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Purpose:to compare gadolinium-enhanced magnetic resonance angiography (Gd-MRA), digital subtraction angiography (DSA) and duplex of the iliac arteries with intra-arterial pressure gradient measurement as the reference method. Materials and methods:Gd-MRA, DSA and duplex examinations of the iliac arteries were performed in 30 patients (60 arteries) with lower-limb arterial occlusive disease. In 29 arteries, pressure measurements were made (n=25) or the artery was found to be occluded on catheterisation (n=4). An aortofemoral peak systolic pressure gradient of 20 mmHg or more was regarded as haemodynamically significant. Stenoses with a diameter reduction of 50% or more on MRA or DSA, or an increase in peak systolic velocity greater than 150% (duplex) were considered significant. MRA examinations were evaluated by means of maximum intensity projections (MRA-MIP) and using source images and curved multiplanar reconstruction (MRA-MPR). Results:the sensitivity (specificity) for a significant iliac artery stenosis were 81% (75%) for MRA-MIP, 76% (75%) for MRA-MPR, 86% (88%) for DSA, and 72% (88%) for duplex. Conclusion:with intra-arterial pressure measurements as the reference method, similar results were achieved with Gd-MRA, DSA and duplex concerning the detection of haemodynamically significant iliac artery stenoses. The use of source images and multiplanar reconstructions resulted in higher accuracy for the detection of occlusions.

We analyzed the four class II loci DPB1, DQB1, DQA1 and DRB1 and two microsatellites located close to the TAP1 (25530.5, 26610.3) and TNFα (IR2/4) loci in a Finnish patient cohort comprising twenty-one Finnish multiplex families with 2–6 affected individuals per pedigree. Association analyses, parametric linkage analyses and TDT analyses all suggest that a MS susceptibility locus is to be found in the class II DQ, rather than the DP and DR, subregions. The particular locus involved in the DQ region could not be pinpointed, either due to the strong genetic disequilibrium among loci or the involvement of either of several alternative loci in disease development.

Pfeiffer's Short Portable Mental Status Questionnaire (SPMSQ) is a brief screening test for organic brain syndromes. The validity of the SPMSQ was evaluated in a random sample of 119 community residents and 282 consecutively admitted medical inpatients. The SPMSQ proved to be a sensitive and specific screening test for moderate to severe dementia both in the community and hospital. Using the cut‐off point (number of errors accepted) of three errors, the sensitivity of the test was 86.2% and the specificity 99.0% among medical inpatients. The percentages in the community sample were 66.7% and 100%, respectively. The validity of the SPMSQ was not as good for delirium because of its variable clinical picture. For screening purposes lower cut‐off points than previously recommended should be used: three errors for dementia and two errors for delirium. Among Finnish elderly people it was not necessary to use correction for education in the SPMSQ.

The leucocyte count, total protein, albumin, IgG, IgA and IgM content of the cerebrospinal fluid (CSF) of 103 multiple sclerosis (MS) patients was determined. In 54 cases a simultaneous analysis of serum was also carried out. As a sign of an intact blood brain barrier the albumin concentration was normal in 76.7%. Taking into account the relative IgG quotient in CSF and serum, and the albumin and IgG concentration gradients between CSF and serum, it was possible to reveal an elevation of IgG content in CSF of MS patients in 75 and 83%, respectively. Without a simultaneous analysis of serum this was the case only in 51.5%. In MS cases with an intact blood brain barrier the values for IgA and/or IgM were slightly elevated in 11.7%. This study demonstrates analytic methods, which support the hypothesis of IgG synthesis by cells accumulating within the CNS in MS. A correlation of the laboratory results and clinical manifestation of MS was tried. Bei 103 Multiple Sklerose (MS)-Patienten wurden Zellzahl und Proteinkonzentrationen (Gesamteiweiß, Albumin, IgG, IgA und IgM) im Liquor cerebrospinalis (CSF) gemessen. In 54 dieser Fälle erfolgte eine gleichzeitige Serumanalyse derselben Parameter. Albumin als Indikator einer intakten Bluthirnschranken-Funktion war in 76.7% aller CSF normal. Unter Berücksichtigung von relativen IgG-Konzentrationen in Serum und Liquor und von Konzentrationsgradienten des Albumins und IgG zwischen Liquor und Serum war IgG in 75 bzw. in 83% der Fälle pathologisch vermehrt. Bei alleiniger Analyse von CSF war diese Konstellation nur in 51.5% nachweisbar. Eine geringgradige Vermehrung der IgA- und/oder IgM-Konzentrationen war bei intakter Bluthirnschranken-Funktion nur in 11.7% feststellbar. Die Arbeit demonstriert analytische Methoden, mit denen eine Abgrenzung solcher CSF-Immunglobulinkonzentrationen möglich ist, die bei dieser Krankheit von Zellen synthetisiert werden, die sich im Zentralnervensystem anreichern. Eine Korrelation der Laborparameter zu klinischen Daten wurde versucht.

