Uncertainty and agreement regarding the role of flow diversion in the management of difficult aneurysms.

BACKGROUND AND PURPOSE: The role of flow diversion in the management of aneurysms remains unknown. We sought to evaluate the community agreement regarding indications for flow diversion. MATERIALS AND METHODS: A portfolio of 35 difficult aneurysm cases was sent to 40 clinicians with varying backgrounds and experience. Responders were asked whether they considered flow diversion a treatment option, whether other options were possible, whether recruitment in a randomized trial would be considered, and to select their final choice. Agreement was studied by using κ statistics. RESULTS: Decisions for flow diversion were more frequent (n = 300, 39%) than decisions to coil (n = 163, 21.2%), to observe (n = 121, 15.7%), to occlude the parent vessel (n = 102, 13.2%), or to clip (n = 66, 8.6%). Sidewall aneurysm morphology was associated with flow diversion as the final choice (P = .001). Interjudge agreement was fair at best (κ <0.3) for all cases and all judges, despite high certainty levels (range, 7.2-8.9 ± 2.0 on a 0-10 scale). Agreement was no better within specialties or with more experience. All patients were judged to have other treatment options. Judges were willing to offer trial participation in 417 of 741 (56.3%) scenarios, more frequently when the aneurysm was sidewall (P = .001) or in the anterior circulation (P = .028). CONCLUSIONS: Individuals did not agree regarding the indications for flow diversion. There is sufficient uncertainty to justify trials designed to protect patients from the potential risks of premature adoption of an innovation.

Changing prevalences of overweight and obesity in primary school children--a glimmer of hope?

BACKGROUND: The current epidemic of childhood obesity is a growing public health concern. Estimates of the prevalence of obesity are necessary so that secular trends can be monitored and the need for preventative measures assessed. AIMS: To establish the prevalences of overweight and obesity in Aberdeen primary schoolchildren and to investigate how children have been changing with respect to body fatness during their primary school years. METHODS: Retrospective study of two cohorts of school entrants, using height and weight data from school nurse records. RESULTS: Data were collected on 1018 children. The prevalence of overweight among children in primary year 1 decreased from 28.7% in 1997/98 to 21.5% in 2001/02 (P<0.01). The mean BMI SD score also significantly decreased in boys from 0.51 in 1997/98 to 0.32 in 2001/02. For the 1997/98 school entrants, the prevalences of overweight and obesity did not change between school entry and the end of primary school. The mean BMI SD score decreased significantly during primary school in boys but not in girls. CONCLUSION: Although childhood overweight and obesity remain major public health concerns, we report a slight improvement in measures of obesity over time, particularly in boys.

Is the increase in asthma prevalence occurring in children without a family history of atopy?

We investigated the familial associations of asthma and atopic disease in a population in which the prevalence of asthma and atopy is increasing. Interviewer administered abbreviated family history questionnaires were applied in 416 families with a total of 1005 children ascertained through index children attending fracture and dressing clinics. The prevalence of reported asthma (22.5%), eczema (24%) and hayfever (20%) in the children was high but similar to previous studies in this population. Asthma was reported in 20.8% of children of parents without a history of asthma and 18% of children of parents without any history of atopic disease. Logistic regression analysis of outcomes in the index children showed increased risk of atopic disease associated with parental history of the same atopic disease. The presence of an affected sibling was associated with an increased risk of eczema (OR 3.04 CI 1.83-5.05) or hayfever (OR 1.79 CI 0.97-3.3) but not asthma (OR 1.18 CI 0.66-2.08). Increasing number of siblings was associated with reduced risk although this was significant only for hayfever (OR 0.62 CI 0.41-0.86). Although the presence of affected relatives is associated with an increased risk of atopic disease the high prevalence of reported atopic disease, particularly asthma. in children of parents without a family history of atopic disease suggests that much of the increase in asthma prevalence is occurring in children without a significant genetic predisposition. Childhood asthma developing in what would previously have been regarded as low risk families may differ in its aetiology from classical atopic asthma.

Suppressive effects of Corynebacterium parvum on primary and secondary antibody responses in mice.

The splenic plaque forming cell (PFC) response of mice to an intraperitoneal injection of sheep erythrocytes was severely depressed by prior treatment with Corynebacterium parvum given four days beforehand by the same route. However, total antibody levels were less affected, and soon attained near normal titres. This implied that the effects of C. parvum were limited to the spleen, and that other tissues gave a substantial response during the period when the splenic response was suppressed. Equally, this apparently local immunosuppressive effect of C. parvum failed to inhibit the eventual development of a normal memory cell pool. It was also shown that primed cells in the spleen, challenged during the period when C. parvum inhibited primary IgG responses, were relatively refractory to its suppressive effects.

Age-related changes in cell localization and proliferation in lymph nodes and spleen after antigenic stimulation.

Antigen-dependent localization of 51Cr-labelled lymphocytes, and the subsequent uptake of IUdR into lymphoid organs has been studied as a function of age. Measures of cell localization indicated that while old age can alter the patterns of entry of lymphocytes into lymph nodes and spleen, these changes are variable and probably not sufficient alone to explain decreased primary antibody responses in old animals. Proliferation of cells, however, was consistently affected in both organs and this phenomenon is discussed in terms of abnormal T-cell function.

Changes in lymphocyte accumulation and proliferation in the lymph nodes draining the pregnant uterus.

Changes in weight, lymphocyte accumulation and cellular proliferation have been measured in the lymph nodes draining the uterus during inter- and intra-strain pregnancies and compared with similar effects after other antigenic stimuli. From the data obtained it was concluded that "paternal" antigenic stimulation from the conceptus initiated an immune response in these nodes. The mechanisms of the subsequent suppression of this response are discussed.