Malaria in the WHO European Region (1971-1999).

The number of autochthonous reported cases of malaria fell from 90 506 to 37 170 between 1996 and 1999 in the WHO European Region. There has been, however, an eight-fold increase in imported cases since the 1970s: 1500 cases were reported in 1972, 13 000 cases in 1999. France, Germany, Italy, and the United Kingdom are the west European countries with the largest numbers of cases.

Rapid, direct enzyme immunoassay of 11-keto-thromboxane B2 in urine, validated by immunoaffinity/gas chromatography-mass spectrometry.

We have developed a direct enzyme immunoassay (EIA) for quantifying immunoreactive 11-keto-thromboxane B2 (iKTXB) in unprocessed human urine. Cross-reactivity with other thromboxane metabolites and prostanoids was negligible. Analytical recovery of 11-keto-TXB2 in urine specimens was 97.4% to 99.8%. Total imprecision for two clinical specimens was 8.5% and 12.2%. Intake of acetylsalicylic acid decreased the measured concentration of iKTXB. Cardiopulmonary bypass, a procedure known to activate platelets, increased the mean excretion rate of iKTXB 10-fold. Simultaneous gas chromatography-mass spectrometry analysis of 11-keto-TXB2 and 11-keto-2,3-dinor TXB2 in urine specimens (n = 17) from healthy subjects indicated that urinary iKTXB concentrations measured by EIA represented a sum of the two 11-keto metabolites. We conclude that the direct EIA is sufficiently sensitive, rapid, simple, and specific to allow screening for alterations in thromboxane biosynthesis in patients.

A randomized double-blind trial of glucagon in treatment of first attack of severe acute pancreatitis without associated biliary disease.

The effects of glucagon versus placebo were evaluated in a double-blind trial including only patients with a first attack of severe acute pancreatitis not associated with biliary disease. All 22 patients had deterioriation of their clinical condition, elevated serum amylase and pulse rate above 100/min. or shock. An initial dose of 1 mg. glucagon was given as a bolus injection followed by infusion of 6 mg. in 1,500 ml. saline/24 hr. for three days. All were treated with nasogastric decompression, fluids, calcium and antibiotics. Severe complications developed in five of the 10 patients receiving glucagon and in eight of the 12 given a placebo. Three of the 10 (glucagon) and five of the 12 (placebo) died from these complications. Hemorrhagic pancreatitis was found in 11 patients at laparotomy or autopsy. Three of the five with hemorrhagic pancreatitis in the glucagon group and four of the six in the placebo group died. Pooling the data of the present and two other studies makes it probable that glucagon has no effect on mortality from acute severe pancreatitis.

Assessment of completeness of vagotomy and surgical experience 10 days and 3 months after proximal gastric vagotomy.

Spontaneous and maximum acid secretion was measured before, and 10 days and 3 months after proximal gastric vagotomy (PGV) to determine the optimal time for testing the completeness of vagotomy. Insulin tests were done 10 days after PGV and it was investigated whether any of the tests could distinguish between experienced and less experienced surgeons. Sixty-eight patients were studied, 38 being operated by experienced and 30 by less experienced surgeons. No significant changes were found in BAO and PAO from 10 days to 3 months after PGV in any of the groups. In contrast to the insulin test results, measurements of BAO and PAO did not discriminate between the two groups of surgeons. However, very incomplete vagotomies according to insulin test results were identified by measurements of PAO 3 months after PGV. It is concluded that early postoperative insulin tests are preferable. The surgeon remembers details of the PGV, the patients is liable to accept the test at this time and insulin tests are more sensitive in discriminating between experienced and less experienced surgeons. Measurements of maximum acid secretion should only replace these tests in patients with cardiac diseases and they should then be performed 3 months after PGV.