Association between intracranial vessel calcifications, structural brain damage, and cognitive impairment after minor strokes: a prospective study

Background

Vascular calcifications are a hallmark of atherosclerosis, and in the coronary arteries are routinely used as a prognostic marker. Calcifications of intracranial vessels (ICC) are frequently observed on non-contrast CT (NCCT) and their effect on post-stroke cognitive impairment (PSCI) remains unclear. Our aim was to explore the association of ICC with prospective long-term cognitive function and advanced MRI-measures in a large prospective cohort of cognitively intact mild stroke survivors.

Methods

Data from the Tel-Aviv brain acute stroke cohort (TABASCO) study [ClinicalTrials.gov #NCT01926691] were analyzed. This prospective cohort study (n = 575) aimed to identify predictors of PSCI, in cognitively intact mild stroke survivors. A quantitative assessment of the intracranial calcium content - The ICC score (ICCS) was calculated semi-automatically on NCCT using a validated calcium quantification application. Participants underwent a 3 T-MRI and prospective comprehensive cognitive clinical and laboratory assessments at enrollment, 6, 12, and 24-months.

Results

Data were available for 531 participants (67.4 years, 59.5% males). The incidence of PSCI at two-years doubled in the high ICCS group (26% vs. 13.7%, p < 0.001). The high ICCS group had significantly greater small-vessel-disease (SVD) tissue changes and reduced microstructural-integrity assessed by Diffusion-Tensor-Imaging (DTI) maps (p < 0.05 for all). In multivariate analysis, a higher ICCS was independently associated with brain atrophy manifested by lower normalized white and gray matter, hippocampal and thalamic volumes (β = -0.178, β = -0.2, β = -0.137, β = -0.157; p < 0.05) and independently predicted PSCI (OR 1.83, 95%CI 1.01-3.35).

Conclusion

Our findings suggest that the ICCS, which is a simple and readily available imaging marker on NCCT, is associated with brain atrophy, microstructural damage, the extent of SVD, and may predict PSCI. This finding has implications for identifying individuals at risk for PSCI and implementing targeted interventions to mitigate this risk.

Bright and ultrafast electron point source made of LaB6 nanotip

The development of time-resolved transmission electron microscopy (TEM), ultrafast electron spectroscopy and pulsed X-ray sources relies on the realization of stable and high brightness sources of ultra-short electron bunches with a long service time. The flat photocathodes implanted in thermionic electron guns have been replaced by Schottky-type or cold-field emission sources driven by ultra-fast laser. Recently, lanthanum hexaboride (LaB₆) nanoneedles have been reported to have high brightness and high emission stability when working in a continuous emission mode. Here, we prepare nano-field emitters from bulk LaB₆ and we report on their use as ultra-fast electron sources. Using a high repetition rate laser in the infrared range, we present different field emission regimes as a function of the extraction voltage and laser intensity. The properties of the electron source (brightness, stability, energy spectrum and emission pattern) are determined for the different regimes. Our results show that LaB₆ nanoneedles can be used as ultrafast and ultra-bright sources for time-resolved TEM, with better performances as compared to metallic ultra-fast field-emitters.

Detecting Dissociation Dynamics of Phosphorus Molecular Ions by Atom Probe Tomography

Dissociation processes involving phosphorus cations were investigated during laser-assisted atom probe tomography of crystalline indium phosphide (InP). This technique not only allows the formation of medium-sized phosphorus cations by means of femtosecond laser pulses under ultrahigh vacuum and high electric field conditions but also allows one to study the time-resolved dissociation dynamics. Data reveal the formation of cations up to P₂₃²⁺ and their subsequent dissociation into two smaller P_k⁺ cations (k > 2). The use of a time- and position-sensitive detector combined with numerical calculations provided information related to the molecule orientation, decay time, and kinetic energy release during dissociation phenomena. Results suggest that the dissociation processes are most likely due to the emission of P_k²⁺ cations in excited states and their subsequent decay in low field regions during their flight toward the detector. This study provides operative guidelines to obtain information on dissociation processes using a tomographic atom probe as a reaction microscope and indicates the current capabilities and limitations of such an approach.

Photoassisted and multiphoton emission from single-crystal diamond needles

Practical realization of stable and high brightness sources of ultra-short electron pulses is an important issue in the development of time-resolved electron microscopy for the study of ultra-fast dynamics in materials. Here, we report on the experimental investigation of static (in the dark) and pulsed (under illumination by sub-picosecond laser pulses at 1040 nm) electron emission from single-crystal diamond needles. A significant increase of electron emission current was detected under laser illumination. The nonlinear dependence of the emission current on the laser intensity and on the angle between the needle and the laser beam polarization axis suggests multi-photon emission processes. This interpretation is in agreement with electron spectroscopy measurements performed for electrons emitted at different bias voltages and different laser power levels and repetition rates. The remarkable feature of the diamond emitters is their stability under high average power of laser radiation. This provides a new highly efficient source of photoemitted electrons based on single-crystal diamond.

