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Introduction: Patients with midgut neuroendocrine tumours (NETs) suffer from decreased health-related quality of life (HRQoL), in large part due to bowel symptoms. However, it is unknown which bowel symptoms affect HRQoL the most. An enhanced understanding of this is essential to better focus treatment on this aspect of the disease. This study aimed to determine which bowel symptoms affect HRQoL the most in patients with midgut NETs., Methods: Consenting patients with midgut NET completed the Memorial Sloan Kettering Bowel Function Instrument and the HRQoL questionnaire (EORTC QLQ-C30). The correlation between bowel symptoms and HRQoL was analysed using multiple linear regression, adjusting for age, Charlson Comorbidity Index score, presence of metastatic disease, chromogranin A, and BMI yielding ß-coefficients with 95% confidence intervals., Results: Totally, 119 patients with midgut NET completed the questionnaires and were included in the study. Loose stool and bowel frequency ≥ 3/day were the most common bowel symptoms, reported by 47% and 56% of patients, respectively. However, sensitivity to certain types of food and beverages, a feeling of incomplete emptying of the bowel, and soiling were the symptoms most strongly correlated with decreased HRQoL, especially within domains concerning role and social function, with ß-coefficients for the strongest correlated symptoms of 15.0 and 14.6, respectively., Discussion: While symptoms concerning stool consistency and frequency are common in patients with midgut NET, our study suggests that other, more socially stigmatising symptoms affect patients' HRQoL more. Our findings could help caregivers understand patients' perceptions of the disease and provide avenues for more directed therapies., (© 2021. The Author(s).)

Lung cancer (LC) generally lacks unique core symptoms or signs. However, there are a multitude of bodily sensations that are often non-specific, not easily understood, and many times initially not recognized as indicative of LC by the affected person, which often leads to late diagnosis. In this international qualitative study, we inductively analyzed retrospective accounts of 61 people diagnosed with LC in Denmark, England and Sweden. Using the bodily sensations they most commonly spoke about (tiredness, breathlessness, pain, and cough), we constructed four sensation-based cases to understand the pre-diagnostic processes of reasoning and practice triggered by these key indicators of LC. We thereafter critically applied Hay's model of sensations to symptoms transformation, examining its central concepts of duration, disability and vulnerability, to support understanding of these processes. We found that while duration and disability are clearly relevant, vulnerability is more implicitly expressed in relation to perceived threat. Tiredness, even when of long duration and causing disability, was often related to normal aging, rather than a health threat. Regardless of duration, breathlessness was disturbing and threatening enough to lead to care-seeking. Pain varied by location, duration and degree of disability, and thus also varied in degree of threat perceived. Preconceived, but unmet expectations of what LC-related cough and pain would entail could cause delays by misleading participants; if cough lasted long enough, it could trigger health care contact. Duration, disability, and sense of threat, rather than vulnerability, were found to be relevant concepts for understanding the trajectory to diagnosis for LC among these participants. The process by which an individual, their family and health care providers legitimize sensations, allowing them to be seen as potential symptoms of disease, is also an essential, but varying part of the diagnostic processes described here., Competing Interests: The authors have declared that no competing interests exist.

Background: Oesophageal and gastric cancer are highly lethal malignancies with a 5-year survival rate of 15-29%. More knowledge is needed about the quality of end-of-life care in order to understand the burden of the illness and the ability of the current health care system to deliver timely and appropriate end-of-life care. The aim of this study was to describe the impact of initial treatment strategy and survival time on the quality of end-of-life care among patients with oesophageal and gastric cancer., Methods: This register-based cohort study included patients who died from oesophageal and gastric cancer in Sweden during 2014-2016. Through linking data from the National Register for Esophageal and Gastric Cancer, the National Cause of Death Register, and the Swedish Register of Palliative Care, 2156 individuals were included. Associations between initial treatment strategy and survival time and end-of-life care quality indicators were investigated. Adjusted risk ratios (RRs) with 95% confidence intervals were calculated using modified Poisson regression., Results: Patients with a survival of ≤3 months and 4-7 months had higher RRs for hospital death compared to patients with a survival ≥17 months. Patients with a survival of ≤3 months also had a lower RR for end-of-life information and bereavement support compared to patients with a survival ≥17 months, while the risks of pain assessment and oral assessment were not associated with survival time. Compared to patients with curative treatment, patients with no tumour-directed treatment had a lower RR for pain assessment. No significant differences were shown between the treatment groups regarding hospital death, end-of-life information, oral health assessment, and bereavement support., Conclusions: Short survival time is associated with several indicators of low quality end-of-life care among patients with oesophageal and gastric cancer, suggesting that a proactive palliative care approach is imperative to ensure quality end-of-life care., Competing Interests: The authors have declared that no competing interests exist.

Experiences of cancer diagnosis are changing in light of both the increasingly technological-clinical diagnostic processes and the socio-political context in which interpersonal relations take place. This has raised questions about how we might understand patient-doctor relationship marked by asymmetries of knowledge and social capital, but that emphasise patients' empowered choices and individualised care. As part of an interview study of 155 participants with bowel or lung cancer across Denmark, England and Sweden, we explored participants' stories of the decisions made during their cancer diagnostic process. By focusing on the intersections of care, choice and medical authority - a convivial pastoral dynamic - we provide a conceptual analysis of the normative ambivalences in people's stories of their cancer diagnosis. We found that participants drew from care, choice and medical authority to emphasise their relationality and interdependence with their doctors in their stories of their diagnosis. Importantly negotiations of an asymmetrical patient-doctor relationship were part of an on-going realisation of the healthcare processes as a human endeavour. We were therefore able to draw attention to the limitations of dichotomising emancipatory-empowerment discourses and argue for a theorisation of the patient-doctor relationship as a contextually bounded and relationally ambivalent humanity., (© 2020 The Authors. Sociology of Health & Illness published by John Wiley & Sons Ltd on behalf of Foundation for SHIL.)

