Minor H antigen matches and mismatches are equally distributed among recipients with or without complications after HLA identical sibling renal transplantation.

Studies of the effect of minor H antigen mismatching on the outcome of renal transplantation are scarce and concern mainly single center studies. The International Histocompatibility and Immunogenetics Workshops (IHIW) provide a collaborative platform to execute crucial large studies. In collaboration with 16 laboratories of the IHIW, the role of 15 autosomal, 10 Y-chromosome encoded minor H antigens and 3 CD31 polymorphisms, was investigated in relation to the incidence of renal graft rejection and graft loss in 444 human leukocyte antigens (HLA)-identical sibling renal transplantations. Recipient and donor DNA samples were genotyped for the minor H antigens HA-1, HA-2, HA-3, HA-8, HB-1, ACC-1, ACC-2, SP110, PANE1, UGT2B17, C19Orf48, LB-ECGF-1, CTSH, LRH-1, LB-ADIR and HY. The correlation between minor H antigen mismatch and the primary outcome graft rejection or graft loss was statistically analyzed. The incidence of rejection was very low and no correlation was observed between one or more minor H antigen mismatch(es) and a rejection episode (n = 36), of which only eight resulted in graft loss. In summary, in our study cohort of 444 renal transplants, mismatching for neither autosomal nor HY minor H antigens correlate with rejection episodes or with graft loss.

Monitoring of photodynamic therapy results in age-related macular degeneration by means of preferential hyperacuity perimeter.

PURPOSE: To describe changes revealed by Zeiss Preferential Hyperacuity Perimeter (PreView PHP) in age-related macular degeneration (AMD), before and after photodynamic therapy (PDT), and determine usefulness of such monitoring. METHODS: Forty patients (40 eyes) with subfoveolar choroidal neovascularization (CNV) and 20 volunteers with cataract (40 eyes) were examined in a prospective study. Control group was screened for false positive results to evaluate reliability of the test. Subfoveolar CNV was confirmed by fluorescein angiography and optical coherence tomography (OCT). Best-corrected visual acuity (BCVA) and macular visual field in the PHP (area and intensity of distortion) were assessed 1 day before and 1 week and 4 weeks after PDT. RESULTS: Four weeks after PDT there was improvement in PHP results in 20 eyes (50%), stabilization in 15 eyes (37.5%) and progression in 5 eyes (12.5%). At this time there was BCVA improvement in 9 eyes (22.5%), stabilization in 28 eyes (70%), and worsening in 3 eyes (7.5%). 1 week after PDT 30 eyes (75%) presented temporary progression in PHP but only 3 patients (7.5%) presented temporary decrease of visual acuity and progression in OCT. Correlation coefficient of BCVA and PHP results was low during whole study. There was no significant change in control group during observation. 17.5% false positive PHP results were obtained at baseline. In the PDT group no false negative results were noted. CONCLUSIONS: Visual outcome after PDT cannot be predicted with use of PreView PHP. Temporary progression of changes in PHP 1 week after PDT can be expected in most cases.

Sterilization 1. The changing attitude.

PIP: Since the end of World War 2 in the U.S., there has been a marked change in attitude towards and treatment of the mentally handicapped, and the result - in terms of sterilization - is that many States no longer use their compulsory sterilization laws and some have repealed them. In any event, the incidence of compulsory sterilization has decreased markedly. Yet, in the past decade there have been occasional attempts to resort to the procedure for punitive reasons. These efforts have generally involved women with illegitimate children who are supported by welfare payments. Over the same decade there has been in the U.S. a remarkable growth in the use of voluntary and contraceptive sterilization as the means of preventing additional children. Preliminary results from the national Survey of Family Growth 1973 revealed that 29% of couples between the ages of 15 and 44 years who did not want more children were sterilized - males and females about equally. In Britain the development of sterilization has followed a somewhat different path. During the 1st decades of the 20th century the people in Britain were very concerned about the extensiveness of mental subnormality in the population and with the care of this group. In 1930 the Eugenics society made its 1st formal statement on the use of sterilization, advocating its use for those individuals who might transmit severe physical or mental defects which might affect the health of their progeny. More evidence was determined needed before there would be an attempt made to initiate legislation, and no legislation was ever effected. Also, from 1925 onwards, there was a debate in medical and legal circles on the consequences for patients and doctors of sterilizing operations and on the risks of litigation in the criminal and civil courts. The most marked change came in 1972 when the National Health Service (Family Planning) Act empowered local authorities to provide facilities for vasectomy on the same basis as other contraceptive services.^ieng

Sterilisation: the Aberdeen experience, and some broader implications.

In her paper, Sue Teper outlines the various methods of contraception or fertility control and their relationship to sterilisation. She also considers a particular group of women in Aberdeen as a mini case-study. From these two aspects of sterilization develops a third--that of broader medical and economic issues. Sterilisation usually concerns patients who are free from illness, therefore the attitudes of medical personnel are much more relevant to whether or not the operation is performed on request purely as a means of fertility control, rather than for medical reasons where the patient may be at risk were a pregnancy to occur. Ms Teper calls for medical staff in this instance to clarify their own attitudes in decisions which involve surgical skills and healthy patients.

Mortality from carcinoma of cervix uteri in Britain.

A review of age-specific mortality-rates from cervical cancer in England and Wales and in Scotland in 1968--76 shows a decline, striking at some ages. In England and Wales, however, there has been an increase at ages 25--34 and, possibly, at 15--24. Signs of such an increase are also seen in Scotland for the age-groups 25--34 when figures for two regions with well-established screening programmes are removed. Indeed trends in these regions compared with those for the rest of Scotland support the benefit of cervical screening.

Uterine cervical cytology and young women.

9000 women aged 20 years and under who had cervical smears taken in the 10-year period 1967-76 were studied. The number of young women with abnormal smears rose, but this increase was in proportion to the number screened. Abnormal smears were found in 145 (1.6%) cases. Follow-up for periods of up to 10 years showed that in over half the cases subsequent smears had reverted to normal without treatment. 19 of the 145 patients progressed to have smears which were suggestive of malignancy: 16 of these were diagnosed histologically as carcinoma-in-situ, and the other 3 were histological dysplasias. At follow-up no cases of carcinoma-in-situ were found in women under 21. No cases of invasive cancer were found on the initial biopsy. One microinvasive cancer was found in a woman aged 26 on a second biopsy 6 1/2 years after the first atypical smear. The preclinical cases were detected from smears taken during pregnancy, or, in the case of the one possibly nulliparous girl, during a gynaecological consultation. These women did not attend family-planning clinics until after a pregnancy.