Dissociation of GaN2+ and AlN2+ in APT: Analysis of experimental measurements

The use of a tip-shaped sample for the atom probe tomography technique offers the unique opportunity to analyze the dynamics of molecular ions in strong DC fields. We investigate here the stability of AlN²⁺ and GaN²⁺ dications emitted from an Al_0.25Ga_0.75N sample in a joint theoretical and experimental study. Despite the strong chemical resemblance of these two molecules, we observe only stable AlN²⁺, while GaN²⁺ can only be observed as a transient species. We simulate the emission dynamics of these ions on field-perturbed potential energy surfaces obtained from quantum chemical calculations. We show that the dissociation is governed by two independent processes. For all bound states, a mechanical dissociation is induced by the distortion of the potential energy surface in the close vicinity of the emitting tip. In the specific case of GaN²⁺, the relatively small electric dipole of the dication in its ground 1³Σ^- and excited 1¹Δ states induces a weak coupling with the electric field so that the mechanical dissociation into Ga⁺ + N⁺ lasts for sufficient time to be observed. By contrast, the AlN²⁺ mechanical dissociation leads to Al²⁺ + N which cannot be observed as a correlated event. For some deeply bound singlet excited states, the spin-orbit coupling with lower energy triplet states gives another chance of dissociation by system inter-system crossing with specific patterns observed experimentally in a correlated time of flight map.

Nonsyndromic orofacial clefts among Jews and non-Jews born in 13 hospitals in Israel during 1993-2005

OBJECTIVES

Orofacial clefts are one of the most common birth malformations and represent a significant public health economic expenditure. The purpose of this investigation was to study the epidemiology of orofacial clefts in newborns from 1993 to 2005 in Israel. In addition, a comparison of data from the National Birth Defects Registry (NBDR) and Hospital records will be made.

METHODS

A retrospective data review of reports to the Israeli NBDR on infants with orofacial clefts in comparison with records reviewed at 13 major hospitals, accounting for 60% of all births in Israel.

RESULTS

Of 1334 newborns found to be with orofacial clefts all over Israel between 1993 and 2005, 1015 were reported to the NBDR and 319 were unreported but retrieved from hospital files. During this period, of the 976 578 live births found in the 13 participating hospitals, there were 866 newborns with orofacial clefts. Of those, 684 (79%) were nonsyndromic orofacial clefts and 182 (21%) had additional syndromes. The prevalence of nonsyndromic orofacial clefts was 7/10 000 live births, lower than reported outside Israel. Only 65% of orofacial clefts retrieved from the 13 hospitals were reported to the NBDR. A significantly higher orofacial cleft prevalence was found among non-Jews than Jews (11 and 6 of 10 000 live births, respectively), (P < .00 001). CL/P was found more frequently than isolated cleft palate (CP). More males had orofacial clefts than females, mostly unilateral with left side predominance.

CONCLUSIONS

The prevalence of nonsyndromic orofacial clefts was found to be 7/10 000 live births. The higher orofacial cleft prevalence among non-Jews may be explained by the high prevalence of consanguinity and deprived maternal nutritional status in this population.

Electronic structure and stability of the SiO2+ dications produced in tomographic atom probe experiments

The molecular electronic states of the SiO²⁺ dication have been investigated in a joint theoretical and experimental analysis. The use of a tip-shaped sample for tomographic atom probe analysis offers the unique opportunity to produce and to analyze the lifetime of some excited states of this dication. The perturbation brought by the large electric field of the polarized tip along the ion trajectory is analyzed by means of molecular dynamics simulation. For the typical electric fields used in the experiment, the lowest energy triplet states spontaneously dissociate, while the lowest energy singlet states do not. We show that the emission process leads to the formation of some excited singlet state, which dissociates by means of spin-orbit coupling with lower-energy triplet states to produce specific patterns associated with Si⁺ + O⁺ and Si²⁺ + O dissociation channels. These patterns are recorded and observed experimentally in a correlated time-of-flight map.

