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We have applied cluster analysis methods to forty-nine laboratory and clinical characteristics (including 26 HLA-A, B antigens) observed in 196 Graves' disease patients. Three subgroups could be identified: group I (seventy-nine patients) had small goitres, low indices of autoimmunity and a tendency to remission with medical treatment; group IIa (twenty-nine patients) had clinical and laboratory features of 'Hashitoxicosis'; Group IIb (eighty-four patients) had a high incidence of ophthalmopathy, familial aggregation, marked evidence of autoaggression and a tendency to relapsing hyperthyroidism. The prevalence of HLA-B8 was 8.9% in group I, 20.7% in group IIa and 86.9% in group IIb. This study demonstrates that Graves' disease can be subdivided using cluster analysis into clinically relevant subgroups which are further distinguished by their correlation with HLA-B8. Possible immunological bases for these observed patterns are discussed.

We have typed 196 patients with Graves' disease from eastern Hungary (an iodine-deficient region) for HLA-A, -B, and -C antigens and 80 of the same patients for HLA-DR antigens. Our data confirm the previously described association of HLA-B8 and DR3 with Graves' disease, particularly in patients with ophthalmopathy. We also describe several new findings: an increase in the prevalence of HLA-BW35, particularly in combination with B8, among patients with ophthalmopathy and a slight increase in the prevalence of B8, DR7 among patients with ophthalmopathy. These results support the concept that MHC-linked susceptibility to Graves' disease is dose-dependent. Our results do not confirm a report suggesting that the prevalence of HLA-DR5 is increased among patients without ophthalmopathy in iodine-deficient areas: we found that the prevalence of HLA-DR5 was slightly decreased among patients with Graves' disease, with and without ophthalmopathy, in comparison with controls.

A group of 67 juvenile insulin dependent diabetic patients and their 167 healthy first degree blood relatives were HLA-typed. In the patients the frequency of HLA-A9 and B8 antigens was significantly increased as compared to healthy controls, while in the family members only the presence of HLA-B8 was significantly increased. All diabetics carrying HLA-B8 antigen had frequently higher 125I-insulin-antibody complex levels than those lacking the antigen. Prevalence of some autoantibodies to human thyroglobulin, microsomal thyroid and antigastric mucosa antigen were investigated and compared to healthy controls. Increased antibody titres were more frequent in diabetics and their blood relatives than in the healthy controls, and more frequent in those carrying the HLA-B8 antigen than in those lacking it.

In an Eastern Hungarian population of patients, we sought to confirm an association with IgG heavy-chain allotypes (Gm) with Graves' disease. We found an increase in the phenotype fb (chi 2(1) = 4.7, p less than 0.05) among the patient group compared to controls. The influence of Ig-linked genes to Graves' disease susceptibility is, thus, dose-dependent. We found no interaction between fb homozygosity and HLA-DR3 positivity in Graves' disease susceptibility.

For 75 patients with systemic lupus erythematosus (SLE), 39 laboratory and clinical characteristics, including HLA-A, B, C and DR typing, were analysed using a cluster analysis technique. Three groups were identified. Group I (46 patients) was characterized by infrequently severe disease, good response to therapy and infrequent multisystem involvement. Group II (24 patients) was characterized by a severe course of disease (although the tendency to remit after therapy was not unusual), and frequently, renal involvement and pericarditis. Group III (5 patients) was characterized by more severe renal disease. Of the 75 patients studied, 38.7% possessed HLA-DR3, compared to 17.4% of controls. Group I patients did not differ from controls but 80% of Group II patients and 4/5 Group III patients had DR3. Cluster analysis identifies subsets of SLE patients who show marked differences in disease course and severity, correlated with possession of the HLA B8, DR3 phenotype.

15 patients presented with cervical spine dislocation and kyphotic spondylosis due to traumatic fracture and vertebral body tumour underwent surgical decompression and fixation via the anterior approach in one stage. Decompression was achieved by resection of the body of the vertebra while fixation meant implantation of iliac bone graft with metal plate fixation. Early reduction of the dislocation was impossible or insufficient in most of the cases. Therefore the majority of operations were "late decompression". Patients with root or partial cord lesions had the most significant improvement. In some selected cases, however, who suffered from a total cord lesion due to C6 or C7 fracture-dislocation, surgical decompression of the C7 and/or C8 roots by resection of the C6 or C7 vertebral bodies could lead to useful motor improvement in the hands and the fingers.

In the literature the authors found reports about 18 concordant and 1 undoubtedly discordant case of ankylosing spondylitis. We describe a 34 year old male pair of twins: one of them has suffered from this disease for 12 years, while the other has had no problems. The interesting point of this case is that at present the twins are living together. Genetic problems are also discussed.

An association of HLA-DR5 and goitrous autoimmune thyroiditis has been reported elsewhere (Farid et al., 1981; Weissel et al., 1980). Recently, the disease was found to be associated with HLA-DR4 in Newfoundlanders (Farid & Thompson, 1986). In order to find out whether different HLA associations with the disease may be found in different ethnic groups, we have now typed 68 patients with autoimmune goitrous thyroiditis from Eastern Hungary for HLA-A, -B, -C, and -DR antigens; 66 of these patients were also typed for IgG heavy-chain markers (Gm). A significant increase in DR3 (OR = 3.30) and a non-significant increase in DR4 (OR = 1.67) were found in the patients when compared with controls. The Gm3 allele, g, interacted with DR3 to enhance the risk for goitrous autoimmune thyroiditis. Hashimoto's disease may show different associations in different ethnic groups, and indeed within the same ethnic group, when newly diagnosed patients are typed several years apart.

Based on experiences over half a year authors found that the introduction of safety belts, beside obvious advantages, resulted in new types of injuries. They describe own experiences and draw attention to heart contusions joining thoracic fractures, and to possible thoraco-abdominal organ injuries with characteristic symptom free or delayed appearance, caused by blount trauma.