Background: Breast cancer (BC) and related treatment are associated with the risk of developing a wide range of persistent disabling impairments. Despite extensive research in the field and an enhanced focus on BC rehabilitation, up to 34-43% of these patients are at risk of developing chronic distress. In addition, it is known that these patients repeatedly report unmet needs, which are strongly associated with reduced quality of life. However, despite knowledge that patients' needs for support during BC rehabilitation varies greatly, individualized rehabilitation is often lacking. Therefore, this study aimed to explore health care professionals' (HCPs) experiences of current rehabilitation practice and describe current barriers and facilitators for individualized rehabilitation for patients following BC treatment., Methods: A total of 19 HCPs were included, representing various professions in BC care/rehabilitation within surgical, oncological and specialized cancer rehabilitation units at a university hospital in Sweden. Five semi structured focus group interviews were conducted and inductively analysed using conventional qualitative content analysis., Results: Three categories were captured: (1) varying attitudes towards rehabilitation; (2) incongruence in how to identify and meet rehabilitation needs and (3) suboptimal collaboration during cancer treatment. The results showed a lack of consensus in how to optimize individualized rehabilitation. It also illuminated facilitators for individualized rehabilitation in terms of extensive competence related to long-term experience of working with patients with BC care/rehabilitation. Further, the analysis exposed barriers such as a great complexity in promoting individualized rehabilitation in a medically and treatment-driven health care system, which lacked structure and knowledge, and overarching collaboration for rehabilitation., Conclusion: This study suggests that the cancer trajectory is medically and treatment-driven and that rehabilitation plays a marginal role in today's BC trajectory. It also reveals that structures for systematic screening for needs, evidence-based guidelines for individualized rehabilitation interventions and structures for referring patients for advanced rehabilitation are lacking. To enable optimal and individualized recovery for BC patients', rehabilitation needs to be an integrated part of the cancer trajectory and run in parallel with diagnostics and treatment.

To avoid discomfort, health care professionals may hesitate to pursue conversations about end of life with patients. Certain tools have the potential to facilitate smoother conversations in this matter. The objective was to explore the experiences of patients in palliative care in using statement cards to talk about their wishes and priorities. Forty-six cards with statements of wishes and priorities were developed and tested for feasibility with 40 participants, who chose the 10 most important cards and shared their thoughts about the statements and conversation. Data from individual interviews and field notes were analyzed using content analysis. One category describes practical aspects of using the cards including the relevance of the content and the process of sorting the cards. The second category describes the significance of using the cards including becoming aware of what is important, sharing wishes and priorities, and reflecting on whether wishes and priorities change closer to death. The cards helped raise awareness and verbalize wishes and priorities. All statements were considered relevant. The conversations focused not only on death and dying, but also on challenges in the participants' current life situation. For the most ill and frail participants, the number of cards needs to be reduced.

Aim: The aim of the study was to describe patients' experiences of emotional adaption following treatment for oesophageal cancer from diagnosis to 6 months after surgery., Design: A qualitative interview study using an inductive approach was carried out., Methods: Participants were recruited from two university hospitals in Sweden. Ten patients who had been operated for oesophageal cancer with curative intent 6 months earlier and consented to participate in the study were included. Patients who had a disease recurrence were not eligible for inclusion. Participants were interviewed with a semi-structured interview approach. Data were analysed using qualitative content analysis., Results: One overarching theme was identified; Experiencing a crisis reaction , which comprised three key categories; (a) From emotionally numb to feeling quite alright ; (b) From a focus on cure to reflections about a whole new life ; and (c) From a severe treatment to suffering an emaciated, non-compliant body , derived from 14 distinct sub-categories., Conclusion: This study highlights the process of emotional adaptation following oesophageal cancer surgery that patients describe when reflecting back on the first 6 months postoperatively pointing to a crisis reaction in this early postoperative period., Competing Interests: The authors report no conflicts of interest., (© 2019 The Authors. Nursing Open published by John Wiley & Sons Ltd.)

High temperature crystal elasticity constants for face centred cubic austenite are important for interpreting the ultrasonic properties of iron and steels but cannot be determined by normal single crystal methods. Values of these constants have recently been calculated using an ab-initio approach and the present work was carried out to test their applicability using laser-ultrasonic measurements. Steel samples having a known texture were examined at temperatures between 800 °C and 1100 °C to measure the velocity of longitudinal P-waves which were found to be in good agreement with modelled values., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Purpose: The emphasis on early diagnosis to improve cancer survival has been a key factor in the development of cancer pathways across Europe. The aim of this analysis was to explore how the emphasis on early diagnosis and timely treatment is reflected in patient's accounts of care, from the first suspicion of colorectal or lung cancer to their treatment in Denmark, England and Sweden., Method: We recruited 155 patients in Denmark, England and Sweden who were within six months of being diagnosed with lung or colorectal cancer. Data were collected via semi-structured narrative interviews and analysed using a thematic approach., Results: Participants' accounts of quality of care were closely related to how quickly (or not) diagnosis, treatment and/or healthcare processes went. Kinetic metaphors as a description of care (such as treadmill) could be interpreted positively as participants were willing to forgo some degree of control and accept disruption to their lives to ensure more timely care. Drawing on wider cultural expectations of the benefits of diagnosing and treating cancer quickly, some participants were concerned that the waiting times between interventions might allow time for the cancer to grow., Conclusions: Initiatives emphasising the timeliness of diagnosis and treatment are reflected in the ways some patients experience their care. However, these accounts were open to further contextualisation about what speed of healthcare processes meant for evaluating the quality of their care. Healthcare professionals could therefore be an important patient resource in providing reassurance and support about the timeliness of diagnosis or treatment., (Copyright © 2018. Published by Elsevier Ltd.)

Background: To expand our clinical and scientific knowledge about holistic outcomes within palliative care, there is a need for agreed-upon patient-reported outcome measures. These patient-reported outcome measures then require translation and cultural adaptation, either from country-specific languages to English, or the other way around. The aim of this study was to translate and cross-culturally adapt the Integrated Palliative care Outcome Scale (IPOS) to the Swedish care context., Methods: Swedish versions of IPOS Patient and IPOS Staff were developed and culturally adapted using recommended guidelines including cognitive interviews with patients (n = 13) and staff (n = 15) from different care contexts including general and specialised palliative care., Results: The comprehension and judgement difficulties identified in the pre-final patient and staff versions were successfully solved during the cognitive interviewing process. IPOS was well accepted by both patients and staff, none of the questions were experienced as inappropriate, and all questions were judged important., Conclusions: In this study, we translated and culturally adapted the patient and staff versions of IPOS, and demonstrated face and content validity and acceptability of the scale through cognitive interviewing with patients and staff within residential care facility, surgical and specialised palliative home care units. Cognitive interviewing in parallel with patients and staff in rounds, with tentative analysis in between, was a suitable method for identifying and solving challenges with comprehension and evaluation in the pre-final version of IPOS. The Swedish IPOS is now available for use in a variety of clinical care settings.