Role of the resistivity of insulating field emitters on the energy of field-ionised and field-evaporated atoms

In order to improve the accuracy of laser atom probe analyses, it is important to understand all the physical processes induced by the combination of the high electrical field and the femtosecond laser beam during field evaporation. New information can be accessed from the energy of evaporated surface atoms or field-ionised atoms of an imaging gas. In order to study the ions energy, we combine La-APT and FIM analyses in a new experimental setup equipped with electrostatic lenses. We report measurements for semiconductors and oxides and we study the influence of the illumination conditions (laser power and wavelength), the evaporation rate, the sample geometry and the tip preparation processes. The results are discussed taking into account the resistive properties of non-metallic samples and the photo-stimulated conductivity. This work clarifies the role of the laser and DC field in the energy deficit of field evaporated ions.

Prevalence of non-syndromic orofacial clefts among Jews and Arabs, by type, site, gender and geography: a multi-center study in Israel

BACKGROUND

Orofacial clefts are the most common craniofacial congenital malformations, with significant anatomic, ethnic, racial and gender differences.

OBJECTIVES

To investigate the prevalence, distribution and characteristic features of various types of non-syndromic clefts among Israeli Jews and Arabs.

METHODS

We conducted a retrospective multi-center survey in 13 major hospitals in Israel for the period 1993-2005. To obtain the true prevalence and detailed clinical characteristics, data on liveborn infants with non-syndromic clefts were obtained from the Ministry of Health's National Birth Defect Registry and completed by chart reviews in the 13 surveyed hospitals.

RESULTS

Of 976,578 liveborn infants, 684 presented unilateral or bilateral clefts, with a prevalence of 7.00/10,000 live births; 479 were Jews and 205 were Arabs. The prevalence was higher among Arabs compared to Jews (11.12 and 6.22 per 10,000 live births in Arabs and Jews, respectively, P 0.00001). Males had higher cleft rates than females (7.69/10,000 and 6.17/10,000 live births, respectively, P = 0.05). Males had more cleft lips (P < 0.05) and cleft lips with cleft palate (P < 0.001). There was left-side predominance. Newborns of younger mothers (age < 20 years) and of older mothers (age ≥ 45 years) had higher cleft rates than those with mothers in the 20-44 year bracket (P < 0.009). Children born at or above the 5th birth order had a higher cleft rate (P < 0.001).

CONCLUSIONS

The prevalence of non-syndromic clefts was 7.00/10,000 live births. The markedly higher rate in Arabs is related to the high rate of consanguinity. Both very young and old maternal age represents a higher risk of clefts in their offspring.

The effects of 'old' red blood cell transfusion on mortality and morbidity in elderly patients with hip fractures--a retrospective study

BACKGROUND

Elderly patients admitted with hip fractures often receive allogenic blood transfusion (ABT) in the perioperative period. We examined the effect of the shelf life of the ABT on mortality and morbidity.

METHODS

A total of 1381 patients with hip fractures were retrospectively analysed. Two groups were compared, group A ('new'), with an ABT shelf life≤14 days, and group B ('old'), with an ABT shelf life>14 days. Data collected for both groups included general demographic data, data regarding postoperative infections and other complications rates and data regarding mortality. Kaplan-Meier curves were used to assess difference in survival between the groups. Cox regression was performed to analyse the survival after controlling for age, sex, pre-surgical haemoglobin concentration, pre-surgical creatinine, American Society of Anesthesiologists (ASA) score, surgery type and number of blood units given.

RESULTS

Higher mortality was seen in hip fracture patients who received 'old' blood unit compared to 'new' blood unit but the difference was not statistically significant (P=0.5). Cox regression model demonstrated that designation into either young or old groups was not associated with mortality (hazard ratio: 1.14 (confidence interval: 0.85-1.53)). No differences were noted between the groups with regard to infection and other postoperative complication rates.

CONCLUSION

Patients undergoing surgery for hip fractures who received 'old' units of blood did not differ from those receiving 'new' units with regard to mortality and morbidity. Large-scale clinical trials are needed to further investigate this association.

Pituitary and bilateral adrenal enlargement: an unusual presentation of hepatocellular carcinoma

Pituitary metastases account for about 1% of operated pituitary lesions. Most derive from primaries in the breast or lung. Pituitary metastases from hepatocellular carcinoma (HCC) have rarely been reported. We describe a patient in whom headache and left external ophthalmoplegia were the only presenting signs of a clinically silent and radiographically undetectable HCC, that had metastasized to the pituitary and both adrenal glands. Pituitary histology and adrenal needle biopsy failed to establish the final diagnosis, which was reached only after surgical exploration of the abdomen. This case illustrates the difficulties encountered in the histopathological diagnosis of pituitary metastasis and the need for good clinical judgment when confronting pituitary tumors with atypical features.

