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Reliable data on the epidemiology of multiple sclerosis (MS) in Finland are available from 1964 and 1972. They show that the whole country is a high-risk area of MS with clustering in the western part. A reassessment of the prevalence data was carried out in the southern province of Uusimaa and in the western province of Vaasa, the prevalence day being January 1, 1979. The age-adjusted prevalence was 52.9 per 100,000 in Uusimaa and 92.9 per 100,000 in Vaasa, figures that were three times higher than those recorded for the same areas in 1964. The communities with the highest prevalence rates in the province of Vaasa were the same as those in the survey of 1972; some rates exceeded 200 per 100,000. The increase in the prevalence rates may be due to a better registration of MS cases, but it may also represent a true increase, a possibility that only can be answered by further incidence studies.

In a multicenter study the clinical data of 1271 patients with multiple sclerosis (MS) were recorded in a standardized manner and analysed by a computer program. Some of the retrospective data are compared with previous reports. The frequency of optic nerve involvement in the present series was close to the Japanese figures. The development of signs and symptoms during the course of MS was given for the 1271 patients and differences in the reversibility of symptoms are presented. In this study, one of the chief purposes was the selection of groups of MS patients with particular symptomatology and course of the disease for prospective, detailed study. The following groups were selected and are under further investigation: 109 patients with an exclusively spinal symptomatology throughout the course of their disease; 441 patients with optic neuritis as initial symptom; 110 patients with early brain-stem involvement; 64 benign cases (duration of the disease more than 14 years and disability not more than 3 according to Kurtzke), 35 malignant cases (duration of the disease under 5 years and disability grade of 7 or more); 83 families with more than one member with MS; 289 females with a history of pregnancy, childbirth and/or use of oral contraceptives. In 339 patients a lumbar puncture was performed at the present examination. The parameters determined constitute a pathognomonic pattern highly indicative of the diagnosis of MS.

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 greater than or equal to 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 histocompatibility antigens of the A, B and C loci were typed for 32 patients with Alzheimer's disease and 35 controls of the same age. The results were also compared to the distribution of HLA antigens in a series of 900 healthy blood donors. No statistically significant differences were found between the Alzheimer patients and the controls. HLA--Cw1 was found significantly less frequently in the group comprising the patients with Alzheimer's disease and their controls together, than in the younger blood group. This leads us to suggest that an age-matched control group may be needed, at least when the patients are elderly.

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 amoung 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.

Mortality statistics were used to check the previously observed uneven geographical distribution of multiple sclerosis (MS) in Finland, and also to compare the distribution of tuberculosis and MS with each other. In total, 331 MS deaths which could be regarded as deaths primarily due to MS were registered during the period from 1963 to 1971. The mean age at death was 49.9 years. The mean annual mortality rate was 0.8 per 100,000 population. The highest rates due to MS were registered in the western county of Vaasa. The cumulative mortality and birth rates showed a significant accumulation of MS cases to the western county of Vaasa and the southwestern county of Turku and Pori. A previous study revealed a high percentage of familial cases of first-degree kinship in the selected district of Jalasjärvi in the county of Vaasa. The mortality material revealed one additional MS case which raised the familial percentage to 13 among the living patients in this district. Statistics of tuberculosis have shown a constant accumulation of the disease in the western part of the country for more than 100 years. The mean annual mortality rate for tuberculosis was 17.1. The highest rate (23.0) was found in the western county of Vaasa, where the mortality rate (1.34) for MS was highest. Previous immigrant studies in Finland suggest that the uneven geographical distribution of tuberculosis is due to hereditary factors. The population of Finland consists of varying degrees of isolates, and the similarity of the distributions of MS and tuberculosis may thus reflect a common genetic factor in their aetiology.

