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Evaluation of diagnostic ('classification') criteria in Behçet's disease--towards internationally agreed criteria. The International Study Group for Behçet's disease.

No fewer than five sets of diagnostic criteria for Behçet's disease are currently in use. The International Study Group have therefore undertaken an extensive study of existing criteria and have developed recommended new international criteria based on the collection of data from 914 patients with Behçet's disease and controls, of whom 886 (97%) and 97 respectively had mouth ulceration. It is recommended that these new criteria should replace the existing criteria sets although further studies are required to evaluate their performance in new patient groups.

Behcet Syndrome↗

[Evaluation of carcinogenic risk at the international (International Agency for Research on Cancer--World Health Organization) and the Czechoslovak level. A basis for consideration prior to amending Guideline no. 64/1984 on hygienic principles in working with chemical carcinogens].

The aim of the International Agency for Research on Cancer (IARC) attached to WHO is to facilitate world-wide cooperation in cancer research in the fields of science, methodology, information service, organization or even legislation. For this purpose the IARC publishes specialized monographs containing critical evaluation of risk materials, their mixtures as well as assessment of working procedures involving the risk of carcinogenesis. Within the IARC scope, so far 700 agents have been submitted for comprehensive investigation from the genotoxic aspect, and 628 out of these yielded valid results; 50 agents listed in Group 1 of demonstrable carcinogens, Group 2 contained 196 agents suspect of various degrees of carcinogenicity (subgroups 2A and 2B). The author compares the internationally accepted list of high-risk agents with the present Czechoslovak list--Guidelines No. 64/1984 containing 15 demonstrable carcinogenic agents and 17 potential carcinogenic agents, and he recommends that the prospective Amendment to the Guidelines No. 64/1984 should respond more keenly to the IARC conclusions and recommendations.

Carcinogens↗

International Federation of Clinical Chemistry standardization project for measurements of apolipoproteins A-I and B. IV. Comparability of apolipoprotein B values by use of International Reference Material.

We performed temporal and thermal stability studies on SP3-07, a liquid-stabilized reference material for apolipoprotein (apo) B, selected during the previous phase of the International Federation of Clinical Chemistry project on standardization of apolipoprotein measurements. Results indicate that SP3-07 stored at -70 degrees C has the long-term stability required for a reference material. We assigned an accuracy-based apo B value of 1.22 g/L to SP3-07, using a nephelometric method that was calibrated with freshly isolated low-density lipoprotein for which the apo B mass value was determined by a standardized sodium dodecyl sulfate-Lowry procedure. Using a common protocol, the study participants transferred the assigned mass value from SP3-07 to the individual calibrators of the analytical systems and measured the apo B concentration of 20 fresh-frozen samples obtained from individual donors and covering a clinically relevant range of apo B values. The among-laboratory CV on these samples, analyzed by 25 analytical systems, ranged from 3.1% to 6.7%. These results demonstrate the lack of matrix effects of SP3-07 and its ability to provide accurate and comparable apo B values in a variety of immunochemical methods. On the basis of the outcome of these studies, the World Health Organization has endorsed SP3-07 as the International Reference Material for Apolipoprotein B.

Apolipoprotein A-I↗

An international multicentre study: Clivarin in the prevention of venous thromboembolism in patients undergoing general surgery. Report of the International Clivarin Assessment Group.

A randomized multicentre double-blind study was organized to evaluate the efficacy and the safety of Clivarin (reviparin-sodium) (anti-Xa/anti-IIa ratio: 3-5 International units) for the prevention of post-operative thromboembolism in patients undergoing general surgery. 1,351 patients were randomly allocated to receive subcutaneously either 5,000 U of unfractionated heparin (UFH) twice a day or 1,750 anti-Xa IU of reviparin-sodium once a day (morning) followed by a placebo injection (evening) for at least 6 days. Deep vein thrombosis (DVT) was detected with the 125I-fibrinogen technique confirmed by phlebography if necessary. After randomization thrombotic risk factors were equally distributed in each group. More than 50% of the patients had a cancer. The incidence of DVT and of pulmonary embolism was 4.8% (CI 95%: 3.3-6.7%) in the reviparin-sodium group and 4.4% (CI 95%: 2.9-6.2%) in the UFH group, a non-significant difference. The number of transfusions required was equivalent in the two groups. However, post-operative bleeding complications, including wound haematomas and internal bleeding, were less frequent in the reviparin-sodium group (P < 0.01). Therefore, for the first time, this study demonstrates that an unusual low dose of a low molecular weight heparin retains its antithrombotic efficacy by comparison with UFH and that the tolerance of this low dose is better.