Lack of plasma norepinephrine cyclicity, increased estradiol during the follicular phase, and of progesterone and gonadotrophins at ovulation in women with premenstrual syndrome

In healthy women, plasma norepinephrine (NE) has a cycle with the highest levels occurring at ovulation and early luteal phase. We examined plasma NE cyclicity in premenstrual syndrome (PMS) patients as compared to controls, its relation to estradiol (E(2)), progesterone (P), luteinizing hormone and follicle-stimulating hormone, and the correlation of these parameters with the PMS symptoms. Lack of NE cyclicity was observed in PMS patients. In controls, peak NE levels occurred at ovulation and early luteal phase. In PMS, serum E(2) was higher during the follicular phase, while P and gonadotrophins were higher especially at ovulation and the luteal phase. In the late luteal phase, E(2) levels were lower in PMS patients than in controls. A negative correlation was observed between the area under the curve for E(2) in the luteal phase and PMS somatic and mental scores. Plasma NE showed a negative correlation with abrupt mood swings, impatience, nervousness, tiredness, weakness, apathy, and headache. These data suggest that lack of NE cyclicity characterizes PMS, some symptoms being related to low E(2) levels during the late luteal phase and decreased noradrenergic activity at ovulation and the luteal phase.

Pulmonary function in patients with diabetes mellitus

BACKGROUND

Pulmonary complications of diabetes mellitus have been poorly characterized. Although some authors have reported normal pulmonary function, others found abnormalities in lung volumes, pulmonary mechanics, and diffusing capacity.

SUBJECTS AND METHODS

We studied pulmonary function in a group of patients with diabetes using a combined cardiopulmonary exercise test. Twenty-seven patients with diabetes aged 48 +/- 13 years participated in the study.

RESULTS

Overall, forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow, midexpiratory phase, were within the predicted values, but the residual volume/total lung capacity ratio was slightly elevated. Comparison by diabetes type showed nonsignificant differences in forced expiratory volume in 1 second and forced expiratory flow, midexpiratory phase. Residual volume/total lung capacity ratio was significantly elevated in type 1 patients compared with type 2. Carbon monoxide diffusion capacity (DLCO) was normal in both groups. There was no correlation between the results on pulmonary function test and duration of disease, presence of microangiopathy, or glycemic control. The DLCO was significantly lower in patients with microangiopathic changes, but not when DLCO was corrected for alveolar volume. On the cardiopulmonary exercise test, maximal workload, maximum oxygen uptake, and maximal heart rate were less than predicted, whereas anaerobic threshold and ventilatory reserve were normal. No significant differences were noted in diabetes type, and there was no correlation between parameters of cardiopulmonary exercise test and the other variables.

CONCLUSION

Spirometric values are preserved in patients with diabetes mellitus, and there are no defects in diffusing capacity. Cardiovascular factors may account for impaired physical performance. There is no need for routine screening of pulmonary function among diabetic patients.

Hospitalization for general medical conditions among diabetic patients in Israel

BACKGROUND

Diabetes mellitus is a serious, costly and growing public health problem. Very few studies have been published on the economic impact of diabetes in Israel.

OBJECTIVE

To estimate health fund expenditures and rates of hospitalization for general conditions among the diabetic population in Israel.

METHODS

The total number of hospitalizations in Israel in 1998 of beneficiaries of the General Sick Fund (Kupat Holim Clalit) was obtained from its bureau of statistics. The diabetic and general populations were compared for age and gender distribution, days of hospitalization and cost of hospitalization. All hospitals in Israel were included.

RESULTS

There were 618,317 general admissions for a total of 3,005,288 hospitalization days. The diabetic population accounted for 11.5% of all admissions and 13.7% of all hospitalization days. Analysis by age revealed that diabetic patients over age 45 represented 18.3% of all admissions and 17.5% of all hospitalization days. The average stay in hospital was 4.8 days per patient for the general population and 5.3 days for diabetic patients. The overall hospital expenditure of the GSF for general medical conditions among diabetic patients in 1998 was estimated at US $173,455,790, of which 57% accounted for the daily hospitalization cost. Of the total hospital expenditures for that year, 13.3% was allocated to patients with diabetes of whom 96.4% were over 45 years old. No significant difference was found between males and females.

CONCLUSION

Hospital expenditures for diabetic people increase with patient age and represent one-fifth of the total health insurance expenditure for the middle-aged and elderly population.

Amiodarone-induced thyrotoxicosis type 2: a case report and review of the literature

Amiodarone-induced thyrotoxicosis (AIT) is not an uncommon complication in countries with low iodine intake. Two types of AIT have been described. Type 1 is associated with an underlying disorder of the gland that becomes clinically evident because of the high intrathyroidal iodine content, which acts as a trigger for hyperthyroidism. Type 2 is characterized by an ongoing inflammatory process of the thyroid, with derangement of the parenchyma causing the release of thyroid hormones into the circulation. Yet, there are no definitive tools for the differential diagnosis of these two entities, and the therapeutic approach is still a subject of controversy. A case of AIT type 2 successfully treated with steroids is described followed by a review of the literature.