The epidemiological investigation of multiple sclerosis (MS) in Finland revealed a prevalence rate of 40.3 per 100.000 inhabitants. The geographic distribution of MS was uneven in the country. MS seemed to occur more often in the western and southwestern parts of the country, where the prevalences varied between 51.7 and 62.1 This phenomenon became even more pronounced when the distribution of the disease was investigated in small geographic units. Optic neuritis showed a geographic distribution similar to that of MS, with clustering in the same parts of the country and even in the same narrow districts. The correlation between the birthplaces of MS and optic neuritis patients was very significant (p less than 0.001), which suggest that they share a common aetiology. The possible aetiological role of genetic and exogenous factors was discussed in the western cluster of MS, where the percentage of familial cases was 13 and an accumulation of muscular dystrophy of cattle was observed.

In 15 patients with multiple sclerosis about half of the patients showed decreased gonadotropin and estrogen values in the urine. A control examination of these findings in 19 additional patients showed normal plasma FSH and LH values. Except for one slightly elevated value the prolactin levels were normal in this group.

The epidemiology of multiple sclerosis (MS) was investigated in a small selected area within the western high-risk county of Finland. The investigation was extended to the level of single communes, villages and even houses, together with the search for all familial cases born in this district. The results were compared to those obtained for Helsinki, a city of medium-risk for MS. Prevalences by present domicile that exceeded 100 per 1000,000 inhabitants were recorded in several communes of the western high-risk county. The highest prevalence was 174.2. Seventy patients were born in the small high-risk area. This was 25% of the MS patients born in the whole county and much higher than expected (16%). A positive familial history of another MS patient was recorded in 8 cases (11%). They were all living, first-degree relatives. A similar history was found in only 2 cases (2%) among the 99 MS patients born in Helsinki. The birthplaces of the 123 parents of these 70 MS cases could be confirmed. All villages with high MS frequencies were located along the rivers, running through the area. The birthplaces of the patients showed a similar accumulation to the valleys. No conjugal cases were found. If the preponderance of familial cases in the small high-risk area reflects the role of genetic factors in the aetiology of MS, it is only of polygenic nature. The pronounced clustering of the birthplaces in the small high-risk area and, especially, along the rivers also suggests the importance of environmental influences in early childhood.

Further studies pm yjr rofr,op;phu pg ,i;yo;r dv;rtpdod (MS) IN Finland were carried out in three different types of geographical unit: in counties, combined clerical districts, and single clerical district. For longitudinal studies, the prevalence of MS by present domicile was compared to that by place of birth, and also to the number of MS cases in relation to the number of births. The analysis was based on 1,866 living MS patients. The highest prevalence by present domicile was recorded in the southwestern county of Turku and Pori (52.3 cases per 100,000 inhabitants). It was 39.6 for the whole country. Two separate clusters were found at the level of combined and single clerical districts: one in the western county of Vaasa, and another in the southwestern county of Turku and Pori. The highest prevalences by present comicile were found in two clerical districts of Vaasa (83.5 and 79.7). They also had very high prevalences by place of birth. They lie close to each other, but are not immediate neighbours. Another high-risk focus was revealed in an area of the neighbouring districts of Turku and Pori. In fact, the two highest prevalences by place of birth were found in this region (123.1 and 95.0). The focus extended from the coastal area to the more central region of the county, and further to the western districts of the otherwise medium-risk county of Hme. Thus, two separate foci were found in Finland: one in the western and another in the southwestern part of the country. The clustering became even more pronounced when the prevalences by place of birth were analysed. Considering that the Finnish population still largely originates from genetic isolates of varying degrees, gene enrichment explains the clustering at least partly.

Documented cases of classic amyotrophic lateral sclerosis (ALS) combined with severe dementia are few and come from the isolated populations of the Western Pacific. In this report, three women had a clinically and neuropathologically documented combination of ALS and dementia. In all cases the symptoms and signs of ALS were mainly bulbar. In two of them dementia appeared first, followed by ALS. At autopsy, there was a marked discrepancy between the severe degree of dementia of Alzheimer's type and the sight nonspecific neuropathologic findings without Alzheimer's changes. Our cases bear a close resemblance to recently published Japanese cases. It may be concluded that the combination of sporadic ALS and progressive dementia seems to be a clinical entity without consistent neuropathologic changes and that it also occurs in the western countries.

