Interictal behavioral alterations and cerebrospinal fluid amino acid changes in a chronic seizure model of temporal lobe epilepsy

This study extends our previous work in which we described the presence of an interictal behavioral disturbance in a chronic animal model of temporal lobe epilepsy (TLE). In this study, we investigated the cerebrospinal fluid (CSF) neurotransmitter changes underlying the development of chronic recurrent seizures of temporal lobe origin and interictal behavioral disturbance in cats made epileptic after intrahippocampal injection of kainic acid (KA). Using high-performance liquid chromatography, we measured 22 putative neurotransmitter amino acids. After intrahippocampal KA injection, cats developed an initial acute period of intense seizure activity. Cisternal CSF amino acids, which were repeatedly sampled during the acute period through a permanent indwelling cannula, were unchanged apart from a mild elevation in CSF alanine. The high-level seizure activity gradually decreased, and cats entered a chronic epileptic period characterized by recurrent yet intermittent temporal lobe seizures. CSF GABA levels during the chronic epileptic period were significantly decreased. In contrast, CSF levels of other amino acids--alanine, tyrosine, taurine, aspartic acid, and glutamic acid--did not change significantly. Behavioral testing also showed a heightened interictal defensive reactivity during the chronic epileptic period. To the extent that CSF GABA concentration reflects brain GABA concentration, this study suggests that a decrease in brain GABA may contribute both to the epilepsy and interictal emotional lability of animals with a chronic seizure disorder of temporal lobe origin.

HealthLine--marketing and public education wrapped up in one

A service which can promote both marketing and public education is especially useful in these highly competitive times, writes Bridget Larsen Wright, M.P.H., et al. HealthLine, an information service for the general public, was developed to promote these areas, and Wright explains how a Southern California clinic implemented the service, and provides some preliminary results.

Resurgence of hydatid disease (echinococcosis) in communities in northern Israel

Hydatid disease (echinococcosis), formerly endemic in the area of Israel, has occurred only sporadically in the past 40 years, mostly in immigrants. An unusual spatial and temporal cluster of surgically confirmed infections in northern Israel led to a review of echinococcosis hospital records. This revealed a resurgence of the disease in some rural and semirural Arab and Druze communities. Between 1960 and 1989, 224 cases of hydatid disease were surgically confirmed in residents of these communities. During this period, as the Arab-Druze population doubled, the mean annual surgical incidence of new cases per 100,000 rose 5-fold from 1.4 to 7.1. In Yirka, a Druze community of 7500 persons, from which no cases were known before 1970 and in which 52 cases were surgically confirmed thereafter, the mean annual surgical incidence for 1980-1989 rose to 53/100,000, to become one of the highly endemic areas of the world. The probable explanation of the outbreak is that, since 1967 with the opening of the border, importation of infected sheep has occurred from the hydatid-endemic West Bank region to individual homes in the communities in northern Israel. The sheep are raised to maturity in pens before home slaughtering; the offal, available to dogs, resulted in canine and then human infections.

Evaluation of albendazole, pyrantel, bephenium, pyrantel-praziquantel and pyrantel-bephenium for single-dose mass treatment of necatoriasis

An effective drug for single-dose mass treatment of necatoriasis was sought by testing three drugs and two drug combinations in Ethiopian immigrants to Israel found to have light infections. The drugs tested sequentially in single-doses were pyrantel pamoate (20 mg kg-1, 81 subjects); bephenium hydroxynaphthoate (2.5-5 g, 65 subjects); combined pyrantel and bephenium (25 subjects); combined pyrantel (20 mg kg-1) and praziquantel (40 mg kg-1) (16 subjects); and albendazole (400 mg, 77 subjects). Follow-up under conditions without likelihood of reinfection was by one stool examination. Cure rates with albendazole, pyrantel-bephenium and pyrantel-praziquantel were 84, 80 and 81% respectively; these rates were significantly higher than the 49% found for bephenium and the 51% for pyrantel (P less than 0.05). Egg reductions in those not cured were pyrantel (22%), bephenium (6%), pyrantel-bephenium (34%), pyrantel-praziquantel (3%) and albendazole (6%). Albendazole was the most promising single drug treatment; unexpected was the high effectiveness of pyrantel-praziquantel in combination.