Cushing's syndrome presenting as a schizophrenia-like psychotic state

Neuropsychiatric abnormalities, of which depression is the most common, are frequently associated with Cushing's syndrome. The following paper describes a 58-year-old woman in whom a prolonged psychotic state--schizophrenia-like--was the presenting sign of Cushing's syndrome. The psychiatric symptoms disappeared shortly after the cortisol level has been normalized. Due to the variety of symptoms, both organic and psychiatric, which may occur with Cushing's syndrome, a high suspicion index is advisable. Suspect clinical findings should always prompt the appropriate endocrine work-up.

Treatment of antithyroid drug-induced agranulocytosis by granulocyte colony-stimulating factor: a case of primum non nocere

A 48-year-old woman who was treated for thyrotoxicosis with methimazole developed agranulocytosis. The methimazole was stopped and treatment with subcutaneous granulocyte colony-stimulating factor (G-CSF) was initiated. Administration of the drug for 8 days did not effectively shorten the recovery period compared with the average reported in the literature without the drug, and may have triggered additional iatrogenic complications. A search of the literature yielded 15 instances of severe antithyroid-drug-induced granulocytopenia (ATDIA) (granulocyte count of less than 0.1 x 10(9)/L) treated with G-CSF. Of the 16 patients, including the 1 reported here, only 3 displayed significant shortening of the agranulocytic period after treatment. We conclude that routine therapeutic application of G-CSF in afebrile severe ATDIG is not justified, and in some cases may generate a cascade of iatrogenic adverse events.

Low platelet-poor plasma concentrations of serotonin in patients with combat-related posttraumatic stress disorder

BACKGROUND

Combat-related posttraumatic stress disorder (CR-PTSD) is associated with a dysregulation of various neurotransmitter systems.

METHODS

We assessed levels of platelet-poor plasma (PPP) norepinephrine (NE), and serotonin (5-HT), and 24-hour urinary excretion of NE, dopamine (DA), and homovanillic acid (HVA) in 17 male outpatients with untreated chronic CR-PTSD (age, 33.1 +/- 7.4 years) and 10 normal control subjects (age, 35.8 +/- 2.7 years).

RESULTS

Compared with the control subjects, the PTSD patients showed significantly lower PPP 5-HT levels, elevated PPP NE levels, and significantly higher mean 24-hour urinary excretion of all three catecholamines (NE, DA, and HVA). The 24-hour urinary HVA values of the CR-PTSD patients correlated significantly and positively with the total Impact of Event Scale scores and the avoidance symptoms cluster scores, and the PPP 5-HT levels correlated negatively with the Hamilton Anxiety Rating Scale scores. The PPP NE/5-HT ratio was significantly higher in the study group than in the control subjects.

CONCLUSIONS

We believe this combined enhanced noradrenergic activity and diminished 5-HT activity may be relevant to the neurobiology of CR-PTSD.

The effect of estrogen replacement therapy on plasma serotonin and catecholamines of postmenopausal women

We examined the effect of estrogen replacement therapy (ERT) on plasma serotonin (5HT) and norepinephrine (NE) and their correlation with serum estradiol, luteinizing hormone (LH) and follicle-stimulating hormone (FSH) in 12 postmenopausal women. Plasma 5HT and NE, estrogen, progesterone, LH and FSH were examined every 4 days for 2 consecutive months (before and during ERT). Serotonin values were low (32.29 +/- 38.36 nmol/l) and showed an intrinsic spontaneous cyclicity with a nadir every 10-11 days. Plasma NE was similar to that observed during the follicular phase of the ovulatory cycle (1,216.8 +/- 503.4 pmol/l) and showed no cyclicity. ERT significantly increased mean (+/- SD) serum estrogen values (from 95.40 +/- 73.31 to 390.72 +/- 347.17 pmol/l, P = 0.0001), significantly decreased serum FSH (from 84.04 +/- 14.97 to 52.97 +/- 20.74 mIU/ml, P = 0.0001) and LH (from 35.35 +/- 13.82 mIU/ml to 29.69 +/- 16.46 mIU/ml, P = 0.03). Plasma 5HT levels showed a tendency to rise under the influence of ERT, but this increase was not statistically significant. Plasma NE decreased significantly from 1,216.8 +/- 503.4 to 994.1 +/- 353.89 pmol/l, P <0.05. In conclusion, plasma serotonin in postmenopausal women has a 10-11 day cycle and is significantly lower than in the follicular phase of ovulating women. Plasma NE shows no cyclicity and is significantly decreased by ERT.

