Micellization of AOT in aqueous sodium chloride, sodium acetate, sodium propionate, and sodium butyrate media: A case of two different concentration regions of counterion binding

Critical micelle concentrations of AOT in water in the presence of sodium chloride, sodium acetate, sodium propionate, and sodium butyrate were determined at 25 degrees C by the surface tension method. The co-ions do not have any effect on the value of critical micelle concentration. The surface density of AOT at the air-water interface increases in the presence of added electrolyte and attains a maximum value of 2.5+/-0.1 mol m-2 at a particular electrolyte concentration which is different for sodium chloride and the other three electrolytes. From the Corrin-Harkins plot it has been found that for AOT micelles the counterion binding constant has values 0.40 and 0.82 below and above approximately 0.015 mol kg-1 electrolyte concentration (c*), respectively. Measurement of sodium ion activity from the EMF method has confirmed such a shift in the counterion binding constant of AOT at c*. The higher value of the counterion binding constant for AOT has been reported for the first time. From fluorescence spectroscopy it has been found that the aggregation number of AOT is 22 in water and its average aggregation numbers in the presence of electrolytes are about 34 and 136 below and above c*, respectively. The increase by a factor of 2 in the counterion binding constant is shown to be due to a change in the shape of the AOT micelles around c*. The shape of AOT micelles in the electrolyte concentration range c* is inferred to be oblate spheroid and a change from this shape appears to occur above c*. A sudden increase in the polarity of the micelle-solution interface is also observed above c*.

Indications and efficacy of continuous subcutaneous insulin infusion (CSII) therapy in Type 1 diabetes mellitus: a clinical audit in a specialist service

AIM

To determine if current guidelines correctly identify patients who will benefit from continuous subcutaneous insulin infusion (CSII) therapy by comparing outcomes between Type 1 diabetic patients with recurrent severe hypoglycaemia (SH) indications with those without; and between patients without and with classic contraindications to CSII managed in a single multidisciplinary pump clinic.

METHODS

Changes in biomedical outcomes [glycated haemoglobin (HbA1c), hypoglycaemia, diabetic ketoacidosis (DKA) rates], from before CSII to the end of the study (median duration 20.5 months, range 1-192), were analysed retrospectively from data collected from notes and interviews of 40 patients. Quality of life was assessed by three validated questionnaires at study end (33 patients).

RESULTS

Twenty-five out of forty patients were started for reasons other than SH and 15 out of 40 had contraindications to CSII. Overall, CSII was associated with a reduction in HbA1c (9.6 +/- 2.7% to 8.3 +/- 1.2%, P = 0.011), SH (6.45 +/- 16.15/year to 0.34 +/- 1.01/year, P = 0.034) and DKA (1.83 +/- 4.48/year to 0.27 +/- 1.12/year, P = 0.036). The fall in SH was greater for patients started for SH (P < 0.001). However, only patients started for other indications showed a fall in HbA1c (P = 0.001). The fall in DKA rate was greater in patients with contraindications (P = 0.042), and they did not lose the other benefits of CSII therapy, including quality of life.

CONCLUSIONS

In the setting of a specialist multidisciplinary service, CSII can be an effective and safe therapy. It confers benefit outside the setting of severe hypoglycaemia and can confer benefit in some patients with classic contraindications. This questions the validity of criteria that may exclude these patients in such a service.

Pyrimidines. Part II: Synthesis of novel pyrimidines, 1,2,4-triazolo[4,3-a]pyrimidin-7-ones and pyrimidino[2,1-c][1,2,4]triazin-8-ones for their antimicrobial and anticancer activities

