Screening of 43 healthy Danish haemophiliacs revealed a significantly lower helper/suppressor (H/S) ratio than in controls. 8 of the haemophiliacs had an H/S ratio less than or equal to 1.0. A significant negative correlation occurred between the total lifetime factor VIII treatment and the H/S ratio. However, high-dose factor VIII treatment given to patients with antibodies against factor VIII was not associated with immunological abnormalities. Children had a significantly higher H/S ratio than the adult haemophiliacs. Patients exclusively treated with Danish cryoprecipitate during the last year had a significantly higher H/S ratio than patients receiving preparations from other sources. This difference might, however, be explained by lower age and lower total lifetime dose in the group receiving Danish preparations. Haemophiliacs treated with American preparations did not differ immunologically from those treated with preparations of other origin. Total serum IgG was increased in 23% of the patients. This parameter was negatively correlated with the H/S ratio. The possible relation of the observed immunological alterations among otherwise healthy haemophiliacs to the acquired immune deficiency syndrome warrants further attention.
392 patients with amoebiasis, diagnosed at Roslagstull Hospital, Stockholm during 10 yr, are reviewed. The disease is increasing in frequency, due both to increased travelling by Swedish citizens and immigration from non-European countries. The risk for an ordinary charter tourist is, however, rather low. Two-thirds of the patients were symptomatic and one-third were regarded as asymptomatic cyst carriers. The importance of repeated examination of stool samples and examinations using different techniques, especially direct microscopy of fresh faeces, is pointed out. The latter technique is in our laboratory shown to be as efficient in cases with no diarrhoea as in those with diarrhoea, with trophozoites demonstrated in the same frequency in both groups. Sigmoidoscopy with scrapings was seldom of diagnostic value.
The author traces the history of appendicitis through the successive stages of its evolution--from the early anatomic descriptions of the appendix by Leonardo da Vinci and Vesalius to Louyer-Villermay's recognition of the fatal course that appendiceal inflammation may take; through the confusion of typhlitis and perityphlitis, until Reginald Fitz at the end of the last century classified its pathology and the disease appendicitis was born. The author has described the efforts of the early surgeons as they grew to understand the symptomatology of appendicitis and to realize that only by early operation could the tragic outcome of delay be averted. Credit is given to those whose contributions have advanced the frontiers of surgery-- Lawson Tait was the first to diagnose and remove a diseased appendix in 1880 in England and Abraham Groves the first on the North American continent, in 1883, in Ontario. Within a decade, the early surgical treatment of appendicitis became established. The writings of men like Charles McBurney and John B. Murphy are shown to be as pertinent today as they were at the turn of the century.
Maternal and child health has a long tradition in Europe, going back to the turn of the century when it was already becoming clear in several parts of Europe that to decrease infant mortality rates and maternal death it was necessary to add to sanitation more direct services reaching the mother in her home and educating her in baby care and nutrition as well as hygiene. Health progress in this field was more than consolidated with the advent of modern medicine and antibiotics.
A survey of population-based cancer registries in the European Community (EC) is reported: 82 (92%) of 89 registries replied. In 3 of the 12 EC countries (Denmark, Netherlands, UK), general cancer registration applies to the entire population; national registration for childhood neoplasms also applies in 3 countries (FRG, Ireland, UK). About 350,000 new cancers were recorded each year during 1982-1985 in the 32% of the EC population which is covered by general registration. It is estimated that during this period about 988,000 new cancers (excluding non-melanoma skin cancer) occurred each year in the 10 EC countries for which incidence data are available. Most registries report 90-95% completeness of cancer registration, but there is evidence of imprecision in these estimates. Risk factors for cancer are recorded in 43 registries, in particular occupation (38), but recording of occupation is often incomplete. The use of international or compatible systems of coding occupation would facilitate screening of cancer registration data for occupational hazards in the European Community. The quality of cancer information in the Community would be greatly improved by the systematic and widespread use of simple methods to estimate completeness of registration and by allowing registries confidential access to death certificates.
Motor neuron disease (MND) is used in this paper as the generic label, encompassing the clinical variants of amyotrophic lateral sclerosis (ALS), progressive myelopathic muscular atrophy (PMMA), and progressive bulbar palsy (PBP). ALS is limited to instances of anterior horn cell plus pyramidal tract involvement. When only anterior horn cell lesions are inferred, either PMMA or PBP is used, depending on the levels of involvement; when both cord and brain stem are affected. PBP is the designation. Mortality data on MND have been available for a number of countries since 1949. The coding used under international rules has varied considerably over this interval. Before 1969, hereditary muscular atrophies were included. Since 1979, no subdivision by type of MND is possible. International death rates for MND have all been rather close to 1 per 100,000 population per year, though perhaps nearer to 1.4 on the average in recent years. There has been an increasing proportion of MND deaths coded to ALS between 1949 and 1977. There is no notable geographic variation among countries, nor within countries such as the U.S. and Denmark. A slight upward trend in death rates over time in the U.S. is matched by a slight decrease in Denmark. Death rates from all sources indicate a male preponderance for ALS or MND as a whole, at about 1.5 to 1, male to female. There is also a consistent predilection by age, with few deaths under age 50 or so and a clear maximum in age-specific death rates at about age 70. This holds for both sexes. In the U.S., there is also a white-nonwhite difference, with a ratio of about 1.6:1 but with age and sex differences similar to whites. Average annual incidence rates from among white occidental populations range mostly between 0.6 and 1.8 per 100,000 population for MND and about 0.8 and 1.5 per 100,000 for ALS. Again a male predilection is seen. There is a clear maximum in age-specific incidence rates at about age 65 in all surveys except that of Rochester, Minnesota, where the age-specific rate for those 75+ years of age is apparently higher than that for those age 65 to 74. Incidence rates, then, are quite similar one land to another. A reported deficit in Mexico may reflect case-selection bias. An excess among Filipinos on Hawaii seems more a function of population age-distributions than a true racial or ethnic difference. Prevalence rates from outside the Orient range from about 1 to 7 per 100,000 population for MND and about 2 to 7 for ALS. Those surveys more likely to be reasonably complete provide ALS prevalence rates of about 4 to 6, and an overall estimate of ALS prevalence of some 5 per 100,000 population is a reasonable figure. In the Orient, most of the MND prevalence rates fall within the same range as in the occident, except for two areas of the Kii peninsula of southern Honshu, Japan, where the reported prevalence rates are some 100 to 200 per 100,000 population. These cases are similar to the Guamanian ALS, both clinically and pathologically...