Primary biliary cirrhosis is a chronic, destructive autoimmune liver disease of humans. Patient sera are characterized by a high frequency (greater than 95%) of autoantibodies to a Mr 70,000 mitochondrial antigen, a component of the M2 antigen complex. We have identified a human cDNA clone encoding the complete amino acid sequence of this autoantigen. The predicted structure has significant similarity with the dihydrolipoamide acetyltransferase (EC 2.3.1.12) of the Escherichia coli pyruvate dehydrogenase multienzyme complex. The human sequence preserves the Glu-Thr-Asp-Lys-Ala motif of the lipoyl-binding site and has two potential binding sites. Expressed fragments of the cDNA react strongly with sera from patients with primary biliary cirrhosis but not with sera from patients with autoimmune chronic active hepatitis or sera from healthy subjects.

Objective. To examine maternal morbidity in primary surgical management of placenta accreta. Design. Retrospective case series. Setting. Quaternary perinatal referral center in Melbourne, Australia. Population. Clinically suspected and histologically confirmed cases of placenta accreta, increta and percreta. Methods. Women were identified from our hospital database coded for placenta accreta, increta, percreta and peripartum hysterectomy. Relevant details were sought from medical records. Main outcome measures. Predefined maternal morbidities: blood loss, transfusion requirements, surgical complications, reoperation rate, duration in hospital. Predefined neonatal outcomes: gestational age at birth, birth-weight, admission to intensive (NICU) or special care nurseries (SCN), respiratory distress syndrome. Results. Between 1999 and 2009, 33 women were diagnosised with invasive placentation. A total of 27 were confirmed histologically after hysterectomy: 12 accreta, one increta, and 14 percreta. Median blood loss was 2 L. There was a 1.8-L reduction in mean blood loss with elective vs. emergency hysterectomy (p = 0.04). Nearly twothirds of women required four or more units of packed red-blood-cells. Half of the women suffered from surgical complications, mostly from bladder injury. The risk of returning to theater for further surgery was 20%. Women with placenta percreta were more likely to require additional blood products (p = 0.03), sustain renal tract injury (p = 0.003) and require intensive care admission (p = 0.002). Conclusions. A primary surgical approach to management of placenta accreta is associated with significant maternal morbidity, even when managed in a dedicated quaternary perinatal referral center.Abbreviations: NICU, neonatal intensive care unit; SCN, special care nursery.

The profile of antinuclear antibodies (ANA) in 49 Thais with scleroderma (systemic sclerosis) was compared with that in 68 white Australians with scleroderma. Forty-eight (98%) of the Thais and all (100%) of the white Australians were positive for ANA, with the majority (100% and 97%, respectively) showing a diffuse speckled pattern of nuclear fluorescence. The distribution of the patterns was different in the 2 races; 35 (71%) of the Thais and 17 (25%) of the Australians showed staining of the nucleolus, and 1 (2%) of the Thais and 35 (51%) of the Australians showed staining of the centromeres. The frequency of precipitating antibodies to extractable nuclear antigens was also strikingly different: 86% in Thais and 26% in Australians (P < 0.001). Precipitating antibodies to Scl-70 (topoisomerase I), the predominant extractable nuclear antigen in patients with scleroderma, were detected in 37 (76%) of the Thais and 18 (26%) of the Australians, and these were shown by Western blotting to react with the Scl-70 (topoisomerase 1)-associated polypeptides. Differences in the frequencies of the ANA specificities in the 2 races were consistent with differences in the clinical manifestations of scleroderma; all of the Thai patients, in contrast to 15% of the Australian patients, had diffuse scleroderma with widespread skin involvement. This suggests that environmental or genetic factors may influence the expression of scleroderma.Autoantibodies to nuclear antigens (ANA) are frequently detected in patients with scleroderma (1-3). The CREST variant of scleroderma (calcinosis, Raynaud's phenomenon, esophageal dysmotility, sclerodactyly , telangiectasias) is characterized serologically by anticentromere antibodies (ACA), with the frequency of ACA varying from 44% to 96%, depending upon the patients selected for study (1,2,(4)(5)(6)(7)(8)(9)(10). The diffuse variant is characterized serologically by antiScl-70 (anti-topoisomerase I) antibodies, with the frequency of anti-Scl-70 ranging from 34% to 40% (1,2,5,6,10,11). These data are derived from studies of white populations, and to our knowledge, no comparative studies have shown racial differences, either in the frequency of ANA or the expression of the 2 major variants of scleroderma.In the present study, a comparison was made between the frequencies of anti-Scl-70 and ACA in a group of non-white Thais and a group of white Australians, all of whom had scleroderma. A high frequency of anti-Scl-70 antibodies (76%) and a low frequency of ACA (2%) were detected in the Thais, in contrast to a low frequency of anti-Scl-70 (26%) and a high frequency of ACA (51%) in the Australians.