Food preferences, body weight, and platelet-poor plasma serotonin and catecholamines

The possible relationship between body weight, food preferences, and plasma neurotransmitters was investigated in 96 healthy volunteers. The volunteers were divided into groups according to sex, body mass index, and food preferences. In all groups fasting platelet-poor plasma (PPP) norepinephrine and serotonin (5-HT) were examined. PPP-5-HT was low in obese individuals (mean +/- SD: 51.7 +/- 34.6 nmol/L) in comparison with lean individuals (94.31 +/- 85.2 nmol/L; P < 0.01), in lean male carbohydrate cravers (22.7 +/- 16.4 nmol/L) in comparison with protein cravers (132.9 +/- 80.6 nmol/L; P < 0.005) and noncravers (64.7 +/- 51.7 nmol/L; P < 0.05), and in obese male carbohydrate cravers (34 +/- 22.7 nmol/L) in comparison with obese male protein cravers (98.8 +/- 28.4 nmol/L; P < 0.001). In conclusion, PPP-5-HT might be seen as a peripheral indicator of processes linked with food consumption and food preferences.

Plasma neurotransmitter profile during different phases of the ovulatory cycle

The influence of the different phases of the menstrual cycle on platelet-poor plasma norepinephrine (NE) and serotonin (5HT) was examined in 17 normal volunteers. The examinations were performed consecutively during 3 phases of the ovulatory cycle: 1) follicular phase, 2) ovulation, and 3) luteal phase. This investigation was initiated after a preliminary study in 51 volunteers showed wide and consistent variations of plasma NE and 5HT during the different phases of the cycle. Since in this first group the determinations had not been performed consecutively in the same subjects, and the changes observed in the different phases of the cycle could reflect interpersonal variations, the determinations were performed consecutively in a second group, concomitantly with serum estradiol (E2) and LH measurements. The results showed a decrease in plasma 5HT from the follicular phase [144.3 +/- 69.3 nmol/L (+/- SD)] to ovulation (55.7 +/- 41.4; P less than 0.001) and a subsequent increase in the luteal phase (141.3 +/- 96.4; P less than 0.01). The nadir in plasma 5HT showed an inverse correlation with serum LH (r = -0.07). Plasma NE increased from the follicular phase (1226.5 +/- 475.1 pmol/L) to ovulation (1694.0 +/- 564.4; P = 0.027) and reached a maximum in the luteal phase (2335.0 +/- 728.2; P = 0.0034). This rise correlated positively with serum E2. In conclusion, plasma 5HT and NE vary with the different phases of the menstrual cycle. Plasma NE rises during ovulation and seems to to correlate positively with serum E2 levels. Plasma 5HT reaches a nadir during ovulation and correlates inversely with serum LH.

The influence of meal composition on plasma serotonin and norepinephrine concentrations

Reports concerning changes in plasma neurotransmitter values that result from dietary manipulations have not been published so far. The influence of various meal compositions on platelet-poor plasma (PPP) serotonin (5-HT) and norepinephrine (NE) levels was investigated. Healthy volunteers were subjected to three test meals: a carbohydrate-rich meal (86% carbohydrates), a protein-rich meal (70% protein), and a fat-rich meal (92% fat). After a carbohydrate-rich meal, PPP 5-HT values increased significantly (4.47-fold, P less than .02), whereas a smaller increase (1.66-fold, P = NS) was observed after a fat-rich meal. These effects on PPP 5-HT values could be correlated with insulin plasma levels. A protein-rich meal significantly reduced (P = 0.0011) PPP 5-HT to 28% of initial values, despite an increase in plasma insulin levels. This study has shown that (1) changes in meal compositions influence PPP 5-HT and, to a lesser extent, NE values; (2) the resulting changes in PPP 5-HT levels parallel those reported for brain neurotransmitters; and (3) these results seem to indicate that PPP 5-HT levels may be a model for brain synthesis and release of 5-HT.

