Prevalence of IgA-antiendomysium and IgA-antigliadin autoantibodies at diagnosis of insulin-dependent diabetes mellitus in Swedish children and adolescents.

OBJECTIVE: This study was conducted to investigate the prevalence of celiac disease (CD) in children and adolescents at diagnosis of insulin-dependent diabetes mellitus (IDDM) before insulin treatment was started. MATERIAL AND METHODS: At diagnosis of IDDM, and before treatment was started, 115 children and adolescents were screened for IgA- antiendomysium (EMA) and IgA-antigliadin antibodies (AGA). Those found to be EMA-positive and/or AGA-positive were investigated further with intestinal biopsy. RESULTS: Of the 115 patients, 2 had known CD at diagnosis of IDDM; of the remainder of patients, 6% (7/113) were found to be EMA-positive and 9% (10/113) were found to have AGA levels above normal. Of the 6 patients who underwent biopsy, 5 manifested villous atrophy. In addition, 2 patients with high EMA and AGA antibody titers refused biopsy, and 4 patients with low EMA and/or AGA titers were found to have normal titers at control before biopsy decision. CONCLUSION: Because the prevalence of CD at diagnosis of IDDM would seem to be 6% to 8%, screening for CD seems to be justified among patients with newly diagnosed IDDM.

The collapsed cone superposition algorithm applied to scatter dose calculations in brachytherapy.

Methods for scatter dose calculations in brachytherapy have been developed based on the collapsed cone superposition algorithm. The methods account for effects on the scatter dose caused by the three-dimensional distribution of heterogeneities in the irradiated volume and are considerably faster than methods based on straightforward superposition of kernels or direct Monte Carlo simulations. Use of a successive-scattering approach, in which the dose contribution from once- and multiply scattered photons are calculated separately, was found superior to conventional superposition using a single point kernel for all scatter generations. Use of the successive-scattering approach significantly reduces artifacts stemming from steep fluence gradients, typical of the brachytherapy geometry and critical for the collapsed cone approximation. The algorithm is tested versus Monte Carlo simulations for point sources of energies 28.4, 100, 350, and 662 keV. Results agree well for both a homogeneous water phantom and an air-water half-phantom.

Point kernels and superposition methods for scatter dose calculations in brachytherapy.

Point kernels have been generated and applied for calculation of scatter dose distributions around monoenergetic point sources for photon energies ranging from 28 to 662 keV. Three different approaches for dose calculations have been compared: a single-kernel superposition method, a single-kernel superposition method where the point kernels are approximated as isotropic and a novel 'successive-scattering' superposition method for improved modelling of the dose from multiply scattered photons. An extended version of the EGS4 Monte Carlo code was used for generating the kernels and for benchmarking the absorbed dose distributions calculated with the superposition methods. It is shown that dose calculation by superposition at and below 100 keV can be simplified by using isotropic point kernels. Compared to the assumption of full in-scattering made by algorithms currently in clinical use, the single-kernel superposition method improves dose calculations in a half-phantom consisting of air and water. Further improvements are obtained using the successive-scattering superposition method, which reduces the overestimates of dose close to the phantom surface usually associated with kernel superposition methods at brachytherapy photon energies. It is also shown that scatter dose point kernels can be parametrized to biexponential functions, making them suitable for use with an effective implementation of the collapsed cone superposition algorithm.

Monte Carlo and analytical calculation of proton pencil beams for computerized treatment plan optimization.

Proton pencil beams in water, in a format suitable for treatment planning algorithms and covering the radiotherapy energy range (50-250 MeV), have been calculated using a modified version of the Monte Carlo code PTRAN. A simple analytical model has also been developed for calculating proton broad-beam dose distributions which is in excellent agreement with the Monte Carlo calculations. Radial dose distributions are also calculated analytically and narrow proton pencil-beam dose distributions derived. The physical approximations in the Monte Carlo code and in the analytical model together with their limitations are discussed. Examples showing the use of the calculated set of proton pencil beams as input to an existing photon treatment planning algorithm based on biological optimization are given for fully 3D scanned proton pencil beams; these include intensity modulated beams with range shift and scanning in the transversal plane.

Radiation dose measurements with alanine/agarose gel and thin alanine films around a 192Ir brachytherapy source, using ESR spectroscopy.