Injuries occuring among 457 licensed floorball players in teh Swedish National League were analysed prospectively during the season from 1993 to 1994. Fifty‐one (11%) players sustained 58 injuries. The majority (76%) of the injuries were due to trauma mostly during the game (55%). Twenty‐three (52%) of the traumatic injuries were caused by an opponent or a stick. Ankle sprain (35%) was the most common diagnosis. Injury severity classified with regard to time of absence from sport participation were similarly distributed for minor (36%), moderate (29%) and major (35%) injuries. The total rate of injury was 2.5 per 1000 hours for female and 2.6 for male players. Although this rate is lower than for contact sports like soccer and ice‐hockey, we feel that further investigation of floorball injuries and improvement of protection devices would be valuable.

There is some evidence that the incidence of malignant neoplasms in the central nervous system of patients with multiple sclerosis (MS) is more infrequent than among the general population. The examination of 3 MS cases with different type of neoplasms in the central nervous system revealed mainly inactive demyelinated plaques. These plaques and the neoplastic lesions were dispersed diffusely and coincidentally all over the brain and spinal cord. The benign course of MS in all three cases is discussed in relation to the malignant diseases.

The serological responses of 195 multiple sclerosis (MS) patients and 251 controls were tested against 6/94-parainfluenza virus, which was previously isolated from brain tissue of two patients with MS. The hemagglutination-inhibition titers of =1:128 were found more frequently in MS patients (21.5%) than in controls (14.0%). However, the geometric mean titers did not differ between these two groups. The present study concludes that a causal relationship of 6/94-virus to MS, based on a specific immune response, is improbable, although it does not exclude the possibility of a pathogenetic significance of the agent in the cases from which the autopsy material was derived.

The presence of measles cytotoxic (CT) and hemagglutination inhibiton (HI) antibodies in 195 multiple sclerosis (MS) patients and 251 controls was tested. The measles virus Lu carrier cells labeled with 51Cr were exposed to serum specimens in the presence of complement in order to test the presence of CT antibody. The analysis of complement dependent CT antibodies against measles virus revealed significantly (P<0.01) higher titers in MS patients than in the control group. However, the measles HI test failed to show this difference. Measles CT titers =1:32 among MS patients occured in 54.9% and in 35.5% among the controls. In comparison with this the HI method revealed measles titers =1:128 more often in the control group than in MS cases (27.9 and 17.9%, respectively). The presence of CT antibodies against measles virus in MS proves that these patients have a functional defence mechanism to eliminate virus infected cells. The high measles antibody titer among MS patients could be due to recurrent antigenic stimulation caused by measles virus persistency. Whether this virus persistency plays a role in MS can not be decided on the available data.

During the period 1984-1985 amputation of the lower limb at a level potentially requiring a prosthesis was performed on 577 patients in 16 operative units. The mean age was 75.7 years for females and 68.1 for males. The most common site of the amputation was above the knee (49.9%). The majority of amputations (93.8%) were performed for vascular diseases and diabetes. Survival figures showed that 25.5% of amputees died within 2 months of amputation, 60.7% were alive after one year and 43.2% after two years. Out of a total of 577 patients, 26.9% were fitted with a prosthesis. Out of below-knee and above-knee amputees surviving over 2 months, 61.5% and 27.2% respectively were fitted with a prosthesis. There were markedly fewer prosthetic fittings in the over-60 age group. Diabetic patients of both sexes were fitted with a prosthesis more often than arterio-sclerotic patients. Among tumour patients 82.4% received a prosthesis. In the study area more emphasis must be put on the concept of preserving the knee joint and preoperative assessment of vascular patients for selection of amputation level. Every effort must be made to avoid delay in the postoperative mobilization and rehabilitation. Prosthetic fitting of amputees could be improved by better liaison between surgical unit and specialized rehabilitation unit and by closer team approach of amputee care.

Coronal slices of three fetal MRIs performed post mortem and 37 performed in utero, all without intracranial pathology, was assessed. Progress of the hippocampal inversion was analyzed, the left and right sides were compared and occurrence of the collateral sulcus was revealed. The fetuses in the post mortem examinations were at gestation weeks (GW) 17–18 and in the in utero examinations at GW 19–35. The symmetric development of the hippocampal sulcus was revealed in 26 subjects and asymmetric in 14. The non-ovoid hippocampal formation could be evaluated at GW 24 at earliest and an ovoid hippocampus at GW 29. The collateral sulcus could be recognized at GW 17 in post mortem and at GW 22 in in utero examinations. From GW 29 onwards it was seen in all fetuses and it was symmetric in all but one case. Evaluation of the hippocampi is difficult on fetal MRI, especially in in utero examinations. The hippocampal development is not fulfilled at GW 21 as presumed. There is a wide temporal variation in the development of the hippocampal region, and the developmental process does not progress simultaneously in the right and left side of the same individual.