Biomedical subjects
Publications and source records attributed to P Møller.
Intestinal obstruction in a 14-year-old boy was caused by herniation of small intestine through a defect in the lesser omentum. The aetiology and management of this rare condition are discussed.
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Serum and EDTA blood from 120 patients with ankylosing spondylitis (Bechterew's syndrome) and serum from 138 first-degree relatives of patients and from 42 adult blood donors were investigated. Increased serum concentrations of IgA and IgG and complement factors C3 and C4 were found in total groups of HLA B27-positive male or female patients compared with controls or relatives. The men had higher serum concentration of IgA and complement factors than the women, whereas IgM concentration was higher in the women. These patterns were found in controls, in relatives and in patients. Increased concentrations of IgA and of C4 were characteristic of all patients whereas IgG and IgM and C3 concentrations were likewise elevated in patients with peripheral joint arthritis/arthropathy. Increased levels of circulating immune complexes (CIC) were associated with peripheral joint arthritis and were strongly correlated with IgG or CRP concentrations in serum. Total haemolytic complement activity in serum was negatively correlated with concentrations of CIC or CRP indicating complement activation in patients with such complexes. No differences in serum concentrations of Ig or complement factor concentrations were seen between HLA B27-positive and negative relatives with normal sacro-iliac joints or between relatives and controls. Strong mutual correlations were seen among IgG, IgM, complement factors, CRP, SAA, sedimentation rate and alpha 2-macroglobulin. When the present findings were combined with our previous results it turned out that AS, and psoriasis with or without arthropathy, and acute anterior uveitis (AAU) in combination with sacro-iliitis, may be described as IgA-related conditions and that increased serum C4 was related to sacro-iliitis in all these disorders.
Tympanosclerosis of the ear drum in children is associated with secretory otitis media. The tympanosclerotic changes affect the pars tensa and seem to be a dynamic process of new formation together with regress and restoration to normal tissue. Our study includes 90 cleft palate children followed for 7.8 years with a total of 2068 examinations. During the observation period 59% of the ear drums were affected by tympanosclerosis, while only 42% had tympanosclerosis at the last examination. The tympanosclerotic lesion of the ear drum disappeared completely in 30%, seemed stable in 40% and tended to grow steadily in 30% of the ear drums affected. The pathogenesis of tympanosclerosis is not clear, although the inflammation known to exist in secretory otitis media probably plays an important part.
A total of 168 interns who have graduated from the Medical Schools of Bergen and Tromsø were asked about various aspects of the medical curriculum. In Bergen the curriculum has a traditional structure with a pre-clinical and a clinical part, but in Tromsø the pre-clinical and clinical subjects are integrated. In addition, the students in Tromsø spend long periods in municipal hospitals and in the primary health care service. We were interested in how the interns from the two universities evaluated their respective curricula and how prepared they felt for their current work. There was a response rate of 86% to the questionnaire. The results showed that the interns from Tromsø are more satisfied with their education and feel more confident in their practical skills than the interns from Bergen. They are also more motivated for future work in general practice. In our opinion the main reason for these results is the difference in curricula in the two medical schools. Other possible reasons are also discussed.
Pi phenotypes were determined in patients hospitalized with ankylosing spondylitis, acute anterior uveitis, psoriasis or chronic prostatitis. The allele frequencies were calculated. No deviation in allele frequencies from Norwegian controls could be demonstrated.
Complex associations between the different subgroups of seronegative arthritis, acute anterior uveitis, psoriasis and inflammatory bowel disease were found in a series of patients and relatives. Different HLA-B antigens were associated with different clinical signs. The results indicated the existence of a multigenic syndrome whose main clinical manifestations are relapsing innflammations at various sites. The genetic factors appeared to be 1) HLA-B27 associated disease susceptibility, 2) predisposition to psoriatic arthropathy, 3) predisposition to early onset familial psoriasis and, 4) a probable predisposition to inflammatory bowel disease and its associated arthropathy. The results indicated that the different genetic factors may interact and influence each other's penetrance and expression.
Tympanosclerosis of the ear drum in children with SOM differs from normal ear drums in children with SOM. In tympanosclerosis the numbers of fibroblasts, fibrocytes and macrophages are increased in lamina propria and in the submucosa. The collagen microfibrils and procollagen filaments have increased in numbers with a partly disorganized pattern. Fibrolysis of microfibrils is conspicuous and hyaline degeneration appears in areas. Calcareous deposits are found scattered to a limited extent in lamina propria and in the submucosa. Profound calcification could only be found in children with tympanosclerosis coexisting with chronic perforation of the ear drum.