Alanine/agarose gel and alanine films in stacks have been used for measurements of absorbed dose around an HDR 192Ir source in a vaginal cylinder-applicator, with and without a 180 degrees tungsten shield. The gel and the films were analysed by means of ESR spectroscopy and calibrated against an ion chamber in a 4 MV photon beam to obtain absolute dose values. The gel serves as both dosimeter and phantom material, and the thin (130 microm) films are used to achieve an improved spatial resolution in the dose estimations. Experimental values were compared with Monte Carlo simulations using two different codes. Results from the measurements generally agree with the simulations to within 5%, for both the alanine/agarose gel and the alanine films.

Prophylactic antibiotics against early and late deep infections after total hip replacements.

A review with a longer observation period is performed of a previously published double-blind investigation of the prophylatic value of cloxacillin against late infections after total hip replacements; In addition, a retrospective patient material is examined. The total material consisted of 1065 total hips. 15.4 per cent deep, late infections were found in the group without prophylaxis and 20 per cent in the one with prophylaxis. The frequency of haematogenous deep infection was estimated to be less than 1 per cent.

Prediction of silent celiac disease at diagnosis of childhood type 1 diabetes by tissue transglutaminase autoantibodies and HLA.

AIMS: The aims were to estimate the diagnostic sensitivity and specificity of autoantibodies to tissue transglutaminase (IgA- and IgG-tTG), gliadin (AGA) and endomysium (EMA) in relation to human leukocyte antigen (HLA)-DQB1 alleles to identify silent celiac disease at diagnosis of type 1 diabetes. METHODS: IgA- and IgG-tTG were measured in radioligand binding assays in 165 type 1 diabetic patients. Data on HLA-DQB1 were available for 148 patients and on both AGA and EMA for 164 patients. For patients considered positive for AGA or EMA, or both, an intestinal biopsy was suggested. HLA-DQB1 typing was carried out by polymerase chain reaction and hybridization with allele specific probes. RESULTS: Three patients, left out from further study of antibodies, but not from HLA-DQB1 analysis, had treated celiac disease at diagnosis. Out of the other 162 type 1 diabetic patients tested, nine had IgA-tTG, six IgG-tTG, eight EMA, and 11 AGA. Biopsy was suggested for nine patients, of whom six showed villous atrophy, one did not and two refused to participate. Thus, silent celiac disease was probable in 8/162 and biopsy-verified in 6/162, where five patients were AGA-positive and six either EMA-, IgA-tTG- or IgG-tTG-positive. Of the 11 patients with celiac disease (three with treated and eight with silent celiac disease), 10 were HLA-DQB1-typed, of whom 65% (13/20) had the DQB1*02 allele, compared with 36% (100/276; p = 0.011) of those without celiac disease. IgA-tTG levels were higher in patients having either *02 or *0302 (0.6; -1.3-112.4 RU) compared with those not having these alleles (0.4; -0.7-3.4 RU; p = 0.023). CONCLUSION: IgA-tTG are HLA-DQB1*02-associated autoantibodies with high sensitivity and specificity for silent celiac disease at diagnosis of type 1 diabetes.

Serological screening for celiac disease in healthy 2.5-year-old children in Sweden.

OBJECTIVE: The study was designed to investigate the prevalence of celiac disease (CD) among 2.5-year-old children in a Swedish urban population with a high incidence of CD. MATERIAL AND METHODS: Six hundred ninety apparently healthy children, born in the 12-month period of July 1992 through June 1993, were screened for immunoglobulin A (IgA) antigliadin antibodies and IgA antiendomysium antibodies, and those antibody-positive at repeated testing were further investigated with intestinal biopsy. RESULTS: Of the 690 children, 6 were both IgA antigliadin antibody- and IgA antiendomysium antibody-positive, and 7 were antiendomysium antibody-positive but antigliadin antibody-negative. Jejunal biopsy, performed in 12 cases, manifested partial or total villous atrophy in 8 cases. Thus, together with an additional child whose parents declined the offered biopsy, but whose response to a gluten-free diet confirmed the presence of CD, the prevalence of CD in the study series was 1.3% (9/690; 95% confidence interval:.4-2.2). However, independent of the study, an additional 22 cases of symptomatic, biopsy-verified CD have already been detected in the birth cohort of 3004 children. CONCLUSIONS: The prevalence of CD in our study series was high, at least 1.0%, but may be as high as 2.0% if the frequency of silent CD is as high as we have found in the remaining unscreened cohort. These findings confirm that CD is one of the most common chronic disorders.