Five main classes of novel pyrimidine derivatives have been synthesized; namely 6-substituted phenyl-5-cyano-3-methyl-2-phenacylhydrazino-3,4-dihydropyrimidin-4-ones 4a-e; 6-substituted phenyl-2-arylidene hydra-zino-5-cyano-3-methyl-3,4-dihydropyrimidin-4-ones 5a-i; 6-substituted phenyl-2-acylhydrazino-5-cyano-3-methyl-3,4-dihydropyrimidin-4-ones 7a-d, 8a-e and 9a-c; three novel series of 1,2,4-triazolo[4,3-a] pyrimidones 10a,b, 11a-d and 12a-d and 6-substituted phenyl-7-cyano-9-methyl-3-phenyl or 4-chlorophenyl-4,9-dihydropyrimido[2,1-c][1,2,4] triazin-8-ones 13a-c. Besides, the azide compound 2-azido-5-cyano-3-methyl-6-phenyl-3,4-dihydropyrimidin-4-one 6 was also synthesized. The prepared compounds were tested for antimicrobial and anticancer activity. Compounds 4b and 4d showed promising activity against Escherichia coli. Compounds 3c, 5c, 5e, 5g and 7b were active in the three cell line antitumor one dose primary assay and were evaluated in the 60 human tumor full panel cell line invitro screening. Compound 5c showed promising activity against all types of leukemia especially leukemia K-562 and leukemia SR with GI50 = 1.61 and 2.63 mmol/l respectively.

Stability of recall of military hazards over time. Evidence from the Persian Gulf War of 1991

BACKGROUND

War time traumatic events are related to subsequent psychological and physical health, but quantifying the association is problematic. Memory changes over time and is influenced by psychological status.

AIMS

To use a large, two-stage cohort study of members of the UK armed forces to study changes in recall of both traumatic and 'toxic' hazards.

METHOD

A questionnaire-based follow-up study assessed 2370 UK military personnel, repeating earlier questions about exposure to military hazards.

RESULTS

The k statistics for reporting of hazards were good for some exposures, but very low for others. Gulf veterans reported more exposures over time (no significant rise in the Bosnia cohort). In the Gulf cohort only, reporting new exposures was associated with worsening health perception, and forgetting previously reported exposures with improved perception. We found no association between physical health, psychological morbidity or post-traumatic stress disorder symptoms and endorsement or non-endorsement of exposures.

CONCLUSIONS

Reporting of military hazards after a conflict is not static, and is associated with current self-rated perception of health. Self-report of exposures associated with media publicity needs to be treated with caution.

Synthesis of novel pyrimidine-2,4-diones and 2-thioxo-pyrimidine-4-ones as potential anticancer and antimicrobial agents

Two novel series of pyrimidine derivatives have been prepared, namely; 3,6-disubstituted perhydropyrimidine-2,4-diones 8a-l as well as 3,6-disubstituted 2-thioxo-perhydropyrimidine-4-ones 9a-k. The anticancer as well antimicrobial activities of these compounds and their open-chain counterparts have been determined.

Estimation of micellization parameters of sodium dodecyl sulfate in water+1-butanol using the mixed electrolyte model for molar conductance

The mixed electrolyte model of Shanks and Franses has been applied to estimate the critical micelle concentration, aggregation number, and counterion binding constant of sodium dodecyl sulfate in a water + 1-butanol medium from its measured conductivity data at 25 degrees C. The surface potential of the ionic micelle in this mixed solvent medium was computed by solving the nonlinear Poisson-Boltzmann equation. The standard free energy terms of micellization were also calculated. The present study confirms further the observation made in the previous studies that ionic micelles do not contribute to the ionic strength of a surfactant solution, an inference originally made by McBain and coworkers.

The health effects of peace-keeping in the UK Armed Forces: Bosnia 1992-1996. Predictors of psychological symptoms

BACKGROUND

Peace-keeping duties are associated with unique stresses for military personnel. There have been few reports on the effects of peace-keeping on psychological health.

METHOD

We used data from a cross-sectional study originally established to examine health effects of service in the Gulf War, which included a control group who had been deployed in Bosnia (N= 2049). This group was examined to establish which demographic, occupational, and deployment-related risk factors were associated with psychological distress measured on the General Health Questionnaire (GHQ-12) and stress symptoms akin to a post-traumatic stress reactions.

RESULTS

The main risk factors for stress symptoms in the Bosnia group were--lower rank, being deployed early in the campaign, having more deployment-related exposures, and serving on staff duties. There was no protective effect of previous deployments to the Falklands or Northern Ireland, and time off following deployment was not protective. For GHQ-12 cases, the main risk factors were: female gender, lower rank, increased deployment-related exposures and serving on staff duties.

CONCLUSIONS

This study suggests that stress symptoms and GHQ-12 cases, are strongly predicted both by experiences during deployment and demographic factors.