A response by A. K. Wikstrom and others to a letter to the editor about their article "Random albumin/creatinine ratio for quantification of proteinuria in manifest pre-eclampsia" in the 2007 issue is presented.

Abstract: Two types of refractory bricks were used in reaction tests with slag from a production kiln for iron ore pellet production. Electron microscopy was used to characterize morphological changes at the slag/brick interface and active chemical reactions. Phases such as kalsilite, nepheline and potassium β-alumina form, in a layered structure, as a consequence of alkali metals migration in the brick. Larger hematite grains (50–100μm) in the slag remain at the original slag/brick interface, while smaller grains dissolve and move through the partly dissolved brick bulk, and forms micrometer sized needle-shaped crystals deeper in the lining material. Thermodynamic simulations predict the formation of a solid solution between hematite and corundum which is also observed in the reaction zone after extended time periods. [Copyright &y& Elsevier]

Sexual problems in patients suffering from multiple sclerosis. Lilius, H. G., Valtonen, E. J. and Wikström, J. (Departments of Physical Medicine and Neurology, University Central Hospital, Helsinki, Finland).A questionnaire which allowed anonymous answering and which also included many other questions besides those dealing with sexual life was sent to 302 patients suffering from multiple sclerosis (MS). Sexual life had changed for 91% of males and 72% of females. About half of the patients replied that their sexual life was unsatisfactory or had ceased altogether. These patients were as a rule in a relative poor physical condition. In males, disturbances in erection (62%) were the most common problem, erection was normal in only 20%. In females the essential figures were: loss of orgasm in 33%, loss of libido in 27% and spasticity in 12%. There was no correlation between the incidence of sexual disturbances and the duration of the MS. It seems that the neurological disturbances in sexual life depend simply on the location of the plaques in the central nervous system. [ABSTRACT FROM PUBLISHER]

Purpose: We evaluated in a clinical setting the INTERPRET decision-support system (DSS), a software generated to aid in MRS analysis to achieve a specific diagnosis for brain lesions.Methods: The material consisted of 100 examinations of focal intracranial lesions with confirmed diagnoses. MRS was obtained at 1.5 T using TE 20-30 ms. Data were processed with the LCModel for conventional analysis. The INTERPRET DSS 3.1. was used to obtain specific diagnoses. MRI and MRS were reviewed by one interpreter. DSS analysis was made by another interpreter, in 80 cases by two interpreters. The diagnoses were compared with the definitive diagnoses. For comparisons between DSS, conventional MRS analysis, and MRI, the diagnoses were categorised: high-grade tumour, low-grade tumour, non-neoplastic lesion.Results: Interobserver agreement in choosing the diagnosis from the INTERPRET database was 75%. The diagnosis was correct in 38/100 cases, incorrect in 57 cases. No good match was found in 5/100 cases. The diagnostic category was correct with DSS/conventional MRS/MRI in 67/58/52 cases, indeterminate in 5/8/20 cases, incorrect in 28/34/28 cases. Results with DSS were not significantly better than with conventional MRS analysis. All definitive diagnoses did not exist in the INTERPRET database. In the 61 adult patients with the diagnosis included in the database, DSS/conventional MRS/MRI yielded a correct diagnosis category in 48/32/29 cases (DSS vs conventional MRS: p = 0.002, DSS vs MRI: p = 0.0004).Conclusion: Use of the INTERPRET DSS did not improve MRS categorisation of the lesions in the unselected clinical cases. In adult patients with lesions existing in the INTERPRET database, DSS improved the results, which indicates the potential of this software with an extended database. [ABSTRACT FROM AUTHOR]