Adult↗

1993 progress report from the International Bone Marrow Transplant Registry. Advisory Committee of the International Bone Marrow Transplant Registry.

The International Bone Marrow Transplant Registry is an organization devoted to scientific research in BMT. More than 230 transplant teams worldwide contribute detailed information about recipients of allogeneic and syngeneic BMT for study. Results of analyses are published in medical journals and presented at national and international scientific meetings (more than 60 publications and more than 500 presentations in the past 4 years). This collaborative research program has grown rapidly with more than 2000 cases reported annually. This report summarizes results of several recent investigations and reviews the state of BMT in leukemia and aplastic anemia.

Anemia, Aplastic↗

Antiretroviral therapy for HIV infection in 1996. Recommendations of an international panel. International AIDS Society-USA.

OBJECTIVE: To provide clinical recommendations for antiretroviral therapy for human immunodeficiency virus (HIV) disease with currently (mid 1996) available drugs. When to start therapy, what to start with, when to change, and what to change to were addressed. PARTICIPANTS: A 13-member panel representing international expertise in antiretroviral research and HIV patient care was selected by the international AIDS Society-USA. EVIDENCE: Available clinical and basic science data, including phase 3 controlled trials, clinical endpoint data, virologic and immunologic endpoint data, interim analyses, studies of HIV pathophysiology, and expert opinions of panel members were considered. Recommendations were limited to drugs available in mid 1996. PROCESS: For each question posed, 1 or more member(s) reviewed and presented available data. Recommendations were determined by group consensus (January 1996); revisions as warranted by new data were incorporated by group consensus (February-May 1996). CONCLUSIONS: Recent data on HIV pathogenesis, methods to determine plasma HIV RNA, clinical trial data, and availability of new drugs point to the need for new approaches to treatment. Therapy is recommended based on CD4+ cell count, plasma HIV RNA level, or clinical status. Preferred initial drug regimens include nucleoside combinations; at present protease inhibitors are probably best reserved for patients at higher progression risk. For treatment failure or drug intolerance, subsequent regimen considerations include reasons for changing therapy, available drug options, disease stage, underlying conditions, and concomitant medication(s). Therapy for primary (acute) infection, high-risk exposures to HIV, and maternal-to-fetal transmission are also addressed. Therapeutic approaches need to be updated as new data continue to emerge.

Antiviral Agents↗

Base of skull internal carotid and internal jugular gunshot wounds treated conservatively: inadequate treatment, or was well enough left alone?

Zone three carotid injuries present problems of access in emergency situations. Not only are the methods time consuming, but they also put certain structures in the neck at risk. A patient was treated at this institution with a large calibre gunshot injury of the right internal carotid and internal jugular vein. He was neurologically intact and his bleeding had been completely controlled. A decision was made to treat him conservatively and he recovered uneventfully with no neurological deficit and no further bleeding. Emergency exposure of the distal carotid artery involves dislocating the mandible, putting the facial nerve and parotid gland at risk of injury. Base of skull carotid injuries are best treated expectantly if there is no active bleeding or progressive neurological impairment. Careful follow-up is required to diagnose and treat carotid-jugular fistulas, false aneurysms and stenoses early.

Adolescent↗

The serum IgA class anti-tissue transglutaminase antibodies in the diagnosis and follow up of coeliac disease. Results of an international multi-centre study. International Working Group on Eu-tTG.

