Incidence Of Secondary Disease Research Articles

Qualität der Versorgung chronisch Kranker in Deutschland

Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term.

Differential Diagnosis Between Complete and Partial Mole by TSSC3 Antibody Completely Correlates to DNA Diagnosis

Complete hydatidiform moles (CHMs) are a type of androgenetic fertilization without an ovum. Cases of CHM exhibit a generalized swelling of the villi and are known to be highly associated with persistent disease or carcinoma. In contrast, partial hydatidiform moles (PHMs) also show characteristic hydropic changes among the villi, but the incidence of secondary disease is relatively low. Because PHMs are fertilized by one ovum and two sperm and CHMs are fertilized by one or two sperm alone, we considered whether or not maternally imprinted genes might be useful for achieving a differential diagnosis. The validity of the imprinted genes in CHMs was assessed by implementation of a microarray technique. Among the genes examined, TSSC3, SLC22A1L, KCNQ1, and Decorin were shown to be down-regulated, and TSSC3 was the most markedly suppressed of these genes. In this study, 20 cases of CHM, the diagnosis of which was confirmed by DNA polymorphism, were investigated. In all of these cases, the expression of TSSC3 was completely absent, as determined by Western blot analysis. Conversely, 12 cases of PHM, also diagnosed by DNA polymorphism, were examined here; in all of these 12 cases, TSSC3 was found to be expressed normally. Immunohistochemical (IHC) analysis also produced the same results. The complete silencing of TSSC3 in cases of CHM will provide a novel, convenient strategy for the diagnosis of molar lesions in the placenta.

小児浸出性中耳炎の予後と乳突蜂巣発育度

We examined 858 ears of children aged 3 to 15 years to determine whether or not the prognosis of otitis media with effusion could be predicted from the degree of pneumatization. The area of the cellulae was determined by the square area technique, from X-ray films taken according to the method of Schüller. Four areas were considered: below 6cm2, 6-10cm2, 10-15cm2 and over 15cm2.When the area was over 15cm2, the disease was healed in nearly all ears, and rapid healing (within one year) was observed in 55%. When the area was 10-15cm2, the rate of healing was over 90%. When the area was 6-10cm2, the incidence of complication by secondary disease was 7%, and the percentage of ears requiring treatment for 5 years or longer was 8%, although the final rate of healing was close to 90%. But the area was 6-10cm2 at ages over 10 years, the incidence of secondary disease was 28%. When the area was below 6cm2, healing took even longer, and the incidence of secondary disease rose sharply to 26%, although the final rate of healing was 60%. But the area was below 6cm2 at ages over 10 years, the incidence of secondary disease was as high as 64%.These results suggest that patients with a cellula area below 10cm2 require careful treatment, and that those whose cellulae increase during the follow-up period tend to have a better prognosis.

Inhibition of growth and spontaneous metastasis of syngeneic transplantable tumors by an aromatic retinoic acid analogue. 1. Relationship between tumour immunogenicity and responsiveness.

Aromatic retinoic acid analogues selected for their favourable therapeutic ratios were tested for their effects on the growth (in vivo and in vitro) and spontaneous metastasis of a variety of murine sarcomas and carcinomas. Ro 10-1670 (a trimethylmethoxyphenyl analogue of retinoic acid) was used in in vitro studies, while its corresponding ethyl ester Ro 10-9359 was used for oral administration. Four of six fibrosarcomas, one of three squamous cell carcinomas, and one of five mammary adenocarcinomas responded to retinoid treatment in vivo by reduced growth rates (first detectable after 8-10 days), and in some cases by complete regression. The magnitude of the response was directly proportional to tumour immunogenicity, and eight tumours which failed to respond to retinoids did not evoke detectable transplantation immunity in syngeneic recipients. Retinoid administration did not significantly inhibit the development of spontaneous metastasis of non-immunogenic tumours, but decreased the incidence of secondary disease in the case of tumours of moderate immunogenicity. In vitro, retinoid treatments were generally without significant effects on tumour cell growth rate or morphology, and where growth inhibition was obtained it did not correlate with in vivo tumour responsiveness. No evidence of increased differentiation of retinoid-treated tumours was obtained either in vitro or in vivo. Taken together, the data suggest that in the 14 transplantable syngeneic tumours studied the inhibitory effects of retinoids on tumour growth and metastasis in vivo were mediated indirectly by potentiation of cell-mediated immunity directed against antigenic determinants on the tumour cell surface.

IMMUNOLOGICAL MEMORY IN RADIATION CHIMERAS

Humoral antibody formation in the long-term allogeneic radiation chimera was found to be dependent upon the type and dose of antigen and the degree of secondary disease experienced. The antigen most capable of revealing a defect in the immunological mechanism of these murine chimeras was rat red blood cells (RBC), a phylogenetically closely related antigen. Thus, two different allogeneic chimera combinations, with contrasting incidence and severity of secondary disease, failed to mount significant antibody titers to rat RBC even after repeated immunizations. Sheep RBC and Salmonella typhosa antigens, although evoking a subnormal response after primary immunization, were capable of inducing normal antibody titers after two or more injections. The consistent immunological defect, independent of antigen type, dose, and incidence of secondary disease, was the inability of these animals to show normal conversion from 19 S to 7 S antibody synthesis. On this basis we speculate that the deficiency in the allogeneic chimera lies in the T cell component of the immune system, since 7 S antibody formation has been shown by others to be a thymus-dependent function.

The Pathogenesis of the Secondary Disease After Foreign Bone Marrow Transplantation in X-Irradiated Mice<xref ref-type="fn" rid="FN1">2</xref>

The available information on the pathogenesis of the secondary disease after foreign bone marrow transplantation in irradiated mice is reviewed. Additional experiments are reported. The incidence of secondary disease after foreign bone marrow transplantation in mice was studied in various host-donor combinations after irradiation at three dosage levels. A characteristic secondary mortality was observed in CBA mice that received isologous bone marrow after the larger doses of x rays. Secondary mortality did not occur in F/sub 1/ hybrid mice that received isologous bone marrow, but severe diarrhea developed after the higher doses of x rays when followed by treatment with parental-strain bone marrow. In mice treated with rat bone marrow the development and persistance of symptoms of secondary disease was correlated with the presence of a functional rat bone marrow. Skin lesions and vasting, typical of secondary disease, as well as a high rate of mortality were observed in F/sub 1/ mice after the establishment of a parabiotic junction with a parental strain mouse of the same sex and age. Evidence has been provided in support of the hypothesis that the secondary disease in mice treated with foreign bone marrow is due to the combined effects of late radiation damage,more » an immunological reaction of the graft against the host, and an impaired immunological defense against microorganisms. (auth)« less