Objective: To evaluate in-vivo placental perfusion fraction, estimated by magnetic resonance imaging (MRI), as a marker of placental function.Methods: A study population of 35 pregnant women, of whom 13 had pre-eclampsia (PE), were examined at 22-40 weeks' gestation. Within a 24-h period, each woman underwent an MRI diffusion-weighted sequence (from which we calculated the placental perfusion fraction), venous blood sampling and an ultrasound examination including estimation of fetal weight, amniotic fluid index and Doppler velocity measurements. The perfusion fractions in pregnancies with and without fetal growth restriction were compared and correlations between the perfusion fraction and ultrasound estimates and plasma markers were estimated using linear regression. The associations between the placental perfusion fraction and ultrasound estimates were modified by the presence of PE (P  <  0.05) and therefore we included an interaction term between PE and covariates in the models.Results: The median placental perfusion fractions in pregnancies with and without fetal growth restriction were 21% and 32%, respectively (P = 0.005). The correlations between placental perfusion fraction and ultrasound estimates and plasma markers were highly significant (P = 0.002 and P = 0.0001, respectively). The highest coefficient of determination (R(2)  = 0.56) for placental perfusion fraction was found for a model that included pulsatility index in the ductus venosus, plasma level of soluble fms-like tyrosine kinase-1, estimated fetal weight and presence of PE.Conclusion: The placental perfusion fraction has the potential to contribute to the clinical assessment of cases with placental insufficiency. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 31-year-old primiparous woman with antenatal care at 12 weeks' gestation. She has undergone ultrasound examination and experienced symptoms interpreted as symphysiolysis at 23 weeks. The patient has an emergency Cesarean section at 28+3 weeks due to suspicion of placental abruption and her infant had an anemia, requiring a blood transfusion. The use of magnetic resonance imaging in the diagnosis of placental mesenchymal dysplasia is discussed.

Background: The aim of this study was to investigate the relationship between (i) carotid intima-media thickness (CIMT) at baseline as well as (ii) change in CIMT over 5 years (∆CIMT) and atherosclerotically induced luminal narrowing in non-coronary arterial territories assessed by whole-body magnetic resonance angiography (WBMRA). Methods and results: In subgroups of the Prospective Investigation of Vasculature in Uppsala Seniors (PIVUS) study, US measurements of CIMT in the common carotid arteries were analysed at 70 and 75 years and ∆CIMT was calculated (n = 272). WBMRA, assessing arterial stenosis in five different territories by which also a total atherosclerotic score (TAS) was calculated, was performed at 70 years (n = 306). Results: Carotid intima-media thickness in the carotid artery at baseline was correlated with TAS (P = 0·0001) when adjusted to a set of traditional risk factors for atherosclerosis, as well as to stenosis in two of the different investigated territories (aorta and lower leg, P = 0·013 and P = 0·004), but there was no significant correlation between ∆CIMT and TAS (P = 0·41). Conclusions: In the present study, CIMT, but not ∆CIMT over 5 years, in the carotid artery was related to overall stenoses in the body, as assessed by WBMRA. These findings support CIMT as a general marker for atherosclerosis. [ABSTRACT FROM AUTHOR]

Abstract: Objective: The principal aim of this study was to determine whether the amount of visceral adipose tissue (VAT) is more related than subcutaneous adipose tissue (SAT) to atherosclerosis assessed by whole-body MRA (WBMRA). A further objective was to investigate whether traditional risk factors, inflammation, or adipokines could explain the hypothesized relationship between VAT and atherosclerosis. Methods: Men and women aged 70 were recruited from the general population into the Prospective Investigation of The Vasculature in Uppsala Seniors (PIVUS) and 306 of them underwent WBMRA in a clinical 1.5-T scanner. The arterial tree was assessed for degree of stenosis or occlusion and a total atherosclerotic score (TAS) was established. Information on risk factors and BMI and on SAT and VAT, segmented on an axial MR scan was collected. Adiponectin, leptin, and high sensitive C-reactive protein (hsCRP) were measured in serum. HOMA index was used as a marker of insulin resistance. Results: VAT was related to TAS independently of gender, total obesity (BMI), amount of SAT, hsCRP and also to the traditional risk factors included in the Framingham risk score (FRS) in an elderly population. Adiponectin or the HOMA insulin resistance, but not leptin or VAT, together with FRS was significantly related to TAS in a multiple censored regression model. Conclusion: Adiponectin attenuated the relationship between VAT and TAS, suggesting that adiponectin and insulin resistance is an important link between visceral adiposity and atherosclerosis. [Copyright &y& Elsevier]