The Netherlands journal of medicine
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The subject of this review is the humoral autoimmune response in Sjögren's syndrome. Autoantibodies in this disease are primarily directed against the Ro/SS-A and La/SS-B autoantigens and against IgG (rheumatoid factor). The Ro/SS-A and La/SS-B autoantigens consist of a number of antigenic proteins coupled to small RNA molecules. ⋯ The origin and possible pathogenetic role of autoantibodies in Sjögren's syndrome is still unclear. Our view is that the current evidence supports a mechanism whereby autoantibodies are the product of an oligoclonal B-cell proliferation. The only instance where autoantibodies probably play a direct pathogenetic role is the occurrence of congenital heart block in the offspring of anti-Ro/SS-A and anti-La/SS-B positive mothers.
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The serum tumour marker CA 125 is useful in the management of ovarian cancer, although it has its limitations. Approximately 85% of the ovarian cancer patients have an increased serum CA 125 at the start of treatment. There is a good correlation between the course of CA 125 and the clinical response of the tumour. ⋯ High levels can also be found in patients with non-ovarian gynaecological and non-gynaecological tumours as well as patients with benign diseases and even in apparently healthy persons. In view of this aspecificity, serum CA 125 cannot be proposed for mass screening. For the same reason, serum CA 125 and the immunohistochemical staining with OC 125 are of limited value in the differential diagnosis between a primary ovarian tumour and metastatic disease in an ovary, as well as for differential diagnosis of pelvic tumours.
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A patient is described who developed acrodermatitis chronica atrophicans, arthralgias and polyneuropathy as manifestations of Lyme borreliosis. The clinical diagnosis was confirmed by histological and serological examinations. Despite a long delay before the diagnosis was established, the patient responded very well to treatment with doxycycline.
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A written 'do not resuscitate' (DNR) order is given after judging cardiopulmonary resuscitation (CPR) as medically futile in either quantitative (effectiveness of CPR) or qualitative (quality of life before and after CPR) terms. Eighteen resuscitation studies have been reviewed, with special attention being paid to the definitions of CPR, the pre-arrest morbidity, the localization of the CPR in a hospital and the effectiveness of CPR. The effectiveness of CPR (as discharge rate from the hospital) of elderly in-patients is only below 5% in exceptional conditions. ⋯ The qualitative aspects of CPR seem to be more important, but more studies are needed to clarify the practice of present-day DNR policy. The qualitative aspects of CPR need ethical consideration, and two main viewpoints are discussed: favouring the physician's authority and favouring the patient's authority. Because of a lack of thorough research, practical advice remains difficult.