Myocardial infarction, severe reversible ischemia, and shock following excess thyroid administration in a woman with normal coronary arteries

In the absence of fixed coronary artery disease, thyrotoxicosis is rarely associated with acute myocardial infarction and/or ischemia. There are no known reports on the association of acute myocardial infarction with iatrogenic or factitious thyrotoxicosis in the absence of fixed coronary artery stenosis or coronary artery spasm. A 68-year-old woman, clinically in a state of thyrotoxicosis as a result of taking 0.3 g/d of exogenous thyroid replacement, sustained a severe, reversible myocardial ischemic event. Echocardiographic and scintigraphic evaluations demonstrated a large apical dyskinetic region. Subsequently, after the original dose of levothyroxine sodium was reduced to 0.15 mg and the patient became euthyroid, two-dimensional echocardiography and scintigraphic and cardiac catheterization studies demonstrated normal left ventricular contractility and normal coronary anatomy. Coronary artery spasm was not induced by ergonovine maleate therapy. Exogenous thyroid administration may directly influence myocardial oxygen supply and demand, exclusive of coronary artery disease and coronary spasm. A critical imbalance may then result in acute myocardial ischemia and reversible left ventricular segmental wall motion abnormalities.

Lung cancer mortality in workers exposed to sulfuric acid mist and other acid mists

Mortality patterns were studied in 1,165 workers exposed to sulfuric acid mist and other acid mists (primarily hydrochloric acid mist) in steel-pickling operations. Standardized mortality ratio (SMR) analysis of the full "any acid exposure" cohort (n = 1,165), with the use of U.S. death rates as a standard, showed that lung cancer was significantly elevated, with a mortality ratio of 1.64 [95% confidence interval (CI) = 1.14-2.28, based on 35 observed deaths]. The lung cancer mortality ratio for workers exposed only to sulfuric acid (n = 722) was lower (SMR = 1.39), but further restriction to the time 20 years and more from first employment in a job with probable daily sulfuric acid exposure (approximately equal to 0.2 mg/m3) yielded a mortality ratio of 1.93 (95% CI = 1.10-3.13). An excess lung cancer risk was also seen in workers exposed to acids other than sulfuric acid (SMR = 2.24; 95% CI = 1.02-2.46). When comparison was made to other steel workers (rather than to the U.S. general population) to control for socioeconomic and life-style factors such as smoking, the largest lung cancer excess was again seen in workers exposed to acids other than sulfuric acid (SMR = 2.00; 95% CI = 1.06-3.78). Adjustment for potential differences in smoking habits showed that increased smoking was unlikely to have entirely explained the increased risk. Mortality from causes of death other than lung cancer was unremarkable, with the exception of significantly low rates for deaths due to digestive system diseases.

Phenobarbitone dosage in neonatal convulsions

In order to find the optimal dosage schedule of phenobarbitone for neonatal convulsions, four groups of patients were studied. Twelve infants (group 1) received a mean phenobarbitone dose of 9.5 mg/kg a day given intramuscularly for 3 days followed by 5.8 mg/kg a day given intramuscularly and then orally. Six infants (group 2) received a mean intravenous loading dose of 9.5 mg/kg followed by 6.8 mg/kg a day given intramuscularly or orally. Nine infants (group 3) received a mean loading dose of 14.9 mg/kg intravenously followed by a maintenance dose of 5.9 mg/kg a day. Thirteen patients (group 4) received a mean intramuscular loading dose of 15.2 mg/kg followed by 5.9 mg/kg a day. Blood samples were taken regularly and phenobarbitone levels were determined by gas liquid chromatography. A mean intravenous or intramuscular loading dose of 15 mg/kg of phenobarbitone safely achieved therapeutic levels within 2 hours of injection and high therapeutic levels were maintained with a dose of 6 mg/kg a day.