All available adult first-degree relatives of 66 patients with HLAB27 positive ankylosing spondylitis were examined clinically and radiographically and their white blood cells were HLA typed. Ten per cent of all relatives and 20% of HLAB27 positive relatives had Bechterew's syndrome. An additional 10% had minimal radiographical changes in the sacro-iliac joints, or peripheral arthropathy. Sixteen out of 19 persons who had minimal radiographical changes in the sacro-iliac joints were HLAB27 positive. Backache was common (25% or more) in any group of relatives, and did not discriminate well between relatives with or without Bechterew's syndrome. Spine or chest stiffness should prompt examination for Bechterew's syndrome, but is an inadequate diagnostic criterion for the syndrome. Typing for HLAB27 is probably the best prognostic test, although most HLAB27 positive persons did not exhibit any objective sign of disease. Repeated radiographical examination of HLAB27 negative persons should be avoided.
All available adult first-degree relatives of 9 probands with HLAB27 negative ankylosing spondylitis were examined. Completion rate was 90%. Prevalences of symptoms and signs and distributions of chest and spinal mobility are presented. No secondary case of Bechterew's syndrome was found among the relatives, compared with 10% among the relatives of HLAB27 positive probands (p = 0.05). We conclude from this study and that of relatives of HLAB27 positive probands, that a HLAB27 negative relative runs a low risk of contracting Bechterew's syndrome, irrespective of the HLAB27 status of the proband.
Sixteen patients with Bechterew's syndrome (ankylosing spondylitis, AS) were investigated. All except one of the patients were HLA B27-positive. Peripheral blood lymphocytes from the patients were examined for spontaneous cytotoxicity against 51Cr-labelled K562 target cells. The cytotoxicity index of the non-T lymphocytes was negatively correlated with the serum CRP concentration (Pearson's r = 0.613, p less than 0.02). This finding seems to be caused by an alteration of the natural killer (NK) cell activity of the non-T lymphocytes during the active phase of the disease and not due to serum factors. The activity of the non-T cell fraction was slightly but not significantly reduced in patients with high disease activity (CRP greater than 0.01 g/l) compared with normal controls, (14.6 +/- 2.8 g/l versus 20.4 +/- 2.4 g/l mean +/- SE; p less than 0.10) Serum IgG and IgA concentrations were increased (p less than 0.001 and p less than 0.05 respectively) Interferon caused normal augmentation in the NK cell activity in AS patients, and no correlation was found between serum gamma interferon titres and the NK cell activity.
A case is presented in which a gastric cancer primarily presented with symptoms of acute appendicitis. The difficulty of determining the origin of a carcinoma of the appendix with involvement of all layers of the wall is emphasized.
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Patients hospitalized for psoriasis, acute anterior uveitis, ankylosing spondylitis or with chronic prostatis were examined. From previous reports and our own results we formulated hypotheses of the genetic mechanisms involved. We then examined all available adult relatives of 75 patients with ankylosing spondylitis. Our previously established genetic hypotheses were tested by segregation analyses in these families. All our results point to the existence of a syndrome of distinct but interacting genetic factors. The main factor is the HLA-B27 associated disease predisposition. Manifestation of this predisposition seems to be influenced by sex and by presence of factors coding for psoriasis and/or psoriatic arthropathy. Our results concerning psoriasis and psoriatic arthropathy supported the previous suggestions that these diseases exhibit genetic heterogeneity. It is known that disease signs may be triggered by infection in genetically predisposed persons. The syndrome therefore has a multifactorial aetiology. Seronegative arthropathy is a term that includes all arthritic components of the syndrome. There is a need for a term that encompasses all clinical signs of the genetic factors involved. We propose 'Hereditary multifocal relapsing inflammation' (HEMRI) as a descriptive term for this syndrome. The disease entities included may be regarded as subtypes of the syndrome.
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The results of segregation analyses in 75 families where the proband had ankylosing spondylitis, are presented. Of the 278 adult, living first degree relatives, approximately 85% cooperated in the study. Clinical and radiographical examinations were performed and HLA typing was conducted. The results were in agreement with our hypothesis that ankylosing spondylitis is part of a syndrome where different genetic factors interact. Such known factors are HLA B27 associated disease susceptibility, susceptibility to psoriatic arthropathy and susceptibility to entero-arthropathy. Radiographical sacro-iliitis was restricted to HLA B27 positive relatives, and was more frequently found in relatives to probands with psoriasis than in relatives to probands without psoriasis. Environmental factors (intestinal bacteria) are known to trigger the disease at least in some persons, and we have postulated that all or most of them have the predisposition to develop disease. Thus, the syndrome has a multifactorial etiology. The phenotypic expressions of the different genetic predispositions involved, include sacro-iliitis, psoriasis, acute anterior uveitis, peripheral arthropathy and inflammatory bowel disease. We suggest the descriptive name HEREDITARY MULTIFOCAL RELAPSING INFLAMMATION (HEMRI) for this syndrome. Ankylosing spondylitis, psoriatic arthropathy and entero-arthropathy may be regarded as clinical sub-types of the syndrome.