OBJECTIVES: So far the reliability of the anti-tissue transglutaminase (anti-tTG) test for the diagnosis of coeliac disease has mostly been evaluated using slightly different enzyme-linked immunosorbent assays (ELISAs) in selected and usually small groups of patients. The aims of this study were: (1) to evaluate the reliability of the IgA anti-tTG antibodies for the diagnosis of coeliac disease; and (2) to define the sensitivity and specificity of a commercially available kit for the anti-tTG antibodies' quantitative determination. DESIGN: Each centre in this international multi-centre study collected sera from three groups of subjects: coeliac disease patients at the onset of (1) or on a gluten-free diet for at least 12 months (2); disease and healthy controls (3). METHODS: The anti-tTG antibodies were determined in duplicate using an ELISA-based commercially available kit (Eu-tTG Eurospital, Trieste, Italy). RESULTS: The following overall cases and controls have been enrolled: (1) 399 subjects with active coeliac disease; (2) 351 treated coeliac disease cases; (3) 432 controls. The centralized re-testing was performed on: (1) group a: 176 patients with active coeliac disease (mean anti-tTG, 21 arbitrary units [AU]); (2) group b: 172 treated coeliac disease cases (mean anti-tTG, 5 AU); (3) group c: 206 controls (mean anti-tTG, 3 AU). In active coeliacs, the anti-tTG antibodies showed a significant progressive decrease with age, while in controls an opposite trend was found. In active coeliac disease patients, the anti-tTG antibodies were significantly higher in coeliacs with a grade III enteropathy than in those showing a grade II lesion. In treated coeliacs, the mean anti-tTG values were significantly lower in patients strictly adhering to a gluten-free diet than in those reporting dietary transgressions. The sensitivity and the specificity of the Eu-tTG assay were 90% and 96%, respectively. CONCLUSION: The results of this study show that the commercially available test for the anti-tTG antibodies' determination is a reproducible and valuable tool for the diagnosis and follow up of coeliac disease.

Adolescent↗

Redesigning residency education in internal medicine: a position paper from the Association of Program Directors in Internal Medicine.

There has been considerable change in the practice of internal medicine in the past quarter century, including the rise of specialization, increasing time pressure, the hospitalist movement, and the rapidly changing responsibilities of internists in inpatient and outpatient settings. Training programs have not adequately responded to these trends, and there is a consensus that the residency education system urgently needs redesign.

Ambulatory Care↗

[Early and late results following 244 reconstructions of the internal carotid artery with contralateral internal carotid occlusion].

Between December 1974 and March 1985 244 reconstructions of the internal carotid artery with contralateral occlusion were performed. 7.3% of the patients were asymptomatic, 48.4% had typical transient ischemic attacks and 44.3% had a completed stroke. The postoperative mortality was 2.0% and a permanent neurologic deficit occurred in 3.3%. An intraluminal shunt was used in only 5.4%. The long-term survival rate after 5 years was 65.2 +/- 4.8%. In the follow-up period of 103 months 9.2% of the patients had a new stroke.

Arteriosclerosis↗

Internal migration in contemporary Nepal: models which internalize development policies.

"A set of models is developed to assess at the interdistrict level the relative importance of economic, demographic, social and government policy determinants of internal migration in Nepal. The first 'proximate' model and the second 'structural' model estimates are generated using ordinary least squares regression and specification error is investigated by spatial autocorrelation tests of the residuals of each model in its reduced form....Finally, to formalize and evaluate empirically the linkages between the 'proximate' and 'structural' determinants, a simultaneous equation model is developed using three stage generalized least squares regression."

Asia↗

Surveillance in hereditary nonpolyposis colorectal cancer: an international cooperative study of 165 families. The International Collaborative Group on HNPCC.

During its second meeting at Amsterdam in 1990, the International Collaborative Group on Hereditary Non-Polyposis Colorectal Cancer (ICG-HNPCC) decided to carry out a pilot study on colorectal cancer surveillance in HNPCC. The objectives of the study were to ascertain in each of the participating centers the number of HNPCC families, the recommended screening procedures, the age at diagnosis of colorectal cancer (CRC), and the occurrence of interval cancers. Nine centers in seven countries including Denmark, Finland, Italy, Japan, The Netherlands, Switzerland, and the United States participated. Data were derived from a total of 165 families. With respect to screening, half of the centers advise colonoscopy as the only procedure. The interval between the consecutive examinations varies from one to three years. In the majority of the centers, screening begins at 20 to 25 years. Lifelong screening is recommended by three centers, while the rest advise discontinuation at age 60 to 75 years. The family material included 840 patients with colorectal cancer. The mean age at diagnosis was 45 years, and about 15 percent were diagnosed at age 60 or later. A total of 682 high-risk relatives are being followed. After the follow-up of 1 to 10 years in these families, only six cases of interval cancers were encountered.

Adolescent↗

International system of radiographic grading of vesicoureteric reflux. International Reflux Study in Children.

The classification of grading of vesicoureteric reflux (VUR) agreed to by the participants in the International Reflux Study in Children is described. It combines two earlier classifications and is based upon the extent of filling and dilatation by VUR of the ureter, the renal pelvis and the calyces. A standardised technique of voiding cystography is also described to ensure comparability of results.

Child↗

Results of angioplasty (with or without stent) at the site of a narrowed coronary anastomosis of the left internal mammary artery graft or via the internal mammary artery.