The survival rate after childhood cancer has improved markedly and today more than 80% of patients will survive. Many childhood cancer survivors suffer from late complications due to radiotherapy and chemotherapy. Survivors of Acute Lymphoblastic Leukaemia (ALL), treated with cranial radiotherapy, are at a particularly high risk of having endocrine complications., Purpose: To illuminate childhood ALL survivors' experiences of a long-term follow-up in an endocrine clinic., Method: Data collection carried out using semi-structured focus-group interviews. Fifteen ALL survivors were included in the study, divided into 4 groups. Data was analysed with conventional qualitative content analysis., Results: The survivors' experiences were captured in the theme: "The need for understanding and support in order to manage daily life". An understanding of their situation, as well as support for managing daily life was fundamental. Lack of understanding and support from the community was connected with a fear for the future. The follow-up at the endocrine clinic was shown to be crucial for increasing the survivors' understanding of late complications. The past feeling of being out of control was replaced with an increased self-confidence., Conclusion: Many leukaemia survivors experienced their daily lives as a struggle and as a complicated issue to cope with. The theme "understanding and support to manage daily life" mirrors how the survivors are in need of knowledge and support in order to handle and understand their complex situation after surviving leukaemia. Offering understanding and support with a holistic approach, may be a way in which to strengthen the survivors' health., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Background: Following oesophagectomy, a major surgical procedure, it is known that patients suffer from severely reduced quality of life and have an unmet need for postoperative support. Still, there is a lack of research testing interventions aiming to enhance the patients' life situation after this surgical procedure., Aim: The aim of the study was to evaluate the effect of a nurse led telephone supportive care programme on quality of life (QOL), received information and the number of healthcare contacts compared to conventional care following oesophageal resection for cancer., Method: The study was designed as a randomized controlled trial (RCT) aiming to test the effect of a nurse led telephone supportive care program compared to conventional care. Patient assessments were conducted at discharge, 2 weeks, 2, 4 and 6 months after discharge and comprised evaluation of QOL, received information and the number of health care contacts. Statistical testing were conducted with repeated measurements analysis of variance to test if there were differences between the groups during follow-up., Result: The results show that the intervention group was significantly more satisfied with received information for items concerning the information they received about things to do to help yourself, written information and for the global information score. The control group scored significantly higher on the item regarding wishing to receive more information and wish to receive less information. No effect of the intervention was shown on QOL or number of health care contacts., Conclusion: Proactive nurse-led telephone follow-up has a significant positive impact on the patients' experience of received information. This is likely to have a positive effect on their ability to cope with a life that may include remaining side effects and adverse symptoms for a long time after surgery., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

A numerical model for amplification of ultrashort pulses with high repetition rates in fiber amplifiers is presented. The pulse propagation is modeled by jointly solving the steady-state rate equations and the generalized nonlinear Schrödinger equation, which allows accurate treatment of nonlinear and dispersive effects whilst considering arbitrary spatial and spectral gain dependencies. Comparison of data acquired by using the developed model and experimental results prove to be in good agreement.

Background: Oesophagectomy is a major procedure with known side effects and reduced postoperative quality of life (QOL). It has been shown that support of patients in their new life situation is often lacking. Knowledge about how QOL changes over time is fundamental for addressing patient needs and for determining the optimal timing of supportive care. The aim of this study was to identify QOL changes over time as well as factors that may impact patient QOL during the first year after oesophagectomy for cancer., Methods: Patients operated on for adenocarcinoma or squamous cell cancer of the oesophagus were included in this study. Seventy-nine patients completed the European Organisation for Research and Treatment of Cancer QOL questionnaires (QLQ-C30 and QLQ-OES18) before and 2, 4, 6, 9, and 12 months after surgery. A general linear model with repeated measurement analysis of variance was used for statistical testing., Results: There was a significant QOL nadir at 2 months compared to 12 months after surgery (QLQ-C30 function scales p < 0.001, symptom scales p < 0.001, QLQ-OES18 scales p < 0.001). Treatment with proton-pump inhibitors was associated with enhanced QOL according to QLQ-C30 symptom scales (p = 0.003) and OES-18 scales (p = 0.015), but age, gender and American Society of Anaesthesiologists classification did not significantly impact QOL., Conclusions: Patient QOL is severely hampered the first year after oesophagectomy for cancer, with a nadir at 2 months after surgery. Treatment with proton-pump inhibitors improved patient responses to symptom scales. Evidence of severely affected QOL after surgery indicates that these patients need support at an early stage after surgery. These results can be used by healthcare professionals to develop a postoperative supportive-care programme that is timed and better optimised to meet patient needs., Trial Registration: EudraCT database 2009-009997-28.

Unlabelled: After oesophageal cancer surgery quality of life (QOL) is severely reduced for a long time. Even though this is a well-documented fact no previous studies have focused on the patients' experiences of supportive care after surgery., Purpose: To illuminate patients' experiences of supportive care from a long-term perspective after oesophagectomy or oesophagogastrectomy for cancer., Method: Data collection was carried out using semi-structured focus-group interviews. Seventeen patients were included in the study, divided into 4 focus groups. Data was analysed with conventional qualitative content analysis., Results: The patients' experiences of supportive care were captured in the theme "The need for a guiding light in the new life situation" and it was shown that support from the healthcare system as well as from the social network was experienced as important. The patients need support that starts at the hospital and that continues throughout the transition to out-patient care. This support should focus on developing a plan for the future and on providing the patients with information that will enable them to understand their new life situation., Conclusion: The findings indicated that the patients need a plan for the future, help in navigating the healthcare system and the provision of clear and honest information as well as a healthcare system that better overarches the gap between in and out-patient care. This suggests the need of developing and testing a supportive care programme that is designed according to the patients' needs and with focus on the potential to enhance the patients QOL after this life-changing surgery., (Copyright © 2013 Elsevier Ltd. All rights reserved.)

Purpose: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control. However, the causal relationship between the impact of cervical pain on proprioception and thus on sensorimotor control has to be established., Methods: Eleven healthy subjects were examined in their ability to reproduce two different head on trunk targets, neutral head position (NHP) and 30° target position, with a 3D motion analyser before, directly after and 15 min after experimentally induced neck pain. Pain was induced by hypertonic saline infusion at C2/3 level in the splenius capitis muscle on one side (referred to as "injected side")., Results: All subjects experienced temporary pain and the head repositioning error increased significantly during head repositioning to the 30° target to the injected side (p = 0.011). A post hoc analysis showed that pain interfered with proprioception to the injected side during acute pain (p < 0.001), but also when the pain had waned (p = 0.002). Accuracy decreased immediately after pain induction for the 30° target position to the side where pain was induced (3.3 → 5.3°, p = 0.033), but not to the contralateral side (4.9 → 4.1°, p = 0.657). There was no significant impact of pain on accuracy for NHP. A sensory mismatch appeared in some subjects, who experienced dizziness., Conclusions: Acute cervical pain distorts sensorimotor control with side-specific changes, but also has more complex effects that appear when pain has waned.