Searching for a Gulf War syndrome using cluster analysis

BACKGROUND

Gulf veterans report medically unexplained symptoms more frequently than non-Gulf veterans did. We examined whether Gulf and non-Gulf veterans could be distinguished by their patterns of symptom reporting.

METHOD

A k-means cluster analysis was applied to 500 randomly sampled veterans from each of three United Kingdom military cohorts of veterans; those deployed to the Gulf conflict between 1990 and 1991; to the Bosnia peacekeeping mission between 1992 and 1997; and military personnel who were in active service but not deployed to the Gulf (Era). Sociodemographic, health variables and scores for ten symptom groups were calculated.

RESULTS

The gap statistic indicated the five-group solution as one that provided a particularly informative description of the structure in the data. Cluster 1 consisted of low scores for all symptom groups. Cluster 2 had veterans with highest symptom scores for musculoskeletal symptoms and high scores for psychiatric symptoms. Cluster 3 had high scores for psychiatric symptoms and marginally elevated scores for the remaining nine groups symptom groups. Cluster 4 had elevated scores for musculoskeletal symptoms only and cluster 5 was distinguishable from the other clusters in having high scores in all symptom groups, especially psychiatric and musculoskeletal.

CONCLUSION

The findings do not support the existence of a unique syndrome affecting a subgroup of Gulf veterans but emphasize the excess of non-specific self-reported ill health in this group.

Skin disease in Gulf war veterans

BACKGROUND

Gulf war veterans report more symptomatic ill-health than other military controls, and skin disease is one of the most frequent reasons for military personnel to seek medical care.

AIM

To compare the nature and prevalence of skin disease in UK Gulf veterans with non-Gulf veterans, and to assess whether skin disease is associated with disability.

DESIGN

Prospective case comparison study.

METHODS

Disabled (n=111) and non-disabled (n=98) Gulf veterans and disabled non-Gulf veterans (n=133) were randomly selected from representative cohorts of those who served in the Gulf conflict 1990-1991, UN Bosnia Peacekeeping Force 1992-1997, or veterans in active service between 1990-91, but not deployed to the Gulf. Disability was defined as reduced physical functioning as measured by the Short Form 36 [score <72.2]. All subjects recruited were examined by a dermatologist, blind to the military and health status of the veteran.

RESULTS

The prevalences of skin disease in disabled Gulf, non-disabled Gulf and disabled non-Gulf veterans were 47.7, 36.7, and 42.8% respectively. Seborrhoeic dermatitis was twice as common as expected in the Gulf veterans (both disabled and non-disabled).

DISCUSSION

Skin disease does not appear to be contributing to ill health in Gulf war veterans, with the exception of an unexplained two-fold increase in seborrhoeic dermatitis.

Antinuclear autoantibodies (ANA) in Gulf War-related illness and chronic fatigue syndrome (CFS) patients

It is established that veterans of the 1991 Gulf War have an increased frequency of experiencing multiple symptoms. The underlying mechanism of these ailments is unclear, although they do not correspond to any clearly defined syndrome. The most common symptoms overlap with those of chronic fatigue syndrome (CFS). CFS was recently associated with a novel subtype of antinuclear autoantibody (ANA) that reacts with nuclear envelope (NE) antigens. NE autoantibodies are not known to be linked with any distinct clinical condition, but have been observed in patients with unusual mixed chronic autoimmune disorders and connective tissue diseases. In this study we examined whether NE ANAs are a feature of patients with CFS and symptomatic Gulf War veterans (sGWV). We studied the prevalence of ANA in 130 sGWV, 90 well Gulf War veterans (wGWV), 128 symptomatic Bosnia and Era veterans (sBEV), 100 CFS patients, and 111 healthy control subjects matching for age and sex. We found no significant difference in the prevalence of ANAs between any of the groups. None of the patients/or veterans we studied had ANA of the NE type. Our results show that multisymptom illness due to CFS or related to Gulf War service is not associated with antinuclear autoimmunity.

Reported chemical sensitivities in a health survey of United Kingdom military personnel

OBJECTIVE

To report the prevalence of self reported chemical sensitivities in three cohorts of United Kingdom service personnel.