The epidemiology of bladder cancer: a second look

A case-control study among 574 male and 158 female bladder cancer patients and equal numbers of matched controls was conducted between 1969 and 1974 in 17 hospitals in six United States cities. We determined that cigarette smokers of both sexes were at higher relative risk than nonsmokers. Cigarette smoking was responsible for about one-half of male and one-third of female bladder cancer. There was an excess of bladder cancer patients with some previous occupational exposure, such as rubber, chemicals, and textiles. A weak association with coffee drinking, which appeared to be independent of smoking, was found for males. Users of artificial sweeteners were not over-represented among the cases. The authors conclude that the epidemiologic pattern of bladder cancer cannot be fully accounted for by cigarette smoking and occupational exposure and suggest a series of metabolic studies to assess the role of additional factors, such as nutrition.

Orphan airlift. Enteric pathogens isolated from Vietnamese children immigrating to the United States

Isolation studies for bacterial and parasitic agents were carried out on stool specimens from Vietnamese infants at the time of their mass airlift to the United States. One or more bacterial pathogens were found in 49% of the 367 stool specimens cultured. The isolates included enteropathogenic Escherichia coli (161), Shigella (16), Salmonella (15), but no Salmonella typhi or Vibrio cholerae. Parasites identified in 88 stool specimens included Giardia lamblia (10), Ascaris lumbricoides (7), and Entamoeba histolytica (1). Transmission of agents to volunteers probably occurred, because 48% of 272 adults questioned had diarrhea shortly after caring for the children, and stool cultures from these adults resulted in the isolation of E coli (105), Salmonella (1), and Shigella (3).

Planning for a pediatric disaster -- experience gained from caring for 1600 Vietnamese orphans

The sudden arrival of 1600 Vietnamese orphans in San Francisco required the rapid development of a co-ordinated disaster plan, including the overnight establishment of a 1000-bed pediatric field hospital. The plan required rapid identification and involvement of lay and governmental resources, acute medical triage and provision of ongoing medical care and basic nurturing services and eventual discharge to adoptive families. Because one third of the orphans were under six months of age, conventional nursery resources were insufficient, and a "warehouse" model was implemented. This process required development of a specialized transportation and communication system, the services of 800 physicians, 1400 nurses, and 3200 volunteers and 162 back-up acute hospital beds. Disaster planning in most sizable American cities has focused on the problems of adults. Because of the unusual problem presented by infants and small children, we recommend that cities carefully evaluate their disaster planning with special reference to the needs of children.

Public health aspects of Down's syndrome (Mongolism)

Down's syndrome (trisomy 21) which is associated with childbearing in older women has declined in incidence as childbearing in older women has declined. Expectation of life has increased markedly over the same period, leading in turn to a rise in prevalence at older ages. Prenatal diagnosis now makes it technically possible to screen at risk pregnancies. Public health needs to consider the implications of the demographic and obstetric changes.

Food intake and energy expenditure of army recruits

1. The food intake of sixty-four infantry recruits was measured at six centres during 3 weeks of initial training. The daily energy expenditure was measured in thirty-five of these men.

2. The mean daily consumption of the sixty-four subjects provided them with 3850 kcal (16110 kJ); the energy expenditure of the thirty-five subjects averaged 3750 kcal (15690 kJ).

3. Serial auto- and cross-correlations of intake and expenditure were very small and there was no significant relationship between food intake and energy expenditure on the same day.

4. The intakes and expenditures of different subjects at the same centre were not independent.

5. There was a significant relationship between intake and expenditure for the whole period of the survey when results for all subjects were included. In three centres the correlation was high, +0.788 (P < 0.001), but was only + 0.083 (P < 0.5) in the remaining three centres.

6. There was a positive but not significant correlation between body-weight and the average food intake of 6 d.

7. There was a negative correlation between body-weight and calorie balance.

8. Weight change and calorie balance over 1 week were related, the correlation averaging 0.40. There was a correlation of 0.32 between daily weight changes and calorie balance. A rather small amount of variation in calorie balance can be explained by contemporary changes in weight.