Background: After surgery for oesophageal or gastric cancer, patients suffer from a variety of problems that affect their physical and mental health. Most previous studies on quality of life after this type of surgery are based on quantitative methods, and no studies to date have focused on the patient's subjective experiences of their quality of life from a long-term perspective., Objective: To illuminate patients' experiences of their quality of life, and how they handle their new life situation, from a long-term perspective, after oesophagectomy or gastrectomy for cancer., Method: This study was carried out in accordance with a descriptive explorative design focusing on the patients' quality of life after surgery for oesophageal/gastric cancer. Data collection was carried out using semi-structured focus group interviews. A total of 17 participants divided into 4 focus groups were included (2-5 years after elective surgery) in the study. Data was analysed with qualitative content analysis., Results: The results show that the patients' lives are severely hampered by adverse symptoms long time after surgery. The patients experienced the recovery period as a struggle and the theme "When moving on becomes a struggle" was shown to capture the patients' experiences. The main problems that acts as barriers in the patients' new life situation are those connected with nutrition and diarrhea who was shown not only affecting the patients from a physical perspective but also on a social and emotional level. The feeling of losing control of life was shown as a prominent problem and resulted in anxiety and fear about the future., Conclusion: This study shows that the patients' quality of life is heavily influenced by the remaining symptoms for a long time after surgery. However the patients ability to handle their new life situation does not only depend on the remaining symptom but on their ability to take control of the new life situation and learn to live life with the symptoms instead of letting the symptoms limit their life. The complex new life situation that the patients meet after surgery motivates the needs of a supportive care programme, focusing on the patients' physical, mental and social needs., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Two 78-cm long electrooptic fibers with nonlinear coefficient χ((2)) ~0.26 pm/V are used in a Sagnac loop for pulse selection at up to 1 MHz repetition rate. Laser pulses of 1.5 µm wavelength arriving at every 140 ns are selected with an extinction ratio as high as -30 dB. The arrangement is entirely based on silica fiber., (© 2012 Optical Society of America)

This work demonstrates an actively mode-locked fiber laser operating in soliton regime and employing an all-fiber electro-optic modulator. Nonlinear polarization rotation is utilized for femtosecond pulse generation. Stable operation of the all-fiber ring laser is readily achieved at a fundamental repetition rate of 2.6 MHz and produces 460 fs pulses with a spectral bandwidth of 5.3 nm.

Permanent storage of spent nuclear fuel in crystalline bedrock is investigated in several countries. For this storage scenario, the host rock is the third and final barrier for radionuclide migration. Sorption reactions in the crystalline rock matrix have strong retardative effects on the transport of radionuclides. To assess the barrier properties of the host rock it is important to have sorption data representative of the undisturbed host rock conditions. Sorption data is in the majority of reported cases determined using crushed rock. Crushing has been shown to increase a rock samples sorption capacity by creating additional surfaces. There are several problems with such an extrapolation. In studies where this problem is addressed, simple models relating the specific surface area to the particle size are used to extrapolate experimental data to a value representative of the host rock conditions. In this article, we report and compare surface area data of five size fractions of crushed granite and of 100 mm long drillcores as determined by the Brunauer Emmet Teller (BET)-method using N(2)-gas. Special sample holders that could hold large specimen were developed for the BET measurements. Surface area data on rock samples as large as the drillcore has not previously been published. An analysis of this data show that the extrapolated value for intact rock obtained from measurements on crushed material was larger than the determined specific surface area of the drillcores, in some cases with more than 1000%. Our results show that the use of data from crushed material and current models to extrapolate specific surface areas for host rock conditions can lead to over estimation interpretations of sorption ability. The shortcomings of the extrapolation model are discussed and possible explanations for the deviation from experimental data are proposed.

Two new methods for determining sorption coefficients in large rock samples have been developed. The methods use electromigration as a means to speed up the transport process, allowing for fast equilibration between rock sample and tracer solution. An electrical potential gradient acts as a driving force for transport in addition to the concentration gradient and forces the cations through the rock sample towards the cathode. The electrical potential gradient induces both electromigration and electroosmotic flow with a resulting solute transport that is large compared to diffusive fluxes. In one of the methods, the solute is driven through the sample and collected at the outlet side. In the other, simpler method, the rock sample is equilibrated by circulating the solute through the sample. The equilibration of rock samples, up to 5 cm in length, with an aqueous solution has been accomplished within days to months. Experiments using cesium as a sorbing tracer yield results consistent with considerably more time demanding in-diffusion experiments. These methods give lower distribution coefficients than those obtained using traditional batch experiments with crushed rock.

The Oostriku peat bog (central Estonia) has been exposed to metal-rich groundwater discharge over a long period of time and has accumulated high concentrations of Fe (up to 40 wt-%), heavy metals (e.g. Pb, Zn, Mn, Cu), and As. In this study, the peat was characterised with respect to composition and metal content with depth. The peat pore water was analysed and compared to a spring water emerging at the site. Sequential extraction, using a Tessier scheme optimised for iron-rich sediments, was used to understand the relative roles of binding mechanisms involved in the retention of different metals in the peat. Significant difference in depth distribution was found between different metals bound in the peat, which was partly attributed to varying compositions of the peat with depth and different dominant binding mechanisms for different metals.

Background: In this cross-sectional study, we analyze whether foreign-born women in Sweden had more non-normal childbirths than Swedish-born women during 1996-1998, adjusting for age, parity, level of education, number of antenatal care visits, and complications in pregnancy., Methods: The study includes 215 497 singleton deliveries (including the first childbirth of each woman during the time period) of women aged 18-47 in Sweden during 1996-1998, divided into 12 subgroups of countries. The risk of non-normal birth was analyzed by means of logistic regression., Results: Women from Sub-Saharan Africa, Iran, Asia, and Latin America had a higher age-adjusted risk of non-normal childbirth than Swedish-born women that remained and even increased for the African and Latin American women in the main effect model. Interactions between country of birth and antenatal care visits showed that women from Sub-Saharan Africa, Iran, Asia, and Latin America had almost 50% higher risk of non-normal birth with > or =13 antenatal care visits than Swedish-born women. Interactions between country of birth and complications in pregnancy showed that women from Turkey, Iran, Asia, and Latin America had over 50% higher risk of non-normal birth than the Swedish-born women., Conclusions: This study shows an association between being foreign-born and non-normal childbirth. Questions can be raised whether we are aware of, pay sufficient attention to, and allocate sufficient resources for these women at higher risk of non-normal birth in maternity care.

Effective treatment techniques for eliminating iron-oxidizing (IOB) and sulfur-oxidizing bacteria (SOB) are required for the comparison of abiotic and microbial sulfide oxidation rates and mechanisms in mine tailings. This study evaluates the effect of autoclaving, repeated heating, ethanol treatment, antibiotic treatment, gamma-radiation, and washing with deionized water on tailings characteristics and concentrations of IOB and SOB. Most probable number enumeration indicates that IOB and SOB were present at very low concentrations or below detection limits following treatment with all methods except rinsing and antibiotics treatment, where higher concentrations of IOB and SOB were present. The physical, chemical, and mineralogical characterization of the tailings indicated no changes in bulk mineralogy or bulk chemical composition as a result of treatment. However, an increase in oxidized sulfur species at the tailings surface, as determined by X-ray photoelectron spectroscopy, was observed for the heating, autoclaving, and antibiotics treatments. Batch weathering experiments, used to evaluate the effect of treatment on element release rates, indicated that the final element release rates (after >30 d) were similar between treated and untreated control samples. On the basis of the results of this study, experiments over relatively long periods (>30 d) are to be recommended forthe establishment of microbial and abiotic weathering rates in mill tailings samples. For the determination of abiotic reaction rates, treatment by gamma-radiation is suggested to be the most appropriate method for sulfide-rich tailings.