METHOD

Cross sectional postal survey of three cohorts of United Kingdom military personnel comprising Gulf veterans (n=3531), those who had served in Bosnia (n=2050), and those serving during the Gulf war but not deployed there (Era cohort, n=2614).

RESULTS

Sensitivity to at least one everyday chemical was reported by a considerable proportion of all three cohorts, and particularly by veterans of the Gulf war (Era: 14%; Bosnia: 13%; Gulf: 28%).

CONCLUSION

Reported chemical sensitivities were common in all three military cohorts. Our understanding of chemical sensitivities remains limited and objective evidence for a causal link between low level exposures to chemicals and reported symptoms is lacking. Given their frequency in the population, further work in this area is necessary.

Prevalence of Gulf war veterans who believe they have Gulf war syndrome: questionnaire study

OBJECTIVES

To determine how many veterans in a random sample of British veterans who served in the Gulf war believe they have "Gulf war syndrome," to examine factors associated with the presence of this belief, and to compare the health status of those who believe they have Gulf war syndrome with those who do not.

DESIGN

Questionnaire study asking British Gulf war veterans whether they believe they have Gulf war syndrome and about symptoms, fatigue, psychological distress, post-traumatic stress, physical functioning, and their perception of health.

PARTICIPANTS

2961 respondents to questionnaires sent out to a random sample of 4250 Gulf war veterans (69.7%).

MAIN OUTCOME MEASURE

The proportion of veterans who believe they have Gulf war syndrome.

RESULTS

Overall, 17.3% (95% confidence interval 15.9 to 18.7) of the respondents believed they had Gulf war syndrome. The belief was associated with the veteran having poor health, not serving in the army when responding to the questionnaire, and having received a high number of vaccinations before deployment to the Gulf. The strongest association was knowing another person who also thought they had Gulf war syndrome.

CONCLUSIONS

Substantial numbers of British Gulf war veterans believe they have Gulf war syndrome, which is associated with psychological distress, a high number of symptoms, and some reduction in activity levels. A combination of biological, psychological, and sociological factors are associated with the belief, and these factors should be addressed in clinical practice.

Seasonal variation in energy expenditure, water flux and food consumption of Arabian oryx Oryx leucoryx

We report on the energy expenditure and water flux, measured in the laboratory and in the field, of the Arabian oryx Oryx leucoryx, the largest desert ruminant for which measurements of the field metabolic rate of free-living individuals have been made using doubly labeled water. Prior to extirpation of this species in the wild in 1972, conservationists sequestered a number of individuals for captive breeding; in 1989, oryx were reintroduced in Saudi Arabia into Mahazat as-Sayd (2244km2). Apart from small pools of water available after rains, oryx do not have free-standing water available for drinking and therefore rely on grasses that they eat for preformed water intake as well as their energy needs. We tested whether oryx have a reduced fasting metabolic rate and total evaporative water loss (TEWL) in the laboratory, as do some other arid-adapted mammals, and whether oryx have high field metabolic rates (FMRs) and water influx rates (WIRs), as predicted by allometric equations for large arid-zone mammals. We measured FMR and WIR during the hot summer, when plant moisture content was low and ambient temperatures were high, and after winter rains, when the water content of grasses was high.

For captive oryx that weighed 84.1kg, fasting metabolic rate averaged 8980kJday−1, 16.7% lower than predictions for Artiodactyla. Our own re-analysis of minimal metabolic rates among Artiodactyla yielded the equation: logV̇O2=−0.153+0.758logM, where V̇O2 is the rate of oxygen uptake in lh−1 and M is body mass in kg. Fasting metabolic rate of oryx was only 9.1% lower than predicted, suggesting that they do not have an unusually low metabolic rate. TEWL averaged 870.0mlday−1, 63.9% lower than predicted, a remarkably low value even compared with the camel, but the mechanisms that contribute to such low rates of water loss remain unresolved.

For free-living oryx, FMR was 11076kJday−1 for animals with a mean body mass of 81.5kg during summer, whereas it was 22081kJday−1 for oryx in spring with a mean body mass of 89.0kg, values that were 48.6% and 90.4% of allometric predictions, respectively. During summer, WIR averaged 1310mlH2Oday−1, whereas in spring it was 3438mlH2Oday−1. Compared with allometric predictions, WIR was 76.9% lower than expected in summer and 43.6% lower in spring. We found no evidence to support the view that the WIR of large desert ungulates is higher than that of their mesic counterparts. On the basis of the WIR of the oryx averaged over the year and the water contents of plants in their diet, we estimated that an oryx consumes 858kg of dry matter per year.