Hyperphosphataemia and hypocalcaemia induced by hypertonic phosphate enema--an experimental study and review of the literature

1. The study objective was to determine the hyperphosphataemic and hypocalcaemic effect of hypertonic phosphate enema. The study was conducted in a department of Internal Medicine at a University Medical Center. 2. Fourteen patients were studied. Patients' mean age (+/- s.d.) was 78.5 +/- 9 years. The creatinine clearance was 48.2 +/- 17.4 ml min-1 (mean +/- s.d.). 3. 500 ml (approx. 7 ml kg-1) of Fleet enema (FE - Na2HPO4.7H2O 224 mmol l-1 and NaH2PO4.H2O 1160 mmol l-1) were administered to each patient. Blood was drawn before FE administration and 1/2, 1, 3, 5, 12 and 24 h thereafter. Serum was analysed for levels of inorganic phosphorus and for calcium. 4. The serum inorganic phosphorus level rose from 1.01 +/- 0.3 mmol l-1 to 1.4 +/- 0.5 mmol l-1 (P = 0.001) 1 h after FE was administered. Serum calcium decreased from 2.32 +/- 0.12 mmol l-1 to 2.12 +/- 0.1 mmol l-1 (P less than 0.001) 12 h after FE was administered. 5. We conclude that FE carries a potential risk for acutely ill elderly patients. To avoid untoward effects due to hyperphosphataemia and hypocalcaemia, the phosphate load must be adjusted to the patient's renal function, i.e. enema volume is to be lowered when phosphate concentration is high, so that if renal function is compromised the amount of phosphate absorbed does not exceed renal excretion capacity.

Alterations of polymorphonuclear leukocyte glycogen metabolism and glucose uptake in dialysis patients

Human polymorphonuclear leukocytes (PMNs) are activated during extracorporeal circulation. An indicator of PMN activation may be the glycogen-degrading enzyme phosphorylase. It is unknown whether dialysis therapy may influence PMN carbohydrate metabolism. Therefore, PMNs were isolated from healthy control subjects, patients undergoing continuous ambulatory peritoneal dialysis (CAPD), and patients undergoing regular hemodialysis therapy (RDT) before, during, and at the end of hemodialysis (HD) treatment using dialyzers made of polysulfone or polymethylmethacrylate (PMMA). Nifedipine (NIF) was continuously infused during HD with PMMA in 5 patients at a dose of 18 micrograms/kg body weight per hour. Glycogen, activity of glycogen synthetase and phosphorylase (active and inactive forms of both enzymes), and glucose uptake with and without stimulation with the chemotactic peptide FMLP were determined in these PMNs. During HD with PMMA, there was a significant increase of PMN phosphorylase "a" activity 15 and 30 minutes after the start of HD. HD with polysulfone did not stimulate the active "a" form of the glycogen-degrading enzyme in PMNs. HD with PMMA significantly inhibited the active I-form of glycogen synthetase, whereas polysulfone activated glycogen synthetase I. NIF inhibited phosphorylase "a" activation during HD with PMMA. PMN glycogen content and glucose uptake were improved during HD with polysulfone, but not with PMMA. PMN glycogen content, activity of glycogen synthetase, and glucose uptake were significantly lower also in CAPD patients compared with healthy controls. These data show that HD with PMMA activates PMN glycogenolysis. This effect can be inhibited by calcium channel blockers. PMN glycogen content of RDT and CAPD patients is significantly lower compared with healthy controls due to inhibition of glycogen synthesis. Elimination of dialyzable factor(s) improves, but does not restore, PMN glycogen synthesis and glucose uptake.

Antisperm antibodies in young oral contraceptive users

Thirty-five young oral contraceptive users (group A) and twenty-four non-users (group B) of comparable age and background were screened for the presence of serum antisperm antibodies, antibodies to Chlamydia trachomatis and vaginal infections. Twenty-three per cent (8/35) of the oral contraceptive users were found to have significant titers of antisperm antibodies as compared to none in the non-user group (p less than 0.05). In 17% of group A patients (6/35) the presence of antisperm antibodies coincided with the presence of serum antibodies to chlamydia and vaginal candidiasis. One of these patients had E. coli in her vaginal culture in addition to the serum antichlamydia antibodies. The other two patients harboring serum antisperm antibodies were free of any sign of vaginal infection. A significant correlation (r = 0.7038, p less than 0.0000005) was found between the presence of antisperm antibodies and antichlamydia antibodies. There appears to be an increased frequency of serum antisperm antibodies in oral contraceptive users. This finding coincides with infections or colonizations with potential pathogens of the lower genital tract.

Influence of oral contraceptive treatment on blood pressure and 24-hour urinary catecholamine excretion in smoking as compared with non-smoking women

Microgynon-30 was administered to 15 smoking (group B) and 14 non-smoking young women (group A) for a period of 4 months. Prior to the institution of treatment supine blood pressure and daily urinary catecholamine excretion (DUCE) were measured in both groups of patients. Both values were elevated in group B in comparison with group A. Treatment with Microgynon-30 for 4 months induced a significant increase in DUCE in both groups, the increase being most marked in group B (p less than 0.0004). The increased catecholamine excretion accompanied small non-significant elevations in blood pressure. It is concluded that treatment with low-dosage estrogen oral contraceptives produces a significant increase in daily catecholamine excretion, especially in patients who smoke.