Few studies have examined the relationship between social, cultural and religious participation, political empowerment and coronary heart disease (CHD). The aim of this study was to examine whether low social participation, as described in a social participation index, predicted incidence rates of CHD. This is a follow-up study, from 1990-91 to 31 December 2000, of 6861 Swedish women and men, who were interviewed about their social participation, education, housing tenure and smoking habits. A social participation index was constructed, based on 18 variables from the survey. The outcome measure was CHD morbidity and mortality. Respondents with a CHD incident from 1986 until interview were excluded from the study. Data were analysed using Cox' regression and the results are presented as hazard ratios (HR) with 95% confidence intervals (CI). In the sex- and age-adjusted model there was a gradient between the social participation index and CHD, so that persons with low social participation had the highest risk of CHD with HR=2.15; CI=1.57-2.94, followed by HR=1.67; CI=1.23-2.27 for those with middle social participation. In the full model, when education, housing tenure and smoking habits were included, the increased risk of CHD for persons with low social participation remained high, with HR=1.69, CI=1.21-2.37. We conclude that persons with low social participation in the social participation index exhibited an increased risk of CHD that remained after adjustment for education, housing tenure and smoking habits.

Background: Our previous findings in oral lichen planus (OLP) and lichenoid reactions (LR) raised the question whether the histopathological changes observed in sensory and autonomic innervation produce oral sensory disorders., Methods: Spontaneous pain was assessed using the Visual Analogue Scale (VAS). Thermal pain thresholds were measured with a contact thermostimulator and mechanical pain thresholds with an electronic algometer., Results: Patients with OLP reported a higher intensity of spontaneous pain than LR patients (P = 0.001). Even erosive LRs were relatively painless. No thermal or mechanical hyperalgesia was detected in oral lesions. Highest separate cold pain threshold was measured in lesions affected by intense Candida growth., Conclusion: Together with previous histological findings, the present data suggest that increased somatic innervation and sympathetic denervation do not promote clinical pain sensitivity or hyperalgesia in oral mucosa and that these sensory functions are not affected by OLP and LR. Candida growth may function as secondary irritant modulating the pain responses.

This article is a multilevel analysis of the effects on self-reported long-term illness and mortality of the socio-economic position of the neighbourhood. Using data from the Swedish Level of Living Survey, neighbourhood social position is measured by a composite Care Need Index, (CNI) together with such indicators of individual socio-economic position as occupation and housing tenure, with adjustment for age, sex, marital status and social network. Data came from 22,236 people aged 25-74, and were collected from 1988 to 1992. The cross-sectional data were analysed using a hierarchical logistic regression model. In a second analysis, each participant was followed from the initial interview until his or her death, or until the termination of data collection (31 December 1996). A neighbourhood's low social position and an individual resident's low socio-economic position (i.e., a manual worker, or person renting a flat) were found to be associated with increased risk of long-term illness. We conclude that a neighbourhood's low socio-economic position, that is, a high score on the CNI, is a risk factor for long-standing illness above and beyond an individual's socio-economic position. The differences in mortality could be explained by the included independent individual variables.

Objective: Modulation of TNF-alpha by neutralizing antibodies, soluble receptors and TNFR: Fc fusion proteins are being developed for the therapeutic modulation of immune inflammation. It is becoming increasingly important to understand the state and involvement of the TNF-alpha/TNFR system in various rheumatic diseases. Tumor necrosis factor-alpha (TNF-alpha) affects its target cells through binding to two different receptors, TNFR-p55 and TNFR-p75. Mitogenic, cytostatic and cytotoxic effects of TNF-alpha on various cells have been reported. In Sjögren's syndrome (SS) focal sialadenitis leads to salivary gland destruction and loss of function. Although TNF-alpha is one possible mediator in these processes, nothing is known about the spatial distribution of TNF-alpha in relation to its receptors/target cells in salivary gland tissue., Methods: Labial salivary glands (LSG) were obtained from 16 SS patients and 13 healthy controls and stained using the immunohistochemical peroxidase-anti-peroxidase (PAP) method for TNF-alpha, TNFR-p55 and TNFR-p75., Results: TNF-alpha, TNFR-p55 and TNFR-p75 staining was absent, weak or relatively inextensive in controls compared to SS patients. Infiltrating mononuclear inflammatory cells in SS patients displayed moderate to strong TNF-alpha and TNFR expression. In addition, resident vascular endothelial cells, ductal epithelial cells and fibroblasts co-expressed TNF-alpha and TNFR. In contrast, acinar end piece cells did not express TNF-alpha or TNFR-p75 although TNFR-p55 was expressed., Conclusion: The interrelated localization of TNF receptors and their ligand TNF-alpha in inflammatory and in endothelial cells suggests a proinflammatory role of TNF-alpha in SS. The expression of TNF-alpha and its receptors in fibroblasts and ductal cells may contribute to ductal hyperplasia and glandular fibrosis. However, in contrast to expectations, the cellular localization of the TNF-alpha/TNRF system argues against its role in acinar cell atrophy.

The biosynthesis of dermatan sulfate is a complex process that involves, inter alia, formation of L-iduronic acid residues by C5-epimerization of D-glucuronic acid residues already incorporated into the growing polymer. It has been shown previously that this reaction is promoted by the presence of the sulfate donor 3'-phosphoadenosine-5'-phosphosulfate. In the present investigation, the role of sulfation in the biosynthesis of L-iduronic acid-rich galactosaminoglycans was examined more closely by a study of the substrate specificities and kinetic properties of the sulfotransferases involved in dermatan sulfate biosynthesis. Comparison of the acceptor reactivities of oligosaccharides from chondroitin and dermatan, in an in vitro system containing microsomes from cultured human skin fibroblasts and 3'-phosphoadenosine-5'-phosphosulfate, showed that Km values for the dermatan fragments were substantially lower than those for their chondroitin counterparts. Calculation of Vmax values likewise showed that dermatan was the better substrate. Whereas dermatan incorporated [35S]sulfate exclusively at the C4 position of N-acetylgalactosamine residues, approximately equal amounts of radioactivity were found at the C4 and C6 positions in the labelled chondroitin. Under standard assay conditions, the 4-O-sulfation of dermatan proceeded about six times faster than the 4-O-sulfation of chondroitin. On the basis of these results, we propose that L-iduronic acids, formed in the course of the biosynthesis of dermatan sulfates, enhance sulfation of their adjacent N-acetylgalactosamine residues, and will thereby be locked in the L-ido configuration.

