The New England journal of medicine
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We examined the role of circulating autoantibodies in the pathogenesis of pemphigus vulgaris by passively transferring IgG fractions from five patients with pemphigus vulgaris into neonatal Balb/c mice, in doses of 1.5 to 16 mg per gram of body weight per day. Cutaneous blisters and erosions with the histologic, ultrastructural, and immunofluorescence features of pemphigus occurred in 39 to 55 mice given intraperitoneal injections of IgG from patients with pemphigus and in none of 58 control mice given normal human IgG. ⋯ Titers of circulating IgG in mouse serum closely correlated with the extent of disease induced (P less than 0.002). This study strongly supports the proposed role of pemphigus autoantibodies in the pathogenesis of pemphigus vulgaris in human beings and demonstrates that pemphigus can be passively transferred to laboratory animals.
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We prospectively evaluated infections with several gastrointestinal pathogens in patients undergoing bone-marrow transplantation, in an attempt to correlate infection with morbidity and mortality. Thirty-one of 78 patients (40 per cent) were infected with one or more of the following enteric pathogens during the study: adenovirus (12 infections), rotavirus (nine), coxsackievirus (four), or Clostridium difficile (12). Several patients were infected with more than one pathogen. ⋯ The mortality rate among the infected patients was 55 per cent--significantly higher than the rate (13 per cent) among the noninfected patients (P less than 0.001). This study indicates that enteric pathogens that often cause mild diarrhea in normal populations can cause serious infections in marrow-transplant recipients. Measures aimed at preventing or treating such infections might reduce the morbidity and mortality associated with marrow transplantation.
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In the Framingham Study 2325 men and 2866 women 30 to 62 years old at entry were followed biennially over 22 years for the development of chronic atrial fibrillation in relation to antecedent cardiovascular disease and risk factors. During surveillance, atrial fibrillation developed in 49 men and 49 women. The incidence rose sharply with age but did not differ significantly between the sexes. ⋯ Hypertensive cardiovascular disease was the most common antecedent disease, largely because of its frequency in the general population. Among the risk factors for cardiovascular disease, diabetes and electrocardiographic evidence of left ventricular hypertrophy were related to the occurrence of atrial fibrillation. The development of chronic atrial fibrillation was associated with a doubling of overall mortality and of mortality from cardiovascular disease.