Multiple chemical sensitivity and chronic fatigue syndrome in British Gulf War veterans

The objective of this study was to measure the prevalence of multiple chemical sensitivity (MCS) and chronic fatigue syndrome (CFS) in British Gulf War veterans and to investigate their association with reported exposures and psychologic morbidity. In 1997--1998, the authors undertook a cross-sectional survey of three cohorts of British military personnel comprising Gulf veterans (n = 3,531), those who had served in Bosnia (n = 2,050), and those serving during the Gulf War but not deployed there (Era cohort, n = 2,614). MCS and CFS were defined according to operational criteria. The prevalence of MCS in the Gulf, Bosnia, and Era cohorts was 1.3%, 0.3%, and 0.2%, respectively. For CFS, the prevalence was 2.1% (Gulf cohort), 0.7% (Bosnia cohort), and 1.8% (Era cohort). In Gulf veterans, MCS was strongly associated with exposure to pesticides (adjusted odds ratio = 12.3, 95% confidence interval: 5.1, 30.0). Both syndromes were associated with high levels of psychologic morbidity. These findings suggest that CFS and MCS account for some of the medically unexplained illnesses reported by veterans after deployment to the Gulf. MCS was particularly associated with Gulf deployment and self-reported exposure to pesticides, findings that merit further exploration given the controversial status of this diagnosis and the potential for recall bias in a questionnaire survey.

Occupational risk factors for ill health in Gulf veterans of the United Kingdom

OBJECTIVES

To study the association between occupational factors specific to the Armed Forces (rank, functional roles, Service, regular or reservist status and deployment factors) and symptomatic health problems in Gulf veterans, after sociodemographic and lifestyle factors have been accounted for.

DESIGN

A postal cross sectional survey of randomly selected UK Gulf veterans was conducted six to seven years after the Gulf conflict. Physical ill health was measured using the Fatigue Questionnaire and a measure of the Centers for Disease Control and Prevention (CDC) multi-symptom syndrome. Psychological ill health was measured using the General Health Questionnaire and a post-traumatic stress measure.

SETTING

Population of servicemen who were serving in the UK Armed Forces during the Gulf conflict between 1 September 1990 and 30 June 1991.

PARTICIPANTS

3297 Gulf veterans.

MAIN RESULTS

In multivariate logistic regression, there was an inverse relation between higher rank and psychological and physical ill health (test of trend: General Health Questionnaire, p=0.004; post-traumatic stress, p=0.002; fatigue, p=0.015; CDC case, p=0.002). Having left the Armed Forces was associated with a two to three times increase in reporting ill health. Of the deployment factors, there was a weak association between being deployed as an individual reinforcement in a combat role and post-traumatic stress but there was no association between receiving pre-deployment training or post-deployment leave and ill health. Marital status and smoking were associated with psychological and physical ill health.

CONCLUSIONS

Rank was the main occupational factor associated with both psychological and physical ill health in Gulf veterans. This may parallel the associations between socioeconomic status and morbidity in civilian populations. Ill health seems to be greater in those who return to civilian life. Sociodemographic factors also seem to be important in ill health in Gulf veterans.

Do common mental disorders increase cigarette smoking? Results from five waves of a population-based panel cohort study

A prospective panel cohort design was used to investigate whether mental disorders common in the general population increase the likelihood of increased cigarette smoking at 12 months follow-up. By 1995, the last year for which data were available, a random sample of 12,057 persons aged 16-75 years residing in private households in Great Britain had been recruited. At each of five annual waves, the main exposure, past mental disorder, was derived from assessments of psychiatric morbidity as measured by the General Health Questionnaire-12. Increased cigarette smoking was derived from observations of number of cigarettes smoked and was defined by an increase of five or more per day relative to the previous calendar year. After logistic regression analysis, persons with a common mental disorder were about 30% more likely to have increased their cigarette smoking over the previous year (odds ratio = 1.29, 95% confidence interval: 1.16, 1.43). The estimated effect in the youngest (16-21 years) and oldest (51-75 years) age groups was higher than that in the middle (31-50 years) age group (odds ratios = 1.50, 1.57, and 1.12, respectively; test for interaction, chi2 = 6.8 (3 df), p = 0.078). These findings indirectly support the hypothesis that common mental disorders may have an enduring effect of increasing cigarette smoking a year later.