Lymphocytes bearing the T-cell receptor (TCR) gamma/delta are increased in the peripheral blood of patients with recurrent aphthous ulcers (RAU) and Behcet's disease. In this study, we examined whether the density of TCR-gamma/delta bearing lymphocytes was also increased locally in RAU lesions. Ten RAU lesions from ten patients were compared with ulcer-free mucosa from sites contralateral to the lesions, and with 10 samples of clinically healthy oral mucosa taken from 10 healthy volunteers. Samples were labeled with a panel of monoclonal antibodies specific to CD3, alpha/beta TCR and gamma/delta TCR in avidin-biotin-peroxidase complex (ABC) staining. Lymphocytes expressing gamma/delta TCRs were very low in non-lesional mucosa and clinically healthy mucosa. By contrast, gamma/delta T-cells were numerous and observed in all RAU lesions especially within the epithelium, inflammatory infiltrates and at perivascular locations. The count of gamma/delta T-cells was high in connective tissue of RAU (200 +/- 126 cells/mm2) compared with connective tissue of controls (4+/-4 cells/mm2; P<0.0001) or non-lesional mucosa (5+/-7 cells/mm2). Interestingly, the density of gamma/delta T-cells was also high in the epithelium of RAU (70+/-34 cells/mm2) compared with the epithelium of non-lesional mucosa (2.8+/-06 cells/mm2; P<0.0001) or epithelium of healthy controls (1.2+/-1.5 cells/mm2; P<0.0001). Moreover, the mean percentage of gamma/delta+ T-cells among total CD3+ lymphocytes was increased in the connective tissue area from 4% and 5% in controls and non-lesional mucosa, respectively, to 19% in RAU. In epithelial areas, the average percentage was increased from 2% and 6% in controls and non-lesional mucosa, respectively, to 36% in RAU. These data showed that gamma/delta T-cells are more numerous in RAU lesions and such an increase was purely restricted to RAU inflammatory areas.

Objective: Although all-cause mortality and coronary heart disease (CHD) mortality is declining in Sweden, as in most other countries in the industrialised world, we have limited information about the distribution and trends of mortality in deprived and affluent neighbourhoods., Design: This study analyses the extent to which the decline in all-cause mortality and CHD mortality (over the age range 25-74 y) differs between affluent and deprived neighbourhoods during the decade 1984-1993. Incidence density ratios (IDR), estimated by Poisson regression, were calculated for small areas, grouped into population deciles, by both the care need index (CNI) and the Townsend deprivation score. On average, there were about 14 500 residents and 560 deaths in each decile over the period., Setting: A large Swedish city., Main Outcome Measures: All-cause mortality and mortality from CHD., Results: The most deprived neighbourhoods had the highest IDR for all-cause mortality and CHD mortality. Over the period from 1984-1988 to 1989-1993 there was an overall decrease in all-cause mortality and CHD mortality, which was significantly higher in the most affluent areas. The mortality ratios for the most deprived neighbourhoods were almost three times higher than those of the most affluent areas., Conclusions: People liviing in more affluent neighbourhoods have had the benefit of most of the last decade's decline in CHD mortality.

Background: Although it is well known that analgesics contribute to suicide, there is little knowledge about how much of the mortality and suicide can be explained by socioeconomic deprivation or by sales of analgesics., Methods: This ecological study analyses the relationships between the sales (defined daily doses per 1000 inhabitants per day) of dextropropoxyphene, dextropropoxyphene combinations, paracetamol, codeine and paracetamol combinations, and other codeine combinations and the Swedish UPA (underprivileged area) score, mortality and suicide rates in 33 municipalities in Skåne in 1987 and 1994 for people aged 20-64 years. The association of each of the subgroups of analgesics with all-cause mortality, and with standardised mortality rates for suicide, adjusted for UPA score, was investigated by using weighted (by population size) regression analysis., Results: In 1994 there was a moderate to strong significant correlation between sales of analgesics and UPA scores, mortality and suicide (r = 0.49-0.78). Although UPA score explained 68.9% and 67.4% respectively of the variance between the analgesics and all-cause mortality and suicide, codeine and paracetamol combinations explained a further 10.1% of the variance in suicide. Dextropropoxyphene and codeine and paracetamol combinations explained an additional 3.8% and 2.9% respectively of the variance in mortality., Conclusions: Local prescription rates for analgesics were associated with mortality and suicide, when adjusted for socioeconomic deprivation defined as UPA score.

Oral lichen planus (OLP) carries a very small probability of becoming malignant. Our Finnish series comprised eight patients suffering from OLP and concurrent or subsequent oral squamous cell carcinoma over a 10-year period. The mean interval between the histologically suggested initial diagnosis of OLP and carcinoma was 3.4 years. An oral ulcer as a clinical manifestation of malignant change appeared in seven of these eight patients; five of the eight died of carcinoma on average 13 months (range 7-20) after the final squamous cell carcinoma diagnosis. These eight patients were compared to eight control OLP patients without malignant transformation matched as to follow-up time, age, gender, sites of the lesions, etc. We could discover no histological features leading to malignant development. However, the clinically unilateral atrophic/erosive type of OLP more often preceded the malignant change, compared to the situation for control patients, in whom the most prevalent type was the bilateral reticular OLP. However, the probability seems to be very small.

Thirty-seven samples of oral mucosa were analysed and divided histologically into groups of normal mucosa (6), hyperplastic lesions (6), dysplastic lesions (14), and squamous cell carcinoma (11). All lesions displayed some expression of c-erbB-2 but the distribution and intensity of expression varied strongly according to the differentiation. The lower the epithelial differentiation of the sample, the higher the expression of c-erbB-2 oncoprotein showing very strong staining in carcinoma samples. This suggests that in oral carcinoma, transformation might be related to c-erbB-2 interaction.

This study aimed to examine two indices of need, the underprivileged area (UPA) score and a Swedish Care Need Index (CNI, in Swedish vårdbehovsindex) with weightings from British and Swedish GPs respectively, and an index of material deprivation, Townsend score at SAMS (Small Area Market Statistics) level and at municipality level for the whole of Sweden. One third of primary health care physicians from the whole of Sweden received a questionnaire about their workload. CNI, UPA and Townsend scores were calculated using information from the Swedish census of 1990 and the registers of unemployment and migration for 1992. The Swedish GPs weighted some of the variables quite differently from the GPs in the UK. This may be important, especially at the SAMS level. The GPs in both countries considered that older people living alone contributed most to their workload. However, in Sweden the physicians ranked foreign-born people high compared with the English doctors, and in England the GPs ranked children under five years much higher than the doctors in Sweden. The correlation between the scores was high.

