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Biological weapons are the most commonly used weapons of mass destruction. Serious international concerns exist about their use by non-state actors, and such use is facilitated by developments in biotechnology. In Denmark, counter-proliferation is served by a new biosecurity act and the establishment of a new biosecurity authority. Aspects of biopreparedness have also been strengthened. International collaboration is necessary in order to enhance both the security measures aimed at avoiding the misuse of science but also to enhance societal resilience if potentially devastating biological attacks should occur.

Biological weapons have been known for centuries, and since World War II, offensive programs have accelerated the development of these weapons considerably. The anthrax attacks in the fall 2001 and speculations regarding the research and development of Iraqi bioweapons have been causes for concern. The effect of biological weapons may be overwhelming, in particular when one is dealing with a contagious agent. The National Centre for Biological Defence provides a preparedness capability through evidence-based research and practical operational capabilities.

The first positive clinical results of gene therapy trials have now become evident. The relatively few positive results and the numerous negative trials make it possible to identify both problems and potential for new development. The biggest problems have come from the viral vectors used for gene transfer. Most of the successful gene therapy trials have involved monogenetic diseases, where the relevant tissue has been isolated ex vivo, and where a retroviral vector has been inserted into the therapeutic gene in the nuclear DNA. Gene therapy seems to have a definite therapeutic potential in several rare, inherited diseases and also in certain acquired diseases, such as ischaemic heart disease.

Biological weapons are an important part of the level of international threat. Technological development has made biological weapon production relatively simple and cheap, and although a UN convention from 1972 bans biological weapons, governments as well as non-governmental organisations or individuals have developed biological weapons for offensive use in war or terrorism. This article reviews the publically available literature, and clinical and therapeutic possibilities are described. The possibilities for protection of military and civilian groups are discussed and the need for a national contingency plan is emphasized.

Traditional treatment modalities of diffuse nontoxic goitre are thyroid hormone suppression or surgery. When treating nodular nontoxic goitre with 131I treatment, a reduction in thyroid volume to about 50% is seen. In the present study we evaluated the effect of 131I treatment in 21 patients treated for a diffuse nontoxic goitre and followed by evaluation of thyroid volume measured by ultrasound. Thyroid volume declined in all patients from median of 66 ml (range 27-160 ml) to 21 ml (9-108 ml) over a year, a reduction of 62%. Three patients developed hypothyroidism in the follow-up period (14%), one of these had a temporary hyperthyroid fase. In conclusion, 131I treatment of diffuse nontoxic goitre reduces thyroid volume by approximately 60% within 12 months. Hypothyroidism developed in 14% during a limited follow-up period.

Five patients with falsely elevated serum triiodothyronine (T3) concentrations (> 9 nmol/l) in a radioimmunoassay are reported. The high T3-values disagreed with the other thyroid variables investigated as well as with the clinical observations. In sera from all patients a normal non-specific binding of T3 was found, thus excluding abnormal serum-protein-binding of the hormone. An ethanol extraction of T3 from serum before RIA reduced the T3 content in serum from all patients to normal levels (2.0-2.4 nmol/l). These findings indicate the presence in the sera of substances, probably of protein nature, that were interfering with the assay by binding the reagent-antibody and not the antigen. Addition of non-immune rabbit serum prevented this interference and normalized the T3-values (1.8-2.4 nmol/l). Thus the interfering substance in T3-RIA could be an anti-rabbit antibody, the interaction of which can be eliminated by a minor modification of the assay making it possible to differentiate true from false T3-values.

This study was conducted to document the trend in arterial hypoxaemia and electrocardiographic (ECG) abnormalities on second to sixth night after acute myocardial infarction (AMI). Nineteen consecutive patients with AMI were monitored continuously during the night with a Holter tape recorder and a pulse oxymeter. Five patients had > 30 episodic oxygen desaturations of > or = 5%, and many patients had episodes with oxygen desaturations < 80% ranging from 46-61% (from 7/15-11/18) during the nights of monitoring. Constant hypoxaemia was found in 11-13% of the patients. Many patients had simultaneous occurrence of episodic hypoxaemia and episodic sinustachycardia, ST-deviation and arrhythmias, giving a summarized simultaneous occurrence of episodic hypoxaemia and ECG-abnormalities ranging from 13/18 (72%) patients on the third night to 7/15 (46%) patients on the sixth night. Episodic and constant hypoxaemia are thus common during the first week after AMI. Episodic hypoxaemia was associated with ECG-abnormalities in the majority of patients.

The aim of this study was to investigate the long term effect of 131I treatment on thyroid function and size in patients with non-toxic multinodular goitre. The subjects were 69 consecutive patients with multinodular non-toxic goitre selected for 131I treatment and followed for a minimum of 12 months. Outcome measures were standard thyroid function variables and ultrasonically determined thyroid volume before and after treatment. Fifty-nine patients were treated with a single dose of 131I, 12 with two doses, and one with four doses. In 45 patients treated with one dose who remained euthyroid the median thyroid volume was reduced from 73 (interquartile range 50-106) ml to 29 (interquartile range 23-48) ml at 24 months. The median reduction was 40 (22-48) ml, half of which occurred within three months. Patients treated with two doses as well as those developing hypo- or hyper-thyroidism also had a significant reduction in thyroid volume. Eleven patients developed hypothyroidism (cumulative five year risk 22%). Side effects were few. In conclusion we find that 131I treatment of multinodular non-toxic goitre is an attractive alternative to surgery.