Role of vaccinations as risk factors for ill health in veterans of the Gulf war: cross sectional study

OBJECTIVES

To explore the relation between ill health after the Gulf war and vaccines received before or during the conflict. To test the hypothesis that such ill health is limited to military personnel who received multiple vaccines during deployment and that pesticide use modifies any effect.

DESIGN

Cross sectional study of Gulf war veterans followed for six to eight years after deployment.

SETTING

UK armed forces.

PARTICIPANTS

Military personnel who served in the Gulf and who still had their vaccine records.

MAIN OUTCOME MEASURES

Multisymptom illness as classified by the Centers for Disease Control and Prevention; fatigue; psychological distress; post-traumatic stress reaction; health perception; and physical functioning.

RESULTS

The response rate for the original survey was 70.4% (n=3284). Of these, 28% (923) had vaccine records. Receipt of multiple vaccines before deployment was associated with only one of the six health outcomes (post-traumatic stress reaction). By contrast five of the six outcomes (all but post-traumatic stress reaction) were associated with multiple vaccines received during deployment. The strongest association was for the multisymptom illness (odds ratio 5.0; 95% confidence interval 2.5 to 9.8).

CONCLUSION

Among veterans of the Gulf war there is a specific relation between multiple vaccinations given during deployment and later ill health. Multiple vaccinations in themselves do not seem to be harmful but combined with the "stress" of deployment they may be associated with adverse health outcomes. These results imply that every effort should be made to maintain routine vaccines during peacetime.

Is there a Gulf War syndrome?

BACKGROUND

UK veterans of the Gulf War report more ill health than servicemen who were not deployed to the Gulf War. We investigated whether the pattern of symptom reporting by veterans of the Gulf War differed from that in active servicemen who had not fought in the Gulf War or who had fought in other conflicts.

METHODS

We used a population-based cross-sectional design. We sent a standardised survey that asked about 50 physical symptoms to three UK military cohorts; men who had served in the Gulf War, those who had served in the Bosnia conflict, and men who had been in active service but not deployed to the Gulf War (Era cohort). We used exploratory factor analysis to identify underlying factors and describe the factor structure of the symptoms reported in the Gulf War cohort. Confirmatory factor analysis was used to test the fit of this factor structure in the Bosnia and Era cohorts.

FINDINGS

Three factors in the Gulf War cohort together accounted for about 20% of the common variance. We labelled the factors mood, respiratory system, and peripheral nervous system, according to the symptoms that loaded on to them. In the confirmatory factor analysis, the factor structure identified in the Gulf War cohort fitted reasonably well in the Bosnia and Era cohorts.

INTERPRETATION

Although results from complex modelling procedures need to be interpreted with caution, our findings do not support a unique Gulf War syndrome. The mechanisms behind increased self-reporting of symptoms need further investigation.

Health of UK servicemen who served in Persian Gulf War

BACKGROUND

Various symptoms in military personnel in the Persian Gulf War 1990-91 have caused international speculation and concern. We investigated UK servicemen.

METHODS

We did a cross-sectional postal survey on a random sample of Gulf War veterans (Gulf War cohort, n=4248) and, stratified for age and rank, servicemen deployed to the Bosnia conflict (Bosnia cohort, n=4250) and those serving during the Gulf War but not deployed there (Era cohort, n=4246). We asked about deployment, exposures, symptoms, and illnesses. We analysed men only. Our outcome measures were physical health, functional capacity (SF-36), the general health questionnaire, the Centers for Disease Control and Prevention (CDC) multisymptom criteria for Gulf War illness, and post-traumatic stress reactions.