Pregnancy and Cushing's syndrome: example of endocrine interaction

Pregnancy rarely occurs in women with Cushing's syndrome, and when it does, fetal mortality and morbidity are very high. We describe a 30-year-old woman who was found to have severe Cushing's syndrome in the 22nd week of her first pregnancy, after a year of unsuccessful attempts to conceive. The patient had the majority of the symptoms and signs characteristic of the syndrome. Laboratory examinations revealed hypokalemia of 2.7 mEq/l, serum cortisol 39.5 micrograms/dl without diurnal variation, free urinary cortisol 1,850 to 3,500 micrograms/24 h, 17-hydroxycorticosteroids (OHCS) 52.5 mg/24 h, 17-ketosteroids (KS) 12 mg/24 h, and ACTH 29 pg/ml. No suppression was observed upon dexamethasone administration (2 and 8 mg). Ultrasound examination of the adrenal glands revealed a left adrenal tumor with a diameter of 4.2 cm. An adrenocortical adenoma was successfully excised in the 24th week of pregnancy. During the 37th week of pregnancy, she delivered a normal baby girl. Postoperatively, the patient was put on maintenance therapy. One year after delivery, mother and child are in perfect health.

Severe sexual impairment produced by morbid obesity. Report of a case

A 45-year-old man, was admitted for investigation of severe sexual impairment. During 20 years of marriage, he had had no normal sexual intercourse and the couple was childless. Physical examination disclosed a severely obese man (weight 300 kg, height 1.75 m), with a relatively small and invaginated penis and small (5 ml) soft testes. Laboratory examinations disclosed the following: low serum testosterone (1 ng/ml), with a reduced response to HCG (3.8 ng/ml). Sex hormone binding globulin was at the lower limit of normal (0.38 microgram/dl), serum free testosterone was low (0.98% of total testosterone) as well as non-SHBG bound testosterone (22% of total testosterone). Daily total urinary estrogen excretion was increased (107 micrograms), the plasma estrone (78 pg/ml) and estradiol (74 pg/ml) were elevated. The gonadotropins were normal and responded adequately to LRH. Plasma growth hormone was decreased, prolactin, T4 and adrenal steroids were normal and responded normally to stimuli and inhibitors. Chromosomal constitution was 46XY. Thus, in this man the marked obesity produced a significant increase in estrogens which subsequently induced a severe decrease in testosterone and its free counterpart in excessive impairment of sexual function.

Fenbufen induced pure red cell aplasia in rheumatoid arthritis

Pure red cell aplasia occurred after fenbufen administration in a patient with severe rheumatoid arthritis. In vitro studies were performed to determine the pathogenesis of the selective red cell aplasia. No cellular or humoral inhibitory mechanisms were demonstrated on growth of erythroid and multipotent bone marrow progenitors. Also, no direct effect of fenbufen alone or in combination with IgG and/or patient serum was found. It is possible that a metabolite of the drug formed from its metabolism was responsible for the aplasia and that the target marrow cell precursor affected is later than both erythroid bone marrow progenitors (BFU-E and CFU-E) and therefore not apparent in our studies. Recovery upon cessation of fenbufen suggests its implication in the pure red cell aplasia.

A benign course of multicentric Castleman's disease with involvement of the spleen and bone marrow

The multicentric variant of Castleman's disease (MCCD) is associated with a rapidly progressive and fatal course. The case described herein manifested unique clinical and histological features. Initial presentation as isolated splenomegaly was subsequently followed by widespread organ involvement, including lymph nodes and bone marrow. In spite of this, the patient had a very benign course of her disease. The case serves to expand even further the already wide clinical spectrum of Castleman's disease.

Adrenergic receptor hyperactivity--a cause for pseudopheochromocytoma?

Two patients with classical signs and symptoms of pheochromocytoma, are described. In these two patients the 24-hr urinary excretion of dopamine, norepinephrine, epinephrine and their metabolites were normal or low, both in basal states or after attacks (spontaneous or provoked). However, the 24-hr urinary excretion of cyclic AMP was exceedingly high in one patient (13000 nmol/gm creatinine), and elevated in the second (5920 nmol/gm creatinine). Both patients were benefited by treatment with a combination of alpha and beta adrenergic blocking drugs. The first patient, after stopping treatment, developed hypertensive crisis and died. Post-mortem examination did not detect a pheochromocytoma or any other abnormality which could explain the excessively elevated cyclic AMP. In the second patient, extensive X-ray and CT examinations were negative for pheochromocytoma. A hypothesis is developed linking the symptoms and biochemical findings of both patients to an abnormality of the adrenergic receptor.