 years). Total cumulative mtx doses ranged between 633 and 1,655 mg (mean 1,060 mg). The biopsies revealed 16 cases of normal histology, of which 3 showed nuclear variability in the hepatocytes; 4 with mild fatty infiltration, 2 with mild fatty infiltration and portal round cell infiltration. Portal fibrosis was found in one patient who had psoriasis in addition to clinical RA.

Low-dose methotrexate in rheumatoid arthritis: effect and tolerance. An open trial and a double-blind randomized study.

Weekly low-dose Mtx may be considered the preferred drug for the treatment of patients with severe, progressive RA resistant to conventional therapy. The drug is sufficiently safe, provided contra-indications are considered and treatment is carefully supervised. Controlled long-term prospective studies are needed in order to determine whether the drug demonstrably retards progression of the erosions, and to guard against untoward long-term adverse reactions.

Sacro-iliitis in women--a sequela to acute salpingitis. A follow-up study.

Follow-up information is presented on 37 women with SI and a history of severe acute salpingitis. It was found that 18 (49%) had clinical symptoms of intermittent or persistent back pain and stiffness indicating SI; 8 of them had serious and persistent discomfort. The rate of development varied greatly. The long-term prognosis appears to be good. Radiographic progression in the sacro-iliac joint was observed in 3 of the 11 patients who were re-examined. The findings indicate that salpingitis is a pathogenetic factor in SI in both HLA-B27 positive and negative women, but that the etiology and prognosis may differ between these two groups. The frequency of symptomatic SI tends to be higher among women carrying the HLA-B27 compared with those not having this antigen. In the latter group the course of disease was milder; the majority of the women had periodical symptoms or were asymptomatic.

Sacroiliitis in women--a late sequela to acute salpingitis.

Fifty-seven women who were treated for severe acute salpingitis between June, 1974, and June, 1976, were examined in 1978, 24 to 48 months after their first hospitalization. At the same time, 31 healthy women matched for age and parity were examined. All patients and control subjects were examined independently by a gynecologist and a rheumatologist. Forty-two of the patients and all control subjects were examined by quantitative 99mTc-pertechnetate scanning of the sacroiliac joints. These same joints also were examined by x-ray in the 57 patients. Sacroiliitis was documented in 39 of the 57 salpingitis patients (68%) and in one of the control subjects (3%), a difference which was statistically significant. There was no difference between the two groups in the presence of histocompatibility antigen HLA B27. The findings strongly suggest a correlation between severe acute salpingitis and sacroiliitis in women.

Quantitative 99mTc pertechnetate scanning of the sacro-iliac joints. A follow-up study of patients with suspected sacro-iliitis.

Quantitative 99mTc pertechnetate sacro-iliac scanning (QTPS) was performed in 30 patients suspected of having sacro-iliac arthritis (SI). Abnormal scanning results but lack of definite radiographic changes were noted in all of them. Twenty-four of these patients were followed-up for an average of 3.4 years; roentgenological abnormalities were found in 23 patients, or 95%, namely definite SI in 13, slight abnormalities in 1 previously normal patient, inactive changes in 3, suspected SI was unchanged in the radiographs in 5 and regression of previously observed grad-I changes was found in 1. In only 1 patient was the radiological picture unchanged normal. No definite roentgenological SI developed in any of the 12 controls (patients with normal (QTPS) we followed in the same way. A close correlation was noted between the QTPS and the patients' complaints of low back pain/stiffness and the clinical findings, including the presence of HLA-B27. The present study confirms that, despite the absence of radiographic changes, QTPS allows identification of a group of clinical and laboratory features which together are sufficiently characteristic of SI to establish that diagnosis. QTPS also enables us to discover clinically silent SI.

Long-term follow-up of 90Yttrium-treated knee-joint arthritis.

The results are reported of the treatment of 33 patients with long-standing, therapy-resistant synovitis and effusion of the knee by intra-articular injection of 90Yttrium. In 25 patients with bilateral gonitis the effect of the treatment was compared with the effect of local corticosteroid therapy to the contralateral knee. The irradiated group showed statistically significantly better therapeutic results at 3, 6, and 12 months and the effect weakened in proportion to the length of the follow-up period. At the final check-up at 3.5 years, 52% of this group showed improvement, as against 26% of the controls. The difference in radiological deterioration at the end of the observation period between the two groups was not significant. Local remission in the treated joint in spite of high general activity was recorded in 7 patients. In 4 patients, in whom the results were unsatisfactory, severe articular destruction and instability were noted prior to therapy. Assessment of the correlation between clinical diagnosis and therapeutic results shows that the treatment seems to be most successful in patients with rheumatoid arthritis and unsatisfactory in patients with psoriatic arthritis. General reactions were observed in 1, and local reactions in 2 patients. Irradiation therapy seems to be the treatment of choice in patients over 40, with long-standing knee arthritis of rheumatic origin.

Detection of sacro-ilitis. A comparison between profile scanning with the use of 99m Tc pertechnetate and scintigraphy with 99m Tc diphosphonate.

Comparative evaluation of the sensitivity of 99mTc pertechnetate scanning and of 99mTc diphosphonate scintigraphy in detecting sacro-iliac arthritis (S.I.) was performed in 32 patients with definite S.I., 14 with probable S.I., and 6 with inactive S.I., 14 patients without any evidence of S.I. served as controls. Greater diagnostic accuracy was obtained by 99mTc pertechnetate scanning than with 99mTc diphosphonate scintigraphy in patients with active S.I. in the early stages before radiological changes had become evident and in patients 22 years old and younger. In patients with inactive S.I. a close correlation was found between clinical, radiological, and scintigraphical results with 99mTc diphosphonate scintigraphy. An index obtained by adding the uptake values measured by both methods in each subject yielded valuable information in patients with S.I. that is clinically difficult to differentiate.