FINDINGS

There were 8195 (65.1%) valid responses. The Gulf War cohort reported symptoms and disorders significantly more frequently than those in the Bosnia and Era cohorts, which were similar. Perception of physical health and ability were significantly worse in the Gulf War cohort than in the other cohorts, even after adjustment for confounders. Gulf War veterans were more likely than the Bosnia cohort to have substantial fatigue (odds ratio 2.2 [95% CI 1.9-2.6]), symptoms of post-traumatic stress (2.6 [1.9-3.4]), and psychological distress (1.6 [1.4-1.8]), and were nearly twice as likely to reach the CDC case definition (2.5 [2.2-2.8]). In the Gulf War, Bosnia, and Era cohorts, respectively, 61.9%, 36.8%, and 36.4% met the CDC criteria, which fell to 25.3%, 11.8%, and 12.2% for severe symptoms. Potentially harmful exposures were reported most frequently by the Gulf War cohort. All exposures showed associations with all of the outcome measures in the three cohorts. Exposures specific to the Gulf were associated with all outcomes. Vaccination against biological warfare and multiple routine vaccinations were associated with the CDC multisymptom syndrome in the Gulf War cohort.

INTERPRETATION

Service in the Gulf War was associated with various health problems over and above those associated with deployment to an unfamiliar hostile environment. Since associations of ill health with adverse events and exposures were found in all cohorts, however, they may not be unique and causally implicated in Gulf-War-related illness. A specific mechanism may link vaccination against biological warfare agents and later ill health, but the risks of illness must be considered against the protection of servicemen.

The dexamethasone suppression test in schizophrenia

BACKGROUND

Cortisol non-suppression following the dexamethasone suppression test (DST) has been found to a variable extent in schizophrenia. The aetiology is unclear but may be related to depression or negative symptoms.

METHODS

The DST was administered to 64 patients with DSM-IV schizophrenia. All patients were screened for DSM-IV major depression and rated on the Hamilton Rating Scale for Depression (HRSD), Scale for Assessment of Negative Symptoms (SANS) and the Brief Psychiatric Rating Scale (BPRS).

RESULTS

DSM-IV criteria for major depression was fulfilled by 36% of the patients and 42% of patients had a history of parasuicide. Four patients had undetectable levels of dexamethasone and were excluded from the endocrine analyses. Only one remaining patient had a cortisol level above the cut-off point (> 138 nmol/l), indicating escape from dexamethasone suppression. The post-dexamethasone cortisol level correlated significantly with HRSD and BPRS scores but not with the SANS. The SANS and HRSD scores were not correlated, but they were independently correlated with the BPRS score.

CONCLUSIONS

In contrast to some other work, rates of dexamethasone non-suppression were very low; together with the high rates of depression, this suggests that depression in schizophrenia may have a different neuroendocrine profile from major depressive disorders. Failure to measure dexamethasone levels can be misleading.

Intracranial meningioma with progesterone positive receptors presenting in late pregnancy

A 36-year-old female presented with seizures and transient dysphasia in her 31 week of pregnancy. Neuroradiological investigations revealed a large falx meningioma. A decision was taken to deliver the infant and excise the tumor before term because of the risk of an increase in the size of the tumour and the risk of sinus thrombosis. Therefore, she underwent in her 32 week of pregnancy an elective Caesarean section followed by a craniotomy to remove the meningioma. There were no neonatal complications and she made an uneventful recovery. The final pathology report confirmed the diagnosis of meningioma with progesterone positive receptors.

Serum organochlorine pesticide levels in patients with colorectal cancer in Egypt

The widespread use of pesticides in Egypt, the high incidence of colorectal cancer in Egyptian children and young adults, and the published U.S. case reports in which pesticides have been connected with colorectal cancer led the authors to investigate the possible association between organochlorines and colorectal cancer. The authors conducted a pilot study to describe serum organochlorine levels among 31 Egyptian colorectal patients and 17 controls. High levels and large interindividual variability of p,p'-dichloro-diphenyldicholoroethylene (DDE), dichloro-diphenyl-trichloroanthane (DDT), beta-hexachlorocyclohexane (beta-HCH), and hexachlorobenzene (HCB) levels were found among most subjects, especially those from rural areas. Farming and aging were each associated positively with high serum organochlorines. Colorectal cancer patients had higher serum organochlorines levels than controls. The high levels of organochlorines reported and their relation to age, residence, occupation, and disease status justify further study of the possible association between organochlorine pesticides and colorectal cancer in a larger population in Egypt.

