Signatures of natural selection and coevolution between killer cell immunoglobulin-like receptors (KIR) and HLA class I genes.

Natural killer (NK) cells are lymphocytes of the innate immune system. In humans, NK cell activities are partly controlled by the diverse killer immunoglobulin-like receptor (KIR) gene family. The importance of NK cells in both immunity to infection and reproduction makes KIR strong candidates for genes undergoing dynamic evolution in the human genome. Using high-resolution allelic typing, we investigated the potential role of natural selection in the diversification of KIR in the Irish population. Higher diversity than expected is observed at several loci, consistent with a history of balancing selection acting to maintain several allelic variants at high frequency in the population. KIR diversity is enhanced further at the haplotype level with functional polymorphisms at KIR2DL4, KIR3DL1 and KIR2DS4 defining nine 'core' haplotypes. Analysis of these core haplotypes in combination with human leukocyte antigen (HLA) class I ligands revealed several nonrandom associations. In particular, the KIR:HLA association for the core haplotype defined by KIR3DL1(*)01502 was female specific and a likely consequence of negative selection acting against KIR3DL1(*)01502 on an HLA-C1/C1 background. Many of the associations between KIR and HLA in the Irish differ from those previously reported, which argues against universal selective pressures for specific KIR:HLA combinations in diverse human populations.

A double-blind comparison in general practice of a combination tablet containing orphenadrine citrate and paracetamol ('Norgesic') with paracetamol alone.

A double-blind trial of a combination tablet containing orphenadrine and paracetamol, 'Norgesic', was carried out to assess the value of this product compared with paracetamol alone. All three symptomatic parameters which were measured: pain, spasm and impaired activity, showed a significantly quicker recovery when the combination product was used. Further studies are necessary to evaluate the combination product against orphenadrine citrate alone.

Ten years' experience in a British casualty department staffed by general practitioners.

Ten years' documented experience in a British Casualty Department shows that the family physician has a potentially large role to play in the accident and emergency services of his community. It is clear that a well-trained family physician in a properly equipped hospital department can care for the great majority of his patients' injuries, minor surgical operations, and anesthetic needs. This is especially so where group practice and helpful specialist colleagues provide a supportive framework for problem sharing. A case is made for education of all family practice students and residents in this large and important area of medicine.

The health of sterilized women.

PIP: To study the evidence of significant illness subsequent to sexual sterilization by tubal ligation, the morbidity register of the Weaver Vale Practice was employed. 15 patients all younger than 45, with parity 1-5 and who had been sterilized were compared with 15 matched controls. The screening system used counted all events of menstrual cycle disturbance, psychiatric disturbance requiring medication or referral to a psychiatrist, and social disturbance, including disruption of the family and divorce. The study shows a significantly greater incidence of menstruation disorders during the 5 postoperative years, and a much higher incidence of psychiatric disturbances, or in 10 out of 15 patients. A significantly higher incidence of social problems was also found in the sterilized group, the most severe cases being associated with more severe psychiatric disturbances. Prospective and more detailed follow-up studies on sterilized women are needed. Although results from this study must be interpreted very carefully, they underline the importance of meticulous counseling prior to sterilization.^ieng

Vasectomy--a review of 100 cases.

A limited free vasectomy service providing for the needs of a rural area, with the counselling and operation conducted by a specially trained general practitioner is reported. The development of vasectomy as a contraceptive measure and some practical aspects of technique are reviewed and some characteristics of 100 patients operated on are recorded.