Objective: Epidermal growth factor (EGF) and transforming growth factor-alpha (TGF-alpha) affect cells through binding to a shared EGF receptor (EGF-R), which is a transmembrane protein with tyrosine kinase activity. They exert trophic effects on vascular endothelial, salivary acinar, and ductal and mucosal epithelial cells. In Sjögren's syndrome (SS) focal sialadenitis leads to salivary gland tissue damage, diminished salivary flow, and changes in the oral epithelium, a complex referred to as xerostomia. We compared the localization of EGF, TGF-alpha, and EGF-R in labial salivary glands in SS and in healthy controls., Methods: Labial salivary gland tissues of 12 patients with SS and 7 healthy controls were stained with the immunohistochemical peroxidase-antiperoxidase method for EGF, TGF-alpha, and EGF-R., Results: Immunoreactivity for both EGF and TGF-alpha was found in endothelial cells of blood vessels and in some ductal epithelial cells. TGF-alpha, but not EGF, was also found in some acinar cells. EGF-R was found in endothelial, acinar, and salivary duct epithelial cells. There was no difference in the expression of EGF-R between diseased and healthy specimens, but both EGF and TGF-alpha were diminished in SS., Conclusion: The interrelated localization of EGF-R and its ligands, EGF and TGF-alpha, suggests an autocrine, juxtacrine, and paracrine mitogenic/trophic role for them and thus a role in the maintenance of the secretory and excretory cells of the normal salivary glands. The trophic effects on acinar cells seem not to be mediated by EGF, but more likely by TGF-alpha. The diminished expression of EGF and TGF-alpha indicates a failure of this trophic system in SS, which may contribute to the acinar atrophy and secondary changes thereof, including atrophy of the oral mucosa.

Lymphocytes bearing T cell receptor (TcR) gamma/delta are increased in the jejunal mucosa of patients with dermatitis herpetiformis (DH) and coeliac disease. In this study, we examined whether increased numbers of gamma/delta TcR positive lymphocytes occur in the oral mucosa of patients with DH. Oral and jejunal mucosal biopsies were taken from 13 newly diagnosed and 13 gluten free diet (GFD)-treated patients with DH. Monoclonal antibodies and avidin-biotin peroxidase method was used for staining, and TcR positive cells were counted from the buccal and jejunal epithelium. Very few gamma/delta TcR positive lymphocytes were seen in the buccal epithelium of untreated or GFD-treated DH patients (median 0.4 and 0.3 cells/mm2), whereas alpha/beta TcR positive lymphocytes were frequent in both groups of DH patients (154 and 250 cells/mm2) and healthy controls (135 cells/mm2). The numbers of gamma/delta TcR positive intraepithelial lymphocytes were significantly increased in the jejunum of both untreated (43 cells/mm) and GFD-treated (27 cells/mm) DH patients compared to control patients (2.2 cells/mm). The present study did not, therefore, disclose any evidence for active recruitment of gamma/delta TcR positive lymphocytes in the oral epithelium, but showed substantial amounts of intraepithelial alpha/beta TcR positive lymphocytes both in DH patients and healthy controls.

Tongue abscesses are extremely rare. Two cases caused by periodontal pathogens are presented.

Serum IgA class antigliadin antibodies (IgA-AGA) are increased in untreated patients with coeliac disease and dermatitis herpetiformis (DH), and it has been suggested that salivary IgA-AGA measurements could be used as a non-invasive screening test for gluten-sensitive enteropathy. In the present study salivary and serum IgA-AGA were measured by an ELISA test in 10 untreated patients with DH. The results were compared to IgA-AGA levels in nine patients with DH on a long-term gluten-free diet (GFD) and in 20 healthy control subjects on an ordinary diet. The mean serum but not salivary IgA-AGA concentrations were significantly higher in the untreated than in the patients with DH on a long-term GFD. When the 10 untreated patients with DH adhered to a GFD for 3 months, the rash disappeared and the mean serum IgA-AGA decreased to normal levels, but no change was found in the mean salivary IgA-AGA concentration. These results show that serum but not salivary IgA-AGA measurements are suitable for monitoring GFD treatment in patients with DH. The discrepancy between the serum and salivary IgA-AGA concentrations suggests that systemic and salivary IgA-AGA responses are controlled separately.

Objective: The presence and spatial distribution of peptide-containing nerves in labial salivary glands from 10 Sjögren's syndrome patients were compared with those in salivary glands from 7 healthy controls., Methods: Immunoperoxidase staining was used to demonstrate vasoactive intestinal peptide (VIP)-immunoreactive (IR) fibers, postganglionic sympathetic fibers containing the C-flanking peptide of neuropeptide Y (CPON), and sensory fibers containing calcitonin gene-related peptide (CGRP) and substance P., Results: Acini, intralobular ducts, small arteries, and postcapillary veins were richly innervated by VIP-IR fibers, whereas CPON-, CGRP-, and substance P-IR fibers were restricted to blood vessels. Peptide-containing nerves were found surrounding, but not in the middle of, the highly inflamed mononuclear cell areas., Conclusion: This topologic distribution suggests involvement of VIP-IR fibers in vascular, motor, and secretory components of the reflex salivary secretion, whereas the distribution and the vasoactive actions of CPON, CGRP, and substance P suggest a role in the regulation of the salivary gland circulation, and thus of transcapillary flow. Excessive release may contribute to a neurogenic inflammation. Local depletion and absence of trophic neuropeptide stimuli may contribute to acinar atrophy.

Glandular secretion and integrity, local blood flow, salivary secretion, pain perception and neurogenic inflammation can all be controlled by the nervous system. Therefore, the pattern of innervation of labial salivary glands (LSG) was studied in 10 patients with Sjögren's syndrome using neuronal markers: protein gene product 9.5 (PGP 9.5), a cytoplasmic, noncytoskeletal epitope and synaptophysin, a glycoprotein present in presynaptic vesicles. PGP 9.5 immunoreactive nerve fibers were found surrounding the acini, salivary ducts and blood vessels. The rich innervation of LSG was even more evident in immunofluorescence stained sections analyzed using confocal laser scanning imaging. Synaptophysin immunoreactive nerve endings and preterminal varicosities also demarcated the LSG acini. Furthermore, in the small foci, PGP 9.5 and synaptophysin immunoreactive nerve fibers were found amid inflammatory mononuclear cells and in extensive inflammatory areas nerve fibers were found in the peripheral parts of such infiltrates. This suggests a possible neurogenic influence on the local cellular inflammation. When LSG patient samples were compared to unaffected glands from 7 controls, acinar atrophy was found in the areas devoid of a local delivery system of neurogenic trophic stimuli, suggesting this as a possible cause of glandular degeneration. It may become necessary to incorporate this neglected, but existing system into our current view on the local but possibly centrally controlled or influenced pathogenetic mechanisms of Sjögren's syndrome.