Anaphylactic shock following intravenous administration of lignocaine

A 26-year-old female, presenting for dental surgery, developed anaphylactic shock immediately after intravenous administration of lignocaine without preservative added to the propofol to alleviate pain during intravenous injection. We describe the clinical circumstances, the management and the investigations carried out to detect the cause.

Colorectal cancer in Egyptian patients under 40 years of age

Although colorectal cancer is not a common cancer in Egypt, the age distribution of the disease shows that a high proportion occurs in children and adults under 40 years of age. We reviewed the records of 1,608 colorectal cancer patients treated in 4 cancer hospitals in Egypt during a period of 3 to 10 years. The hospitals in which about 85% of all colorectal cancer cases in Egypt were seen included Egypt's 2 major cancer centers, The National Cancer Institute (NCI) in Cairo and Tanta Cancer Center (TCC) in the mid-Nile Delta region, and 2 major university hospitals, Assiut University in South Egypt and Ain Shams University in Cairo. Our review showed that patients younger than 40 years represented 35.6% of all patients in the 4 cancer hospitals, and that these rates were similar among the hospitals and for the years reviewed. The male-to-female ratio increased from 1.0 to 1.7 for the age groups ranging from 0-9 and 30-39 years, and increased from 1.0 to 1.5 for the age groups ranging from 40-49 to over 60 years. More than half of all the patients had rectal tumors, and about 90% of the cancers were adenocarcinomas; 30.6% of patients younger than 40 years, compared with 13.8% of older patients, had mucin-producing tumors. This study confirmed the occurrence of a high colorectal cancer rate in young Egyptians, and it opens the door to future epidemiologic studies to identify causes and risk factors of this disease pattern in Egypt.

Psychiatric complications of corticosteroid therapy

Despite limited evidence, the general consensus is that corticosteroids can cause psychiatric complications, mainly depression. This is most noticeable in high doses or in medical conditions with neuropsychiatric sequelae. The prognosis is usually good if corticosteroids are discontinued, but further study of the prevalence of psychiatric reactions, their mechanism of action and appropriate treatment is necessary.

Acceptability of electroconvulsive therapy to patients with Parkinson's disease

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Surgical treatment of hydatid cysts of the pancreas

This series consists of seven patients with hydatid cysts of the pancreas; five females and two males, with an average age of 31 years. In a follow-up extending up to 33 years, about a 50% rate of correct preoperative diagnosis was recorded. The most sensitive and effective diagnostic modalities such as latex agglutination, ultrasonic, radionuclide, computerized tomographic and magnetic resonance imaging techniques were not available till the late seventies and therefore were only used during diagnosis of the latter 3 cases. Four patients had cysts located in the head of the pancreas. Three cysts were situated in the body and tail. Two distal pancreatectomies, two cystectomies and three marsupialization and external drainage procedures were performed for the surgical management of these cases. Two of the marsupialized and externally drained patients had fistulas which eventually dried up within a month leading to a total morbidity of 29% and a mortality rate of nil.

Subdiaphragmatic abscesses: myths and realities. A report on sixty-two cases

The main cause (60.8%) of subdiaphragmatic abscesses in a series of 62 patients (of which 46 were males), was found to be hepatobiliary in nature. Radiology proved to be helpful in correct diagnosis (61%), as did ultrasonography (60%). Right sided subdiaphragmatic abscesses were (55/62) 88.7% of the total. Mean abscess volume was 500 ml while culturing efforts were in vain in 32% of the abscess cases (able to be cultured). The incidence of morbidity was (12/62) 19.4% and mortality (3/62) 4.8% in this series, where the treatment was solely through surgical drainage. Though closed drainage using ultrasonic guidance has been popular in the past decade, it has its drawbacks. Open surgical drainage therefore, as a well established mode of treatment, is recommended.

Temperature and concentration dependence of viscosity of Mg(NO3)2–H2O systems

Densities and viscosities of aqueous magnesium nitrate solutions are measured as functions of temperature and composition. The temperature dependence of viscosity is described by the Vogel–Tammann–Fulcher (VTF) equation. By accounting quantitatively for the concentration dependences of all three parameters involved in the VTF equation an improved isothermal equation is obtained, it describes satisfactorily the concentration dependence of viscosity.