During the past 6 years, 50 patients underwent percutaneous transluminal coronary angioplasty (PTCA) of a narrowed coronary anastomosis of a left internal mammary artery (LIMA) graft or PTCA of a left anterior descending coronary artery stenosis via LIMA grafts at the investigators' institution. The success rate was high at 88%. Thirty-four of the 44 successfully treated patients (77%) underwent repeat angiography, which showed restenosis in 14 patients (41%). In cases of stent implantation at the coronary LIMA graft anastomosis angioplasty site, the restenosis rate was 80%, but it was only 14% in cases of pure balloon dilation (p = 0.001). Therefore, in cases of coronary LIMA graft anastomosis, stent implantation should be avoided, because it implicates an excessively high restenosis rate.

Aged↗

The International Association for Hospice and Palliative Care: international activities and future initiatives.

The International Association for Hospice and Palliative Care (IAHPC) is a global organization dedicated to the development and improvement of palliative care. The mission of IAHPC is to increase the availability and access to high quality hospice and palliative care for patients and families throughout the world. It does this by promoting communication, facilitating and providing education, and by becoming an information resource for patients, professionals, health care providers and policy makers around the world. This report describes activities of the IAHPC throughout the word and planned future initiatives.

Hospice Care↗

IAEA/EPA international climatic test program for integrating radon detectors. International Atomic Energy Agency/Environmental Protection Agency.

As an element of the joint IAEA-EPA International Radon Metrology Evaluation Program, a climatic test of long-term integrating radon detectors was conducted at the U.S. EPA Radiation and Indoor Environments National Laboratory. The objective of this study was to test the performance of commonly used commercially available long-term 222Rn detector systems under extreme climatological conditions using filtered polycarbonate CR-39 plastic analyzed by the manufacturer using the track-etch method, unfiltered LR-115 film analyzed by the manufacturer, and Teflon based electrets analyzed in the field by EPA using the manufacturer's equipment. The EPA environmental radon chambers were used to expose detectors to extreme cold and dry (less than 4.0 degrees C air temperature and 25% relative humidity) and hot and humid (greater than 35 degrees C air temperature and 85% relative humidity) climatic conditions. During phase I detectors were exposed to low temperatures and low humidities, and during phase II detectors were exposed to high temperatures and high humidities. Typical indoor equilibrium fractions (near 50%) and radon concentrations of about 150 Bq m(-3) were maintained for each phase, which lasted 90 d. The results indicated that the optimal detector for extreme climatic conditions is dependent on the relative importance of bias and precision. Overall, however, the filtered track-etch type detector produced the most reliable results under the extreme conditions.

Air Microbiology↗

Aneurysms at nonbranching sites in the surpaclinoid portion of the internal carotid artery: internal carotid artery trunk aneurysms.

OBJECTIVE: Aneurysms at nonbranching sites in the supraclinoid internal carotid artery (ICA), known as blood blister-like aneurysms or ICA anterior or dorsal wall aneurysms, are not well understood. To clarify this clinical entity, 7408 patients with subarachnoid hemorrhage who were treated during a 5-year period were analyzed. METHODS: Forty-eight patients had aneurysms that were intraoperatively confirmed to be located at a nonbranching site in the supraclinoid portion of the ICA. Neuroradiological and clinicopathological features and outcomes were studied. RESULTS: The aneurysms were divided into the "blister type," with a blood blister-like configuration and fragile walls, and the "saccular type," with a saccular configuration and a relatively firm neck, like ordinary berry aneurysms. The most frequent origin was the anteromedial wall for both types. ICA dissection was associated only with the blister type, and hypertension was more frequent with the blister type (P = 0.0978). The preoperative conditions of the patients were the same, but the outcomes for patients with blister-type aneurysms were worse, because of frequent intra- and postoperative aneurysmal bleeding. Saccular-type aneurysms were safely clipped. Treatment of blister-type aneurysms by clipping on wrapping material achieved good results, but ICA trapping (P = 0.0952), clipping (P = 0.0146), and wrapping (P = 0.0110) were associated with much worse results. CONCLUSION: Blister-type and saccular-type aneurysms have different shapes and wall characteristics. The saccular type can be treated by clipping, whereas the blister type requires clipping on wrapping material. ICA trunk aneurysms may be a better designation to express the diversity of these aneurysms, rather than ICA blood blister-like or anterior or dorsal wall aneurysms.

Adult↗