Tissue lesions from eight patients with recurrent oral ulcers (ROU) were subjected to detailed immunohistopathologic studies. In five patients, a specimen of an unaffected area from the opposite site was obtained. The main inflammatory cells in situ were CD3 positive T lymphocytes, with CD4 cells forming approximately half (range 30-60%) and CD8 cells 20% (range 10-30%) of all cells. CD19 positive B lymphocytes formed 5-12% of all cells. Furthermore, 45% (range 15-65%) of all lymphoid cells had signs of previous antigenous contact and had helper/inducer CDw29 type. Suppressor/inducer CD45R cells formed only about 20% (range 7-50%) of all cells. Although this observation suggests involvement of antigen as a causative and/or triggering stimulus, elements of a non-specific inflammatory response were observed as well. Endogenous peroxidase-positive neutrophils were present at the ulcer site, and were occasionally observed intravascularly and in the extracellular matrix in areas characterized by inflammatory mononuclear cell infiltrates. Although the proportion of endogenous peroxidase-positive, recently recruited monocytes was low, CD11b and nonspecific esterase-positive mature tissue macrophages formed about 14% (range 5-35%) of all inflammatory cells in situ, particularly at the periphery of the lymphoid cell infiltrates. Mast cells were also observed in all samples studied, forming 2-5% of inflammatory cells in the richly vascularized connective tissue beneath the basement membrane. In the specimens from clinically unaffected areas, inflammatory cells were rare. Our observations stress the multifaceted nature and participation of multiple effector systems in the local tissue pathogenesis of ROU.

The records were analyzed of 106 patients with sports-related dental traumas treated in 1983 at the public oral surgery unit in Helsinki, Finland; 51 were examined six years after injury. The mean age was 11.8 years (range 7-24 years). The woman/man ratio was 1:3. In 39% of cases, the injuries had arisen from ice hockey or skating; 30% happened during school hours; 80% were uncomplicated crown fractures, concussions or subluxations. During the six-year follow-up, of 80 teeth in 51 patients, root resorption was found in 6 teeth (7.5%), periapical lesions were noted in 2 teeth (2.5%), and obliteration of the pulp was seen in 4 teeth (5%). Three teeth (3.7%) had suffered loss of vitality. The pulp had been extirpated in 13 of the traumatized teeth (16%). In all, 13.7% of the patients were found to have complications six years later. The results showed that long follow-up periods are needed after dental injury.

In this study, lysozyme mRNA in labial salivary glands has been localized with in situ hybridization technique using 35S-labeled hen lysozyme cDNA (cDNALZM) as a hybridization probe in normals and in patients with Sjögren's syndrome, 35S-DNALZM:mRNA hybrids were detected only in acinar serous cells, although lysozyme was identified in ductal cells using immunohistochemical techniques. Our results suggest that the serous acinar cells are the only site of lysozyme synthesis in small salivary glands. The presence of lysozyme in ductal cells may be a result of reabsorption from the saliva or concentration from the blood or surrounding tissues.

Labial salivary gland (LSG) biopsies from 13 patients were studied. Three were normal glands, five showed fibrosis induced by progressive systemic sclerosis (PSS) and five more had PSS-induced fibrosis combined with and focal sialadenitis compatible with Sjögren's syndrome (SS). Monoclonal antibodies to proline-4-hydroxylase (alpha PH or 5B5-A) and the carboxyterminal domain of human type I procollagen (alpha pC or M-38) were used as fibroblast markers. Immunostaining was done with avidin-biotin-peroxidase complex (ABC). Using various sample controls (including cultured fibroblasts and specimens enriched for lymphocytes, plasma cells, granulocytes, monocytes and dendritic cells) as well as analysis of various LSG resident cells, the specificity of the alpha PH and alpha pC markers for fibroblasts was established. Cross reactions were only seen with plasma cells and acinar cells containing the beta subunit of PH or disulfide isomerase involved in SS-SH interchange reactions in these secretory cells. All fibroblasts in fibroblast monolayer cultures at their logarithmic phase of growth stained with the fibroblast markers studied, but false negative staining was seen with resting, mature fibroblasts in dense connective tissue in LSG sections. Therefore, it can be concluded that proline 4-hydroxylase and the COOH-terminal domain of type-I procollagen both indicate fibroblast involvement in collagen (type l) synthesis and thus identify active but not resting fibroblasts. PH+ fibroblast-like cells and pC+ fibroblasts were both more frequent in PSS LSGs than in normal glands, suggesting active local fibroblast involvement in PSS.(ABSTRACT TRUNCATED AT 250 WORDS)

The ultrastructure of oral lesions in 6 patients with erythema multiforme (EM) and of one apparently clinically healthy oral mucosa in one patient with recurrent EM during remission is described. Alterations were observed in epithelium, basal lamina and lamina propria. Both intercellular and intracellular oedema, intracellular vacuolization, decreased numbers of desmosomes, and also loss of cytoplasmic organelles and occasional nuclei were noted in the epithelium. Inflammatory cells--mainly lymphocytes--were found intra-epithelially. Several discontinuities together with some evidence of duplication of the basal lamina were seen in five of the six lesional mucosa specimens. The inflammatory infiltrate in the lamina propria consisted mainly of lymphocytes, although plasma cells, neutrophilic and eosinophilic leukocytes, macrophages and mast cells were also found. Some of the mast cells were partly degranulated. The apparently clinically healthy oral mucosa in the patient with EM in remission showed mild inflammatory changes. The changes observed in the lesional mucosa in EM are thus according to our study mostly non-specific inflammatory alterations and are not pathognomonic for EM.

Herpes simplex virus (HSV) antigens were sought in 15 biopsy specimens from both lesional mucosa and clinically healthy looking oral mucosa between attacks in patients with erythema multiforme (EM). Four of the eight biopsy specimens obtained from lesional EM mucosa stained positively with HSV-1-and/or HSV-2-specific antisera applied in direct immunoperoxidase staining. Of the 16 tissue specimens used as controls, two displayed positive staining with HSV-1 and/or HSV-2. Five of the seven biopsy specimens from macroscopically healthy oral mucosa obtained between attacks from patients with recurrent EM stained positively with HSV-1 and/or HSV-2. Of the six tissue specimens used as controls, three stained positively. Most of the local inflammatory mononuclear cells belonged to the T cell series, mainly to the CD-4 subset. A small proportion of the local T cells were blast transformed as assessed by CD-25 expression and [3H]thymidine incorporation. This, together with the findings showing a lower degree of activation in the biopsy from macroscopically healthy looking mucosa between attacks suggest an active role of the cell-mediated immune response in the genesis of oral lesions in EM. The persistence of HSV antigens, and the well-established role of HSV as a precipitating factor in recurrent EM, suggest that HSV may be involved, but since HSV seems to be present in other mucosal lesions as well as in clinically healthy mucosa, quite frequently an additional, hitherto unknown factor must be present in order that EM may occur.