J. R. Anderson

Laparoscopic versus minilaparotomy cholecystectomy: a randomised trial

Although laparoscopic cholecystectomy has rapidly become routine practice in the UK, there has been no rigorous comparison of it with open cholecystectomy. In our trial, 302 patients were randomised to laparoscopic or minilaparotomy cholecystectomy. Recovery after surgery was assessed by length of hospital stay, outpatient review at 10 days and 4 weeks, and patient questionnaires 1, 4, and 12 weeks after surgery. The mean operation time was 14 min shorter for minilaparotomy, while median post-operative hospital stay was 2 days shorter after laparoscopic cholecystectomy. The hospital costs were about 400 pounds greater for the laparoscopic procedure. Laparoscopic patients returned to work in the home sooner; at 1 week, they had better physical and social functioning, were less limited by physical problems, and had less pain and depression. At 4 weeks, only physical functioning and depression scores were better in the laparoscopic group, and by 3 months there were no differences. Laparoscopic patients were more satisfied with the appearance of their scars. The incidence of complications after both procedures was 20%. Compared to minilaparotomy cholecystectomy, laparoscopic cholecystectomy results in shorter hospital stay, less postoperative dysfunction, and quicker return to normal activities, but is more costly.

Precipitating Auto-Antibodies in the Connective Tissue Diseases

In a recent communication we described the occurrence in the serum of patients with Sjogrens disease of two factors which reacted to give precipitates with extracts of various tissues. Evidence was provided that both factors were auto-antibodies (Anderson, Gray, Beck, and Kinnear, 1961b). As Sjogrens disease has close associations with the connective tissue diseases (Heaton, 1959; Bunim, 1961), we thought it of interest to see if autoprecipitins could be detected in patients with connective tissue diseases. This paper describes the detection, in the serum of patients with various connective tissue diseases, of the two auto-antibodies which occur in Sj6grens disease and two additional precipitating antibodies, one of which is an autoantibody to deoxyribonucleic acid.

Association of Thyrotoxicosis and Auto-immune Thyroiditis

Roitt and Doniach (1958) have demonstrated that circulating thyroid auto-antibodies are present in a large proportion of patients with auto-immune thyroiditis (Hashimotos disease). In this paper we show that the application of these immunological tests in patients with symptoms suggestive of thyrotoxicosis is of considerable practical importance, since we have been able to identify two groups in which the correct diagnosis could not otherwise have been made and where mismanagement might have occurred. In the first group evidence of auto-immune thyroiditis was found in patients with undoubted thyrotoxicosis. Only one fully documented case of this association has been previously described (Doniach and Hudson, 1959; Doniach et al., 1960). We were also able to define a second group of patients who had been referred to the clinic because of suspected thyrotoxicosis and in whom radioiodine tests had appeared to confirm this diagnosis. Further investigations, however, showed that these patients were in fact euthyroid and that the presence of auto-immune thyroiditis explained the abnormal laboratory findings.

A Study of the Interdependence of Red Cell and Bone Marrow Stem Cell Populations

Haemolytic anaemia was produced in rabbits by the administration of a regular course of incompatible red cell iso‐antibody. A greatly increased rate of red cell production was observed but haemoglobin and reticulocyte counts exhibited vigorous and continuing fluctuations with, in the adult rabbits, a regular periodicity. The effects of steroids and splenectomy on this antibody‐mediated red cell destruction were found to be virtually unobservable, and the implications of this with regard to the haemolytic anaemias of man resulting from red cell destruction by iso‐ or auto‐antibodies are discussed.

Antinuclear and Precipitating Auto-antibodies in Sjögren's Syndrome

The diagnosis of Sjogrens syndrome is usually based on the triad of kerato-conjunctivitis sicca, salivary gland involvement (enlargement and/or xerostomia), and rheumatoid arthritis, but may also be made when any two of these three features are present (Sj6gren, 1943). In addition, the syndrome has been described in patients with systemic lupus erythematosus (Ramage and Kinnear, 1956; Bain 1960), progressive systemic sclerosis (Oblatt, Feher, and Csiky, 1958; Bloch, Bunim, Wohl, and Zvaifler, 1960; Bloch, Wohl, Ship, Oglesby, and Bunim, 1960; Shearn, 1960; Stoltze, Hanlon, Pease, and Henderson, 1960; Bloch and Bunim, 1963), polyarteritis nodosa (Ramage and Kinnear, 1956; Shearn, 1961), and myopathy or polymyositis (Bunim, 1961; Silberberg and Drachman, 1962), any of which may replace rheumatoid arthritis in the diagnostic triad. The sera of patients with Sjogrens syndrome have been found very frequently to contain rheumatoid and antinuclear factors, and precipitating and complement-fixing antibodies reacting with a wide variety of the organs and tissues (Jones, 1958; Heaton, 1959; Bloch and others, 1960a and b; Deicher, Holman, and Kunkel, 1960; Anderson, Gray, Beck, and Kinnear, 1961; Thompson, 1962; Beck, 1963; Bloch and Bunim, 1963; Crews and Whitfield, 1963; Vanselow, Dodson, Angell, and Duff, 1963); in addition,

INHIBITION OF Fc-ROSETTE FORMATION BY SERUM OF PATIENTS WITH RENAL ALLOGRAFT REJECTION

Abstract A test which measures the inhibition of Fc-rosette formation by the patients serum was used in a group of 23 renal allograft re- cipients. All 13 serum samples obtained during acute rejection and 2 of 3 obtained during chronic rejection showed strong inhibitory activity, suggesting that the test is of value in confirming the presence of rejection. Its value as a predictive test remains to be established. Preliminary experiments suggest that both immune com- plexes and alloantibodies copntribute to the observed in- hibition of Fc-rosette formation.

Demonstration of Fc Receptors on the Surface of B Lymphocytes

Human blood lymphocytes were tested by an immunofluorescence technique for surface immunoglobulin and by a rosette test with IgG-sensitised red cells for Fc receptors. From combined tests and experiments involving fractionation of lymphocyte populations it is concluded that Fc receptors are demonstrable on most B lymphocytes by the rosette test, but only if the red cells are optimally sensitised. These observations are advanced as an explanation of the discrepant results of surface marker tests on B cells.